Medigap Supplemental Insurance Guide for Seniors

Expert guide to Medigap policies including plan comparisons, costs, enrollment periods, and coverage options.

Medigap (Medicare Supplement Insurance) helps pay Medicare out-of-pocket costs like deductibles, copayments, and coinsurance. This guide explains plans, costs, and enrollment.

What Is Medigap?

Purpose: Covers gaps in Original Medicare (Parts A & B)

Sold by: Private insurance companies

Standardized: Plans lettered A through N (same benefits regardless of company)

Works with: Original Medicare only (not Medicare Advantage)

Monthly premium: $50-$400+ depending on plan and location

What Medigap Covers

Medicare Gaps

Part A gaps:

Hospital deductible: $1,632 (2025)
Coinsurance days 61-90: $408/day
Lifetime reserve days: $816/day
Additional 365 days (100% after Medicare ends)

Part B gaps:

Annual deductible: $240 (2025)
20% coinsurance (no limit)
Excess charges (if doctor doesn't accept assignment)

Other:

Foreign travel emergency (some plans)
Part B deductible (Plans C & F only, not available to new enrollees)

What Medigap Doesn't Cover

Not covered:

Prescription drugs (need Part D)
Long-term care
Vision care
Dental care
Hearing aids
Private-duty nursing

Medigap Plans Comparison

Full Plan Comparison

Benefit	A	B	C*	D	F*	G	K	L	M	N
Part A coinsurance	✓	✓	✓	✓	✓	✓	50%	75%	✓	✓
Part B coinsurance	✓	✓	✓	✓	✓	✓	50%	75%	✓	✓**
Blood (3 pints)	✓	✓	✓	✓	✓	✓	50%	75%	✓	✓
Part A hospice	✓	✓	✓	✓	✓	✓	50%	75%	✓	✓
Skilled nursing	-	-	✓	✓	✓	✓	50%	75%	✓	✓
Part A deductible	-	✓	✓	✓	✓	✓	50%	75%	50%	✓
Part B deductible	-	-	✓	-	✓	-	-	-	-	-
Part B excess	-	-	-	-	✓	✓	-	-	-	-
Foreign travel	-	-	✓	✓	✓	✓	-	-	✓	✓
Out-of-pocket limit	-	-	-	-	-	-	$7,060	$3,530	-	-

*Plans C & F not available to those new to Medicare after 1/1/2020 **Except $20 office visit and $50 ER copay

Choosing the Right Plan

Plan G vs Plan N

Choose Plan G if you:

Want comprehensive coverage
Visit specialists frequently
Have chronic conditions
Don't want to think about copays
Can afford higher premium

Choose Plan N if you:

Want to save on premiums
Don't mind small copays
Generally healthy
See doctor infrequently
Budget conscious

Annual savings: $400-$800 with Plan N Annual copays: Typically $200-$400

Break-even: If fewer than 20 doctor visits, Plan N often cheaper overall

High Deductible Plans

Consider if:

Very healthy
Have emergency fund
Want catastrophic coverage
Minimize monthly costs

Not good if:

Chronic conditions
Frequent medical care
Can't afford $2,800 out-of-pocket

Medigap Costs

Factors Affecting Premium

Location: Wide variation by state and zip code

Age: Older = higher premium

Tobacco use: 20-50% surcharge

Gender: Women sometimes pay more (longer life expectancy)

Insurance company: Same plan, different prices

Pricing method: See below

Pricing Methods

Community-rated: Same price regardless of age

Best for older enrollees
Not common

Issue-age-rated: Based on age when buy

Premium increases but not due to aging
Uncommon

Attained-age-rated: Based on current age

Lowest initial premium
Increases with age
Most common (watch out for future increases)

Average Costs by Plan (2025)

Plan G: $125-$250/month Plan N: $90-$180/month
High-Deductible G: $30-$60/month Plan F (if eligible): $150-$300/month

Geographic variation:

Rural areas: Often cheaper
Urban/coastal: More expensive
Florida, New York: Highest costs
Midwest: Often lowest

Enrollment Periods

Medigap Open Enrollment

When: 6 months starting when turn 65 AND enrolled in Part B

Guarantee issue: Cannot be denied or charged more for health conditions

Best time to buy: During this period

Example: Turn 65 in June, enroll in Part B → Open enrollment June-November

Miss this window: May face medical underwriting or denials

Guaranteed Issue Rights

Can buy without health questions if:

Losing employer coverage
Medicare Advantage plan leaving your area
Moving out of plan service area
Plan stops providing care
Misled by insurance company

63 days to enroll from triggering event

Special Situations

Under 65 on Medicare (disability):

Not all states require Medigap sales
May pay more
Get 6-month open enrollment at 65

Medicare Advantage switching:

Can switch to Medigap during trial period (first year)
After trial: May require medical underwriting
Not guaranteed

Medical Underwriting

When It Applies

After open enrollment: Most states allow health questions

What insurers look at:

Pre-existing conditions
Current health status
Prescription medications
Recent medical procedures

Can result in:

Higher premiums
Coverage denial
Pre-existing condition waiting period (up to 6 months)

Guaranteed Issue States

Massachusetts, Minnesota, Wisconsin: Unique Medigap rules

Some states: Year-round guarantee issue for certain plans

Check your state: Rules vary

Comparing Companies

All Plans Are the Same... But

Standardized benefits: Plan G is Plan G regardless of company

But companies differ in:

Price
Customer service
Financial stability
Rate increase history
Additional benefits (gym memberships, etc.)

How to Compare

Check:

AM Best rating (A or better)
Rate increase history (ask)
Customer complaints (state insurance dept)
Customer service reviews

Get quotes from 3-5 companies

Look beyond price: Cheap now may increase rapidly

Switching Medigap Plans

Can You Switch?

Anytime: Can apply to switch

But: May require medical underwriting (except open enrollment period)

May be denied: Based on health

Pre-existing waiting period: Possible

When to Switch

Good reasons:

Found lower price (same plan)
Moving to different area
Better customer service
Current insurer raising rates significantly

Be careful: Don't cancel old until new approved

Medigap with Part D

Must Buy Separately

Medigap doesn't include drugs: Need Part D

Total monthly cost:

Medigap: $125-$250
Part D: $30-$80
Total: $155-$330/month

Coordinate: Choose Part D based on your drugs

Medigap vs Medicare Advantage

Key Differences

Medigap + Original Medicare:

Freedom to see any Medicare doctor
No referrals needed
Predictable costs
Higher monthly premiums
Must buy Part D separately

Medicare Advantage:

Network restrictions
Referrals often required
Variable costs (copays)
Lower/no premium often
Drugs included (usually)
Additional benefits (dental, vision)

Can't have both: Medigap only works with Original Medicare

When Medigap Is Better

If you:

Want provider freedom
Travel frequently
See specialists often
Prefer predictable costs
Have chronic conditions

When Medicare Advantage May Be Better

If you:

Want low/no premium
Comfortable with networks
Want dental/vision included
Generally healthy
Budget very tight

Household Discount

Some companies: Discount if both spouses buy

5-12% discount typical
Each needs own policy
Both must buy from same company

Worth asking about

Claims and Coverage

How It Works

You:

See any Medicare-accepting doctor
Doctor bills Medicare
Medicare pays their share
Medigap automatically pays their share
You pay nothing (for covered services)

Automatic: No claim forms to file

Seamless: When doctors participate

Common Questions

Can I be dropped?

No, as long as pay premium
Guaranteed renewable

What if I move?

Coverage follows you
Premium may change based on new location
May want to shop new area rates

What about dental/vision?

Not covered
Buy separate policies
Discount plans available

When does coverage start?

Typically first day of month after application approved
Can request delayed start (during open enrollment)

Money-Saving Tips

Get the Best Rate

Shop around: Prices vary $100+/month for same plan

Ask about discounts:

Household (both spouses)
Pay annually
Auto-pay
Nonsmoker
Wellness program participation

Review annually: Companies raise rates differently

Consider switching: If find better price (reapply, may need underwriting)

High-Deductible Option

Plan G HD: Save $1,000-2,000/year in premiums

Pay $2,800 deductible
Good if healthy and have savings

State Variations

Most states: Follow standard plans A-N

Exceptions:

Massachusetts: Unique Medigap structure
Minnesota: Different plan types
Wisconsin: Own standardized plans

Check your state: If in MA, MN, or WI

Resources

Official Information

Medicare.gov/medigap-comparison: Compare prices
1-800-MEDICARE: Questions
State Health Insurance Assistance Program (SHIP): Free counseling

Tools

Medicare Plan Finder: medicare.gov
State insurance department: Complaints and information

Getting Help

SHIP counselor: Free, unbiased help
Licensed insurance agent: Compare companies
Medicare directly: 1-800-633-4227

Bottom line: Medigap provides peace of mind by covering Medicare out-of-pocket costs. Plan G is best value for most new enrollees. Buy during 6-month open enrollment period for guaranteed acceptance.

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