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Understanding Medicare

Medigap: Your Supplemental Insurance

This optional backup plan can help pay expenses that Medicare doesn't cover

Medigap insurance, which is sold by private companies, helps pay for costs that Medicare doesn’t cover, such as copayments and deductibles. Medigap coverage is available only to people who have Original Medicare Parts A and B.

If you opted for a Medicare Advantage health plan (aka Part C), you cannot also buy a Medigap policy. Although you do have out-of-pocket expenses with Medicare Advantage, they are typically not as great as with Original Medicare.

As a general rule, if you are younger than 65 and on Medicare due to disability, you are not eligible to enroll in a Medigap plan. Exceptions exist, however. Contact your state insurance department for more information.

Eleven standard Medigap policies are available in most states. Each lettered plan — A through G and K through N — offers a different set of benefits, filling different gaps in Medicare Parts A and B coverage. All Medigap plans with the same letter provide the same benefits. Only the premiums and the sponsors of the plans vary.

By law, you can choose only one of these plans. Insurers are not allowed to sell more than one Medigap plan to you. If your spouse is covered by Medicare and also wants Medigap coverage, he or she will need to buy a separate policy. 

Generally, standard Medigap policies cover some or all of the cost of:
• Your Part A deductible and coinsurance (i.e. the 20 percent Medicare doesn't cover) for hospital stays
• Your portion of your doctor’s bills for Part B services
• The first three pints of blood annually, if needed
• Hospice care coinsurance

Medigap plans do not cover:

• Long-term care to help you bathe, dress, eat or use the bathroom
• Vision care, eyeglasses, hearing aids or dental care
• Private-duty nursing
• Prescription drugs, or any out-of-pocket costs for Part D plans

Before Buying a Medigap Policy
When deciding what to do, review what other health insurance you have in addition to Medicare, if any.

If you already have a comprehensive retiree health plan to supplement Original Medicare, you may not need a Medigap plan. If your retiree policy provides more-generous benefits, or benefits not covered by Medicare or Medigap policies, you should think carefully before dropping your retiree health plan for a less expensive choice. (You might not be able to get that employer plan back once you drop it.) Check with your union or your former employer’s benefits manager or health plan to make sure you understand all the stipulations.

Can you accept some restrictions on your care? If so, Medicare Select is a Medigap policy that limits the providers you can see. Costs can be lower than with standard Medigap policies because Medicare Select policies cover services only at certain hospitals and through specific doctors. Your state insurance department can tell you if there are Medicare Select plans in your state and give you more information about them.

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