Medigap Coverage and Costs for Seniors

As you approach age 65, you're likely to become eligible for Medicare, the government-funded health insurance program for seniors. There are 10 standardized Medigap plans available to fill in the gaps in Medicare coverage.

Medigap plans are standardized across the US, but the cost can vary depending on your location and insurance company. Plan F is the most comprehensive Medigap plan, covering 100% of Medicare Part A coinsurance and hospital costs.

Medigap premiums can be high, especially for older seniors, but some plans offer more affordable options. For example, Plan G is often less expensive than Plan F but still offers comprehensive coverage.

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Medigap is supplemental health insurance that helps cover some of the gaps in healthcare costs that Original Medicare (parts A and B) does not cover.

These costs include deductibles, copays, and coinsurance. However, since January 1, 2020, Medigap has not covered the Part B deductible.

About 42% of people with Medicare also had Medigap in 2022, according to the most recent information from the Kaiser Family Foundation (KFF).

There are 10 different Medigap policies, which are only available to a person enrolled in Original Medicare.

Medigap policies do not cover out-of-pocket costs of other types of health insurance, such as Medicare Advantage plans, Medicaid, or health insurance through an employer.

Medigap policies do not generally cover expenses like vision care, including eyeglasses, dental care, hearing aids, long-term care, such as nursing homes, or private-duty nursing.

Here are the 10 different Medigap policies:

To be eligible for Medigap, you'll need to first have Medicare Part B. You can enroll in Medigap during the 6-month open enrollment period when you first have Medicare Part B. This is a crucial time, as insurance companies can't refuse coverage based on preexisting conditions during this period.

You can enroll in Medigap at any time, but if you don't enroll during the open enrollment period, you may be refused a policy due to age or preexisting health conditions. However, if you're in a guaranteed issue right period, an insurance company must give you a policy without considering your preexisting conditions.

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Here are the circumstances that qualify you for a guaranteed issue right period:

If you're under 65 and receiving Medicare coverage, there are some important things to know.

Recipients of Social Security Disability Insurance (SSDI) benefits or patients with end-stage renal disease (ESRD) are entitled to Medicare coverage regardless of age.

Under federal law, insurers are not required to sell Medigap policies to people under 65.

However, a slight majority of states require insurers to offer at least one kind of Medigap policy to at least some Medicare recipients in that age group.

Of these states, 25 require that Medigap policies be offered to all Medicare recipients.

In California, Massachusetts, and Vermont, Medigap policies are not available to ESRD patients.

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Enrolling in a plan can be a bit tricky, but don't worry, it's relatively straightforward. You become eligible for Medigap during the 6-month open enrollment period when you first have Medicare Part B.

The good news is that during this time, you can get a Medigap policy even if you have a preexisting health condition. This is a great opportunity to secure coverage without worrying about being turned down due to your health status.

If you don't enroll during the Medigap open enrollment period, a Medigap provider may choose to refuse coverage on the basis of your preexisting condition or charge higher premiums. However, all Medigap plans have "guaranteed renewable" status as long as you pay your premium, so the company can't cancel your policy as long as you continue to pay.

You can enroll in Medigap at any time, but there are certain circumstances when you may be in a guaranteed issue right period, which means an insurance company must give you an insurance policy without taking into account your preexisting health conditions or current health problems.

Here are some circumstances when you may be in a guaranteed issue right period:

Outside of these circumstances, you may be refused a Medigap policy due to age or preexisting health conditions.

It's worth noting that you can switch to a different Medigap plan during the six-month enrollment period, and you have a 30-day "free look period" to decide if you want to cancel or keep it.

Medigap plans are available through private insurance companies and come with different levels of coverage. There are 10 standardized plans labeled A through N, with each offering a unique combination of benefits.

The cost of Medigap plans varies widely, with the lowest cost being $109-per-month in Dallas and the highest being $509-per-month in Philadelphia. These costs can also vary depending on the person's age, location, and pre-existing health conditions.

To compare Medigap plans, consider the following factors: monthly premium, coverage for foreign travel, care at a skilled nursing facility, and blood supplies. Plans that offer more benefits typically have higher premiums, while plans with fewer benefits may cost less.

Here's a brief overview of the different plan types:

Plan F and Plan G offer high-deductible options in some states, and some plans include emergency medical benefits during foreign travel. However, as of January 1, 2020, new Medicare beneficiaries cannot purchase Plan C or F.

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You can sign up for Original Medicare Plus Part D and Medigap by enrolling in a standalone Medicare Part D prescription drug plan and a Medigap supplemental insurance plan when you first sign up for Medicare Parts A and B.

Medigap providers must offer you a policy, regardless of your medical condition, during your initial enrollment period.

Original Medicare includes Part A (hospital insurance) and Part B (medical insurance), but it doesn't cover prescription drugs, hearing aids, eyeglasses, and dental care.

Medigap plans are standardized into ten different plans, labeled A through N, sold and administered by private companies. Each plan offers a different combination of benefits, and the coverage provided is roughly proportional to the premium paid.

The rules governing the sale and offerings of a Medigap insurance policy can vary from state to state. Some states, like Massachusetts, Minnesota, and Wisconsin, require Medigap insurance to provide additional coverage than what is defined in the standardized Medigap plans.

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Medigap plans have undergone changes over the years. For example, marketing for plans E, H, I, and J has been stopped since May 31, 2010, but those who were already covered by these plans can keep them.

The number of offered plans decreased from twelve to ten with the introduction of Medigap plans M and N on June 1, 2010.

Here's a breakdown of the types of Medigap plans available:

Medicare Supplement insurance costs can vary significantly, with the 2020 Medigap Price Index showing that someone turning 65 could pay more than three times more for virtually identical coverage.

The lowest cost for a male age 65 was $109-per-month available in Dallas, while the highest cost was $509-per-month in Philadelphia. It's essential to consider these costs when comparing Medigap plans.

The monthly premium is a crucial factor to consider when choosing a Medigap plan. Some plans offer higher benefits but come with higher premiums, while others have lower premiums but fewer benefits.

Here's a breakdown of the different types of Medigap plans and their associated costs:

Keep in mind that these are general estimates, and actual costs may vary depending on your location, age, and pre-existing health conditions.

When choosing a Medigap plan, it's essential to understand how they cover hospital deductibles. Medicare Part A charges a deductible for each hospital stay.

Medigap Plan A is one of the options, but unfortunately, it doesn't cover the deductible at all. On the other hand, Plans B, C, D, F, G, and N will cover the entire deductible, which can be a big relief.

If you're considering Plan K or M, keep in mind that they'll only cover 50% of the deductible, leaving you with a smaller but still significant bill. Plan L is a bit more generous, covering 75% of the deductible.

Here's a quick rundown of the deductible coverage for each plan: