What is a Medigap plan?

What Medigap does

Original Medicare — Part A (hospital) and Part B (medical) — covers a wide range of healthcare services. But it does not cover everything. When you receive care, you are often responsible for deductibles, copayments, and coinsurance. Those out-of-pocket costs can add up, especially if you need frequent medical care or an extended hospital stay.

A Medicare Supplement plan (commonly called a Medigap plan) is a private insurance policy that works alongside Original Medicare. Its purpose is to help pay some or all of the costs that Medicare leaves behind.

Medigap is not a replacement for Medicare. It is a companion to it. You keep Original Medicare, and the Medigap plan picks up portions of the bill that Medicare does not pay.

How it works in practice

When you visit a doctor or hospital that accepts Medicare:

1. Medicare processes the claim and pays its share.
2. Your Medigap plan then pays some or all of the remaining balance, depending on which plan letter you have.

In most cases, the process happens automatically. You do not need to file separate claims with your Medigap insurer.

Standardized plan letters

One of the most important things to understand about Medigap is that the plans are standardized by the federal government. Each plan is identified by a letter — Plan A, Plan B, Plan G, Plan N, and so on.

The benefits for each letter are the same regardless of which insurance company sells the policy. A Plan G from one company covers the same things as a Plan G from another. What differs between companies is the premium — what you pay each month — and possibly the customer service experience.

This standardization makes comparison simpler than it might seem. Once you know which plan letter fits your needs, you can focus on comparing prices and companies rather than trying to decode different benefit structures.

What Medigap typically covers

While coverage varies by plan letter, Medigap plans can help with costs like:

• Part A coinsurance and hospital costs — after Medicare pays its share
• Part B coinsurance or copayment — the 20% of approved charges you would otherwise owe
• Part A hospice care coinsurance or copayment
• Blood — the first three pints per year
• Skilled nursing facility care coinsurance
• Part A deductible
• Part B deductible (only certain plans, and this option is limited for new enrollees)
• Part B excess charges — amounts above what Medicare approves
• Foreign travel emergency care — limited coverage when traveling outside the U.S.

Not every plan covers every item on this list. The plan letter determines which benefits are included.

What Medigap does not cover

Medigap plans generally do not cover:

• Prescription drugs (a separate prescription drug plan covers those)
• Vision or dental care
• Hearing aids
• Long-term care
• Private-duty nursing

Who is eligible

To enroll in a Medigap plan, you typically need to:

• Be enrolled in both Medicare Part A and Part B
• Live in the state where the plan is offered

If you can choose your timing, enroll during your Medigap Open Enrollment Period — the six-month window that starts the month you turn 65 and are enrolled in Part B. During this period, insurance companies generally cannot deny you coverage or charge you more based on your health history.

After that window closes, you may still be able to apply, but the insurance company may use medical underwriting to decide whether to accept you and how much to charge.

Medigap is one way — not the only way — to structure Medicare coverage

Medigap is specifically a companion to Original Medicare: Medicare pays first, your plan helps with the cost-sharing that remains, and you can generally see any provider in the country who accepts Medicare.

There are other arrangements that deliver Medicare benefits through private plans under different rules — different networks, costs, and enrollment periods — and the two approaches generally cannot be combined. If you want free, unbiased counseling on the different structures before deciding, call 1-800-MEDICARE or contact your local SHINE office (Serving Health Insurance Needs of Elders), Florida’s free counseling program for seniors.

Want to talk it through?

If you are trying to figure out whether a Medigap plan makes sense for your situation, I am happy to walk you through it. Get in touch — no pressure, no obligation.