Medicare Supplement Plans, often called Medigap, are private insurance policies that help cover the out-of-pocket costs left behind by Original Medicare features like deductibles, copayments, and coinsurance. These plans are standardized by the federal government, meaning each plan with the same letter offers the same basic benefits, no matter which insurance company sells it. However, monthly premiums can vary depending on the insurer and location.
To qualify for a Medicare Supplement Plan, you need to be enrolled in both Medicare Part A and Part B. There are ten standardized Medigap plans, plus high-deductible options, each designed to meet different coverage needs. Some offer full coverage of most Medicare costs, while others trade lower premiums for partial cost-sharing. This guide walks through the features of each plan — including popular options like Plan G, Plan N, and high-deductible Plan F, as well as enrollment rules, eligibility tips, and how to choose the plan that best fits your needs.
If you’re approaching Medicare eligibility or reviewing your current coverage, knowing how these supplemental plans work can help you make a confident, informed choice about your healthcare and budget.
Key Takeaways
Medicare Supplement Plans, or Medigap policies, are private insurance policies that cover out-of-pocket costs associated with the deductibles, copay and coinsurance of Original Medicare.
Enrollmnt in a Medicare supplement requires enrollment in Medicare Part A and Part B for eligibility.
Medicare Supplement Plan benefits are standardized by the federal government. While prices may vary from one insurance company to another, the minimum benefits must be the same.
These plans offer different coverage levels to meet various healthcare needs, making it easier to compare options and choose the right plan.
Massachusetts, Minnesota and Wisconsin are the only states that do not have the standadrized Medicare supplement insurance plans. When the standardized supplement plans were created in 2010, these states already had health plans that were equal or better in Medicare benefits.
Overview of Medicare Supplement Insurance Plans
Medicare Supplement Insurance Plans, or Medigap, are additional insurance policies designed to help limit out-of-pocket costs associated with Original Medicare. These plans cover Medicare-approved expenses that Original Medicare does not pay, such as copayments, coinsurance, and deductibles. Individuals must first enroll in both Medicare Part A and Part B to qualify for a Medigap policy.
There are ten different standardized Medicare supplement plans, with two of these plans offering a high deductible option. Medigap policies are identifies by letter and referred to as “plans” as opposed to “parts” of Medicare. For example Medigap Plan A is a Medicare supplement, Medicare Part A is part of Original Medicare. The same can be said for Medigao polcies Plan B, Plan C and Medigap Plan D.
To purchase a Medicare supplement, you must have Original Medicare and cannot have a Medicare Advantage plan. If you have both an Advantage Plan and a Medigap plan, your Medicare providers must bill the Medicare Advantag plan policy. Enrolling in a Medicare supplement does not cancel your Medicare Advantage plan and vice versa.
Medicare Supplement Plan A: Basic Benefits
Medicare Supplement Plan A is the most basic Medigap plan available, designed to cover essential costs not addressed by Original Medicare. It specifically addresses Medicare Part A coinsurance. Additionally, it covers hospital costs for up to 365 more days once Medicare benefits are depleted. This plan ensures that beneficiaries have extended hospital coverage, a significant relief for those facing prolonged hospital stays.
Plan A shares coverage of Part A coinsurance and hospital costs with other plans like B, C, D, F, G, K, L, M, and N, but it stands out for its simplicity and focus on essential benefits. It’s an ideal choice for individuals seeking a straightforward supplement to their Original Medicare coverage.
Medigap Plan A is a popular choice for Medicare beneficaries under the age of 65 who are Medicare eligible due to disability. This is because in many states, Medigap Plan A is the only Medigap Plan option for those under the age of 65.
Comprehensive Coverage with Medicare Supplement Plan F
Medicare plans Plan F and Plan C are only available to those who were eligible for Medicare before January 1, 2020. For those who qualify, Plan F remains the most extensive Medigap option, ensuring that every aspect of Medicare-approved costs is covered. Plan F also covers any excess charge a provider may bill above the Medicare approved amount. However, for new Medicare beneficiaries, Plan G is often recommended due to its similar coverage and lower premiums.
Comparing Medicare Supplement Plan G to Plan F
When comparing Medicare Supplement Plan G to Medigap Plan F, the only difference is that Medigap policy Plan G does not cover the annual Medicare Part B deductible. However, Medigap policy Plan G covers everything else, including Part B excess charges. Excess charges are rare and only allowed by medical practitioners who have a non-participating contract with Medicare and are not practicing in those states that forbid excess charges.
For those eligible for Medicare on or after January 1, 2020, Plan G is the highest coverage option available, as it covers the deductibles, coinsurance and copay of all Medicare covered costs except the Part B deductible.
Medicare Supplement Plan N: Cost Sharing Options
Medicare Supplement Plan N offers a cost-sharing structure that can result in lower monthly premiums compared to other Medigap plans. Key features include:
Is exactly like Plan G in that it does not pay the Medicare Part B deductible
Covers all other costs for Part B services, but includes a small copay for office visits and emergency room visits.
Copayments apply to office visits and emergency room visits (the emergency room copayment is waived if the visit results in an inpatient admission)
Copayment amounts can vary based on the provider and specific services but is maximum of $20 for an office visit and $50 for an emergency room visit.
Medigap policy Plan N does not pay the annual Part B deductible, but it fully covers most outpatient care services. This makes it an attractive value for those who prefer lower premiums and are comfortable with occasional copayments for office visits and emergency care.
Compare Medigap Plans
Footnotes & Legend
- ✓ Covered. ✕ Not covered. Percentages show how much the plan pays.
- * High-deductible versions may be available for Plans F and G.
- ** Out-of-pocket limits apply only to Plans K and L.
- *** Plan N pays Part B coinsurance except: up to $20 office visit & up to $50 ER if not admitted.
High-Deductible Options: Plans F and G
For those looking for lower monthly premiums, high deductible plans such as the high deductible versions of Plans F and G are available. These high deductible plans have the following characteristics:
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Medicare will stay pay it’s portion of the bills for Medicare covered services, after you pay your annual Part B deductible or Part A deductible as appropriate. But your supplement does not pay until your out of pocket costs reach the deductible for the calendar year. This means you will pay the Medicare Part B coinsurance until you reach your Medigap deductible.
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Have an annual deductible for 2026 set at $2,950, and which increases annually at the same percentage rate as the CPI-U, consumer price index.
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The deductible must be met annually before the Medigap plans start providing benefits and resets every January 01.
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My favorite feature of the high deductible Medigap plans is that the deductible is also your annual maximum out of pocket expense.
The deductible applies per calendar year and resets each January 01, meaning you must meet the deductible again every year.
The annual deductible for these high-deductible plans is adjusted each year based on the Consumer Price Index for all Urban Consumers. These options are ideal for individuals who prefer lower premiums and are financially prepared to handle higher out-of-pocket costs when necessary.
Partial Coverage Medigap Plans: K and L
Medicare Supplement Plans K and L offer partial coverage for Medicare expenses, including certain coinsurance amounts and deductibles. These plans cover a fraction of costs for part a hospice care, Part B coinsurance, the first three pints of blood, hospice care coinsurance, skilled nursing facility care coinsurance, and the Part A deductible.
Plan K and Plan L have the following characteristics:
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Plan K has an out-of-pocket expenditure limit projected to be $8,000 for 2026 per calendar year.
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Plan L has a lower out-of-pocket expenditure limit of $4,000 per calendar year.
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The out of pocket limit on these two plans does not include services not covered. That means your Medicare Part B deductible and excess charges are in addition the out of pocket limit.
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Neither plan covers medical expenses incurred during international travel.
Once you reach the yearly part out-of-pocket limit and the annual Part B deductible, the plan pays 100% of covered benefits for the rest of the calendar year.
These plans are suitable for those seeking to balance premium costs with out-of-pocket expenses.
Specialized Coverage with Plans M and D
Medicare Supplement Plan M distinguishes itself by covering 50% of the Part A deductible, allowing policyholders to share some of the costs associated with hospital stays. This cost-sharing structure can make Plan M a more affordable option for some beneficiaries.
Medigap Plan D, on the other hand, is identical to Medicare supplement Plan N except it has no office visit or emergenct room copays.
Enrollment Periods and Eligibility
The Medigap open enrollment period is a crucial time for enrolling in a Medicare Supplement plan. This one-time opportunity begins when you first enroll in Medicare Part B and are at least 65 years old. During this period, insurers cannot use medical underwriting to determine coverage eligibility or premiums.
Delaying enrollment in a Medigap policy can result in increased premiums or denied coverage. Certain states allow residents to switch Medigap plans without considering pre existing health problems. For those living in multiple states, such as Florida snowbirds, understanding specific Medicare options is crucial. Understanding these regulations helps make informed decisions about healthcare.
It’s important to note that tobacco use may impact the pricing and availability of Medigap plans, as insurers can charge higher premiums to tobacco users.
How to Compare Medicare Supplement Plans
One of our beliefs is that a person should select today the insurance plan they will want to have when they are sick or injured. We advise clients to visualize themselves battling a serieous disease or injury. What would be acceptable health insurance in that scenario.
Start with the coverage that most matches your desire under that circumstance, then find the policy that meets those needs and your budget.
Medigap Seminars Insurance Agency helps our clients select the best insurance companies for price stability and health care coverage.
Understanding Medicare Parts vs. Medicare Supplement Plans
Medicare Parts provide essential coverage for health care services, with Part A covering hospital inpateint insurance and Part B covering medical outopatient insurance. Medicare Supplement plans, on the other hand, offer additional benefits to cover costs not fully paid by both Part A and Part B of Original Medicare.
Medicare Supplement plans, also known as Medigap, include 10 standardized plans offering various levels of coverage. These plans help pay for Medicare covered costs, such as deductibles, coinsurance, and copayments, that are not fully paid by Original Medicare. It’s important to note that individuals cannot hold both Medicare Advantage plans and Medicare plans simultaneously, as they serve different purposes within the Medicare framework.
Medigap Seminars Insurance Agency Reviews.
Summary
In conclusion, understanding the different Medicare Supplement Plans can significantly impact your healthcare decisions and financial well-being. From the basic benefits of Plan A to the comprehensive coverage of Plan F, each plan offers unique advantages designed to cover gaps left by Original Medicare.
By comparing plans based on your needs, financial situation, and risk tolerance, you can [find coverage options]make informed choices that best suit your circumstances. For help making informed decisions, consider working with an independent Medicare insurance broker such as Medigap Seminars. For more information about our expertise and approach, learn about us. Remember, the right Medigap plan can provide peace of mind, knowing that you have comprehensive coverage tailored to your needs.
Frequently Asked Questions
The key difference between Medicare Supplement Plan F and Plan G is that Plan F covers all Medicare-approved expenses, including the Part B deductible, whereas Plan G excludes the Part B deductible but includes all other benefits. Plan G also includes coverage for the Part B excess charge, which is the amount a provider may charge above the Medicare-approved amount for Part B services.
Yes, you can switch Medigap plans even with preexisting conditions in certain states, but it is crucial to verify the regulations that apply in your state.
The Medigap open enrollment period starts when you first enroll in Medicare Part B and are at least 65 years old, ensuring that insurers cannot use medical underwriting to influence coverage eligibility or premiums. If you need more information about how and when to sign up for Medicare, see our comprehensive guide. This period is crucial for obtaining supplemental insurance without being subject to medical evaluations.
High-deductible plans F and G are not suitable for everyone; they are best for individuals who can afford higher out-of-pocket expenses and prefer lower monthly premiums. Those with frequent medical needs may find these plans less beneficial.
The out-of-pocket limit for Plan K is projected to be $8,000 in 2026, and for Plan L, the limit is $4,000. These out-of-pocket limits apply per calendar year. Once you reach the yearly part limit for your plan within the calendar year, the plan covers 100% of covered costs for the remainder of that year.
