Medicare Supplement

What is a Medicare Supplement? A Medicare Supplement plan, also called Medigap, is private insurance that works alongside Original Medicare to help pay certain deductibles, coinsurance and copayments that Medicare leaves behind.

Original Medicare provides broad healthcare coverage, but it does not pay every approved expense. Medicare Part A has hospital-related deductibles and coinsurance, while Medicare Part B generally requires beneficiaries to pay an annual deductible and a percentage of many Medicare-approved outpatient services.

Original Medicare also does not have an annual out-of-pocket maximum. A serious illness, repeated hospital care or frequent outpatient treatment can therefore create substantial medical expenses.

A Medicare Supplement plan helps make those expenses more predictable. Depending on the lettered plan you select, the policy may cover most or nearly all the cost-sharing left by Original Medicare.

What Is a Medicare Supplement and How Does It Work?

A Medicare Supplement does not replace Original Medicare. It supplements it.

You remain enrolled in Medicare Part A and Part B, and Medicare continues making the initial decision about whether a service is covered.

When you receive Medicare-covered care:

Your healthcare provider submits the claim to Medicare.
Medicare determines whether the service is covered.
Medicare pays its portion of the approved amount.
The remaining claim information is generally sent to your Medicare Supplement company.
The Medicare Supplement policy pays according to the benefits of your lettered plan.
You are responsible for any expense that Medicare and your supplement do not cover.

You pay a separate monthly premium to the private insurance company for the Medicare Supplement policy. You must also continue paying your Medicare Part B premium.

If you want outpatient prescription drug coverage, you will ordinarily need a separate Medicare Part D plan.

What Does a Medicare Supplement Cover?

The benefits depend on which standardized Medicare Supplement plan you select.

Depending on the lettered plan, coverage may include:

Medicare Part A hospital coinsurance
Up to 365 additional hospital days after Medicare benefits are exhausted
The Medicare Part A deductible
Medicare Part A hospice-care coinsurance or copayments
Skilled-nursing facility care coinsurance
The first three pints of blood
Medicare Part B coinsurance or copayments
The Medicare Part B deductible for people eligible to purchase Plan C or Plan F
Medicare Part B excess charges under Plan F or Plan G
Limited foreign-travel emergency coverage under certain plans

No Medicare Supplement plan covers every possible healthcare expense. The exact protection depends on the standardized benefits included in the plan letter you choose.

Are Medicare Supplement Plans Standardized?

Yes. Medicare Supplement plans are standardized.

In most states, the available standardized plans are identified by letters: A, B, C, D, F, G, K, L, M and N. Massachusetts, Minnesota and Wisconsin standardize Medicare Supplement policies differently.

A Plan G from one insurance company provides the same standardized medical benefits as a Plan G from another company. The same rule applies when comparing Plan N with Plan N or another identical plan letter.

Insurance companies can still differ in important ways, including:

Monthly premium
Household discounts
Application or policy fees
Rate-increase history
Pricing method
Customer service
Billing reliability
Financial strength
Medical underwriting requirements

Some companies may also include optional discounts or memberships. Those extras are not part of the standardized Medicare Supplement benefits and may change independently of the policy.

This is why choosing a Medicare Supplement involves two decisions: selecting the appropriate plan letter and then selecting the insurance company offering that plan.

Which Medicare Supplement Plans Are Most Popular?

Plan G and Plan N are two of the most commonly considered Medicare Supplement plans among people newly eligible for Medicare.

Medicare Supplement Plan G

Plan G provides comprehensive coverage of the major cost-sharing requirements left by Original Medicare.

After you pay the annual Medicare Part B deductible, standard Plan G generally covers the remaining Medicare-approved deductibles, coinsurance and copayments included in the policy.

Plan G also covers qualifying Medicare Part B excess charges and includes limited foreign-travel emergency coverage.

Medicare Supplement Plan N

Plan N can offer a lower monthly premium than Plan G in exchange for accepting more out-of-pocket responsibility.

With Plan N:

You pay the annual Medicare Part B deductible.
Certain office visits may require a copayment of up to $20.
Certain emergency-room visits that do not result in inpatient admission may require a copayment of up to $50.
Medicare Part B excess charges are not covered.

Plan N can provide strong coverage for someone comfortable accepting these potential expenses in exchange for a lower premium.

Medicare Supplement Plan F

Plan F covers nearly all the standardized gaps in Original Medicare, including the Medicare Part B deductible.

However, Plan F generally is available only to people who became eligible for Medicare before January 1, 2020.

Plan F was not discontinued. Federal law changed who can purchase it. Eligible policyholders can generally keep existing Plan F coverage, and people eligible for Medicare before 2020 may still be able to apply for it.

What Does a Medicare Supplement Not Cover?

A newly purchased Medicare Supplement policy does not ordinarily cover:

Outpatient prescription drugs
Your monthly Medicare Part B premium
Routine dental examinations and dental work
Routine vision examinations or eyeglasses
Hearing aids
Long-term custodial care
Private-duty nursing
Routine foot care
Most care received outside the United States
Services that Original Medicare does not cover

Some insurance companies offer separate dental, vision or hearing policies. Certain companies may also include optional discounts or fitness memberships, but these are not standardized Medigap benefits.

Medicare Supplement plans sold after 2005 do not include outpatient prescription drug coverage. Someone who wants prescription coverage normally enrolls in a separate Medicare Part D plan.

Do Medicare Supplement Plans Have Doctor Networks?

A standard Medicare Supplement policy generally does not have a doctor or hospital network.

You can ordinarily use the policy with any healthcare provider nationwide who accepts Original Medicare. The provider does not need a separate contract with your Medicare Supplement insurance company.

This can be valuable for people who:

Travel frequently
Spend part of the year in another state
Want access to specialists outside their immediate area
Prefer not to obtain referrals
Want fewer regional provider restrictions

The insurance company on your Medicare Supplement card does not normally determine which Medicare-participating providers you can use. Original Medicare remains your primary coverage.

Medicare SELECT policies are an exception. A Medicare SELECT policy may require the use of certain hospitals and, in some cases, certain doctors to receive full supplemental benefits except during emergencies.

Must a Doctor Accept Medicare Assignment?

A provider can accept Medicare without accepting Medicare assignment for every claim.

A participating Medicare provider agrees to accept the Medicare-approved amount as full payment for covered services. A non-participating provider may accept Medicare but decline assignment for a particular service.

Where permitted, a non-participating provider may bill a limited amount above the Medicare-approved charge. This is called a Medicare Part B excess charge.

Plan F and Plan G cover qualifying Medicare Part B excess charges. Plan N does not.

A provider who has opted out of Medicare is different from a non-participating provider. An opted-out provider may ask you to sign a private contract agreeing to pay for the service yourself. Medicare generally does not pay that private-contract charge, and a Medicare Supplement policy does not turn it into a Medicare-covered expense.

Can Medicare Supplements Be Used Anywhere in the United States?

A standard Medicare Supplement policy can generally be used nationwide with providers who accept Original Medicare.

Your policy does not stop working merely because you cross a state line. This makes Medicare Supplements attractive to people who travel, visit family in other states or maintain more than one residence.

The policy supplements Medicare-approved care. It does not create coverage for a service simply because it is received outside your home state.

Certain Medicare Supplement plans also provide limited foreign-travel emergency coverage. This benefit is subject to its own deductible, percentage limits, time restrictions and lifetime maximum.

Medicare Supplement vs Medicare Advantage

Medicare Supplement and Medicare Advantage are two different ways of managing healthcare expenses.

A Medicare Supplement works with Original Medicare. Medicare remains your primary coverage, and the supplement helps pay certain expenses Medicare leaves behind.

A Medicare Advantage plan is a private alternative through which you receive your Medicare Part A and Part B benefits. Medicare Advantage plans frequently use provider networks, service areas, copayments and prior-authorization requirements. Many include prescription drug coverage and may offer additional benefits.

With a Medicare Supplement:

You remain enrolled in Original Medicare.
You generally have broad nationwide provider access.
Standard policies ordinarily do not use doctor networks.
Referrals are generally not required.
Medical expenses can be more predictable.
You pay a separate Medicare Supplement premium.
Prescription coverage ordinarily requires a separate Part D plan.

With Medicare Advantage:

You receive Part A and Part B benefits through the private plan.
Provider-network and service-area rules may apply.
Copayments and coinsurance may apply as services are received.
Prior authorization may be required for certain care.
Prescription coverage is commonly included.
Additional dental, vision, hearing or fitness benefits may be offered.
The plan has an annual maximum for covered Part A and Part B out-of-pocket expenses.

You cannot use a Medicare Supplement policy to pay Medicare Advantage copayments, deductibles or premiums. A person choosing Medicare Supplement coverage must have Original Medicare rather than remain enrolled in Medicare Advantage.

When Can You Enroll in a Medicare Supplement?

The best time to purchase a Medicare Supplement is usually during your six-month Medicare Supplement Open Enrollment Period.

This period begins on the first day of the month in which both of the following are true:

You are age 65 or older.
You are enrolled in Medicare Part B.

During this six-month period, an insurance company generally cannot:

Deny your application because of your health
Use medical underwriting to reject you
Charge you more because of existing health conditions

This is a one-time federal enrollment period. It does not repeat every year.

If you delay Medicare Part B because you are actively working and covered by qualifying employer insurance, your Medicare Supplement Open Enrollment Period generally begins when your Part B coverage eventually becomes effective.

Rules for people eligible for Medicare before age 65 because of disability or End-Stage Renal Disease vary by state.

Can You Buy a Medicare Supplement After Open Enrollment?

You can apply for a Medicare Supplement after your Open Enrollment Period, but medical underwriting may apply.

The insurance company may review:

Current health conditions
Medical history
Prescription medications
Recent hospitalizations
Pending tests or procedures
Upcoming surgeries or treatment

Depending on the company’s underwriting requirements, the application may be approved or declined.

Certain circumstances create guaranteed-issue rights that allow someone to purchase specific Medicare Supplement plans without medical underwriting. State law may provide additional protections.

The Medicare Annual Enrollment Period from October 15 through December 7 does not automatically provide a new opportunity to purchase or switch Medicare Supplement policies without underwriting.

Can You Switch Medicare Supplement Plans Later?

You may apply to change Medicare Supplement plans or insurance companies, but approval is not always guaranteed.

Outside your Medicare Supplement Open Enrollment Period or another protected situation, the new company may require medical underwriting.

Reasons someone might consider changing include:

A substantial premium increase
A lower rate from another company
Better household discounts
A desire to change plan letters
Poor billing or customer service
A change in budget or healthcare preferences

Never cancel an existing Medicare Supplement policy merely because you submitted a new application. Wait until the new coverage has been approved and you have confirmed the premium and effective date.

When replacing one Medigap policy with another, Medicare provides a 30-day free-look period. You must pay both premiums during the month in which both policies remain active.

How Much Does a Medicare Supplement Cost?

There is no single Medicare Supplement premium.

The cost may depend on:

Plan letter
Insurance company
Age
ZIP code
Tobacco status
Household-discount eligibility
Pricing method
Application or policy fees
Payment method
When you apply

Insurance companies may price policies using attained-age, issue-age or community-rated methods, depending on the company and state.

Two companies can charge very different premiums for the same standardized plan. A lower starting rate does not automatically guarantee better long-term value.

When comparing policies, review the entire first-year cost, available discounts, company rate history and the difference between competing plan letters.

Does a Medicare Supplement Cover Both Spouses?

No. A Medicare Supplement policy covers one person.

If both spouses want Medicare Supplement coverage, each person must apply for a separate policy and pay a separate premium.

The spouses do not need to select the same plan letter or insurance company. Each person can choose coverage based on individual eligibility, health needs, budget and available rates.

Some insurance companies offer household discounts when two people living together have policies with the same company. The eligibility rules and discount percentages vary.

Can a Medicare Supplement Company Cancel Your Policy?

Standardized Medicare Supplement policies are generally guaranteed renewable.

Once your policy is issued, the insurance company ordinarily cannot cancel it because you developed health problems, filed expensive claims or used the coverage frequently.

The company can generally terminate coverage only in limited circumstances, such as:

You stop paying the premium.
You were not truthful on the application.
The insurance company becomes bankrupt or goes out of business.

The company can increase premiums for an approved class of policyholders. Guaranteed renewable does not mean the premium can never increase.

Is a Medicare Supplement Worth It?

A Medicare Supplement may be worth considering if you value:

Broad access to Medicare-participating doctors and hospitals
Predictable medical expenses
Coverage that travels throughout the United States
Fewer provider-network restrictions
No routine specialist referrals
Protection from substantial Original Medicare cost-sharing
The ability to keep a standardized policy from year to year

The tradeoff is the monthly premium. You may also need to purchase separate Part D, dental, vision or hearing coverage.

The right choice depends on your budget, health, travel habits, preferred doctors and willingness to accept out-of-pocket costs.

The lowest monthly premium is not automatically the least expensive long-term option. The goal is to find the combination of coverage and premium that fits how you expect to use healthcare.

How Can an Independent Medicare Broker Help?

An independent Medicare broker can compare the same standardized plan across multiple insurance companies.

A broker can help you:

Compare Plan G, Plan N and other available plans
Review rates from multiple insurance companies
Identify household discounts
Calculate the complete annual cost
Explain enrollment protections
Review medical underwriting requirements
Compare company rate histories
Coordinate effective dates
Avoid cancelling existing coverage prematurely

There is generally no additional fee to the consumer for using an independent Medicare broker. The insurance company pays the broker when a policy is issued.

The Bottom Line

What is a Medicare Supplement? It is private insurance that works with Original Medicare to help pay certain deductibles, coinsurance and copayments.

Medicare Supplement plans can provide broad nationwide access to providers and make medical expenses more predictable. The plans are standardized, but premiums, discounts, rate histories and service can vary substantially among insurance companies.

The best time to enroll is generally during your six-month Medicare Supplement Open Enrollment Period. After that period, medical underwriting may apply unless you qualify for a guaranteed-issue right or another state protection.

The right policy depends on both the plan letter and the company. Compare the benefits, total cost and long-term value before enrolling.

Frequently Asked Questions

Is Medicare Supplement the same as Medigap?

Yes. Medicare Supplement and Medigap are two names for the same type of private insurance that works with Original Medicare.

Do I need Medicare Part A and Part B to buy a Medicare Supplement?

Generally, yes. You must have Original Medicare, which means Medicare Part A and Part B, before Medicare Supplement coverage can work with your Medicare benefits.

Does a Medicare Supplement include prescription drug coverage?

No. Medicare Supplement policies sold after 2005 do not include outpatient prescription drug coverage. You can obtain that coverage through a separate Medicare Part D plan.

Can I use a Medicare Supplement with Medicare Advantage?

No. A Medicare Supplement cannot pay the copayments, coinsurance, deductibles or premiums of a Medicare Advantage plan. You must return to Original Medicare before Medicare Supplement coverage can begin.

Does a Medicare Supplement have a doctor network?

A standard Medicare Supplement policy ordinarily does not have a provider network. You can generally use any doctor or hospital nationwide that accepts Original Medicare.

Are Medicare Supplement benefits the same with every company?

The standardized medical benefits are the same for identical plan letters. For example, every standard Plan G provides the same basic medical benefits. Premiums, discounts, fees, rate histories and customer service can differ.

Can I be denied a Medicare Supplement because of my health?

During your six-month Medicare Supplement Open Enrollment Period, a company generally cannot deny you because of health conditions. After that period, medical underwriting may apply unless you have a guaranteed-issue right or another enrollment protection.

Can I switch Medicare Supplement companies at any time?

You can apply at any time, but the new company may require medical underwriting. The Medicare Annual Enrollment Period does not automatically guarantee acceptance into another Medicare Supplement policy.

Can my Medicare Supplement policy be cancelled if I get sick?

Standardized Medicare Supplement policies are generally guaranteed renewable. The company ordinarily cannot cancel your policy because you develop a health condition or submit expensive claims.

Does one Medicare Supplement policy cover both spouses?

No. Each spouse needs a separate Medicare Supplement policy.

Schedule Your Medicare Consultation Today

Medicare can be confusing, but getting answers shouldn’t be.

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Independent Medicare broker helping Medicare beneficiaries in Chester County Pennsylvania compare Medicare Supplement plans