Plan A
What it covers:
The 20% of outpatient treatment care charges that Original Medicare does not
Explore Medigap vs. Medicare Advantage Insurance Plans
Medigap plans, also known as Medicare Supplement plans, exist to supplement the coverage provided by the federal government via Original Medicare (Parts A & B). Medicare Advantage plans offer the same coverage as Original Medicare, plus various additional benefits.
Read on to learn more about the differences between Medigap and Medicare Advantage plans.
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Medigap vs. Medicare Advantage plans
While Medigap and Medicare Advantage are both provided by private insurance carriers, the similarities pretty much end there. Medigap, also known as Medicare supplement, exists to provide additional benefits and lower the costs associated with Original Medicare (Parts A & B, coverage delivered by the federal government). Medicare Advantage, on the other hand, is a private-sector alternative to Original Medicare, providing all of the same coverage as Parts A & B but with additional optional benefits that differ by specific plan.
What Medicare Advantage covers
All Medicare Advantage policies are required to offer equivalent coverage for hospital and hospice care, medical insurance, and preventative care as the federally provided Original Medicare. Medicare Advantage plans also entice potential policyholders with additional benefits such as vision, dental, wellness programs, and gym memberships.
What Medicare supplemental insurance covers
To enroll in a Medicare supplement plan, you must first be enrolled in Original Medicare (Parts A & B) to receive governmental coverage. Instead of replacing Original Medicare, Medigap plans fill in the—you guessed it—gaps in your coverage, helping to pay for copayments, coinsurances, and other costs that may come up.
Medigap insurers can make available up to 10 different plans, each noted by a letter, explained in more detail below. These plans are standardized across 47 of the 50 U.S. states, so you’ll always know what you’re getting with a Medigap Plan C, for example, no matter where you are.
Note: Medigap plans are standardized differently in Massachusetts, Minnesota, and Wisconsin, which may change your coverage options.
All Medigap plans cover, in part or in whole:
Medicare Part A coinsurance
Part B coinsurance
Up to 365 hospital days after Medicare benefits are used
Hospice care coinsurance
Three pints of blood
Depending on the specific plan you choose, you may also receive additional coverage:
Part A hospital deductible costs
Skilled nursing facility coinsurance costs
Foreign travel emergency coverage
Medigap coverage does not extend to prescription drugs
How does Medigap Supplemental Insurance work?
Medicare supplemental insurance plans are for individuals only, so if spouses both want Medigap coverage, each will need their own plan. You must be enrolled in Original Medicare already to enroll in a Medigap plan.
When you get care, Medicare pays its approved amount of the costs. With most Medigap policies, your private supplemental carrier receives information directly from Medicare and pays its portion directly to the health care provider. With some carriers, you will need to make claims yourself to receive the funds—be sure to check upfront how your chosen carrier handles payment before signing up.
As long as you pay your Medigap premiums, you will keep your plan—standardized policies renew yearly, automatically.
Different Medicare Supplement plan types:
Plan B
What it covers:
The 20% of outpatient treatment care charges that Original Medicare does not
The Medicare Part A hospital deductible
Plan C
What it covers:
All out-of-pocket Medicare costs except Medicare excess charges
Plan D
What it covers:
All out-of-pocket Medicare costs except Medicare excess charges and the Medicare Part B deductible
Plan F
What it covers:
All out-of-pocket Medicare costs
Note: Plan F is only available for those who qualified for Medicare before 2020.
Plan G
What it covers:
All out-of-pocket Medicare costs except for the Medicare Part B deductible
Plan K
What it covers:
100% of Medicare Part A copayment or coinsurance
50% coverage for:
Part B coinsurance or copayment
Your first 3 pints of blood
Skilled nursing facility care coinsurance
Part A deductible
Plan L
What it covers:
100% of Medicare Part A copayment or coinsurance
75% coverage for:
Part B coinsurance or copayment
Your first 3 pints of blood
Skilled nursing facility care coinsurance
Part A deductible
Plan M
What it covers:
100% coverage for:
Medicare Part A copayment or coinsurance
Part B coinsurance or copayment
Your first 3 pints of blood
Skilled nursing facility care coinsurance
50% coverage for:
Part A deductible
Plan N
What it covers:
Partial coverage for:
Medicare Part A copayment or coinsurance
Part B coinsurance or copayment
Your first 3 pints of blood
Skilled nursing facility care coinsurance
Part A deductible
Note: Plan N offers lower premium costs in exchange for out-of-pocket copayments for the above coverage.
Medigap insurance plans: side-by-side
View the table below for a complete picture of what’s covered and what’s not with each of the available Medicare supplement plans.
Benefit Coverage | Plan A | Plan B | Plan C | Plan D | Plan F* | Plan G* | Plan K | Plan L | Plan M | Plan N |
|---|---|---|---|---|---|---|---|---|---|---|
Medicare Part A | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Partial |
Medicare Part B | Yes | Yes | Yes | Yes | Yes | Yes | 50% | 75% | Yes | Yes** |
Blood (first three pints) | Yes | Yes | Yes | Yes | Yes | Yes | 50% | 75% | Yes | Yes |
Hospice | Yes | Yes | Yes | Yes | Yes | Yes | 50% | 75% | Yes | Yes |
Skilled nursing facility coinsurance | No | No | Yes | Yes | Yes | Yes | 50% | 75% | Yes | Yes |
Medicare Part A deductible | No | Yes | Yes | Yes | Yes | Yes | 50% | 75% | 50% | Yes |
Medicare Part B deductible | No | No | Yes | No | Yes | No | No | No | No | No |
Medicare Part B excess charges | No | No | No | No | Yes | Yes | No | No | No | No |
Foreign travel emergency coverage | No | No | 80% | 80% | 80% | 80% | No | No | 80% | 80% |
Out-of-pocket limit*** | N/A | N/A | N/A | N/A | N/A | N/A | $7,060 | $3,530 | N/A | N/A |
*Plans F & G offer a high deductible plan in some states
**Plan N pays 100% of the costs of Part B services, except for copayments for some office visits and some emergency room visits.
***Plans K & L show how much they'll pay for approved services before you meet your out-of-pocket yearly limit and Part B deductible. After you meet them, the plan will pay 100% of your costs for approved services.
Medigap vs. Medicare Advantage: how to choose
Because Medigap requires Original Medicare enrollment, you cannot enroll in both Medicare Advantage and Medicare supplemental coverage. Both options require monthly premium costs.
Medicare Advantage may offer the coverage and additional benefits you want if you are okay working with a pre-chosen network of physicians, hospitals, and other health care providers. If, on the other hand, you want access to more options, Medigap plans offer the freedom to see any doctor or visit any hospital that accepts Medicare.
Both options have their benefits and their drawbacks. We recommend comparing plans and benefits before you enroll in Medicare to choose the direction that fits you best.
Frequently asked questions about Medigap plans
Who is eligible for Medicare Supplemental Insurance Plans?
You must enroll in Original Medicare (Parts A & B) for coverage through the federal government to be eligible for Medicare supplemental insurance. Once you have enrolled in Medicare Parts A & B, your enrollment period lasts for six months; during this time, you can choose the Medigap plan that best fits your needs and budget.
What isn’t covered by Medigap plans?
Because Medigap plans supplement the coverage you get from Original Medicare, any costs associated with additional benefits you might get from a Medicare Advantage or Medicare Part D prescription drug plan are not covered.
If you need any of the following coverage, you may want to consider a Medicare Advantage and/or Medicare Part D plan instead of going with Original Medicare plus Medigap.
Long-term (nursing home) care coverage
Vision coverage
Dental coverage
Hearing aid coverage
Private duty nursing coverage
Prescription drug coverage
When is the best time to purchase a Medigap plan?
The Medigap enrollment period lasts for six months after you enroll in Original Medicare (Parts A & B) for the first time. Depending on your state, you may be unable to enroll in Medigap after this period; if you can, it may come at a much higher cost.
Are my Medigap options limited based on the state I live in?
In 47 of the 50 states, available Medigap plans are standardized.
Massachusetts, Minnesota, and Wisconsin each have separate regulations and plan types.
To find the most accurate information on the Medigap options available in your area, speak to one of our expert, licensed agents.