Medicare Supplement Plans
What is a Medicare Supplement Plan?
A Medicare Supplement plan, also referred to as Medigap, is a health insurance policy sold by private insurance companies to fill the gaps in Medicare Parts A and B.
Why Enroll in a Medicare Supplement Plan
Original Medicare provides comprehensive health coverage, but it does not pay for all medical expenses.
Beneficiaries are still responsible for deductibles, copays and coinsurance. In addition, Original Medicare does not include an out-of-pocket maximum for covered services. For example, after meeting your Part B deductible, you are generally responsible for 20% of covered services, and that coinsurance has no cap. This means your potential out-of-pocket costs could continue to increase depending on the care you receive.
Medicare Supplement (Medigap) plans are designed to help cover many of the costs that Original Medicare leaves behind, including the 20% Part B coinsurance and certain expenses associated with Part A. By helping fill these coverage gaps, a Medicare Supplement plan can provide more predictable healthcare costs and greater financial protection.
When to Enroll in a Medicare Supplement Plan
The ideal time to enroll in a Medicare Supplement plan is during your Medicare Supplement Open Enrollment period. This six-month period begins the first day of the month in which you are age 65 or older and enrolled in Medicare Part B. During this time, you can enroll in a plan without medical underwriting, meaning insurance companies cannot deny coverage or charge higher premiums due to pre-existing health conditions. If this enrollment window is missed, future applications may be subject to medical underwriting, and coverage approval may depend on health history.
Medicare Advantage vs Medicare Supplement
When becoming eligible for Medicare, one of the biggest decisions you’ll make is whether to enroll in a Medicare Advantage plan or pair Original Medicare with a Medicare Supplement (Medigap) plan.
Both options provide valuable healthcare coverage, but they work very differently. Medicare Advantage plans are private insurance alternatives to Original Medicare that often include additional benefits and prescription drug coverage. Medicare Supplement plans work alongside Original Medicare to help reduce out-of-pocket medical expenses and provide more predictable healthcare costs.
Understanding the differences between these options is important when evaluating your healthcare needs, provider access, travel habits, prescriptions, and budget.
Medicare Advantage (Part C)
Medicare Advantage plans (Part C) are private insurance alternatives to Original Medicare that combine Part A and Part B coverage and often include prescription drug benefits.
To enroll in a Medicare Advantage plan, you must:
✓ Be enrolled in both Medicare Part A and Part B
✓ Live within the plan’s service area
Medicare Advantage plans:
✓ Must provide at least the same coverage as Original Medicare
✓ Often include prescription drug coverage
✓ May include additional benefits like dental, vision, hearing, transportation, fitness, and more
Plan availability and benefits vary by location and carrier.
You may enroll:
✓ During your Initial Coverage Election Period (ICEP)
✓ During certain Special Enrollment Periods (SEP)
✓ During the Annual Enrollment Period (AEP)
You may also change plans during:
✓ Annual Enrollment Period (AEP)
✓ Medicare Advantage Open Enrollment Period (OEP)
Note: You cannot be enrolled in a Medicare Advantage plan and a Medicare Supplement plan at the same time.
Costs may include:
✓ Monthly premiums
✓ Copays
✓ Coinsurance
✓ Deductibles
All Medicare Advantage plans include a yearly maximum out-of-pocket limit for covered medical services.
For 2026, Medicare’s maximum allowable limit is $9,250, though many plans offer lower limits.
You must continue paying your Medicare Part B premium while enrolled in a Medicare Advantage plan.
Certain services may require approval from your Medicare Advantage plan before care is provided.
Prior authorization may apply to:
✓ Specialist services
✓ Durable medical equipment
✓ Home health services
✓ Non-emergency hospital care
Understanding prior authorization requirements is important when evaluating Medicare Advantage plans.
✓ Confirm your doctors are in-network
✓ Check prescription formularies
✓ Review maximum out-of-pocket costs
✓ Understand referral requirements
✓ Review prior authorization rules
Medicare Supplement (Medigap)
Original Medicare provides comprehensive healthcare coverage, but it does not pay for all medical expenses. Beneficiaries are still responsible for deductibles, copays, coinsurance, and other out-of-pocket costs.
Medicare Supplement (Medigap) plans are designed to help cover many of the expenses that Original Medicare does not fully pay for, including Part A and Part B cost-sharing. These plans can help provide more predictable healthcare expenses and greater financial protection.
To enroll in a Medicare Supplement plan:
✓ You must be enrolled in Medicare Part A and Part B
✓ Your policy must be guaranteed renewable
✓ Medicare Supplement premiums cannot typically be deducted directly from Social Security benefits
Depending on the plan selected, Medicare Supplement policies may help cover:
✓ Medicare Part A and Part B deductibles
✓ Medicare Part A coinsurance and hospital costs
✓ Medicare Part B coinsurance or copayments
✓ Blood (first 3 pints)
✓ Hospice care coinsurance or copayments
✓ Skilled nursing facility coinsurance
✓ Part B excess charges
✓ Emergency medical coverage during foreign travel
Benefits vary by plan type.
When you enroll in a Medicare Supplement plan, Original Medicare remains your primary insurance coverage.
Under this arrangement:
✓ Medicare pays first for covered services
✓ Your Medicare Supplement plan may help pay remaining approved costs
✓ You can generally access any Medicare-approved provider nationwide
After Medicare processes a claim, the remaining eligible balance is automatically sent to your Medicare Supplement carrier for secondary payment.
Medicare Supplement plans are standardized nationwide and identified by letters, including:
✓ Plan A
✓ Plan B
✓ Plan D
✓ Plan G
✓ Plan K
✓ Plan L
✓ Plan M
✓ Plan N
Standardization means the same plan letter provides the same core benefits regardless of the insurance carrier offering the plan.
Premiums and out-of-pocket costs will vary depending on the carrier, location, age, and plan selected.
The ideal time to enroll in a Medicare Supplement plan is during your Medicare Supplement Open Enrollment Period.
This six-month enrollment window begins the first day of the month when you are:
✓ Age 65 or older
✓ Enrolled in Medicare Part B
During this period:
✓ Insurance companies cannot deny coverage due to health conditions
✓ Coverage cannot be rated higher because of pre-existing conditions
✓ Medical underwriting does not apply
If this enrollment period is missed, future applications may require medical underwriting and coverage approval may depend on health history.
✓ You must have Medicare Part A and Part B to enroll
✓ Medicare Supplement plans do not typically include prescription drug coverage
✓ Separate Part D coverage is generally needed for prescriptions
✓ Policies are issued to individuals, not couples
✓ You must pay your Part B premium in addition to your Medigap premium
✓ Policies are guaranteed renewable as long as premiums are paid
✓ You can generally see any provider nationwide that accepts Medicare
Medicare Advantage vs Medicare Supplement
| Medicare Advantage | Medicare Supplement |
|---|---|
Alternative to Original Medicare | Works alongside Original Medicare |
Usually network-based | Nationwide Medicare provider access |
Often includes prescription coverage | Requires separate Part D plan |
May include benefits beyond what Original Medicare offers | Focuses on reducing medical cost-sharing |
Lower monthly premiums in many cases | Higher monthly premiums but lower out-of-pocket costs |
Includes annual out-of-pocket maximum | Original Medicare generally remains primary coverage |
Prior authorization may apply | Typically fewer network restrictions |
Need Help Understanding Your Medicare Options?
Choosing between Medicare Advantage and Medicare Supplement coverage can feel confusing, especially when considering provider access, healthcare costs, prescriptions, and long-term coverage needs.
Our licensed agents are here to help simplify your options and guide you through your Medicare choices.
