Medicare Supplement Plan
(Medigap)
Plans A to N
There are eleven standard Medigap policies available in most states. Each lettered plan — A through G and K through N — offers a different set of benefits, filling different gaps in Medicare Parts A and B coverage. All Medigap plans with the same letter provide the same benefits. Only the premiums and the sponsors of the plans vary.
Unlike other private Medicare insurance plans, Medigap plans are regulated by the states. And while the specific coverage in the 11 different types of plans are dictated by federal rules, the prices and availability of the plans depend on state rules.
Federal rules provide guaranteed issue rights for Medigap purchasers when they are new to Medicare and in some instances when they switch between Medicare Advantage and basic Medicare.
However, once the six-month period of federally mandated rights has passed, state rules take over determining the rights people have if they wish to buy new Medigap plans.
Medigap enrollment need to know
If you enroll into a Medigap plan during your one-time open enrollment window (within 6 months of your Part B effective date), there are no health questions. The insurance company will approve your application.
There are also no waiting periods or pre-existing condition exclusions when you apply during this window. If you miss this window and apply later on, then you will usually be required to answer medical questions and be underwritten. The underwriter at the insurance company can accept or decline you based on your medical history.
How do Medigap rules differ in different states?
Only four states – Connecticut, Massachusetts, Maine, and New York – extend guaranteed issue rights to Medigap for everyone age 65 or older. The other 46 states and the District of Columbia all have prohibitions and wrinkles, including three states – Massachusetts, Minnesota, and Wisconsin – that sell only one or two types of Medigap plans and depart from the 11 “letter” plans allowed under federal rules.
In most states, people can face higher Medigap rates or even coverage denials if they try and buy plans once their period of guaranteed issue rights has expired.
Another warning: If you drop your Medigap policy for any reason, you might not be able to get it back. Before dropping a plan, be sure you fully understand the Medigap laws in your state.
Generally, standard Medigap policies cover some or all of the cost of:
Your Part A deductible and coinsurance (i.e. the 20 percent Medicare doesn't cover) for hospital stays
Your portion of your doctor’s bills for Part B services
The first three pints of blood annually, if needed
Hospice care coinsurance
Medigap plans do not cover:
Long-term care to help you bathe, dress, eat or use the bathroom
Vision care, eyeglasses, hearing aids or dental care
Private-duty nursing
Prescription drugs, or any out-of-pocket costs for Part D plans
Freedom of Access & No Referrals Necessary
Medicare supplements also offer you the most freedom of access to providers. You have freedom to choose your own doctors and hospitals from among the 800,000+ Medicare providers in the nation. No referrals are necessary to see a specialist on this type of coverage.
Because these plans offer you the most freedom and flexibility, they have higher premiums than Medicare Advantage plans
Your Retail Drug Coverage is Separate
Medigap plans cover medications administered in a hospital setting, such as injectables or chemotherapy drugs. They do not cover retail medications though, so most beneficiaries will enroll in a separate Part D drug card. There are plans available in every state starting around $15/month.
