What it is
Medigap, also called Medicare Supplement insurance, is sold by private insurance companies. It works alongside Original Medicare (Part A and Part B). It is meant to fill some of the gaps in what Original Medicare pays.
Here is the basic flow. You see a doctor or hospital that accepts Medicare. Medicare pays its share first. Your Medigap plan then pays its share of what is left, depending on the plan letter you chose. Medigap does not replace Medicare. You need Part A and Part B to have it.
Medigap plans are standardized by letter. Plans A, B, D, G, K, L, M and N (and high-deductible Plan G) are sold to people newly eligible for Medicare. Plans C and F (and high-deductible F) are available only to people who became eligible before January 1, 2020. Plans E, H, I and J were discontinued and are not sold today. Massachusetts, Minnesota and Wisconsin standardize Medigap differently. Medigap generally does not include drug coverage, so many people add a separate Part D plan.
How it’s traditionally been approached
Many people look at Medigap when they first become eligible for Medicare. There is typically a window when you may enroll without being asked health questions. The rules vary by state and can change, so it is wise to confirm current details with Medicare.gov, your State Health Insurance Assistance Program (SHIP), or a licensed agent.
People often compare Medigap with Medicare Advantage. Both are reasonable choices, and they work differently. Medigap generally lets you use any provider nationwide that accepts Medicare, with no network or referrals, and its cost-sharing is predictable. Trade-offs may include generally higher monthly premiums, possible medical underwriting outside open enrollment or guaranteed issue, a separate Part D plan for drugs, and no routine dental, vision or hearing.
Medicare Advantage has real strengths too. Premiums are often lower, there is an annual out-of-pocket maximum, many plans include extra benefits, and many include drug coverage. Its trade-offs may include provider networks, prior authorization and copays. Which fits best depends on your health, budget, doctors and comfort with risk.
How the right licensed agent may help
A Medigap agent may help you sort through the plan letters and explain how they differ. Plan G and Plan N are two commonly discussed options for people newly eligible. An independent licensed agent may be able to show plans from several companies, though which carriers are available varies.
A conversation is generally relaxed and informational. The agent may ask about your doctors, your prescriptions, your budget and when your Medicare started. They may explain enrollment timing and whether health questions could apply to you. You are never obligated to enroll.
Good questions to ask include: Which plan letters are sold to me? How does timing affect my enrollment rights? How might my premium change over time? How would my drugs be covered? Call 1-800-MEDIGAP for more information.
The bigger picture
Choosing health coverage is about more than paperwork. Knowing how your costs are likely to work can bring peace of mind and make it easier to seek care when you need it. Worry about surprise bills can weigh on both mind and body.
Take your time, and involve someone you trust. If you are also looking for care providers, Providers.plus is one place you may explore. No single approach is right for everyone, and each has its own strengths.
Keep in mind
- This page is education only, not insurance, legal, tax or medical advice.
- 1-800-MEDIGAP is independent and privately run. It is not connected with or endorsed by the U.S. government or the federal Medicare program. Official information is at Medicare.gov.
- Enrollment windows, guaranteed issue and under-65 access vary by state and change over time. Confirm current rules with Medicare.gov, your SHIP, or a licensed agent.
- No plan is guaranteed to be available to you or to be best for everyone. Costs vary by carrier, state and age.
Take the next step
- Talk with a Medigap agent ↗Jeff Cline on contacts.plus — a person, not a call center.
Not sure where to start? Answer a few gentle questions and choose who you’d like to hear from.
Call 1-800-MEDIGAP for more information
Frequently asked questions
How does Medigap work with Original Medicare?
Medicare pays its share of an approved service first. Your Medigap plan then pays its share of the remaining cost, based on the plan letter you have. You must have Medicare Part A and Part B to buy Medigap.
Does Medigap cover prescription drugs?
Medigap plans sold today generally do not include drug coverage. Many people add a separate Medicare Part D plan. A licensed agent may explain how the two fit together.
Can I use any doctor with a Medigap plan?
Generally yes, you can see any provider nationwide that accepts Medicare. Medigap does not use networks or require referrals. It is still wise to confirm with your provider before a visit.
Which Medigap plan letters can I buy?
It depends on when you became eligible for Medicare. Plans A, B, D, G, K, L, M and N (and high-deductible Plan G) are sold to people newly eligible. Plans C and F are only for those eligible before January 1, 2020. Plan H and Plans E, I and J were discontinued and are not sold today.
When can I sign up for Medigap?
Many people have an open enrollment period when they first have Part B, during which health questions may not apply. Outside that window, medical underwriting may apply in many cases. Rules vary by state, so confirm with Medicare.gov, your SHIP or a licensed agent.
Is Medigap the same as Medicare Advantage?
No. Medigap supplements Original Medicare, while Medicare Advantage is an alternative way to receive Medicare benefits through a private plan. Each has strengths and trade-offs, and you generally cannot use both together. Call 1-800-MEDIGAP for more information.
Educational resource. 1-800-MEDIGAP shares general information and connects people with independent licensed agents. It is not professional advice. Talk with a qualified professional about your own situation.