Original Medicare With Additional Coverage
Medicare Supplements Explained
Medicare Supplement Insurance works with Original Medicare to reduce specified cost sharing. The plan letter, premium, enrollment timing and carrier all matter.
Start With Your Medigap Enrollment Rights
Quick answer: A Medicare Supplement, or Medigap, policy is private insurance that works alongside Original Medicare Parts A and B. Medicare pays first for covered services, and the supplement pays according to the standardized benefits of its plan letter.
Have TRICARE For Life or CHAMPVA? Those benefits may already pay second to Medicare for many eligible services. Do not assume a separate Medigap premium is necessary. Compare the coordination rules in the Veterans and Medicare guide first.
What Is a Medicare Supplement?
Medigap does not replace Medicare. You remain enrolled in Original Medicare, continue paying the Part B premium and pay a separate premium to the private insurance company for the supplement.
When you receive a Medicare-covered service, Original Medicare generally processes the claim first. The Medigap policy then pays its share of specified deductibles, copayments or coinsurance. A supplement normally does not make a service covered when Original Medicare excludes it.
Medigap policies sold today generally do not include outpatient prescription coverage. Someone using Original Medicare with Medigap usually compares a separate Medicare Part D plan using their exact prescriptions and pharmacies. Before delaying drug coverage, verify whether any current insurance is creditable prescription drug coverage and understand how the Part D late-enrollment penalty can apply.
What Can Medigap Cover?
Benefits available in standardized plans
- Part A hospital coinsurance and additional hospital days
- Part B coinsurance or copayments
- The first three pints of blood
- Part A hospice cost sharing
- Skilled nursing facility coinsurance on specified plans
- The Part A deductible on specified plans
- Foreign-travel emergencies on specified plans and within limits
Items generally outside modern Medigap
- Routine outpatient prescriptions
- Routine dental, vision or hearing care
- Hearing aids or eyeglasses
- Long-term custodial care
- Private-duty nursing
- The Medigap and Part B premiums
Benefits depend on the plan letter. Use Medicare’s official benefit chart to compare the standardized coverage, then compare companies selling the letter you want.
Does a Medicare Supplement Have a Network?
A standard Medigap policy generally does not use a conventional local physician network. You can receive Medicare-covered care from healthcare providers throughout the United States who accept Medicare and are willing to treat you.
Nationwide access
Useful for people who travel, split time between states or use specialists outside their home community.
Specialists
Original Medicare generally does not require a plan referral to see a specialist, though Medicare coverage rules still apply.
Medicare SELECT
SELECT policies are an exception and may require particular hospitals or providers for full supplemental benefits.
If travel is important, review how Medicare coverage works away from home, including domestic and foreign-emergency limits.
Why Do Companies Charge Different Prices for the Same Plan?
In most states, Medigap policies are standardized by letter. The medical benefits of one company’s Plan G match another company’s standard Plan G; the same is true for Plan N and other standardized letters.
Companies can differ in premium, rating method, household and payment discounts, underwriting guidelines, service and rate history. Once you choose a plan letter, compare like with like.
| Plan | General structure | Important tradeoff |
|---|---|---|
| Plan G | Covers most standardized gaps after the annual Part B deductible. | Often has a higher premium than Plan N but fewer routine bills. |
| Plan N | Covers most major gaps but permits certain office and ER copays. | Does not cover Part B excess charges; premium may be lower. |
| High-deductible Plan G | Coverage begins after the annual high deductible is met. | Lower premium may come with substantially more initial exposure. |
| Plan F | Includes the Part B deductible. | Only available to people eligible for Medicare before January 1, 2020. |
For a detailed look at popular options, review how Medicare Supplement Plan G works, how Medicare Supplement Plan N works and compare Medicare Supplement Plan G and Plan N.
When Can You Buy a Medicare Supplement?
Your strongest federal protection is a one-time six-month Medigap Open Enrollment Period. It begins the first month you are both at least 65 and enrolled in Medicare Part B.
During that period, an insurer cannot deny one of the Medigap policies it sells or charge more because of current or past health problems. This is separate from Medicare’s fall Annual Enrollment Period.
If you are coordinating Parts A and B, employer coverage and Medigap around your birthday, use the Turning 65 Medicare checklist to work through the decisions in order.
After the six-month period ends, an insurer may use medical underwriting unless a federal guaranteed-issue right or additional state protection applies.
Underwriting and Guaranteed-Issue Rights
When medical underwriting applies, a carrier may ask health questions, review medical or prescription information, offer an available rate or decline the application. Guidelines vary by carrier.
Guaranteed-issue rights protect specified policies after qualifying events such as certain coverage losses, plan terminations or Medicare Advantage trial situations. Deadlines and documents matter.
Keep coverage-end notices, dated envelopes, emails and proof of prior coverage. Do not cancel current coverage until replacement approval and effective dates are confirmed.
Missouri and Illinois Medigap Protections
Missouri anniversary protection
Missouri gives qualifying Medigap policyholders an annual guaranteed-issue opportunity around their policy anniversary. Missouri DCI currently describes the application period as beginning 30 days before the policy anniversary and ending 30 days after it. The protection generally allows a move to the same Medigap plan with another company if that plan is available; specified guaranteed-issue alternatives may apply if it is not.
Illinois birthday protection
Eligible policyholders ages 65 through 75 have a 45-day period beginning on their birthday to buy qualifying Medigap coverage with equal or lesser benefits from the same issuer or an affiliate authorized to transact business in Illinois.
Illinois under-65 disability rights
Illinois also gives people under 65 who qualify for Medicare because of disability a protected Medigap application period tied to Part B, plus another Medigap Open Enrollment Period when they turn 65.
State protections have exact age, carrier, plan, timing and documentation requirements. Confirm the applicable rule before ending current coverage.
How Are Medigap Premiums Priced?
Community-rated
The base premium generally is not based on age, but inflation and other approved factors can still raise it.
Issue-age-rated
The premium uses age when the policy is issued. It does not rise merely because you age, but other increases can apply.
Attained-age-rated
The premium uses current age and may rise as you get older as well as for other approved reasons.
No rating method guarantees the lowest long-term cost. Compare actual premium, age treatment, discounts and available switching rights. Read how attained-age, issue-age and community-rated Medigap premiums work.
Medigap Versus Medicare Advantage
Medigap supplements Original Medicare. Medicare Advantage is another way to receive Part A and Part B benefits through a private plan. You cannot use Medigap to pay Medicare Advantage plan costs.
| Consideration | Original Medicare with Medigap | Medicare Advantage |
|---|---|---|
| Providers | Generally any U.S. provider accepting Medicare | Plan networks and service areas commonly apply |
| Medical costs | Supplement pays standardized benefits | Plan-specific copays and coinsurance |
| Drug coverage | Separate Part D generally needed | Included in many plans |
| Additional benefits | Routine dental, vision and hearing generally excluded | May include additional benefits |
| Changing later | New Medigap application may be underwritten | Changes permitted during applicable election periods |
For the full structural decision, compare Medicare Advantage vs. Medicare Supplement on costs, networks, Part D, extra benefits and flexibility. If you are specifically considering leaving Medicare Advantage, review whether Medigap acceptance is protected before making the election.
Medicare Supplement Questions
Is Medigap the same as Medicare Advantage?
No. Medigap works alongside Original Medicare. Medicare Advantage provides Medicare benefits through a private plan.
Do Medicare Supplements cover prescriptions?
Modern Medigap policies generally do not include outpatient prescriptions. A separate Part D plan is commonly used.
Can I see any doctor?
You can generally use any U.S. provider who accepts Medicare and is willing to treat you. Medicare SELECT can have additional provider requirements.
Can I switch Medigap at any time?
You can apply, but underwriting may apply unless open enrollment, guaranteed issue or a state rule protects the change.
Can my policy be canceled if I become sick?
Standard Medigap policies issued since 1992 are generally guaranteed renewable when premiums are paid and the application was truthful.
Independent Medicare guidance
Compare Medicare Supplement Options
Thompson Medicare Brokerage can help you compare plan benefits, premiums, enrollment rights and carrier options in Missouri and Illinois. Consultations are no-cost and no-obligation.
Thompson Medicare Brokerage is a non-government insurance agency. This page provides general educational information. Policy availability, premiums, underwriting, eligibility and enrollment rights vary by applicant, carrier, state and effective date.