Medicare Supplement Coverage (Medigap)

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A Medicare Supplement Insurance (Medigap) policy helps pay some of the health care costs that Original Medicare doesn’t cover, like Copayments, Coinsurance, and Deductibles. Medicare Supplement Insurance (Medigap) provides coverage for gaps in medical costs not covered by Medicare. Medicare Supplement plans (Medigap) are standardized and offer various benefits to help offset your healthcare cost. Some Medigap policies also cover services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S.

If you elect to use Original Medicare, it can be very beneficial to purchase Medigap (Medicare Supplement Insurance) if you are financially able. There could be a lot less out-of-pocket costs if you purchase Medigap (Medicare Supplement Insurance). Medicare Supplement Coverage (Medigap) policies are purchased from private insurers.

Generally, Medigap policies do not have networks of providers. You can go to any doctor that accepts Medicare.
Generally, Medigap policies do not require referrals. You can go to any doctor that accepts Medicare and accepts new patients without referrals.

As of 9/2023, approximately 66.5 million people are on Medicare. That’s up from 57 million in 2016 and up from 63.6 million in 2021. In 2023, 34 million people (over 51%) are enrolled in Original Medicare. As of 2023, 44% (14.96 million) of Original Medicare beneficiaries have a Medigap policy. That’s up 5.5% from 2021 when about 38.5% (14.5 million) of Original Medicare beneficiaries had a Medigap policy. That’s up from 20 percent in 2016. ” In 2023, more than 32.5 million people are enrolled in a Medicare Advantage plan, accounting for 49 percent of the total Medicare population.”

If you are enrolled in a Medicare Advantage plan (Part C) you cannot purchase Medicare Supplement Coverage (Medigap).

You must have Medicare Part A and Part B to purchase Medicare Supplement Coverage (Medigap).

Here is a good publication from Medicare covering Medicare Supplement plans (Medigap).
2024 Choosing a Medigap Policy – A Guide to Health Insurance for People with Medicare.
At this time, there is no comparable 2025 document to be found for Choosing a Medigap Policy.
However, you can go to the Medicare “How to compare Medigap policies” website for information.

The Official U.S. Government Medicare Handbook.

Medicare Supplement Coverage (Medigap) policies are purchased from private insurers.

Medicare Supplement Coverage (Medigap) policy costs vary. Costs May include:

Premium
coinsurance or co-pays

As with most any of the Medicare options, coverage can vary and out-of-pocket limits and maximum payouts can vary.

You can go to the Medicare “How to compare Medigap policies” website to get a summary of the basic offering for the different Plans A through N.
Plan A has the least coverage.
Plans D, G and N have the most coverage (as of right now).

FIND A MEDIGAP POLICY
You can use the Medicare site to Find a Medigap Policy in your area. However, you’ll have to contact the company to enroll. You will enter a zip code.

A list of the types of Medigap policies (Plans A through N) is displayed. You can go to the Compare Medigap plans page to get a summary of the basic offering for the different Plans A through N.

At the top of the page you can elect to enter more information to get a more accurate price (i.e. age, sex, tobacco user).

For each of the Plans (A through N) available in your area you can look at the “Plan Details” or “View Policies” that offer the plan type in your area.

Plan A has the least coverage.

Plans D, G and N have the most coverage (as of right now).

Plans C and F are being discontinued.

When selecting “View Policies” for any of the Plans (A through N) a list of companies is initially shown, maybe with a word or two identifying the type of policy. Select the “View company website” link to go to that company’s website or call them to get more information.

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If you have a Medicare Advantage Plan, it’s illegal for anyone to sell you a Medigap policy unless you’re switching back to Original Medicare.

Medigap policies generally don’t cover long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing.

Every Medigap policy must follow federal and state laws designed to protect you, and it must be clearly identified as “Medicare Supplement Insurance.” Insurance companies can sell you only a “standardized” policy identified in most states by letters.

All policies offer the same basic benefits but some offer additional benefits, so you can choose which one meets your needs. Policies can have out of pocket limits and will vary on what is covered.

Make sure your chosen Medigap plan is portable, in case you want to move.

After January 1, 2020, Medicare Supplement (Medigap) Plans C and F are discontinued and you will not be able to enroll in Medicare Supplement (Medigap) Plan C or F. That means that people whose birthday is December 31, 1954 (turning 65 on December 31, 2019) are the last group able to enroll in Medicare Supplement Plan F or C. If you signed up for Plan C or F and choose to keep the plan, there is no way to know at this time if the premiums will rise too much. Plan D and G are good alternatives.

As of 2024 Medigap standard benefits include:

Medicare Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up
Medicare Part B coinsurance or copayment (except Medigap plan types K, L, and N are a little different, check the Medigap compare link)
Blood (first 3 pints) (except Medigap plan types K and L are a little different, check the Medigap compare link)
Medicare Part A hospice care coinsurance or copayment (except Medigap plan types K and L are a little different, check the Medigap compare link)
Skilled nursing facility care coinsurance (except Medigap plan types A and B. Medigap plan types K and L are a little different, check the Medigap compare link)
Medicare Part A deductible (except Medigap plan type A. Medigap plan types K, L and M are a little different, check the Medigap compare link)
Medicare Part B deductible (only Medigap plan types C and F, both of which were discontinued in 2020)
Medicare Part B excess charge (only Medigap plan types F and G, plan F will be discontinued in 2020) Excess Charges are “If you have Original Medicare, and the amount a doctor or other health care provider is legally permitted to charge is higher than the Medicare-approved amount, the difference is called the excess charge.”
Foreign travel exchange (up to plan limits, e.g. $50,000.00) (80% only with Medigap plan types C, D, F, G, M, and N). Not available with plans A, B, K, and L.
Out-of-pocket limit – (Not applicable (N/A) except for Plan types K and L) “After you meet your out-of-pocket yearly limit and your yearly Part B deductible, the Medigap plan pays 100% of covered services for the rest of the calendar year.”

Medicare will cover an annual wellness visit, but not an annual physical.
The Medicare Wellness exam includes the assessments, but none of the “physical” tests where the doctor has to physically touch you. Under Medicare, a doctor will only perform these types of services if there is a specific diagnosis or symptom which necessitates that type of examination.

It does not appear that any Medicare Supplement (Medigap) coverage includes an annual physical.

Any additional tests or labs that may be required as a result of the findings of your annual wellness visit would be billed separately by your doctor and would fall under a different benefit than your annual wellness visit.

Medicare Wellness Visit vs Annual Physical

It is possible you will want to schedule a physical on a regular basis in addition to the Medicare Wellness exam, although there will probably be a out-of-pocket cost involved.
It is possible issues will be detected with a physical that would not be detected with a Medicare Wellness exam.

Medigap Policies are lettered From A to N.

All policies offer the same basic benefits but some offer additional benefits, so you can choose which one meets your needs.

Medigap plans are standardized differently in Massachusetts, Minnesota, and Wisconsin. Scroll down to the state links with the topic “Important: In Massachusetts, Minnesota, and Wisconsin, Medigap policies are standardized in a different way.”

Medigap Plans K and L policies can have out of pocket limits.
After you meet your out-of-pocket yearly limit and your yearly Part B deductible, the Medigap plan pays 100% of covered services for the rest of the calendar year. Note, Plans K and L initially only pay 50% to 75% of certain services.

Medigap policies generally don’t cover long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing.

If you have a Medicare Advantage Plan, it’s illegal for anyone to sell you a Medigap policy unless you’re switching back to Original Medicare.

If you want to switch to Original Medicare from a Medicare Advantage policy and buy a Medigap policy, contact your Medicare Advantage Plan to see if you’re able to disenroll.

NOTE you may not be able to purchase a Medigap policy after having a Medicare Advantage policy and if you can it may be much more expensive.

You may have special rights under federal law to buy a Medigap policy, if you joined a Medicare Advantage Plan for the first time, and you aren’t happy with the plan. Go to the “What are guaranteed issue rights?” link for more information.

You have these rights if you return to Original Medicare within 12 months of joining. There are other ifs, ands, and buts that should be researched before signing up for Medicare for the first time (e.g. when you turn 65). At this site, scroll down to the “What are guaranteed issue rights?” link for additional information. One of the guaranteed issue rights is a “Trial Right” where “You joined a Medicare Advantage Plan or Programs of All-inclusive Care for the Elderly (PACE) when you were first eligible for Medicare Part A at 65, and within the first year of joining, you decide you want to switch to Original Medicare. “ topic after selecting the guaranteed issue rights link.

Guaranteed issue rights (also called “Medigap protections”) (scroll down to the “What are guaranteed issue rights?” link for additional information) are rights you have in certain situations when insurance companies must offer you certain Medigap policies. Thus allowing you to return to Original Medicare and drop the Medicare Advantage Plan.

Medigap Policies for Supplement Plan C and F are being discontinued.

“Of the 500,000 beneficiaries enrolled in Medicare Supplement in 2010, more than half (53%) had Plan C or Plan F, reports Kaiser Family Foundation (KFF). Of the ten Medicare Supplement plans available in most states (A, B, C, D, F, G, K, L, M, N), Plan C and Plan F are the only two Medicare Supplement plans that cover the Medicare Part B deductible. Plan F is one of the most comprehensive Medicare Supplement plans available.”

“The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) passed by Congress and signed into law on April 16, 2015 changed the law on various aspects of health care, including some Medicare Supplement plans.”

Plan F. The new law states that on or after January 1, 2020, a Medicare Supplement policy that provides coverage of the Part B deductible may not be sold or issued to a newly eligible Medicare beneficiary. That means that people whose birthday is December 31, 1954 (turning 65 on December 31, 2019) may be the last group able to enroll in Medicare Supplement Plan F.
If you already have Plan F, you can keep it. The law only affects new enrollees.

Plan C. After January 1, 2020, you will not be able to enroll in Medicare Supplement Plan C, one of the closest alternatives to Plan F, either, since it also covers the Part B deductible.
If you already have Plan F, you can keep it. The law only affects new enrollees.

If you signed up for Plan C or F and choose to keep the plan, there is no way to know at this time if the premiums will rise too much. Plan D and G are good alternatives.

In 2025 the Part B deductible is $257.00, up from $240.00 in 2024, up from $226.00 in 2023, up from $233.00 in 2022, up from $203.00 in 2021. In 2020 the Part B deductible was $198.00, up $13.00 from 2019, in 2019 the Part B deductible only went up $2.00 to $185.00 from 2018 Part B deductible of $183 per year.

Medicare Supplement Plans D and G may be the best alternatives once Plan C and Plan F are discontinued.

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