Medigap, also called Medicare Supplement insurance, is private coverage that works alongside Original Medicare to fill the gaps in your Part A and Part B benefits. When Medicare leaves you responsible for copayments, coinsurance, or deductibles, a Medigap policy steps in to cover those costs, giving you predictable out-of-pocket expenses. Because federal law standardizes each Medigap plan’s benefits, you can choose any insurer without worrying about changing core coverage, whether you’re asking “What is Medigap?” or “What is a Medicare supplement?” This type of policy is designed to limit your financial risk while letting you keep the freedom to see any Medicare-approved provider.
For even more information on your medicare coverage and Medicare choices, please see my articles and videos title Medicare Explained – Secrets of Who & Why and Medicare Explained – What is Medicare.
What is Medigap Policy?
A Medigap policy is a type of health insurance coverage designed to supplement your Original Medicare benefits. A Medigap policy can help pay for some of the out-of-pocket costs that Medicare doesn’t cover, such as copayments, coinsurance, and deductibles. Medicare enrollees increase their health insurance coverage when they buy a Medigap policy.
Medigap policies cover the coinsurance, copayments and deductibles the Medicare enrollee would pay without supplemental health insurance coverage. They are health insurance policies offered by private companies through an agent or broker and reduce your health care / medical care costs.
To put it simply, because Original Medicare Part A and Part B has gaps in insurance coverage and no maximum out of pocket limit to a Medicare beneficaries financial risk, there is a need for a polciy that fills those gaps and sets a reasonable expectation of limited financial risk. That is what a Medigap policy does. It works hand in glove with Medicare to reduce your out of pocket costs.
Standardized Medigap Coverage
Although these polcies are administered and offered by insurance companies, the benefits of a Medigap policy are standardized by federal law. That means that the basic benefits of each type of Medigap policy are identical regardless of the insurance company that offers them.
Medigap Seminars Insurance Agency Reviews.
When Am I Eligible for Medicare?
To be eligible to enroll in a Medigap plan, you must first be enrolled in both Medicare Part A hospital insurance, and Medicare Part B outpatient and physician services, also known as Original Medicare. This calculator will show you when your Medicare initial enrollment will be.
Once you have an Original Medicare and a Medigap policy, whenever Medicare pays its portion of a bill, the Medigap policy will also pay their portion of the bill . Medicare and the Medigap policy communicate electronically, with the Medigap policy paying most claims automatically and within 48-hours of receipt.
Medigap coverage can be a valuable addition to your Original Medicare plan. However, it is important to note that Medigap is not a stand alone policy. It’s a supplemental policy that works hand-in-glove with your Original Medicare to improve your Medicare benefits.
Medigap Plans are sold by private companies, not the United States Government. An independent insurance broker should work with multiple insurance companies to offer all the plans available in your area. Medigap Seminars is the “Medicare Agent Near Me” most people ask for.
What are The Different Types of Medigap Insurance?
There are ten Medicare supplement plans, standardized by the federal government. Although they’re sold by private insurance companies, the benefits are identical regardless of the company. In addition, a Medigap policy is guaranteed renewable. This means the benefits never change. Medicare beneficiaries with a Medigap plan can be secure in knowing exactly what their benefits will be from year to year.
You can find a handy Medical Supplement Plans Comparison Chart Here. This chart helps you compare Medigap policies. For a personalized quote, please use this quote form to provide us the information we need. We will respond by email with your quotes.
What Do Medigap Plans Cover?
There are ten different Medicare supplement health insurance plans plus two with a high deductible option. Which of the deductibles, copay and coinsurance your Medigap poicy pays on your behalf depends on the supplemental insurance option you chose.
Most Medigap policies cover hospital costs. Except for the high deductible options, every Medigap policy will pay 100% of the Medicare Part A inpatient coinsurance for up to 365 consective days. Each of the most popular plans also pay the Medicare Part B 20% coinsurance that is your responsibility. Please see the Medigap Benefits table comparison chart for specifics on each plan type.
What do Medigap policies not cover?
If Medicare does not cover a service or procedure, the Medicare supplement plan cannot cover it either. Read more “What Does Medicare Not Cover”. The Medigap plan pays the copays, coinsurance and deductible of Medicare’s covered health care costs. Consumers who buy a Medigap policy increase their coverage over having just Medicare or just a Medicare Advantage plan.
Medigap plans do not cover:
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Long-term care
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Private duty nursing
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Dental care
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Vision care
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Hearing aids and exams to fit them
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Custodial or at-home recovery care
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Prescription drugs
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Healthcare not Medicare approved
Comparison of Medigap Policies and Medicare Advantage Plans
To help you better understand the differences between Medigap policies, including the high deductible plan, and Medicare Advantage plans, here is a detailed comparison table highlighting key features, coverage, costs, and flexibility.
| Feature | Medigap Insurance / 2025 Medigap Benefits Table / 2025 Medicare Part A & B benefits and IRMAA aka Medicare Supplement | Medicare Advantage Plan (Part C) |
|---|---|---|
|
Coverage |
Supplements Original Medicare (Parts A and B) |
Replaces Original Medicare (Parts A and B) |
|
Provider Network |
No network restrictions; can use any Medicare-approved doctor or hospital |
Usually requires use of plan’s network providers |
|
Preauthorization |
Not required |
Often required for non-urgent treatments |
|
Monthly Premiums |
Requires monthly premium in addition to Medicare Part B premium |
Generally lower premiums, sometimes $0 monthly premium |
|
Out-of-Pocket Costs |
Can be near zero with coverage of copayments, coinsurance, deductibles |
May have higher out-of-pocket costs for medical services. |
|
Prescription Drug Coverage
|
Not included; requires separate Medicare Part D plan |
Often includes bundled Part D prescription drug coverage |
|
Flexibility |
High; can see any Medicare-approved provider in the USA |
Limited by network and plan rules |
|
Enrollment |
Must be enrolled in Medicare Parts A and B |
Enrollment replaces Original Medicare |
|
Medical Underwriting |
Guaranteed issue during Medigap Initial Enrollment Period; otherwise medical underwriting may apply |
Not applicable |
|
Additional Benefits
|
Limited foreign travel coverage, some include coverage for Part B excess charges. |
May include extra benefits such as fitness memberships |
|
Coverage Outside U.S. |
Some Medigap plans cover emergency & urgent care abroad |
Typically limited or no coverage outside U.S. |
This table provides a clear overview to help you decide which option best fits your health care needs and financial situation. Medigap is ideal if you want predictable costs and flexibility in choosing providers, while Medicare Advantage plans may appeal to those looking for lower premiums and extra benefits bundled together.
When Can I Sign Up for a Medigap Plan?
You can sign up for a Medigap plan during or immidiately before your six-month Medigap Initial Enrollment Period. This period starts on the first day your Medicare Part B is active. Technically, this six months window is 180-days, which may be less than six full calendar months. You can calculate your enrollment period here
Technically, you can apply for a Medigap policy up to six months before your initial enrollment date in most states, but the Medicare supplement insurance cannot start until your Medicare is effective. Both Medicare Part A and Medicare Part B must be active for Medigap policies to function.
It should be noted that there is no federal mandate requiring states to offer a Medigap policy to those eligible for Medicare but under the age of 65. If you are in this situation, check with your state insurance department or an independent Medicare broker.
No Medical Underwriting
During your Medigap Initial Enrollment Period, you are guaranteed to be accepted by a Medigap insurance company. You cannot be denied Medigap health insurance coverage or charged more due to preexisting conditions. This is true even if you have health problems. In addition, you will not be required to undergo medical underwriting during this time.
If you wait to sign up for a Medigap plan outside of this window, you may be subject to medical underwriting. Medical underwriting could result in higher premiums or being denied coverage.
What Is Medical Underwriting?
Medical underwriting is the process by which insurance companies evaluate your health history to determine your premiums or whether or not to accept your application. Minor health probelms are not an issue. Even a history of cancer, once two years cancer free, is not an issue. Insurance companies are looking for a recent history of critical or chronic illness that will require costly medical care.
How Much Does a Medigap Policy Cost?
The cost of a Medigap policy depends on a few different factors, including the state you live in, your age, tobacco use, gender and the specific insurance company and plan you choose. In general, Medigap plans are available for purchase from insurance companies or through their independent agents. Your monthly premium is paid directly to the insurance company and automatically renews yearly with the benefits being guaranteed renewable.
In some states, the monthly cost for a supplement policy can be under $100 for a 65-year old non-smoker. In other states in can be closer to $300. Keep in mind, you must also pay your monthly Part B premium and enroll in Medicare prescription drug plans.
How do Insurance Companies Price Medigap Plans?
There are three different ways that insurance companies can price Medigap plans:
Community rating: All people living in the same area and enrolling in the same Medigap plan pay the same monthly premium, regardless of age, gender or health status.
Issue-age rating: Your monthly premium is based the age you were when you first enroll in a Medigap plan. if you purchase a policy at age 65, you will always pay the 65-year old rate. That rate can and will change over time.
Attained-age rating: Your monthly premium starts low but gradually increases as you age. This is the most common pricing method and often the lowest cost over your lifetime.
Some Medicare beneficiaries mistakenly believe that one pricing method will always be a lower cost over their lifetime. This is not true. No pricing method will turn an insurance company into a philanthropic organization. Insurance companies can increase their prices in every situation and will do so if they need to remain profitable.
What’s the Difference Between Medigap Policies and Medicare Advantage Plans?
People often believe their choice is between a Medicare supplement plan and a Medicare Advantage plan. But these two types of polices are not comparable.
A Medicare Advantage plan replaces your original Medicare with a similar level of insurance coverage offered by private insurance companies. These Advantage plans will have a set annual maximum out of pocket, but in return limit your care to a local network of medical providers and then control their costs by requiring those providers to seek prior approval from the insurance company before offering non-urgent care.
A Medigap policy builds on your Original Medicare policy by paying all or some of the deductibles, copays and coinsurance that is designed into Original Medicare. With a Medigap policy you keep the two greatest benefits of Original Medicare; you can see any medical provider in the US or its territories as long as they accept Original Medicare. In addition, no insurance can interfere with your care. There are no prior authorization requirements.
For more on Advantage plans, please see my article and video; Medicare Advantage Plans Explained.
What is the Difference Between a Medigap Policy and Medicare Advantage?
| Feature | Medigap (Medicare Supplement Insurance) | Medicare Advantage Plan (Part C) |
|---|---|---|
|
Coverage |
Supplements Original Medicare (Parts A and B) |
Replaces Original Medicare (Parts A and B) |
|
Provider Network |
No network restrictions; covers any Medicare-approved provider |
Typically requires use of plan’s network providers |
|
Preauthorization |
Not required |
Often required for non-urgent treatments |
|
Premiums |
Requires monthly premium in addition to Medicare Part B premium |
Generally lower premiums than Medigap |
|
Out-of-Pocket Costs |
Can be near zero with coverage of copayments, coinsurance, deductibles |
Can have higher out-of-pocket costs for medical services |
|
Prescription Drug Coverage
|
Not included; requires separate Medicare Part D plan |
Often includes bundled Part D prescription drug coverage |
|
Flexibility |
High; can see any Medicare-approved provider in the USA |
Limited by network and plan rules |
|
Enrollment |
Must be enrolled in Medicare Parts A and B |
Enrollment replaces Original Medicare |
|
Medical Underwriting |
Guaranteed issue during Medigap Open Enrollment Period; otherwise may apply |
Not applicable |
|
Additional Benefits
|
Covers certain out-of-pocket costs not paid by Medicare |
May include extra benefits such as fitness memberships |
Contact Medigap Seminars for Enrollment and Questions
If you’re ready to buy a Medigap policy or have questions about your Medicare supplement insurance options, Medigap Seminars is here to help. Our experienced agents work with multiple private insurance companies to provide you with all the options you need find a plan that fits your budget and your needs. Request a personalized quote and let us guide you through the enrollment process.
Whether you want to understand the differences between Medigap plans, find the best coverage for your needs, or get assistance with Advantage plans or your Medigap open enrollment period, we offer expert support every step of the way.
Don’t navigate the complexities of Medigap insurance alone. Contact Medigap Seminars today to schedule a consultation, request a quote, or get answers to all your Medigap questions. We’re committed to helping Medicare beneficiaries make informed decisions and secure the supplemental coverage they deserve.
