The cost for Medicare supplemental insurance, also known as Medigap, varies depending on the plan provider and the coverage options.
A person with original Medicare can sign up for the optional Medigap insurance policies. The variation in cost and coverage means a person may want to research which plan suits their personal needs.
This article discusses Medigap and looks at the differences between the plans. It also looks at eligibility, enrollment, and costs.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Medigap plans are provided by private companies and cover out-of-pocket Medicare costs such as deductibles, copays, and coinsurance. They may also cover emergency medical costs if the plan holder is traveling outside the United States.
The plans are identified by letters, including A, B, C, D, F, G, K, L, M, and N. Since January 1, 2020, Plan C and Plan F are no longer available to a person who is new to Medicare, because Medigap plans can no longer, from January 2020, cover the Medicare Part B deductible.
Medigap plans providers do not have to offer every plan, but they must offer at least Medigap Plan A and either Plan C or Plan F. Medicare standardizes the plans across all states except for Massachusetts, Minnesota, and Wisconsin.
According to the Centers for Medicare & Medicaid Services, plans with the same letter must offer the same benefits, no matter where in the country the plan holder lives or which company provides the plan.
However, Medigap plans do not generally cover such items as dental or vision care, hearing aids, or long-term care. The chart below shows the different coverage offered by the various Medigap plans.
| Cover | Plan A | Plan B | Plan C | Plan D | Plan F | Plan G | Plan K | Plan L | Plan M | Plan N |
|---|---|---|---|---|---|---|---|---|---|---|
| Part A deductible | no | yes | yes | yes | yes | yes | 50% | 75% | 50% | yes |
| Part A coinsurance and hospital costs | yes | yes | yes | yes | yes | yes | yes | yes | yes | yes |
| Part A hospice care coinsurance or copay | yes | yes | yes | yes | yes | YES | 50% | 75% | yes | yes |
| Part B deductible | no | no | yes | no | yes | no | no | no | no | no |
| Part B coinsurance or copay | yes | yes | yes | yes | yes | yes | 50% | 75% | yes | yes |
| Part B excess charge | no | no | no | no | yes | yes | no | no | no | no |
| Out-of-pocket limit | N/A | N/A | N/A | N/A | N/A | N/A | $5,560 | $2,780 | N/A | N/A |
| Foreign travel exchange | no | no | 80% | 80% | 80% | 80% | no | NO | 80% | 80% |
| Skilled nursing facility co-insurance | no | no | yes | yes | yes | yes | 50% | 75% | yes | yes |
While a person must be enrolled in original Medicare to be eligible for a Medigap plan, a person with a Medicare Advantage plan cannot also have a Medigap plan.
There are several factors that influence the monthly premium costs of a Medigap plan.
Ratings
Insurance companies generally calculate plan premiums based on three ratings:
- An attained-age rating means the policy cost increases as a person gets older.
- The premium for a community-rated plan is not affected by a person’s age. If there is a price increase, it might be because of economic factors.
- Premiums based on issue-age rating are lowest for a person who gets the plan at a younger age, and any changes in premium is unrelated to a person’s age.
Coverage
In addition, plan premiums generally increase along with the level of coverage.
Other factors
There may be other factors affecting the premium costs, such as:
- The high-deductible plans F and G rule that a person must pay $2,340 before the Medigap plan begins to pay.
- With Plan K or Plan L, the annual out-of-pocket limit and the Part B deductible ($198 in 2020) must be paid before the plan pays for covered services.
- Some plan policies mean a person has to pay a $250 annual deductible for an emergency while traveling outside the US.
- A plan may offer discounts, such as for a non-smoker, or for electronic payments.
- If a plan decides to use medical underwriting, the results may change the premium.
- Some plans include a separate deductible for prescription drugs.
SELECT
A person may pay a lower premium if they have a Medicare SELECT policy. However, the policies generally limit the list of providers from which a person can choose to get a Medigap plan.
A person must be enrolled in original Medicare before getting a Medigap plan. However, a person with a Medicare Advantage plan cannot enroll in a Medigap plan.
A person can get a Medigap plan during the 6-month Medigap open enrollment period (OEP), which starts the first day of the month when a person turns 65 and has enrolled in Medicare Part B. During this time, a person cannot be refused a Medigap policy.
If a person wants to enroll after the OEP, the company offering the plan may ask for medical underwriting, which may be used to decide whether or not to offer a person a plan.
This online tool can help a person search for Medigap providers in their area, and compare policies, including coverage options and premiums.
For impartial advice about Medigap plans, a person can call 1-800-MEDICARE (1-800-633-4227), or contact their State Health Insurance Assistance Program (SHIP).
Medigap helps reduce Medicare out-of-pocket costs. While policies are generally standardized, premiums vary and not all plans are available in all areas.
The government provides free resources, such as the SHIP program, to help people choose the Medigap plan for their individual needs.