Medicare Supplement Plans

A Medicare Supplement program, or Medigap, is health insurance sold by private insurance companies to fill the "gaps" in Original Medicare Plan coverage. Medigap policies help pay some of the health care costs that the Original Medicare Plan doesn't cover. If you are in the Original Medicare Plan and have a Medigap policy, the Medicare and your Medigap policy will pay both their share of covered health care costs.

Insurance companies can only sell you a "standardized" Medigap policy. These Medigap policies must all have specific benefits so you can compare them easily. You may be able to choose up to 12 different standardized Medigap policies (Medigap Plan A through L). Medigap policies must follow Federal and State laws. Each plan, A through L, has a different set of basic and extra benefits.

It is important to compare Medigap policies because costs can vary. The benefits in any Medigap Plan A through L are the same for any insurance company. Each insurance company decides which Medigap policies it wants to sell.

Generally, when you buy a Medigap policy you must have Medicare Part A and Part B. You will have to pay the monthly Medicare Part B premium. In addition, you will have to pay a premium to the Medicare insurance company. You and your spouse must each buy separate Medigap policies. Your Medigap policy won't cover any health care costs for your spouse.

Enrollment Periods

The best time to buy a Medigap policy is during your Medigap open enrollment period. Your Medigap open enrollment period lasts for six months. It starts on the first day of the month in which you are both:

  • age 65 or older, and
  • enrolled in Medicare Part B.

If you apply for a Medigap policy after your Medigap open enrollment period has ended, the Medigap insurance company is allowed to use medical underwriting to decide whether to accept your application, and how much to charge you for the Medigap policy. If you are in good health, the insurance company is likely to sell you the Medigap policy, but there is no guarantee that they will. However, not all insurance companies actually use medical underwriting, so be sure to ask.

Types of Medicare Supplement Plans

Since 1992, there have been 10 standardized Medigap policies called Medigap Plans "A" through "J." In 2005, two new standardized Medigap policies became available, called Medigap Plans "K" and "L." You may be able to choose from up to 12 different standardized Medigap policies (Medigap Plans A through L).

Medigap Plans A through J offer different benefits than Medigap Plans K and L and have higher premiums because they provide more benefits and have lower out-of-pocket costs. Each standardized Medigap policy must cover basic benefits. Medigap Plans A through J have one set of basic benefits, and Plans K and L have a different set of basic benefits. Most Medigap policies pay some, if not all, of the Original Medicare Plan coinsurance and outpatient copayment amounts. These policies may also cover Original Medicare Plan deductibles. Some Medigap policies cover extra benefits to help pay for things Medicare doesn't cover. Note: Medigap Plans F and J have a high-deductible option. If you choose this option, you must pay this deductible first before the Medigap policy pays anything.

H3916_S5593_12_0824 CMS Approved This page last updated 1/18/2013

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The information contained on this website regarding the Patient Protection and Affordable Care Act of 2010 (“PPACA”), as amended, and/or any other law, does not constitute legal or tax advice and is subject to change based upon the issuance of new guidance and/or change in laws.

The information provided is intended to provide general information only and does not attempt to give you advice that relates to your specific circumstances. State laws and regulations governing health insurance and health plans may vary from state to state. Further, any information regarding any health plan will be subject to the terms of its particular health plan benefit agreement and some health plans may not be available in every region or state.



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