Helping a parent with their Medicare decisions is a significant responsibility. You want to ensure they have solid coverage without facing surprise medical bills that could drain their savings. A Medicare Supplement plan is often the key to achieving that peace of mind. These plans make healthcare costs predictable by covering the gaps left by Original Medicare. The rules have also evolved, meaning the medicare supplement plans 2019 differ from what’s offered today. This guide provides clear, straightforward information to help you support your parent in making a confident and informed choice for their health and financial future.
One of the biggest challenges in retirement is managing unpredictable expenses, and health care is often at the top of that list. While Original Medicare covers a large portion of your medical bills, it leaves you responsible for the rest, with no annual limit on what you might have to pay. A Medigap plan is a powerful tool that helps you control these costs. It works alongside your Medicare to cover things like coinsurance and deductibles. While the core purpose remains the same, the options have shifted. The choices for medigap plans 2019 included Plan F for all new enrollees, a key option that has since changed. Let’s explore how these plans provide financial security.
Key Takeaways
- Medigap is a partner to Original Medicare, not a replacement: It works with your primary Medicare coverage to fill financial gaps like deductibles and coinsurance, making your healthcare spending much more predictable.
- Use your one-time Open Enrollment Period wisely: This six-month window is your guaranteed opportunity to buy any Medigap plan at the best price, without being denied or charged more because of your health history.
- Compare companies, not just plan letters: Since a Plan G from one company has the same basic benefits as a Plan G from another, your decision comes down to finding a reputable company with a competitive premium that fits your budget.
What Is a Medicare Supplement (Medigap) Plan?
If you’re on Original Medicare, you know it covers a lot of your health care costs—but not everything. Those leftover expenses, like deductibles, copayments, and coinsurance, can add up quickly. That’s where a Medigap plan comes in. Think of it as a safety net for your health care budget.
Medigap plans, also known as Medicare Supplement insurance, are sold by private companies and are designed to help pay for some of the costs that Original Medicare (Parts A and B) doesn’t cover. It’s extra insurance that works alongside your primary Medicare coverage to give you more predictable health care spending and peace of mind. Instead of worrying about unexpected medical bills, you can focus on staying healthy.
How Medigap Fills the Gaps in Original Medicare
It’s important to understand that a Medigap plan doesn’t replace your Original Medicare—it works with it. You’ll still use your red, white, and blue Medicare card when you visit the doctor or hospital. After Medicare pays its share of the approved amount for covered services, your Medigap plan steps in to help pay for its portion.
For example, Medicare Part B typically covers 80% of your outpatient medical costs. Without a supplement, you’d be responsible for the remaining 20%. If you have a Medigap plan, it can cover that 20% for you, depending on which plan you choose. To buy a Medigap policy, you must have Medicare Part A and Part B. It’s a partnership that helps fill the financial gaps in your coverage.
Part A Deductible and Coinsurance
When you’re admitted to the hospital, Medicare Part A helps with the bill, but it doesn’t cover everything. You first have to pay the Part A deductible for each benefit period, which can be a significant out-of-pocket cost. If you need to stay in the hospital for more than 60 days, you’ll also begin paying a daily coinsurance fee that adds up fast. This is where a Medigap plan steps in to protect your savings. Most plans will cover the Part A deductible and coinsurance for you, shielding you from the high price of a lengthy hospital stay and offering valuable peace of mind.
Part B Coinsurance and Excess Charges
Part B covers your doctor visits and other outpatient care, but it generally only pays for 80% of the cost. This leaves you responsible for the remaining 20% coinsurance, with no annual cap on what you might owe. A Medigap plan is specifically designed to pay this 20% for you. Additionally, some doctors can charge up to 15% more than the Medicare-approved amount—a fee known as a Part B excess charge. This can be an unexpected bill if you aren’t prepared. Thankfully, popular options like Medigap Plan G cover these excess charges, so you can visit any doctor who accepts Medicare without worrying about surprise fees.
Coverage for Blood Transfusions
Here’s a detail about Original Medicare that often surprises people: its coverage for blood. If you need a transfusion, Medicare doesn’t pay for the first three pints of blood you receive in a year. You have to pay for them yourself unless the blood is donated. This can lead to a sudden and significant bill during a medical emergency. Fortunately, every standardized Medigap plan includes a benefit to address this. They cover the cost of those first three pints, filling another critical gap in your coverage. It’s a great example of how Medigap provides thorough protection against costs you might not see coming.
A Guide to Medigap Plans A Through N
When you start looking at Medigap, you’ll see plans labeled with letters, from A through N. While different private insurance companies sell these plans, the benefits for each lettered plan are standardized by the federal government. This is a huge help because it means a Plan G from one company offers the exact same basic benefits as a Plan G from another company.
This standardization makes it much easier to compare your options. Your main task is to compare the price and the reputation of the company selling the plan, not to sort through confusingly different benefit packages. This allows you to focus on finding the right balance of coverage and cost for your specific needs without getting lost in the details.
State-Specific Plans: Massachusetts, Minnesota, and Wisconsin
Just when the lettered system starts to make sense, there’s a small exception to the rule. If you live in Massachusetts, Minnesota, or Wisconsin, your Medigap options will look different from the rest of the country. These three states have their own unique, standardized plans. This isn’t just a minor variation; the Kaiser Family Foundation confirms that these states use a different set of standardized policies. The good news is that the core protections, like having guaranteed issue rights during your Open Enrollment Period, still apply. You can find more details on this in the official Choosing a Medigap Policy guide from Medicare. Because the plans in these states are so distinct, it’s especially helpful to have an expert walk you through the local options to find the right fit.
What Does Each Medigap Plan Cover?
While there are several plans to choose from, most people find their needs are met by one of three popular options: Plan F, Plan G, or Plan N. Plan F has historically been the most comprehensive, covering nearly all out-of-pocket costs. However, it’s only available to individuals who were eligible for Medicare before January 1, 2020.
For those new to Medicare, Plan G is now the most popular and comprehensive choice. It offers nearly the same level of coverage as Plan F but requires you to pay the annual Medicare Part B deductible yourself. Plan N is another excellent option, often with lower monthly premiums, in exchange for some small copayments for doctor visits and emergency room trips.
The “Core” Benefits Included in Every Plan
The good news is that every Medigap plan, no matter which letter you choose, covers a set of “core” benefits. This standardization makes comparing plans much simpler. These foundational benefits are designed to cover some of the most common and significant costs left over by Original Medicare. Every single Medigap policy sold today includes coverage for Part A hospital coinsurance for up to an extra year after your Medicare benefits are used, Part B coinsurance or copayments, the first three pints of blood needed for a transfusion, and Part A hospice care coinsurance. This baseline ensures that even the most basic Medigap plan provides a solid layer of financial protection against major hospital and medical expenses that Medicare Parts A and B don’t fully cover.
Additional Benefits in Other Plans
This is where the different plan letters—like G and N—come into play. While all plans include the core benefits, they distinguish themselves by offering various combinations of additional coverage. These extras are designed to fill more specific financial gaps based on your needs. Some of these additional benefits include the Part A deductible, skilled nursing facility coinsurance, and foreign travel emergency care. For example, Plan G is a popular choice because it offers very complete coverage, paying for almost all of your out-of-pocket costs except for the annual Part B deductible. Choosing a plan means deciding which of these extra benefits are most important for your financial security and peace of mind.
Do You Really Need a Medicare Supplement Plan?
One of the biggest reasons to consider a Medigap plan is for financial protection. Original Medicare has no annual limit on what you might have to pay out-of-pocket. A serious illness or unexpected injury could leave you with substantial medical bills, even with Medicare covering its share. This uncertainty can be stressful and make budgeting for retirement difficult.
A Medigap plan helps by covering many of these potentially high costs, effectively putting a cap on your annual medical spending. This creates predictability and protects your savings from being drained by health care expenses. By paying a monthly premium, you gain the security of knowing that your major medical costs are handled, giving you the freedom to enjoy your retirement without financial worry.
When You Might Not Need Medigap
While Medigap is a fantastic tool for many, it isn’t necessary for everyone. If you have other coverage that already pays for Medicare’s out-of-pocket costs, you likely don’t need to add a supplement plan. For example, if you are eligible for Medicaid, your health care costs are generally covered, making a Medigap policy redundant. The same is true if you qualify for the Qualified Medicare Beneficiary (QMB) Program, which helps pay your Medicare premiums, deductibles, and coinsurance. It’s worth noting that other Medicare Savings Programs, like SLMB or QI, only cover your Part B premium, so you might still want a Medigap plan to handle the remaining costs.
Comparing Medigap to Employer Retiree Coverage
If you have access to health insurance from a former employer, you have another important option to consider. Some companies offer retiree health plans that can work similarly to Medigap, and in some cases, they might be more affordable or provide benefits that Medigap doesn’t. It’s essential to compare the two options carefully. Look at the monthly premiums, deductibles, and out-of-pocket costs for each. Does the employer plan have a network of doctors you must use? Understanding the fine print is key to making the right choice. Sorting through these details can feel complex, which is why many people find it helpful to talk with an independent expert who can provide an unbiased comparison of all their options.
Comparing Medigap Plans: Cost vs. Coverage
Choosing a Medigap plan is all about finding the right balance between monthly cost and the amount of coverage you receive. Since private insurance companies sell these plans, prices for the exact same plan can vary. It pays to compare your options carefully. Think about your health needs, your budget, and what gives you the most peace of mind. Let’s walk through how to weigh the costs and benefits to find a plan that feels right for you.
Why Are Plans F, G, and N So Popular?
You’ll hear a lot about Plans F, G, and N, and for good reason—they are the most popular choices. Plan F offers the most complete coverage, but it’s only available if you were eligible for Medicare before January 1, 2020. For everyone else, Plan G has become the new go-to. It covers nearly everything Plan F does, except for the annual Medicare Part B deductible. Plan N is another excellent option with strong coverage but lower premiums. With Plan N, you’ll have small copayments for some doctor visits and emergency room trips, which helps keep your monthly costs down.
The Discontinuation of Plans C and F for New Enrollees
If you’ve been researching Medigap, you might have heard about Plans C and F being the most comprehensive options. That was true for many years, but a federal law changed things for new Medicare members. As of January 1, 2020, Medigap plans sold to newly eligible individuals are not allowed to cover the Part B deductible. Since covering this deductible was a key feature of both Plan C and Plan F, they are no longer available if you became eligible for Medicare on or after that date. If you already had one of these plans, don’t worry—you can keep it. This change simply means that Plan G is now the most comprehensive option for new enrollees.
Understanding Plan N Copayments
Plan N is an attractive choice because it typically has lower monthly premiums than Plan G while still offering excellent coverage for major health costs. The trade-off for these lower premiums is that you agree to handle some small, predictable costs yourself. With Plan N, you will pay some small fees for certain services. This usually means a copayment of up to $20 for a doctor’s office visit and up to $50 for an emergency room visit. However, if your ER visit results in you being admitted to the hospital, that $50 copay is waived. For many people, these minor copayments are a worthwhile exchange for a lower monthly payment.
What Determines Your Monthly Premium?
The monthly premium for your Medigap plan isn’t just a random number. Insurance companies use one of three pricing methods. It’s helpful to understand how insurance companies can set premiums because it affects how your rate might change over time.
- Community-rated: Everyone with the policy 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 go up just because you get older.
- Attained-age-rated: Your premium is based on your current age, meaning it will increase as you age. These plans often start with the lowest premiums but can become the most expensive over time.
Examples of Medigap Premium Costs
So, what can you actually expect to pay? Medigap premiums vary widely based on several factors. For example, a 65-year-old woman in Florida might see quotes for Plan G ranging from $150 to over $250 per month from different insurance companies. This price difference is because each company weighs factors like your location, age, gender, and tobacco use differently. The pricing model they use—attained-age, issue-age, or community-rated—also plays a significant role in your long-term costs. An attained-age plan might seem like a bargain at first, but its premiums will rise as you get older. This is why it’s so important to look beyond the initial monthly price and compare Medigap plans from multiple carriers to find one that offers stable, predictable costs for the years ahead.
Finding the Right Balance: Premiums vs. Out-of-Pocket Costs
When you compare plans, you’re essentially deciding on a trade-off between your monthly premium and potential out-of-pocket costs. A plan with a higher premium, like a standard Plan G, will leave you with very few costs to pay when you receive care. On the other hand, a plan like the High-Deductible Plan G has a much lower monthly premium, but you must pay a larger deductible before the plan starts covering your costs. If you’re in good health and want to keep monthly expenses low, a high-deductible plan could be a great fit. If you prefer predictable costs, a standard plan may be better.
Weighing the Pros and Cons of Medigap
The biggest advantage of having a Medigap plan is knowing you’re protected from major, unexpected medical bills. Original Medicare has gaps in coverage that can lead to significant out-of-pocket expenses, and a Medigap policy fills most of them, giving you financial security. The primary downside is the cost. A Medigap plan requires an additional monthly premium on top of what you already pay for Medicare Part B. For many, this extra payment is a worthwhile investment in their financial stability and is a key part of managing a healthcare budget in retirement.
Ready to Enroll? Here’s How to Get a Medigap Plan
Getting a Medigap plan is a straightforward process, but timing is everything. To get the best plan at the best price, you’ll want to sign up during a specific window. Let’s walk through the key steps and timelines so you can feel confident about your enrollment decision.
Are You Eligible for a Medigap Plan?
First things first, let’s make sure a Medigap plan is an option for you. To buy one, you must be enrolled in Original Medicare (both Part A and Part B). Think of Medigap plans as extra insurance policies sold by private companies that work alongside your Medicare coverage. They help pay for the things that Original Medicare doesn’t, like copayments, coinsurance, and deductibles. If you have Parts A and B, you’ve checked the main box for eligibility. It’s that simple. This supplemental coverage is designed to give you financial predictability and peace of mind.
Medigap Eligibility for Beneficiaries Under 65
If you qualify for Medicare before age 65 due to a disability or another health condition, you might wonder if you can also get a Medigap plan. The answer depends entirely on where you live. While federal law doesn’t require insurance companies to sell Medigap policies to people under 65, many states have stepped in with their own rules. Some states require insurance companies to offer at least one type of Medigap plan to younger beneficiaries, though the plan options and premiums might be different. It’s also important to know that if you qualify for Medicare early due to a disability, you get a second Medigap Open Enrollment Period when you turn 65. This gives you a fresh, six-month window to buy any Medigap plan sold in your state, often with more choices and better rates. Because the rules vary so much from one state to another, getting clear guidance can make all the difference in finding the right coverage.
What Is the Medigap Open Enrollment Period?
This is the most important part of the enrollment process. Your Medigap Open Enrollment Period is a one-time, six-month window that starts on the first day of the month you turn 65 and are enrolled in Medicare Part B. During this period, you have a guaranteed right to buy any Medigap plan sold in your state. An insurance company cannot use your health history to deny you a policy or charge you a higher premium. This is your golden ticket to getting the coverage you want, no questions asked. Missing this window can make it harder and more expensive to get a plan later.
What Happens if You Miss Open Enrollment?
If you miss your six-month Open Enrollment Period, you can still apply for a Medigap plan, but the rules change. Insurance companies are generally allowed to use medical underwriting. This means they can review your medical history, ask you health questions, and decide whether to accept your application. Based on your health, they could charge you a higher premium than someone who signed up during their open enrollment, or they could deny you coverage altogether. That’s why we always encourage people to take advantage of their initial enrollment period to lock in their coverage without any health-related hurdles.
What Are Guaranteed Issue Rights (and Why Do They Matter)?
Once you have a Medigap plan, you have powerful protections. As long as you pay your monthly premium on time, the insurance company cannot cancel your policy, even if your health changes. This is a core feature of Medigap. There are also a few other situations outside of your Open Enrollment Period where you might have guaranteed issue rights to buy a plan. For example, if you lose other health coverage, like a plan from an employer, you may get a special window to enroll in a Medigap plan without medical underwriting. These rights ensure you can get coverage when you need it most.
Other Important Consumer Protections
Beyond your initial enrollment window, several key consumer protections are built into the Medigap system to ensure you are treated fairly. These rules are designed to give you confidence in your decisions and protect you from confusing or predatory practices. They provide a safety net, whether you’re just buying a policy or have had one for years. Understanding these rights helps you hold insurance companies accountable and ensures you get the full value of the coverage you’re paying for. Think of them as your bill of rights as a Medigap policyholder, giving you time to review your choices and safeguarding you from unfair treatment.
The 30-Day “Free Look” Period
It’s reassuring to know you have time to make sure you’ve made the right choice. Medigap policies come with what’s called a “free look” period. According to the Center for Medicare Advocacy, “You have 30 days to cancel a new Medigap policy and get a full refund if you change your mind.” This gives you a month to read through all the policy documents in detail, ask any follow-up questions, and confirm that the plan meets your needs without any financial risk. If you decide it’s not the right fit for any reason, you can cancel and get your money back. This protection ensures you never feel locked into a decision you’re not completely comfortable with.
Protections for Pre-Existing Conditions
Worrying about a past health issue is common, but strong protections are in place for you. During your Medigap Open Enrollment Period, an insurance company cannot use a pre-existing condition to deny you a policy or charge you a higher premium. There’s also protection if you’ve had consistent health coverage before enrolling. The Center for Medicare Advocacy confirms, “If you had health insurance for at least six months before your Medicare coverage started, a new Medigap plan cannot refuse to cover your pre-existing health conditions.” This rule is designed to prevent a gap in your care, ensuring a seamless transition to your new plan without a waiting period for your ongoing health needs.
Rules Against Duplicate Policies
To protect you from paying for unnecessary insurance, federal law prevents you from having more than one Medigap policy at a time. As the Center for Medicare Advocacy explains, “It’s against the law for an insurance company or agent to sell you a second Medigap policy.” This important rule stops you from being sold overlapping coverage that provides no extra benefit. While you are always free to switch plans to find one that better fits your budget or needs, you must cancel your old policy when the new one starts. Comparing plans and managing this transition correctly is key. Working with an independent expert like The Big 65 ensures you follow the rules while finding the best value for your situation.
Finding the Right Medicare Supplement Plan for Your Needs
With ten standardized plans and dozens of insurance companies to choose from, picking the right Medigap plan can feel like a monumental task. But it doesn’t have to be. The best plan for you is the one that fits your unique health needs and financial situation. Think of it as a balancing act between what you pay each month for your premium and how much you’ll pay out-of-pocket when you receive medical care.
Making this choice comes down to a few key steps: understanding your priorities, getting expert guidance, knowing the companies behind the plans, and clearing up any confusion. Let’s walk through how you can find a Medigap plan that gives you peace of mind and predictable health care costs for years to come.
How to Easily Compare Medigap Plans and Rates
When you start comparing Medigap plans, it helps to first think about what’s most important to you. Are you looking for the lowest possible monthly payment, even if it means paying more when you visit the doctor? Or would you prefer a higher monthly premium in exchange for minimal, or even zero, out-of-pocket costs for your care? There’s no right or wrong answer—it’s about what helps you sleep best at night.
You can organize your search based on these priorities. Some people start by looking at the most comprehensive options, like Plan G, to see how much predictable coverage would cost. Others look at the most popular plans to see what most people choose. This process helps you weigh the trade-offs and find a comfortable balance between your monthly premium and your potential medical expenses.
Should You Work With an Independent Insurance Agent?
You don’t have to figure this all out on your own. Working with an independent Medicare insurance agent can make the process much simpler. Unlike a “captive” agent who only works for one insurance company, an independent agent represents multiple carriers. This means they work for you, not the insurance company. Their goal is to help you find the best plan for your needs, regardless of which company offers it.
An independent agent can provide quotes from all the top-rated companies in your area, saving you the time and hassle of calling each one yourself. They can also offer personalized advice based on your specific situation and answer all of your questions along the way. At The Big 65, we provide this kind of expert guidance to help you feel confident in your decision.
Who Are the Top Medigap Insurance Providers?
While Medigap plans are standardized by the government—meaning a Plan G from one company offers the same basic medical benefits as a Plan G from another—the private insurance companies that sell them are not all the same. The biggest difference you’ll notice is the price of the monthly premium. One company might charge significantly more than another for the exact same plan.
Beyond price, companies also differ in their history of rate increases, financial stability, and customer service. That’s why it’s important to look at both the plan and the company offering it. Below are some of the major insurance carriers that offer Medigap plans across the country. An independent agent can help you compare rates from these companies and others available in your state.
The Big 65
First, a quick clarification on what we do. The Big 65 is not an insurance company; we are an independent insurance agency. We partner with the top-rated Medigap insurance companies nationwide to help you compare your options and enroll in the plan that makes the most sense for you, at no extra cost to you.
UnitedHealthcare
UnitedHealthcare is one of the largest health insurance carriers in the country. Its Medigap plans are the only ones endorsed by AARP, which means they have been vetted to meet the organization’s high standards of quality and service.
Aetna
Aetna, now part of CVS Health, is another major player in the Medigap market. Medigap plans are a key part of managing healthcare costs, and Aetna’s offerings are designed to protect you from the high out-of-pocket expenses that Original Medicare doesn’t cover.
Cigna
Cigna is a global health service company that offers Medigap plans in many states. It provides access to some of the most popular plans, including Plan G and Plan N, which are often chosen for their strong balance of coverage and value.
Humana
Humana is a well-known name in the senior health market. A key benefit of any Medigap plan, including those from Humana, is that you can continue to see your own doctor and use your preferred hospitals, as long as they accept Medicare patients.
Blue Cross Blue Shield
The Blue Cross Blue Shield (BCBS) Association is a federation of 34 independent and locally operated companies. A major advantage of Medigap plans, including those from BCBS, is the freedom they provide. You can see any doctor in the U.S. that accepts Medicare, and you don’t need a referral to see a specialist.
Don’t Fall for These Common Medigap Myths
With so much information out there, it’s easy to get confused. Let’s clear up two of the most common myths about Medigap. First, you cannot have a Medigap plan and a Medicare Advantage plan at the same time. They are two completely different ways to get your Medicare coverage. You either stick with Original Medicare and add a Medigap plan for supplemental coverage, or you choose a Medicare Advantage plan to replace your Original Medicare.
Second, Medigap plans are designed to cover the “gaps” in Original Medicare Parts A and B—things like deductibles, coinsurance, and copayments. They do not include extra benefits like routine dental, vision, or hearing exams. Most importantly, Medigap plans do not include prescription drug coverage. For that, you will need to enroll in a separate Medicare Part D plan.
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Frequently Asked Questions
If all Plan G policies have the same benefits, why are the prices so different? This is a great question because it gets to the heart of how to shop for a plan. While the federal government standardizes the medical benefits of each lettered plan, it doesn’t regulate the price. The private insurance companies that sell these plans set their own monthly premiums. A company’s price can be based on its business costs, its history of claims, and the pricing model it uses, which affects how your rate might change over time. This is why you could see two different companies offering the exact same Plan G at very different prices.
Can I change my Medigap plan to a different one later on? Yes, you can apply to switch your Medigap plan at any time. However, the key thing to remember is your Medigap Open Enrollment Period. During that initial six-month window, you have a guaranteed right to buy any plan without answering health questions. If you decide to switch plans later, you will likely have to go through medical underwriting. This means the insurance company can ask about your health history and could charge you a higher premium or even deny your application based on your health.
What’s the real difference between Medigap and a Medicare Advantage plan? Think of them as two completely different paths for your Medicare coverage. A Medigap plan is supplemental insurance that works with your Original Medicare (Parts A and B). You keep your red, white, and blue Medicare card, and the Medigap plan helps pay for the costs that Medicare doesn’t cover. A Medicare Advantage plan (Part C) is an alternative way to get your benefits that replaces Original Medicare. These plans are offered by private companies and often function like an HMO or PPO, with specific networks of doctors and hospitals. You can’t have both at the same time.
Does my Medigap plan cover my prescription drugs? No, a Medigap plan does not include coverage for prescription drugs. Medigap policies are designed only to fill the “gaps” in Original Medicare Parts A and B, which cover hospital and medical services. To get coverage for your medications, you will need to enroll in a separate, standalone Medicare Part D prescription drug plan.
I’m healthy now. Should I still get a Medigap plan or wait until I need more care? It’s smart to think about this now while you’re in good health. Your six-month Medigap Open Enrollment Period is a one-time opportunity to buy any plan you want with no health questions asked. If you wait until you need more medical care, you will have missed this window. Applying later means you’ll likely face medical underwriting, and an insurance company could deny you coverage or charge you a much higher rate because of your health. A Medigap plan is about protecting yourself from unexpected and high medical bills in the future.