Introduction

  • Navigating Medicare can be overwhelming.

  • Common question: What is Medigap and do I need it?

  • This guide explains what Medigap is, how it works, and who it’s for.

What Is Medigap?

Definition

  • Medigap = Medicare Supplement Insurance

  • Private insurance that helps pay for costs not covered by Original Medicare (Parts A & B)

Costs Covered by Medigap

  • Copayments

  • Coinsurance

  • Deductibles

Purpose of Medigap

  • Reduces out-of-pocket costs

  • Provides predictable healthcare expenses

How Does Medigap Work?

Coordination with Medicare

  • Medicare pays its share of approved healthcare costs.

  • Medigap pays its share based on plan coverage.

Important Notes

  • Only works with Original Medicare (not Medicare Advantage).

  • Must be enrolled in Medicare Part A & B.

  • Policies sold by private companies but standardized federally.

What Do Medigap Plans Cover?

Standardized Plans

  • Labeled A, B, C, D, F, G, K, L, M, N

  • Each plan offers different levels of coverage

Typical Coverage Includes

  • Part A coinsurance & hospital costs

  • Part B coinsurance or copayments

  • Blood (first 3 pints)

  • Part A hospice care coinsurance/copayment

  • Skilled nursing facility coinsurance

  • Part A &/or Part B deductibles (depending on plan)

  • Emergency care abroad

Availability Notes

  • Not all plans available in every state

  • Some plans (e.g., Plan F) only available to those eligible before 2020

What Medigap Doesn’t Cover

  • Prescription drugs (need Part D)

  • Long-term care

  • Dental, vision, hearing

  • Private-duty nursing

When Should You Enroll in Medigap?

Open Enrollment Period

  • Six months starting the month you’re 65 and enrolled in Part B

Benefits of Enrolling Early

  • Guaranteed acceptance regardless of pre-existing conditions

  • Avoids medical underwriting later

Medigap vs. Medicare Advantage

Key Differences

  • Medigap supplements Original Medicare

  • Medicare Advantage replaces Original Medicare, often including extra benefits

Important Note

  • Cannot have Medigap and Medicare Advantage at the same time

  • Consider which option aligns best with budget and healthcare needs

Is Medigap Right for You?

Ideal Candidates

  • Want predictable healthcare costs

  • Travel frequently (some plans cover international care)

  • Prefer flexibility in choosing doctors/hospitals

Alternatives

  • Medicare Advantage if you want vision, dental, or prescription coverage bundled

Final Thoughts

  • Medigap reduces surprise medical bills and ensures manageable healthcare costs

  • Compare options carefully

  • Consult a trusted advisor to select the best plan

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