Medicare Supplement Plans Explained helps new and current Medicare beneficiaries understand how Medigap works to fill the gaps left by Original Medicare. The article clearly outlines the benefits and limitations of standardized plans A through N, including how they cover deductibles, coinsurance, copayments, and other expenses. It also explains eligibility rules, why costs vary by plan and location, and offers guidance on choosing a plan that matches your health needs and budget. Whether you’re comparing Plan G, Plan N, or others, this guide gives you the clarity you need to make a confident Medigap decision.
What Are Medicare Supplement Plans?
Medicare Supplement insurance plans are private health insurance policies that work with your Original Medicare Part A & Part B. These plans are also known as Medigap plans.
Medigap plans increase your insurance coverage so that your out-of-pocket maximum risk can be as low as just a few hundred dollars per year. A Medigap policy is an insurance plan offered by private insurance companies (non-governmental) that helps pay the deductibles, copays and coinsurance Original Medicare leaves as the consumer’s responsibility. It pays the gaps in Medicare health insurance coverage. The do not increase Medicare benefits to include procedures or services not covered by Original Medicare. Medigap insurance is the type of insurance that fills the gaps in Medicare coverage.
Unlike Medicare Advantage Plans, the Medicare supplement coverage of acupuncture has no say in your insurance coverage. All decisions are made by Medicare, which relies on your doctor to help determine medical necessity.
Medicare’s intent to cover everything that is medically necessary to diagnose and treat any condition, injury or illness. When Medicare covers a service or procedure, Medicare supplement policies will pay their portion of the bill. In doing so, Medicare supplement insurance increases your insurance coverage and limits your potential out-of-pocket risk.
A great feature of Medicare supplement policies is that the benefits are standardized so that they are the same from one insurance company to another. That means that all Medicare supplement polcies of the same type (i.e. Plan G or Plan N) offer the same health insurance benefits.
Medigap policies are often referred to as Medicare supplements because they supplement Original Medicare.
Medicare Advantage vs Supplement
Many people new to Medicare mistakenly believe that the choice between a Medicare Advantage Plan and a Medicare supplement is choice between two equals. Nothing could be futher from the truth.
A Medicare Advantage plan is designed to compete against Original Medicare with no supplement. The Advantage plan is required to have roughly equal benefits, but provide a maximum out of pocket limit for the consumer. In return, the Advantage plan restricts insurance coverage to a limited local network and requires medical professionals to seek prior authorization from the insurance company before performing any non-urgent health care procedures.
Although Medicare Advantage plans replace Original Medicare, you must still pay your Medicare Part B monthly premium and any IRMAA surcharges if due.
A Medicare supplement plan builds on Original Medicare benefits by paying all or some of the deductibles, copays and coinsurance that Original Medicare expects the consumer to pay. As such, Medigap policies limit the fiancial risk associated with medical bills. Even though Medigap polcies are administrated by private insurance companies, Medicare makes all the decisions. In addition, with Medigap policies the consumer retains the two most important benefits of Original Medicare. The Medigap policy holder can still see any medical provider in the United States or U.S. territory as long as they accept Medicare. Plus, no insurance company can interfere with your healthcare decisions. There are no prior authorizations required.
It is the freedom to choose any doctor or medical provider, combined with the fact that healthcare decisions are kept between you and your doctor that makes Medigap policies the top choice among consumers who research their options.
Medigap Seminars Insurance Agency Reviews.
What Does a Medicare Supplement Insurance Plan Cover?
The next obvious questions you may be asking then is “What are the benefits of Original Medicare that we get to keep when we enroll in a Medicare supplement plan?” and “By how much can I limit my out of pocket costs?”.
Medicare Supplement plans help pay for costs of services covered by Medicare, but not payed for by Medicare. This usually includes coinsurance, copayments, and deductibles that are not fully paid by Original Medicare. There are different coverage options available depending on the Medigap plan type, so it’s important to compare what each plan covers. These plans are designed to enhance your original medicare benefits by filling coverage gaps and improving your overall health care coverage. Medicare Supplement plans also help manage medical costs by covering out-of-pocket expenses.
Medicare Supplement Plans Comparison Table
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.
NA – Not Applicable
= 100% payment for Medicare services.
X = Not Included.
*Plans F & G offer a high-deductible plan option.
**Plans K & L show how much they pay for approved services before you meet your out-of-pocket yearly limit. After you meet the maximum out of pocket limit, the plan will pay 100% of your costs for approved services for the remainder of the calendar year.
***Plan N pays 100% of the costs of Part B services, except for copayments for some office visits and some emergency room visits. Copayments are up to $20 per office visit and up to $50 for an emergency room visit when not admitted as an inpatient.
Note: Plan C & Plan F are only available if you were eligible for Medicare prior to January 01, 2020. You can apply for Plan F or Plan C if you were eligible for Medicare prior to January 1, 2020, even if not yet enrolled.
Medical Necessity Health Care Coverage
It is Medicare’s intent to cover everything that is Medically Necessary to diagnose and treat any disease, condition or injury. This may be everything from physical therapy to surgery and all in-between. It’s not like other insurance products where they itimize what is covered and leave you guessing what isn’t on the list. With few exceptions, if it is Medically necessary, Medicare’s intent is to cover it. Medicare pays its share of the Medicare-approved amount for covered services, and only Medicare-approved services and procedures are eligible for coverage under both Medicare and supplement plans. How does Medicare determine Medical Necessity? They ask your doctor. This too is unlike other insurance products. With most any other insurance you may have had in your lifetime, it’s the insurance company that makes a final judgement over what is or is not covered. In fact, your doctor has to ask permission before proceeding with your treatment. This is huge. With Original Medicare, you and your doctor control your healthcare. Not an insurance company. That’s the first benefit.
Freedom of Choice, Choosing Your Doctor
The second benefit of Original Medicare you get to keep with a Medicare supplement is that you can see any doctor or go to any hospital in the United States or its territories. You have national coverage. As long as the medical provider accepts Original Medicare, your Medicare insurance will pay your Medicare covered costs.
This means you have the flexibility to schedule doctor visits with any provider who accepts Medicare, and you are also covered for office visits as part of your outpatient care options. There is no limiting network and virtually every doctor and hospital in the country and its territories accepts Medicare.
If you require hospital care, supplement plans help cover costs related to inpatient admission, including coinsurance and deductibles. Some plans may also require copayments for emergency room visits, especially if the ER visit does not result in an inpatient admission.
For most people, those two simple benefits are the most important features of their healthcare. You have freedom of choice, choosing any doctor or hospital available, and you have control over your healthcare because your doctor never has to get their recommended procedure or tests pre-approved by an insurance company.
One caveat; there are some doctors that will accept select Medicare Advantage Plans but not Original Medicare. In some cases, the doctor is an employee of the Medicare Advantage company. We see this with Kaiser in California, for example. In other cases the Medicare Advantage plan may pay a doctor a monthly bonus for their business and the doctor decides to only accept their insurance in order to increase their bonus.
I should note, preventive care is run slightly differently between Original Medicare and Medicare Advantage plans. With Original Medicare, preventive care is allowed on a specific schedule set by Medicare. Some preventive care tests can be completed annually, or every other year and so on.
I have another video specifically on that subject called Avoid Surprise Medicare Bills. It’s an important video for everyone on Original Medicare and it’s linked in the top corner of this video.
Are Medicare Supplement Insurance (Medigap) Worth It?
Now we know the benefits of Original Medicare that are passed on to a Medicare supplement insurance. The next question to answer is “By how much can a person limit financial risk?”.
There are more than 10 Medicare supplement plans to choose from, but there are usually only three or four whose price and benefits are worth considering. All plans of the same letter type offer the same basic benefits, regardless of the insurance company or state.
Within those options, you can limit your financial exposure to medical bills down to zero or just a few hundred dollars per calendar year. Some plans, like Plan F and Plan G, also offer a high deductible version, which means you must pay a significant deductible before the plan begins to pay benefits.
A high deductible plan allows you to have lower monthly premiums in exchange for higher out-of-pocket costs until the deductible is met. Or limit your financial risk to approximately $2,500 in any calendar year when looking at one of the two High Deductible Medicare supplement plans.
Think about that. With a Medicare supplement insurance plan you have national coverage. You can see any doctor, go to any hospital in the entire country as long as they accept Medicare. Plus you and your doctor control your healthcare, not an insurance company.
Some plans involve cost sharing, such as copayments and deductibles, while others cover nearly all costs. Certain plans, like Plan F and Plan C, cover the Part B deductible, while others, such as Plan G, Plan D, and Plan N, do not.
Most plans cover Part B coinsurance, but the amount covered can vary, and some plans set copayment limits. Plans K and L cover a portion of hospice care coinsurance until you reach an out-of-pocket maximum.
When comparing plans, it’s important to consider monthly premiums, which you pay directly to the insurance provider in addition to your Medicare Part B premium.
Some plans cover excess charges—costs that providers may bill above the Medicare-approved amount—while others do not, so excess charge coverage can be a key difference. Excess charges can be a potential out-of-pocket cost for beneficiaries if their plan does not cover them.
And, you can limit your financial risk, your annual maximum out-of-pocket for medical bills, your MOOP I mentioned earlier, down to near zero.
No other health insurance program in the country provides the consumer with this much freedom and control. You have the freedom to use the medical provider of your choice and control over your medical decisions.
Considering how inexpensive Medicare supplement insurance premiums are, the Medicare supplement insurance is one of the best values in healthcare.
One point of confusion is with the Medicare supplement plan benefit table and your Maximum Out-of-pocket. I have a separate video that details your maximum out-of-pocket with supplement plans and answers why there is so much confusion around this subject. You should view that video here: https://medigapseminars.com/medicare-maximum-out-of-pocket/
The Best Medicare Supplement Plans
The next question you may be asking yourself is which Medicare supplement insurance is right for you?
First, understand that all these plans are good plans. I frown on suggesting there is a BEST Medicare supplement plan because the right plan for you may not be the right plan for someone else. It depends on both the individual and your geographic location—read more about mistakes to avoid when researching Medicare supplement insurance.
Each Medigap plan, such as Plan G, offers standardized benefits that are set by law, regardless of which insurance provider you choose.
Medicare supplement Plan G is a comprehensive Medigap plan that covers most out-of-pocket costs. In fact, the only inpatient or outpatient Medicare charge not covered at 100% is the annual Medicare Part B deductible. That is why Plan G is the most popular Medicare supplement insurance plan in the U.S.
The medical benefits of each Medicare supplement plan are written into Social Security law so they do not vary from one insurance company to another.
A private insurer is responsible for issuing Medigap policies, and the coverage does not change between different insurance providers. In addition, none of the supplement insurance companies has any say in what is or is not covered or even how much is paid. Medicare calls the shots and makes all decisions
At Medigap Seminars we work hard to help you find the insurance company that is most likely to provide you your lowest premiums over your lifetime, whether you’re considering traditional options or critical illness insurance for cancer, heart attack, and stroke. The lowest price over your lifetime is not always today’s cheapest plan.
Can a State Override a Medicare Law?
The next thing you need to know about Medicare supplement plans is that many states have created laws that override Medicare to the benefit of the consumer. Some states have annual special enrollment periods. Some states outlaw certain Medicare charges, which favors one plan over another and so on. These laws can impact your decision on which Medicare supplement plan is right for you. Trying to find out if your state has specific laws can take hours of internet sleuthing. I know, I’ve done it. But, to make it easy for you we include a couple paragraphs discussing your states rules, if there are any, in our email to you whenever you request a Medicare supplement plan quote from us. Use our free Medicare supplement plan quote request and we will provide you that information for free.
Medicare Supplement Enrollment Period
Next from this Medigap plans explained article, you will want to understand enrollment periods. The enrollment period for a Medicare supplement insurance plan is different than the enrollment period for any other part of Medicare. That’s important. First, in most states you can apply for Medicare supplement insurance plan up to six months before it is to start
if you are new to Medicare Part B
. You are simply getting the application process out of the way. When enrolling, it’s important to know that Medigap plans may impose a waiting period of up to six months before coverage for preexisting conditions begins, unless you had continuous creditable coverage prior to enrollment. This waiting period applies specifically to preexisting conditions, but can be waived if you meet the creditable coverage requirements. States with application date exceptions to this Medicare rule include: Connecticut: No more than 60-days prior to the effective date. Maine, Missouri and Washington State: No more than 60-days prior to the effective date. New York: up to 90-days prior to the month the applicant turns 65 Wisconsin: Applications may be accepted up to three months prior to the Medicare Part B eligibility date.
Medicare Supplement Initial Enrollment
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Warning*: some insurance companies consider your Medicare Supplement initial Enrollment Period to be the first six calendar months of your Medicare Part B coverage. But some insurance companies use a 360-day year, which means your Medicare supplement insurance Initial Enrollment Period is only 180-calendar days from your Medicare part B start date.*
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If you are not new to Medicare Part B, your application can typically be submitted no more than 60 days prior to its proposed effective date. There are often exceptions during the Annual Election Period when switching from a Medicare Advantage Plan to Original Medicare and a supplement. Importantly, your Medicare Supplement Initial Enrollment Period lasts six months (180 days) starting the day your Medicare Part B becomes effective. During this period, you can get any plan available to you without medical questions, at the best offered price, with guaranteed acceptance. For example, if your Medicare Part B starts on July 1, in most states you can begin the application process as early as January 1 and still apply without medical questions until December 31. Some insurance companies may end this enrollment period slightly earlier, such as December 28. This effectively gives you nearly the entire year to complete the process with no medical underwriting, and no one can deny you coverage.
When Can I Switch My Medicare Supplement Plan?
After you have been on Medicare Part B for more than six-months you can still apply for a Medicare supplement insurance plan any day of the year. You can switch plans, switch insurance companies, do anything you want as often as you wish. However, in order to do so you must qualify medically. The insurance company you are applying to has the right to deny your request if your current or recent medical history includes serious critical or chronic illness. They can deny your request for a new Medicare supplement insurance policy. In which case you just keep what you have. Three important points to build on this. One is don’t assume your condition, if you have one, will disqualify you. You can be two years cancer-free or had open heart surgery 10-years ago and still qualify. Every insurance company has a different set of underwriting guidelines. We help with this, so just ask.
Expect Us to Ask About your Medical History
Two, an insurance company is very likely to request underwriting even if you are changing plans within the same insurance company. That is standard. If your insurance company says they will let you switch plans at any time without underwriting, be careful of what they are not saying. What they are not saying is “at what price”. Don’t assume it’s at the same price as if you qualified medically. It’s not. Those companies have a separate price table and it’s much higher for people who switch plans without underwriting. I know, I work with these companies. Third; there is no annual election or open enrollment period for Medicare supplement insurance plans. The Annual Election and Open Enrollment period pertain only to Medicare Advantage Plans and Medicare Part D prescription drug plans. Of course, some states have special rules. As I mentioned earlier. New York, Connecticut and Vermont have a perpetual Open Enrollment Period for Medicare supplement insurance plans. Washington state allows you to switch Medicare supplement insurance plans at any time, no medical questions asked, if you already have a Medicare supplement insurance. Other states allow consumers to switch plans during a birthday month or a policy anniversary, without medical underwriting but with other limitations.
Medicare Supplement Initial Enrollment Period
Your Medicare supplement initial a six month window that starts the day your Medicare Part B becomes effective. Your age does not matter. It is the start of Medicare Part B that determines your Medicare supplement initial enrollment period. Your Medicare Supplement Initial Enrollment Period lasts six months (180 days) starting the day your Medicare Part B becomes effective. During this period, you can get any plan available to you without medical questions, at the best offered price, with guaranteed acceptance.
Other Medicare Supplement Enrollment Periods
Three important points to build on this. One is don’t assume your condition, if you have one, will disqualify you. You can be two years cancer-free or had open heart surgery 10-years ago and still qualify. Every insurance company has a different set of underwriting guidelines. We help with this, so just ask.
Contact Medigap Seminars for Medicare Enrollment Help
Matthew Claassen and his MedigapSeminars.org teamFor personalized assistance with Medicare enrollment and to find the best Medicare supplement insurance plan for your needs, [contact Medigap Seminars today](https://medigapseminars.org/consultation/). Our knowledgeable agents are ready to help guide you through the process, answer your questions, and provide free, no-obligation quotes tailored to your situation. Call us at 800-847-9680 or visit our website to get started on securing the coverage that fits your healthcare and financial needs.
Frequently Asked Questions About Medicare Supplement Plans
Medicare Supplement Plans, also known as Medigap plans, are private insurance policies designed to work alongside Original Medicare Parts A and B. They help cover out-of-pocket costs such as copayments, coinsurance, and deductibles that Original Medicare does not fully cover, thereby enhancing your overall Medicare benefits.
You must be enrolled in Original Medicare Part A and Part B to purchase a Medicare Supplement Plan. Generally, you are eligible if you are age 65 or older or qualify for Medicare due to certain disabilities.
The best time to buy a Medigap policy is during your Medigap open enrollment period, which lasts for six months starting the month you turn 65 and are enrolled in Medicare Part B. During this time, you have guaranteed issue rights, meaning you cannot be denied coverage or charged more due to preexisting conditions.
Yes, you can switch Medigap plans or insurance companies at any time. However, if you switch outside your initial enrollment period, you may be subject to medical underwriting and could be denied coverage or charged higher premiums based on your health. Different insurance companies have varying underwriting guidelines for Medigap policies.
Most Medicare Supplement Plans do not include prescription drug coverage. You will need to enroll in a separate Medicare Part D plan to get prescription drug benefits.
Medicare Supplement Plans work alongside Original Medicare to fill coverage gaps, allowing you to see any doctor that accepts Medicare. Medicare Advantage Plans replace Original Medicare and may have network restrictions and require referrals for specialists.
These plans generally cover Medicare-approved coinsurance, copayments, deductibles, and some plans cover excess charges and hospice care coinsurance. Coverage and plan limits vary depending on the specific Medigap plan you choose.
Yes, some Medigap plans offer a high deductible version, which lowers your monthly premium but requires you to pay a higher deductible before coverage begins.
Certain Medicare Supplement Plans provide limited coverage for emergency care during the first 60 days of foreign travel, subject to plan limits and conditions.
If you miss your initial enrollment period, you can still buy a Medicare Supplement Plan, but you may have to answer health questions and could be denied coverage or pay higher premiums based on your medical history.
