What it is
Medigap is the common name for Medicare Supplement insurance. It is sold by private insurance companies and is designed to help pay some of the out-of-pocket costs that Original Medicare does not cover on its own, such as certain copayments, coinsurance and deductibles.
Medigap works alongside Original Medicare (Part A and Part B). It is not a stand-alone health plan, and it does not replace Medicare. Medicare pays its share first, and then a Medigap policy may pay some or all of the remaining approved costs, depending on the policy.
Medigap policies are generally offered in standardized lettered plans. Plans with the same letter offer the same basic benefits no matter which company sells them, although the companies, rules and prices can differ. Medigap generally does not include things like drug coverage, and it is a different thing from a Medicare Advantage plan.
How it’s traditionally been approached
Many people consider Medigap when they first become eligible for Medicare, or when they want more predictable costs when they receive care. Some like that it is designed to work with Original Medicare and may allow them to see providers who accept Medicare nationwide.
Others prefer Medicare Advantage, which bundles coverage through a private plan and often includes extras such as drug coverage. These plans commonly use provider networks and may have different cost structures. Neither approach is right for everyone. The trade-offs usually involve monthly cost, flexibility in choosing providers, extra benefits and how much cost-sharing a person is comfortable with.
Timing has traditionally mattered with Medigap. There are periods when it is generally easier to enroll, and other times when insurers may be allowed to ask health questions. Rules and dates change and vary by state, so it is wise to confirm current details with Medicare.gov or 1-800-MEDIGAP.
How the right agent may help
An independent agent may help you sort through the many choices. A conversation often starts with your situation: your health needs, the doctors and hospitals you use, your budget, where you live and whether you travel. Agents may be able to explain how the lettered plans differ and how Medigap compares with other options.
A visit, whether by phone or in person, is generally an information-gathering conversation. You might ask which companies the agent can quote, how they are paid, whether they work with multiple carriers, and how plans in your state differ. It can also help to ask how premiums may change over time and what you would need to do if your needs change.
A good agent may also help you think through what Medigap does not cover, such as prescription drugs, and how that fits with the rest of your coverage. You are never obligated to buy, and it's reasonable to compare more than one source and take your time before deciding.
The bigger picture
Health coverage decisions can affect more than your wallet. Knowing roughly what you might owe when you need care can bring peace of mind, while uncertainty about bills can add stress at a time when you would rather focus on your health.
Because every person's needs and comfort with risk are different, it can help to approach the decision calmly and with good information. Talking it over with family, a trusted advisor or an independent agent may help you feel more confident in your choice. Providers.plus is one place to explore wider wellbeing resources.</p>
Keep in mind
- Medicare News is an independent directory, not a government site, and not a professional advisor. This page is educational only and is not medical, legal, tax or financial advice.
- Premiums, deductibles, plan availability and enrollment windows change often and vary by state, so confirm current numbers with Medicare.gov or 1-800-MEDIGAP.
- Medigap and Medicare Advantage each have real advantages and drawbacks. The better fit depends on your health, budget, providers and preferences.
- An agent may help you explore options, but no outcome is promised or guaranteed.
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Call 1-800-MEDIGAP →Frequently asked questions
What is Medigap in simple terms?
Medigap is private insurance, also called Medicare Supplement insurance, that may help pay some costs Original Medicare doesn't cover, like copayments, coinsurance and deductibles. It works alongside Original Medicare rather than replacing it. What each plan covers depends on the lettered plan you choose.
What is Medigap and how does it work with Medicare?
Medigap works as a second layer of coverage after Original Medicare pays its share of an approved service. The Medigap policy may then pay some or all of the remaining approved costs, depending on the plan. You generally pay a monthly premium to the insurance company for the policy.
Is Medigap the same as Medicare Advantage?
No, they are different. Medigap supplements Original Medicare, while Medicare Advantage is a private plan that takes the place of Original Medicare's delivery of benefits. In general, you can't use both together, and each has its own trade-offs in cost, network flexibility and extra benefits.
Does Medigap cover prescription drugs?
Medigap policies generally do not cover prescription drugs. People who want drug coverage typically look at a separate Medicare drug plan or at a Medicare Advantage plan that includes it. An agent or 1-800-MEDIGAP can explain the current options.
Who can buy a Medigap policy?
Medigap is generally for people who have Original Medicare Part A and Part B. Eligibility rules, enrollment periods and whether an insurer can ask health questions vary and can change. Check Medicare.gov or call 1-800-MEDIGAP for current details for your state.
How can an agent help me understand what Medigap is?
An independent agent may help by explaining the lettered plans, comparing companies and describing how Medigap fits with your other coverage. They may also answer questions about your situation. Agents are not a substitute for official sources, so it's wise to confirm key details with Medicare.gov or 1-800-MEDIGAP.
Educational resource. Medicare News shares general information and connects people with independent agents. It is not professional advice. Talk with a qualified professional about your own situation.