Medigap (Medicare Supplement Insurance)
Medigap is sold by private insurers to help fill the “gaps” in Original Medicare. It helps pay certain out-of-pocket costs that Parts A & B don’t cover.
What Medigap Helps Pay For
- Copayments — fixed amounts for certain services
- Coinsurance — your percentage share of costs
- Deductibles — amounts you pay before Medicare pays
Key Features
- You must be enrolled in Part A and Part B to buy Medigap.
- Policies are standardized by plan type (A–N); coverage is the same across companies, premiums vary.
- No drug coverage: add a separate Part D plan for prescriptions.
- Individual policies — each person needs their own plan.
- Use any doctor or hospital nationwide that accepts Medicare.
8 Things to Know About Medigap Policies
1) You Must Have Original Medicare
Enrollment in Parts A & B is required to purchase Medigap.
2) Not for Medicare Advantage
If you have a Medicare Advantage plan, that coverage must end before a Medigap policy can begin.
3) Monthly Premiums
You pay a premium to the insurer for Medigap, in addition to your Part B premium.
4) Individual Coverage
Medigap covers one person; spouses need separate policies.
5) Choose Any Licensed Insurer
You can buy from any company licensed in your state to sell Medigap.
6) Guaranteed Renewable
As long as you pay premiums, your policy can’t be canceled — even with health issues.
7) No Prescription Drug Coverage
Medigap policies sold after 1/1/2006 do not include drug coverage. Add a separate Part D if needed.
8) Not Compatible with MSA Plans
You cannot have Medigap with a Medicare Medical Savings Account (MSA) plan.
Insurance Plans That Aren’t Medigap
Medicare Advantage (Part C)
Alternative to Original Medicare; often includes Part D and extras. It is not Medigap.
Medicare Drug Plans (Part D)
Standalone prescription coverage; doesn’t pay deductibles/coinsurance like Medigap.
Medicaid
Separate federal/state program helping with medical costs for limited income/resources.
Employer/Union Coverage
Group retiree or active coverage; different from Medigap and can affect choices.
TRICARE / VA
Military/veterans’ benefits; not Medigap, though they may coordinate with Medicare.
FEHB
Federal Employee Health Benefits; separate from Medigap.
Long-Term Care Insurance
Covers custodial care (nursing home/assisted living/home care); Medigap doesn’t.
Dropping Your Entire Medigap Policy
Key Points
- You’re still in Original Medicare: Dropping Medigap doesn’t cancel Parts A & B.
- Higher out-of-pocket: You’ll pay deductibles, copays, and coinsurance Medigap used to cover.
- Re-enrollment may require underwriting: You could be denied or charged more based on health.
- Guaranteed-issue rights: Limited situations let you switch or buy again without underwriting (e.g., move, plan/insurer issues).
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If you feel like you have been spinning your wheels wondering how to make the best decision when it comes to your Medicare plan, you are in the right place. The good news is, you don’t have to do this alone. We are in the business of helping people understand Medicare, in simple, plain terms that everyone can understand. We believe it’s important that your first understand Medicare itself. You can’t understand your Medicare options until you first understand basic Medicare benefits. Fortunately, we’ve mastered how to make it simple.