Medicare Supplement plans are one of the additional Medicare insurance options that provide beneficiaries with more comprehensive coverage. Original Medicare has gaps. To start, there’s no out-of-pocket limit, and Original Medicare doesn’t pay about 20% of costs. This means that Medicare recipients who only have Original Medicare could be on the hook for thousands of dollars with no upward limit. Original Medicare also doesn’t cover prescription drugs or vision, hearing, and dental services.
No one solution is perfect, but Medicare Supplement plans, which stack on top of Original Medicare, are known for providing better financial predictability by reducing out-of-pocket costs. In this guide, you’ll learn everything you need to know about Medicare Supplement plans, including what each one covers, their key benefits, and how to choose the right one for your health and financial needs.
Note: Medicare Supplement plans are also called Medigap plans, and we use the two terms interchangeably.
Medicare Supplement plans help cover the 20% of costs that Original Medicare doesn’t pay. These plans sit on top of your Original Medicare, rather than replacing it like Medicare Advantage plans. Broadly speaking, Medicare Supplement plans provide better access to care. By significantly reducing out-of-pocket expenses, they ensure the cost of services isn’t a barrier to care. They also don’t limit your access through provider networks and prior authorization requirements. We’ll explain more about how all of this works in the key benefits section.
There are ten types of Medigap plans, labeled by letters A-N. (Plans G and F both also have high-deductible plan variations.) The most popular Medigap plans are Plans F, G, and N, and these plans make up 82% of Medigap policies held by beneficiaries. As of 2021, 40% of Medicare Supplement plan holders were enrolled in a Plan F, 32% in a Plan G, and 10% in a Plan N.
Note: If you turn (or turned) 65 after January 1, 2020, Medigap Plan F is not an option for you.
Medigap plans are meant to fill the gaps in Original Medicare coverage. They do this by covering a significant portion of out-of-pocket costs without adding restrictions that could limit your access to timely care. Below are the four key benefits that Medigap policyholders gain.
Monthly premiums are only one type of expense tied to Medicare. You’re also responsible for out-of-pocket costs, including deductibles, coinsurance, and copayments. With Medigap, your Medicare out-of-pocket costs are limited, so you don’t have to worry about the cost of covered services.
For example, with a Plan G, after you meet your annual Part B deductible (which is $226 in 2023), you owe nothing else for Medicare-covered services for the remainder of the year.
Original Medicare and Medigap plans don’t limit you to provider networks. This means that Medigap policyholders can see any doctor who accepts Original Medicare, which is the majority of doctors nationwide.
Wise Advice: If you split time between two or more states or travel a lot domestically, you can use your Medigap plan wherever you go within the US.
With Original Medicare and Medigap, you don’t need to worry about getting prior authorization for covered services, making it easier to get the care you need without delay.
We mentioned previously that all plans of the same type have identical coverage. This makes decisions easier and means consumers don’t need to pore over plan benefit summaries to determine exactly what is covered and how much they’ll pay.
Medicare Advantage plans are popular among Medicare beneficiaries because they provide additional coverage and often have $0 or low premiums. (Note: Medicare Advantage plans come with low premiums, but beneficiaries are still responsible for their Original Medicare premiums.)
We’ve all heard the saying, “nothing in life is free,” and unfortunately, that additional coverage comes at a cost. To keep premiums low, Medicare Advantage plans have restrictions that limit your access to care. The cons of Medicare Advantage plans are essentially the same as the pros of Medigap plans.
Medicare Advantage plans come with low premiums, but they do little to limit your out-of-pocket costs. That said, unlike Original Medicare without Medigap, Medicare Advantage plans do have an out-of-pocket limit that cannot exceed $8,300 in 2023.
One of the ways that Medicare Advantage carriers keep their costs low is by implementing provider networks. This limitation makes it more difficult to find new providers who have availability and is a deterrent for beneficiaries who value their choice of doctors.
Medicare Advantage plans are notorious for requiring (and denying) prior authorization. In many cases, beneficiaries are denied services that they need! This is one of the most common complaints against Medicare Advantage plans.
Medicare Advantage plans can vary drastically. Provider networks, cost structures, and added benefits are different from plan to plan, and unfortunately, misleading advertising and sales tactics exacerbate the confusion. Many Medicare Advantage plan holders experience surprises, like realizing a prescription or service they need isn’t covered or the cost is higher than expected.
Medicare Supplement plan costs vary, not just by plan, but also based on personal factors and policy pricing structures. The estimated average range of premiums for all types of Medigap plans is between $150-200. Learn about what can affect the price you pay below.
The premium you pay can vary based on these personal factors:
Medigap plans can have one of three different types of “ratings” or pricing structures. These pricing structures determine if and how your premium will change over time. Note: all types of Medigap policies may change premiums due to inflation and other economic factors.
Community-rated (or no-age-rated) policies have the same premiums for all policyholders.This means your premiums won’t be different based on your age.
Issue-age-rated (or entry age-rated) policies base their premiums off of how old you were when you first enrolled in the policy. This means premiums are lower for beneficiaries who signed up when they were younger.
Attained-age-rated policies base their premiums off of your current age (the age you’ve “attained”). These policies have premiums that will be low when you first enroll, but will increase as you continue to age.
There are three elements of enrolling in Medigap: eligibility, timing, and choice. Learn about each below.
You are eligible to enroll in Medigap if you meet all of the following conditions:
It’s important to know when you are guaranteed issue into a Medigap plan. Guaranteed issue means that you are guaranteed acceptance into any Medigap plan available to you.
The best time to enroll in Medigap is during the Medigap Open Enrollment Period, which lasts for six months after your Medicare Part B effective date. Outside of this and a handful of other guaranteed issue periods, insurance carriers may ask you questions about your health history and can deny you Medigap coverage.
Because Plan F is not available to those who turn 65 after January 1, 2020, we generally recommend Plan G. We also sometimes recommend Plan N, but rarely recommend plan types outside of F, G, and N. (That said, we’ll gladly review every Medicare option available to you to ensure you feel comfortable making an informed choice.)
Once you’ve settled on a plan type, you should consider plan premiums, pricing structures, and insurance carrier reputations to choose your specific policy.
Everyone’s health and financial situation is different, so we always recommend speaking with one of our licensed, unbiased Medicare Advisors to receive personalized advice. We’ll walk you through all of your Medicare options (including prescription plans) to ensure you feel confident in your Medicare choices.