Choosing the Best Medigap Plan for Your Needs

Helping a parent with their Medicare decisions is a huge act of love, but it can also feel overwhelming. You want to protect them from high medical bills, but the system is filled with confusing terms and deadlines. If you’re trying to understand what Medigap covers and how it works with Original Medicare, you’re in the right place. This guide breaks it all down. We’ll help you compare the best Medigap plans so you can confidently choose a policy that protects your parent’s health and their savings, making this process less stressful for everyone involved.

Key Takeaways

Medigap is your financial safety net: A Medigap plan works with your Original Medicare, not in place of it. Its purpose is to pay for the out-of-pocket costs that Medicare leaves behind, helping you budget for healthcare without surprise bills.
Choose a plan based on your budget and health: There is no single “best” plan. The right choice involves balancing a plan’s monthly premium with the out-of-pocket costs you’re comfortable with, which is why plans like G and N are common starting points.
Prioritize your Open Enrollment window: Your six-month Medigap Open Enrollment Period is the most important time to act. Enrolling during this window guarantees you can get any plan at the best price, regardless of your health history.

What is a Medigap Plan and How Does It Work?

Think of a Medigap plan, also called Medicare Supplement Insurance, as a safety net for your healthcare costs. While Original Medicare (Parts A and B) covers a lot, it doesn’t cover everything. It leaves behind certain “gaps” that you’re responsible for paying, like deductibles, copayments, and coinsurance. These out-of-pocket expenses can add up quickly, especially if you have a serious health issue. This is where a Medigap plan steps in.

Sold by private insurance companies, Medigap policies are designed specifically to help pay for those remaining costs. The plans are standardized by the government and labeled with letters, like Plan G or Plan N. This means that a Plan G from one company offers the exact same basic benefits as a Plan G from another. While the coverage is the same, the price can vary quite a bit between companies. This standardization makes it easier for you to compare plans and find one that fits your budget and health needs without having to decipher complicated policy differences. The key takeaway is that these plans help cover costs Original Medicare doesn’t, giving you more predictable healthcare expenses and peace of mind.

One crucial point to remember is that Medigap plans are built to work alongside Original Medicare, not replace it. They also have a specific focus: they help with medical bills from doctors and hospitals. What they don’t cover are things like long-term care, dental, vision, or hearing aids. Most importantly, Medigap plans do not cover prescription drugs. For that, you’ll need to enroll in a separate Medicare Part D plan. Understanding this distinction is essential to building a complete healthcare coverage package that truly protects you.

Do I Really Need a Medigap Plan?

Think of Original Medicare (Parts A and B) as the foundation of your health coverage. It’s essential, but it doesn’t cover everything. After Medicare pays its share for a doctor’s visit or hospital stay, you’re often left with out-of-pocket costs like deductibles, copayments, and coinsurance. These gaps can add up quickly, especially if you have ongoing health needs or an unexpected medical event.

This is where Medicare Supplement Insurance, or Medigap, comes in. As the name suggests, it’s designed to fill the “gaps” in your Original Medicare coverage. Private companies sell Medigap plans to help pay for those remaining costs, giving you more predictable expenses and greater peace of mind. If you have Original Medicare and want help managing your share of the bills, a Medigap plan is something you should seriously consider. It works alongside your Medicare to create a more complete safety net for your health and your finances.

Understanding the Gaps in Original Medicare

Original Medicare provides a solid foundation for your healthcare, but it was never designed to cover 100% of your medical bills. It leaves behind certain “gaps” in coverage that you are responsible for paying out-of-pocket. These costs include deductibles you must meet before coverage kicks in, as well as copayments and coinsurance for various services. While these individual costs might seem manageable on their own, they can accumulate quickly, especially if you need frequent medical care or face a sudden, serious health issue. This is precisely why Medigap plans were created: to fill those financial gaps and provide a more predictable way to budget for your healthcare expenses.

The 80/20 Cost-Sharing Rule

One of the most significant gaps in Original Medicare is the 80/20 cost-sharing rule for Part B, which covers doctor visits and outpatient services. After you’ve paid your annual Part B deductible, Medicare will pay for 80% of your approved medical expenses. You are responsible for the remaining 20%. The critical thing to understand is that there is no annual cap on that 20%. If you have a year with extensive medical treatments, your 20% share could easily amount to thousands or even tens of thousands of dollars. This potential for unlimited out-of-pocket costs is a major reason why many people choose to purchase a Medigap plan to cover that financial risk.

Key Medicare Costs to Know

Beyond the 80/20 rule, there are other key costs to be aware of with Original Medicare. You have the Part A deductible for each hospital stay and the annual Part B deductible for medical services. Medigap plans are specifically designed to help pay for these remaining costs that Original Medicare doesn’t cover. The plans are standardized by the government and identified by letters, like Plan G or Plan N. This means a Plan G from one insurance company offers the same basic benefits as a Plan G from another. However, the monthly premiums for the exact same plan can vary significantly between companies, which makes comparing your options essential to finding a policy that fits your budget and health needs.

Busting Common Medigap Myths

When you first start looking into Medigap, you’ll likely run into some confusing information. Let’s set the record straight on a few common points of confusion. First, many people think Medigap and Medicare Advantage are the same, but they serve different purposes. Medigap supplements Original Medicare, while Medicare Advantage replaces it. Another myth is that Medigap covers prescription drugs. It doesn’t. For that, you’ll need a separate Part D plan. Finally, some believe that working with an agent is an extra cost, but the opposite is often true. An experienced agent can help you compare plans and find savings you might have missed on your own.

What Medigap Covers to Protect Your Savings

The main benefit of a Medigap plan is financial security. It can significantly reduce out-of-pocket medical costs, making your health care expenses much more predictable from month to month. Instead of facing an unexpected and potentially large bill, you pay a steady monthly premium for your Medigap plan. This allows you to budget effectively without worrying that a health issue will disrupt your finances. With so many plans and companies to choose from, finding the right fit can feel overwhelming. That’s why many people turn to resources that analyze the best Medicare Supplement Insurance companies to find a plan that offers the right balance of coverage, cost, and customer satisfaction.

Comparing the Best Medigap Plans: G, F, and N

When you start exploring Medigap, you’ll notice a whole alphabet of plans available: A, B, C, D, F, G, K, L, M, and N. Seeing all those letters can feel like trying to solve a puzzle. The good news is that you don’t need to become an expert on every single one. For most people, the choice boils down to three standout options: Plan G, Plan F, and Plan N. These have become the most popular for a simple reason—they offer excellent, well-rounded coverage that meets the needs of many retirees.

One of the most helpful things to know about Medigap is that the plans are standardized by the government. This means that a Plan G from one insurance company offers the exact same medical benefits as a Plan G from any other company. While the core coverage is identical, the monthly premium you pay can vary significantly between insurers. This setup actually works in your favor. It allows you to first focus on choosing the right plan letter for your health and budget. Once you’ve decided on the plan, you can then shop around to find the company that offers it at the best price. Let’s break down the big three so you can see which one might be the right fit for you.

Why Plan G is a Top Choice for New Enrollees

If you became eligible for Medicare on or after January 1, 2020, Plan G is the most comprehensive coverage you can buy. It has quickly become the new gold standard for its extensive benefits. Many people choose Plan G because it covers nearly all of your out-of-pocket costs, which means you have very few medical bills to worry about after you’ve met your deductible.

The only major cost that Plan G doesn’t cover is the annual Medicare Part B deductible. After you pay that one-time yearly deductible out of pocket, Plan G takes over and pays 100% of the remaining Medicare-approved expenses. This structure makes your healthcare spending incredibly predictable and simple to budget for, offering significant peace of mind.

Average Cost of Plan G

When you’re considering Plan G, one of the first questions is usually, “How much does it cost?” On average, the monthly premium for Plan G is about $159. Because it provides such thorough coverage, it’s often called the “new gold standard” of Medigap. The only significant cost you handle yourself is the annual Medicare Part B deductible, which is $257 for 2025. After you meet that deductible, Plan G covers 100% of your remaining Medicare-approved expenses for the rest of the year. This predictability is why many find it to be the best Medigap plan for managing their budget and avoiding surprise medical bills. Just remember, while the plan’s benefits are the same everywhere, the price isn’t. Insurance companies set their own premiums, so it’s always a good idea to compare plans to find the best rate.

Plan N: Lower Premiums for Predictable Costs

Plan N is a wonderful option if you’re looking for solid protection without the higher price tag of Plan G. It strikes a great balance between lower monthly premiums and strong coverage. With Plan N, you accept some small, predictable cost-sharing in exchange for a more affordable monthly payment. This is a trade-off that many people find very appealing.

Specifically, you may have a copayment of up to $20 for some doctor’s office visits and a $50 copay if you visit the emergency room and aren’t admitted to the hospital. For individuals who are in relatively good health and don’t anticipate frequent doctor visits, these minor copays are a small price to pay for the monthly savings.

Average Cost of Plan N

The primary appeal of Plan N is its lower monthly premium. It’s a fantastic choice if you want robust coverage without the higher monthly cost associated with Plan G. This plan strikes a great balance, giving you strong protection while keeping your fixed expenses more manageable. In exchange for the lower premium, you agree to handle some minor, predictable costs yourself, like small copayments for doctor and ER visits. The exact premium you’ll pay depends on your location, age, and the insurance company you choose, which is why it’s so important to compare your options carefully.

A Key Detail: Part B Excess Charges

One important detail to understand about Plan N is that it does not cover Part B excess charges. An excess charge is a small, extra amount—up to 15%—that a doctor can bill you if they don’t accept the Medicare-approved payment amount as payment in full. While this might sound concerning, these charges are not very common. Many states have laws that prohibit doctors from billing for excess charges, and the vast majority of doctors nationwide accept Medicare’s payment as final. Still, it’s a key difference between Plan N and Plan G. Before choosing, you can easily check if your preferred doctors accept Medicare assignment to see if this is even a factor for you.

Plan F: The Most Comprehensive Plan (If You Qualify)

For many years, Plan F was the top Medigap plan because it offered the most coverage possible. It’s often referred to as “first-dollar” coverage since it pays for all of Medicare’s gaps, including the Part B deductible. If you have Plan F, you generally have no out-of-pocket costs for Medicare-approved services. However, a change in federal law has limited its availability.

Plan F is now only available to people who were eligible for Medicare before January 1, 2020. If you fall into this group, you can still purchase a Plan F. Because its coverage is so complete, it usually comes with the highest monthly premium. For those who qualify and want the simplicity of zero healthcare bills, Plan F delivers the ultimate peace of mind.

Average Cost of Plan F

Because Plan F offers such complete coverage, it typically has the highest monthly premium of all the Medigap plans. You’re essentially paying for the convenience and peace of mind that comes with having virtually no medical bills to handle yourself. The exact cost will vary based on where you live, your age, and the insurance company you choose. Since it’s no longer available to new Medicare enrollees, the pool of people in Plan F is getting older. This is an important detail because it can sometimes lead to higher rate increases over time compared to other plans like Plan G, which are still open to everyone.

Long-Term Cost Considerations

Choosing a Medigap plan is really about deciding how you want to pay for your healthcare. Would you prefer a higher, predictable monthly premium with very few out-of-pocket costs, or a lower monthly premium with some cost-sharing when you see a doctor? The primary benefit of any Medigap plan is the financial security it provides. Instead of facing a large, unexpected bill after a hospital stay, you have a steady, budget-friendly premium. This predictability is invaluable in retirement. Comparing the long-term value of different plans and carriers is where working with an independent agent can make a real difference, ensuring you find a solution that protects both your health and your savings for years to come.

Medigap Plan G vs. F vs. N: A Side-by-Side Look

Deciding between these top three plans really comes down to your personal situation: your eligibility date, your budget, and your comfort level with out-of-pocket costs. Think of it this way: Plan F is the all-inclusive package, but only for those who were eligible for Medicare before 2020. Plan G is the premier choice for new members, covering almost everything after you pay a single annual deductible.

Plan N is the budget-conscious option, offering a lower premium in return for small, fixed copayments for doctor and ER visits. There is no single “best” plan that works for everyone. The right choice is the one that aligns with your health needs and financial plan, giving you the confidence that you’re well-covered for the years to come.

Exploring Other Medigap Options

While Plans G, F, and N get most of the attention, they aren’t the only choices available. For some people, less common plans can offer a better financial fit. If you’re comfortable with a different kind of cost-sharing arrangement in exchange for lower monthly premiums, it’s worth looking at options like the High-Deductible Plan G or the cost-sharing models of Plans K and L. These plans provide the same essential Medigap protection but are structured to appeal to different budgets and risk tolerances. They still provide a crucial safety net against major medical expenses, just with a different balance between your monthly payment and your out-of-pocket costs.

High-Deductible Plan G

This plan is a variation of the popular Plan G, designed for people who want lower monthly premiums and are willing to take on more initial out-of-pocket costs. With this option, you pay for all Medicare-covered costs—deductibles, copayments, and coinsurance—up to a certain amount each year. Once you meet that annual deductible, the plan then pays 100% of your covered services for the rest of the year, just like a standard Plan G would. This high-deductible version can be a smart financial choice if you’re in good health and want to keep your fixed monthly expenses low, while still having a strong safety net in place to protect you from catastrophic costs.

Cost-Sharing Plans: K and L

Plans K and L offer a different approach to managing healthcare costs. They are known as “cost-sharing” plans because you pay a percentage of your medical bills until you reach an annual out-of-pocket maximum. This structure allows for significantly lower monthly premiums compared to more comprehensive plans. For example, with Plan K, you might pay 50% of most costs, while Plan L might have you pay 25%. The key feature of these plans is the built-in financial protection: once your spending hits the yearly limit, the plan covers 100% of your approved services for the remainder of the year. These plans can be a good fit if you prefer to pay less each month and are comfortable covering a portion of your routine medical expenses, knowing there’s a firm cap on your total potential spending.

What Factors Influence Your Medigap Premium?

When you start shopping for a Medigap plan, you’ll quickly notice that the price for the exact same plan can vary quite a bit. A Plan G from one company might have a different monthly premium than a Plan G from another, even though the benefits are standardized by the government. This is because several factors influence your final cost.

Think of it like car insurance—your rate depends on more than just the car you drive. For Medigap, your premium is shaped by your age, where you live, your health history, and how the insurance company calculates its prices. Understanding these key elements will help you see the full picture and find a plan that fits your budget not just today, but for years to come. Let’s walk through what goes into the price tag of a Medigap plan.

How Your Age and Gender Affect Pricing

It’s a simple fact that your age plays a significant role in what you’ll pay for a Medigap plan. Generally, the younger you are when you enroll, the lower your monthly premium will be. This is one of the biggest reasons why signing up during your Medigap Open Enrollment Period when you first turn 65 is so important. Your gender can also be a factor in some cases, though age and location tend to have a much bigger impact on your premium. Insurers use this information to assess risk, which is then reflected in the price of the policy.

Why Your Location Matters for Medigap Costs

You might be surprised to learn that your zip code can have a major effect on your Medigap premium. Costs for the same plan can differ from state to state and even between different counties within the same state. This variation is often due to local market conditions, such as the number of insurance companies competing in your area. More competition can sometimes lead to lower prices for you. State-specific regulations also play a part in how Medigap plans are priced, which is why working with someone licensed in your state is so helpful.

State-Specific Rules and Regulations

When you’re looking at Medigap plans, it’s essential to understand that state-specific rules can significantly impact your options. For instance, some states, including Connecticut, Massachusetts, and New York, have special rules that make it easier for you to purchase a Medigap policy, even if you have pre-existing health conditions. This provides a crucial safety net for those who might otherwise face challenges getting coverage. Additionally, the price for the same Medigap plan can vary widely from one state to another and even between different counties. This is often influenced by local market conditions, like the number of insurance companies competing in your area. Because these state regulations play such a big role, working with an insurance agent who is licensed in your state is incredibly beneficial. Our team at The Big 65 is licensed across 33 states, so we can help you understand the specific rules where you live and find a plan that truly fits your needs.

Understanding Different Pricing Methods

Insurance companies use one of three methods to price their Medigap plans, and the method they choose directly affects your premiums over time.

Community-rated: Everyone in a specific area pays the same premium, regardless of their age.
Issue-age-rated: Your premium is based on your age when you first buy the policy. It won’t increase just because you get older.
Attained-age-rated: Your premium starts lower but goes up as you age. This is the most common pricing method. Understanding which pricing method a company uses is key to anticipating future rate increases and choosing a plan that remains affordable.

The Role of Your Health and Underwriting

Your health is a critical factor, especially if you apply for a Medigap plan outside of your Open Enrollment Period. During this initial six-month window, you have “guaranteed issue rights,” meaning an insurance company cannot use your health history to charge you more or deny you coverage.

However, if you apply later, you will likely have to go through medical underwriting. This means the insurance company will review your medical records. If you have pre-existing conditions, you could face higher premiums or even be denied a policy altogether. This is why your initial enrollment window is the golden ticket to getting the best possible rate.

Understanding Recent Price Trends

It’s also helpful to know that Medigap premiums aren’t set in stone; they can and do increase over time. These changes aren’t random. They are often tied to overall healthcare inflation and the specific pricing model your plan uses, especially if it’s an attained-age-rated policy. While you can’t control inflation, you can be strategic when you first choose a plan by looking at a company’s history of rate increases. Some insurers are known for more stable pricing than others. This is why it’s so important to compare insurance companies, not just plan letters, to find a policy that will remain affordable for years to come.

How to Choose the Best Medigap Plan for Your Needs

Choosing a Medigap plan feels like a big decision because it is. This is about your health and your financial security for years to come. The “best” plan isn’t a one-size-fits-all answer; it’s the one that fits your life. By thinking through a few key areas—your health, your budget, and your timing—you can find a plan that gives you confidence and peace of mind. Let’s walk through how to find the right match for you.

Think About Your Current and Future Health

First, take an honest look at your health. Are you managing a chronic condition or do you see specialists regularly? Or are you generally healthy and only visit the doctor for annual check-ups? If you anticipate needing more medical care, a plan with more comprehensive coverage, like Plan G, can save you from unpredictable out-of-pocket costs. While no one has a crystal ball, considering both your current health and potential future needs helps you choose a plan that will serve you well down the road. It’s about finding coverage that lets you focus on your health, not the bills.

Compare Premiums with Your Potential Savings

Your budget is a major piece of the puzzle. Medigap plans come with different monthly premiums, and it’s tempting to just pick the one with the lowest price tag. But it’s important to look at the whole picture. A lower premium might mean you pay more when you actually use your insurance, like with the Plan N copays. A higher premium, on the other hand, often means more predictable costs and fewer surprises. You can use the official Medicare plan comparison tool to see what’s available in your area and get a sense of the costs. It’s all about finding a balance you’re comfortable with.

Make Sure Your Doctors Are Covered

One of the best features of Medigap is freedom. With a Medigap plan, you can see any doctor or visit any hospital in the U.S. that accepts Original Medicare. You don’t have to worry about networks or getting referrals to see a specialist. This gives you incredible flexibility and control over your healthcare. The main thing to confirm is which insurance companies offer the plan you want (like Plan G or N) in your state. Not every company sells every plan in every location, so you’ll want to check which options are available where you live.

Why Planning Ahead Gives You Peace of Mind

Timing is everything when it comes to Medigap. Your Medigap Open Enrollment Period is the most important time to sign up. This is a six-month window that starts the month you’re 65 and enrolled in Medicare Part B. During this time, insurance companies cannot deny you a policy or charge you more because of your health history. If you miss this window, it can be much harder and more expensive to get a plan later. Taking the time to understand your enrollment period and acting within it is the single best thing you can do to secure your coverage for the future.

Which Companies Offer the Best Medigap Plans?

When you start looking at Medigap plans, you’ll notice that many different insurance companies offer them. This can feel a little confusing at first. After all, if a Plan G has to offer the same basic benefits no matter who sells it, does the company really matter? The short answer is yes. While the government standardizes the coverage for each plan type, the companies themselves are very different.

The price you pay, the quality of customer service you receive, and the company’s financial stability can vary quite a bit. Some companies are known for competitive pricing, while others are praised for their member support. Finding the right fit means looking at the company as a whole, not just the plan letter. To help you get familiar with the landscape, here are some of the most recognized names in the Medigap market.

The Big 65

While we aren’t an insurance company, we play a crucial role in helping you find the right plan. As an independent agency, The Big 65 is a trusted resource for people seeking clear information on Medicare and Medigap plans. We provide insights into the best options available in the market for your specific situation. Instead of working for one insurance company, we work for you. Our goal is to help you compare plans from various top-rated carriers so you can make a choice that feels right, without the pressure of being sold a single company’s product.

AARP/UnitedHealthcare

You’ve likely seen the AARP name before, and their partnership with UnitedHealthcare makes them one of the biggest players in the Medicare space. Because of their size and brand recognition, AARP/UnitedHealthcare is recognized for offering a wide range of Medigap plan options, making it a top choice for many seniors. Their extensive network and variety of plans mean they often have a suitable option for people in many different parts of the country. They are a very common starting point for people just beginning their Medigap research.

Best For: Many Plan Options

AARP and UnitedHealthcare have created one of the most well-known partnerships in the Medigap world. Their primary strength lies in the sheer number of plan options they provide. Because they offer such a wide selection, they often have a plan that fits the needs of people in many different locations and situations. This makes them a popular and reliable choice for seniors across the country. If you’re just starting to explore your options, you’ll almost certainly come across their plans. Their broad availability and variety of choices are why they are consistently recognized as a leading provider of Medigap insurance.

AARP Membership Requirement

One important detail to know about AARP/UnitedHealthcare plans is that they come with a membership requirement. To enroll in one of their Medigap policies, you first need to become a member of AARP. This is a separate step from purchasing the insurance itself. The annual membership fee is relatively small, typically around $20 a year, but it’s a necessary part of the process. When you’re comparing the total cost of different Medigap plans, be sure to factor in this extra fee. While it’s not a large expense, it’s a key piece of information you’ll need to sign up for an AARP plan and is something to keep in mind as you weigh your options.

Mutual of Omaha

Mutual of Omaha has been around for over a century and has a long-standing reputation in the insurance industry. When it comes to Medigap, Mutual of Omaha stands out for its premium discounts and comprehensive coverage options, which appeal to those looking for affordability and value. They are particularly well-known for offering a household discount in many states if both you and your spouse enroll in one of their plans. This can lead to significant savings over time, making them a very attractive option for couples.

Best For: Premium Discounts and Customer Service

Mutual of Omaha has built a solid reputation for over a century, making them a trusted name in the insurance world. They are often recognized for offering competitive premium discounts and a range of comprehensive coverage options. This makes them a great choice if you’re looking for a plan that delivers both value and affordability. Their long history isn’t just about being around for a while; it reflects a deep commitment to customer service. For many people helping their parents or choosing for themselves, knowing you can count on good support is a huge factor when selecting a Medigap provider.

Household Premium Discounts

One of the most popular features offered by Mutual of Omaha is their household premium discount, which is available in many states. This is a fantastic perk for couples. If you and your spouse both enroll in one of their Medigap plans, you could see a significant reduction in your monthly premiums over time. This discount can make a real difference in your budget, making healthcare costs more manageable for two people. For couples who are planning their retirement finances together, this feature makes Mutual of Omaha a particularly attractive option.

Aetna

Aetna, now part of CVS Health, is another major national health insurer that offers Medigap plans. The company has a solid reputation and a large presence across the country. According to industry experts, Aetna is known for its variety of Medigap plans and commitment to customer service, making it a reliable choice for Medicare beneficiaries. For many people, knowing they have access to a strong customer support team is just as important as the monthly premium, and Aetna often receives positive marks in this area.

Cigna

Cigna is a global health service company that provides a range of insurance products, including Medigap supplements. They are a strong competitor in the market, often getting attention for their pricing and service. In fact, Cigna offers competitive pricing and has received high marks for customer satisfaction, making it a strong contender in the Medigap market. If you’re looking for a plan that balances a reasonable premium with dependable service, Cigna is definitely a company worth comparing with other top carriers in your area.

Best For: Low Monthly Premiums

If keeping your monthly premium down is a top priority, Plan N is an excellent option to look into. It offers a smart trade-off: you get a lower monthly bill in exchange for handling some small, predictable costs when you see a doctor. This approach helps you find a great balance between solid coverage and a more affordable payment. Specifically, you may have a copayment of up to $20 for some office visits and a $50 copay for an emergency room visit if you aren’t admitted. For those who are in relatively good health and don’t expect frequent doctor appointments, these minor copays are often a small price to pay for the savings you get each month.

Humana

As one of the largest health insurance providers in the United States, Humana has a significant footprint in the Medicare market. They offer a full suite of products, from Medicare Advantage to Part D and Medigap plans. Humana is noted for its extensive range of Medigap plans and excellent member services, catering to the diverse needs of seniors. Their broad portfolio means they often have multiple plan types available, giving you the flexibility to find coverage that aligns with your health needs and financial comfort zone.

Blue Cross Blue Shield

Blue Cross Blue Shield (BCBS) is one of the most recognized names in American health insurance, but it operates a little differently. It’s an association of 34 independent, locally operated companies. This means your experience with a BCBS Medigap plan can vary depending on where you live. Still, the brand as a whole is a major force in the Medigap market. Blue Cross Blue Shield is well-regarded for its focus on customer satisfaction and offers a variety of typical Medigap plans to choose from.

Best For: Extra Benefits and Plan Flexibility

When you’re comparing Medigap plans, you’ll find that while the core medical benefits are the same, some companies add a little extra to stand out. Cigna is a great example of this. They often provide access to health and wellness discount programs, which can be a nice added bonus for members. This focus on overall well-being, combined with their reputation for competitive pricing and high marks in customer satisfaction, makes them a strong contender. If you’re looking for a plan that delivers solid value—balancing a reasonable premium with dependable service and some useful perks—Cigna is a company worth a close look when comparing top carriers in your area.

The “Blue to Blue” Advantage

Because Blue Cross Blue Shield is made up of local, independent companies, they have a unique understanding of the communities they serve. One of the standout features you might hear about is a “Blue to Blue” program. This can make it easier for members to switch from one BCBS plan to another—for example, moving from an employer-sponsored plan to a Medigap plan upon retirement. While the specifics vary by state, this can offer a seamless transition. As a whole, Blue Cross Blue Shield is well-regarded for its focus on customer satisfaction and offers a variety of typical Medigap plans to choose from, making them a familiar and trusted option for many.

State Farm

Many people know State Farm for home and auto insurance, but they also have a presence in the health insurance market, including Medigap. Partnering with a familiar agent can be a big draw for those who already have other policies with the company. More importantly, State Farm is recognized for its high member satisfaction ratings and offers a range of Medigap plans tailored to meet the needs of seniors. Their reputation for customer care in other insurance areas often carries over, making them a trusted choice for many.

Best For: High Member Satisfaction

While Medigap plan benefits are standardized, the customer service you receive can vary greatly from one company to the next. When you need help with a claim or have a question about your coverage, a positive experience can make all the difference. That’s why it’s so important to consider a company’s reputation for member satisfaction. Several carriers are consistently praised for their service. Companies like Cigna, Humana, and State Farm have all received high marks for keeping their members happy. Similarly, major providers like AARP/UnitedHealthcare and Blue Cross Blue Shield are well-regarded for their member support. Choosing a company known for excellent service provides an extra layer of security, ensuring you have a helpful partner on your side when you need it most.

Companies to Research Carefully

Just as some companies are known for great service, others may have a less consistent track record. A low initial premium can be tempting, but it’s important to look at the bigger picture. A company’s history of rate increases is a critical factor for your long-term budget. It’s also wise to look up customer reviews and check a company’s financial strength rating from an independent agency like AM Best. This is where working with an independent agent provides real value. At The Big 65, we monitor rate histories and industry reputations, helping our clients find stable, reliable coverage without the guesswork.

Key Features to Look For in a Medigap Plan

Choosing a Medigap plan feels like a big decision because it is. But you don’t have to get lost in the details. When you know what to look for, you can confidently compare your options and find a plan that truly fits your life. The goal is to find a balance between monthly cost and long-term protection, so you have peace of mind knowing you’re covered.

Think of this as your personal checklist. As you look at different plans from various companies, you can measure them against these five key areas. This approach helps you cut through the noise and focus on what matters most: your health and your budget. From understanding exactly what costs the plan will cover to checking for the freedom to see your preferred doctors, each point is a crucial piece of the puzzle. Let’s walk through them one by one.

How Much of Your Out-of-Pocket Costs Are Covered?

The main reason to get a Medigap plan is to help pay for the costs that Original Medicare doesn’t cover. Original Medicare pays for a large portion of your medical bills, but you’re still responsible for things like deductibles and coinsurance, which can add up quickly. Medigap plans are designed specifically to cover these gaps.

When you compare plans, look closely at which of these out-of-pocket expenses are covered. For example, some plans cover the Medicare Part A deductible for hospital stays, while others might cover coinsurance for skilled nursing facilities. The more comprehensive the plan, the fewer surprise bills you’ll face. Understanding what Original Medicare covers is the first step to seeing where a Medigap plan can fill in the gaps for you.

Finding the Right Balance of Premium and Value

The monthly premium is the fixed amount you’ll pay to keep your plan active, and it’s often the first thing people look at. While it’s important to find a premium that fits your budget, the cheapest plan isn’t always the best choice. You need to consider the overall value you’re getting for your money.

A plan with a very low premium might leave you with higher out-of-pocket costs when you actually need care. On the other hand, a plan with a higher premium might cover nearly everything, giving you more predictable expenses. The key is to balance the monthly cost with the potential savings on medical bills down the road. Think about your personal healthcare budget and risk tolerance to find the right fit.

Understanding Deductibles and Coinsurance

Beyond the premium, it’s essential to understand the other costs you might be responsible for. Dig into the details of each plan to see what deductibles, copayments, and coinsurance you might have to pay. A deductible is the amount you have to pay for care before your plan starts paying, while copayments and coinsurance are your share of the cost for services after you’ve met your deductible.

For example, Medigap Plan N requires a small copayment for some doctor visits and emergency room trips. While its premium is often lower, you have to be comfortable with these small, predictable costs. Evaluating these potential out-of-pocket expenses is critical to understanding the true cost of a plan over the course of a year.

Can You Keep Your Favorite Doctors?

One of the biggest advantages of Medigap is the freedom it gives you. Unlike some other types of insurance, Medigap plans allow you to see any doctor or visit any hospital in the country that accepts Medicare. There are no restrictive networks, so you don’t have to worry about whether your trusted specialist is “in-network.”

This is a huge benefit if you travel or have doctors you’ve been seeing for years and don’t want to change. When you’re considering a plan, this freedom is a standard feature, so you can rest assured that your access to care won’t be limited. You can always use Medicare’s official tool to find providers who accept Medicare patients near you or anywhere you plan to be.

Don’t Forget to Check for Extra Perks

While all Medigap plans of the same letter must offer the same basic benefits, some insurance companies add extra perks to stand out. These can include benefits like gym memberships through programs like SilverSneakers, discounts on vision or dental care, or even hearing aid benefits. These extras are not part of the standardized Medigap coverage but are offered by the private insurance company.

These perks can be a nice bonus, but they shouldn’t be the main reason you choose a plan. Your top priority should always be the core medical coverage and financial protection the plan provides. However, if you’re deciding between two otherwise identical plans, a valuable extra benefit could be the perfect tiebreaker that adds a little more value to your coverage.

Understanding Medicare Select Plans

While comparing Medigap plans, you might see an option called a Medicare SELECT plan. It’s a specific type of Medigap policy that offers the same standardized benefits as a regular plan, like a Plan G or N, but with a key difference. SELECT plans often have lower monthly premiums because they require you to use a network of specific doctors and hospitals. If you get care from a provider within the plan’s network, you receive your full benefits. You can typically still see doctors outside the network, but you’ll likely have to pay more out of your own pocket for those services. This makes a SELECT plan a potentially cost-effective option, but only if you confirm that your preferred doctors and hospitals are part of its network before you sign up.

How and When to Enroll in a Medigap Plan

Timing is a huge factor when you’re signing up for a Medigap plan. It’s not just about picking the right plan; it’s about picking it at the right time to get the best price and guarantee your coverage. Your initial enrollment window is the most important period, as it gives you protections you won’t have later on. Understanding these key timelines will help you make a smart decision without the stress of missing a critical deadline. Let’s walk through the most important enrollment periods and rules you need to know.

Don’t Miss Your Medigap Open Enrollment Period

This is the single best time to buy a Medigap policy. Your Medigap Open Enrollment Period is a one-time, six-month window that starts on the first day of the month you’re both 65 or older and enrolled in Medicare Part B. During these six months, an insurance company cannot use medical underwriting. This means they can’t refuse to sell you any Medigap policy they offer, charge you more because of your health status, or make you wait for coverage to start. Think of it as your golden ticket to getting the plan you want, regardless of any pre-existing conditions. It’s crucial to take advantage of this period to secure your coverage for the long term.

What Are Your Guaranteed Issue Rights?

What if you miss your Open Enrollment Period? Don’t panic—you might have another chance. In certain situations, you have what are called “guaranteed issue rights,” which also mean insurance companies must sell you a Medigap policy. These rights are triggered by specific life events, like if you lose your employer health coverage after turning 65, or if you move out of your Medicare Advantage plan’s service area. While these protections are a great safety net, they often limit you to a smaller selection of Medigap plans. It’s always best to enroll during your initial Open Enrollment Period if you can, but it’s good to know these rights exist if your circumstances change unexpectedly.

Can You Switch Medigap Plans Later?

This is a question we get all the time. The short answer is: maybe, but it can be difficult. Once your six-month Medigap Open Enrollment Period is over, you lose the federal protection that lets you buy any plan without health questions. If you want to switch to a different Medigap plan later, the insurance company can generally require you to go through medical underwriting. This means they’ll ask about your health history and can charge you a higher premium or even deny your application altogether based on your answers. This is why it’s so important to choose your plan carefully from the start. In most states, you can’t simply change your Medigap policy whenever you want without facing these hurdles.

Your Final Checklist for Choosing a Medigap Plan

Choosing a Medigap plan can feel like a huge decision, but you don’t have to get lost in the details. By breaking it down into a few simple steps, you can move forward with clarity and find a plan that truly fits your life. Think of this as your personal checklist to help you weigh your options, understand the costs, and select a company you can trust. With the right approach, you can feel confident that you’re making a smart choice for your health and your budget.

Compare Plans with Online Tools

A great starting point is to see exactly what plans are available to you. Medicare provides an official online tool that lets you find and compare plans in your specific zip code. This resource is helpful because it cuts through the noise and shows you the policies offered in your area. You can see the differences in coverage and get a general idea of costs. Using this tool helps you create a baseline understanding of your options before you start digging into the specifics of each company. It’s a practical first step that puts the information directly in your hands.

Key Questions to Ask Before Enrolling

Once you have a list of potential plans, it’s time to think about your personal needs. Start by asking yourself: How often do I expect to see a doctor? Do I have any chronic conditions that require regular care? Your answers will help you decide if a plan with more comprehensive coverage, like Plan G, is a better fit than one with lower premiums but more out-of-pocket costs. Next, look at your budget. It’s important to compare monthly premiums alongside potential deductibles and copayments to find a balance that feels comfortable for you.

Check Company Reviews and Financial Ratings

While Medigap plans are standardized, the companies that sell them are not. The insurer you choose affects your monthly premium and your customer service experience. Some companies are known for keeping rate increases stable, while others offer premium discounts. For example, AARP/UnitedHealthcare is often recognized for its plan options, while Mutual of Omaha is noted for its discounts. It’s wise to look at company reviews and ratings to see how they perform in areas like member satisfaction. A company like Blue Cross Blue Shield often gets high marks for its customer-focused approach, which can make a real difference.

Get Free, Unbiased Help

Your State Health Insurance Assistance Program (SHIP)

Sorting through all of this information can feel overwhelming, especially when you’re trying to make the best decision for yourself or a parent. The good news is you don’t have to do it alone. Every state offers a fantastic, free resource called the State Health Insurance Assistance Program (SHIP). SHIP provides one-on-one counseling to Medicare beneficiaries and their families. Because the counselors are highly trained volunteers who don’t sell insurance, you can trust their guidance is completely unbiased. They can help you understand your Medigap options, compare plans, and get answers to your specific questions. You can find your local SHIP office to connect with a counselor for clear, confidential support.

Frequently Asked Questions

If all Plan G policies are the same, why does the company I choose matter? That’s a great question, and it gets to the heart of making a smart choice. While the government standardizes the medical benefits of a Plan G, the insurance companies offering it are very different. The monthly premium you pay can vary significantly from one company to another for the exact same coverage. Beyond price, you should also consider a company’s history of rate increases and its financial stability. A plan that seems cheap today might have larger premium hikes down the road. The quality of customer service also matters when you have a question or need help.

Can my Medigap premium increase after I buy my plan? Yes, it’s very likely that your premium will go up over time. Most Medigap plans are “attained-age rated,” which means the price is based on your current age and will increase as you get older. These increases are in addition to any adjustments for inflation. This is why it’s so important to look at a company’s rate history when you first choose a plan. A stable, predictable company may be a better long-term value than one with a low introductory rate that increases sharply later on.

I missed my initial enrollment window. What are my options now? If you’re outside your six-month Medigap Open Enrollment Period, it can be more difficult to get a policy, but you may still have options. In most cases, you will have to answer health questions, and the insurance company can use that information to charge you more or even deny your application. However, certain life events, like losing employer coverage, can grant you “guaranteed issue rights,” which allow you to buy a plan without health screening. It’s best to explore your specific situation with an expert who can identify any special enrollment opportunities you might have.

What’s the main difference between a Medigap plan and a Medicare Advantage plan? This is one of the most common points of confusion. The simplest way to think about it is that Medigap works with Original Medicare, while Medicare Advantage works instead of it. A Medigap plan supplements your Original Medicare coverage by paying for costs like deductibles and coinsurance. A Medicare Advantage plan (Part C) is an alternative way to get your Medicare benefits, often bundling medical and drug coverage into one plan with a specific network of doctors. They are two completely different paths for your healthcare coverage.

Why do I still need a separate Part D plan if I have Medigap? Medigap plans are designed to cover the gaps in your medical coverage from Original Medicare Parts A and B, which includes things like hospital stays and doctor visits. However, they do not include coverage for prescription drugs. To get help paying for your medications, you will need to enroll in a separate, standalone Medicare Part D prescription drug plan. Building a complete coverage package means having Original Medicare, a Medigap plan for medical costs, and a Part D plan for your prescriptions.