Medicare supplement plans, also known as Medigap coverage, provide additional coverage for Original Medicare beneficiaries to help with out-of-pocket costs. There are several standardized plans available and three different methods of cost determination of the coverage: attained age, issue age, or community rated Medigap plans. Understanding if a Medigap plan is right for you and the cost involved is vital before Medicare enrollment.
Medigap plans are supplemental insurance only available to those with Original Medicare, and usually, it's a one-time offering within the first six months after enrolling in Medicare.
Medigap and Medicare Advantage are not the same. Medicare Advantage is Medicare Part C and offers different benefits than a Medigap Plan. One cannot have both.
The cost of a Medigap plan depends upon which insurance company is providing the coverage and the type of plan purchased: Issue Age, Attained Age, or Community Rated.
Issue Age Medigap plans have costs determined by your age when you first purchase the plan versus Attained Age plans, which increase in costs over time as you age.
Community Rated Medigap Plans are not based on your age and tend to be the least expensive over a lifetime.
Medigap plans are Medicare supplemental or “extra” insurance that can be purchased from a health insurance company. It helps to cover additional costs or out-of-pocket expenses beyond Original Medicare. It’s important to note that you cannot buy Medigap insurance unless you have original Medicare and must have both Parts A and B Medicare.
Medigap enrollment is usually a one-time occurrence during the first six months of starting Medicare Part B. There are some situations in which one may be able to enroll at a later period, such as if the individual has a guaranteed issue right (your health insurance coverage is dropped or changes in some way) or if the insurance company agrees to sell the Medigap policy to the individual, although they are not required if outside the initial enrollment period. Also, some states have different rules regarding Medigap enrollment.
The cost of a Medigap plan depends on which insurance company provides the policy and how the plan is rated. There are three types of Medigap plans: community rated, attained age rated, or issue age rated. It’s important to consider if a Medigap plan is right for you before enrolling in Medicare so you can prepare.
What do Medigap plans cover?
Generally, Medigap coverage helps cover original Medicare out-of-pocket expenses, like copayments and deductibles. Some may even cover travel emergency medical costs when vacationing outside of the United States. Costs that aren’t likely covered are long-term or custodial care in a nursing home, vision or dental care, hearing aids, eyeglasses, private nurses, or prescription drug costs (this is available through Medicare Part D).
Attained-Age, Issue-Age and Community-Rated Medigap plan costs
The Medigap plan's cost may differ depending on the insurance company providing the coverage. The type of plan rating also affects the cost of the supplemental plan. Understanding how they set the price is important so you will know how to plan for costs now and going forward.
There are three main ways in which a Medigap plan cost is determined:
|Medigap Plan Rating||Summary|
|Issue Age Rated|
|Attained Age Rated|
Community Rated Medigap Plans are sometimes called “no age” rated plans, meaning the cost is not based on age, and the same amount is charged despite the number of years you live. Over a lifetime, these tend to be the least expensive type of Medigap coverage. According to the U.S. Department of Health and Human Services, Community Rated plans are the only types of Medigap coverage allowed in Connecticut, Maine, Minnesota, New York, Vermont, and Washington.
This Medigap plan is also called an “entry age” rated plan. This type of plan is based on your age when you first purchased the Medigap policy. It may be best to buy this plan while you are young because your cost will generally be lower as it will be based on your age when first starting the plan. Also, it won’t increase based on your age. This may be the least expensive plan for some individuals if the plan is purchased as soon as one is eligible for Medicare.
These plans increase in cost as you get older, and the cost changes as you age. These plans cost less and may even be less expensive than a Community Rated plan when first purchased. However, over time, they can become the most expensive plans. It may be appealing initially, but the expenses grow over time. This plan type seems to be the most common Medigap plan available in most states.
Other Medigap factors
It’s important to note that with all three plans, costs can rise based on inflation or other factors and not just age. Also, not all three plans may be available in all states. Some states may only have one type of Medigap plan for purchase. When shopping for a Medigap plan, remember that you will want to compare the same plan type, which is generally labeled by a letter, across insurance companies.
It’s imperative to remember that not all plans cost the same and may vary widely across insurance companies, even if the plans have the same coverage. To understand how your costs may change, asking questions and knowing if the policy is priced based on community, issue, or an attained age rating is essential.
To find Medigap policies in your state visit the Medicare website.
For additional help with Medigap policies call your State health Insurance Assistance Program (SHIP) or a local licensed health insurance agent, which are free to use and knowledgeable about plans available in local communities.
Medigap plans vs Medicare Advantage
Medigap plans differ from Medicare Advantage Plans, or Medicare Part C. However, having a Medigap plan in addition to Medicare Advantage is impossible. You can have one or the other but not both. Medigap plans are only available to those enrolled in Original Medicare. It’s important to determine if one would like a Medicare Advantage plan or enroll in Original Medicare with a Medigap supplemental plan.
Some things to consider when deciding:
- Medicare Advantage (MA) covers many services that the original Medicare plus Medigap plan does not cover. For example, MA plans offer additional benefits that fee-for-service Medicare plus Medigap coverage does not provide. Such benefits may include dental, vision, hearing, meals, and sometimes gym memberships.
- Medigap does not cover prescription costs. One must add Medicare Part D to their original Medicare or join a Medicare Advantage plan that includes Part D.
- A possible disadvantage of MA plans is that they may have a narrower provider network, and services may require prior authorizations when Original Medicare often does not; however, MA plans often result in higher quality of care.
- Research has shown that Medigap plans may lead to overconsumption of unnecessary healthcare services and a lower quality of care.
Types of Medigap plans
The table lists the 10 different Medigap plans, briefly describing what they cover.
|Medigap Plan A||Covers Medicare Part A coinsurance, Part B coinsurance, blood transfusions, and coinsurance for hospice at 100%.|
|Medigap Plan B||Covers the items in Plan A above plus Part A deductibles at 100%.|
|Medigap Plan C||Covers the items in Plans A and B above, plus coinsurance for skilled nursing facilities and Part B deductibles at 100%. It also covers travel out of the country emergency care at 80%.|
|Medigap Plan D||Covers the same items as Plan C above except for Part B deductibles.|
|Medigap Plan F||Covers all the items in Plan C, including Part B deductibles, plus covers Part B excess charges at 100%. In some states, Plans F and G may be a high-deductible plan.|
|Medigap Plan G||Covers all the items in Plan F except for Part B deductible. In some states, Plans F and G may be a high-deductible plan.|
|Medigap Plan K||Covers Part A coinsurance at 100%. Also, it will cover Part B coinsurance, blood, hospice coinsurance, skilled nursing facility coinsurance, and Part A deductibles at 50% before you meet the out-of-pocket limit and Part B deductible. This plan will cover these services listed at 100% once the deductible and out-of-pocket limits are reached.|
|Medigap Plan L||Covers Part A coinsurance at 100%. Also, it will cover Part B coinsurance, blood, hospice coinsurance, skilled nursing facility coinsurance, and Part A deductible at 75% before you meet the out-of-pocket limit and Part B deductible. This plan will cover these services listed at 100% once the deductible and out-of-pocket limits are reached.|
|Medigap Plan M||Covers Medicare Part A coinsurance, Part B coinsurance, blood transfusions, hospice coinsurance, and coinsurance for skilled nursing facility care at 100%. Also, it will cover Part A deductibles at 50% and emergency care while out of the country at 80%.|
|Medigap Plan N||Covers Medicare Part A coinsurance, Part B coinsurance, blood transfusions, hospice coinsurance, coinsurance for skilled nursing facility care, and Part A deductibles at 100%. Also, it will cover emergency care while out of the country at 80%. It's important to note that Part B coinsurance is covered at 100% however, some office visits may still require a $20 copay, and an emergency room visit that doesn't result in an admission may require up to a $50 copayment.|
Is Medigap coverage available to all Medicare beneficiaries?
Medigap supplement plans are only available to those who enroll in the Original Medicare plan. It is not an option for those enrolled in a Medicare Advantage plan.
Do I have to purchase a Medigap plan?
No, it’s optional; however, one only has a six-month window from first enrolling in Medicare to make a decision to purchase additional coverage.
Are all Medigap plans priced the same?
It’s conditional based on the Insurance plan offering the Medigap plan and the type of rating of the plan. There are three types of plan ratings: Community Rated, Issue Age rated, and Attained Age Rated.
Are Community Rated Medigap plans available in every state?
No, some states don’t offer Community Rated plans, however some states strictly only offer these types of plans.
Which Medigap plan type rating is the best?
It depends, as many factors must be considered when contemplating a Medigap supplement plan. In most cases, Community Rated plans tend to be the least expensive and Attained Age plans may be the most expensive for those with long life expectancies.
- Centers for Medicare & Medicaid Services. Module: 3 – Medicare Supplement Insurance (Medigap Policies).
- U.S. Department of Health and Human Services. ASPE Report Variation and Trends in Medigap Premiums.
- Centers for Medicare & Medicaid Services. 2023: Choosing a Medigap Policy.
- NIH.gov. Medicare must provide additional cost and access information to enhance decision making around tradeoffs between Medicare Advantage and Medigap.
- Medicare.gov. Costs of Medigap Policies.
Show all references
- Medicare.gov. Learn How Medigap Works.