Medigap
Also known as: Medicare supplement insurance
Medigap is private Medicare supplement insurance that helps pay the out-of-pocket costs Original Medicare leaves behind, such as deductibles, coinsurance, and copayments.
Medigap, formally called Medicare supplement insurance, is a private insurance policy that fills the "gaps" in Original Medicare. Medicare Parts A and B pay a large share of hospital and medical costs, but they leave enrollees responsible for deductibles, coinsurance, and copayments — and those amounts have no annual out-of-pocket cap. A Medigap policy picks up some or all of these costs.
Medigap plans are standardized and identified by letters, so a given lettered plan provides the same core benefits regardless of which insurer sells it — insurers compete mainly on price and service. To buy a policy, a person must be enrolled in both Medicare Part A and Part B, and each policy covers only one person; spouses need separate policies. The best time to buy is the open enrollment window that begins when the applicant is both 65 and enrolled in Part B, because during that period insurers cannot deny coverage or charge more based on health.
Medigap supplements Original Medicare only. It does not work with Medicare Advantage plans, and it generally does not cover long-term custodial care, vision, dental, hearing aids, or private-duty nursing. Prescription drug coverage comes from a separate Medicare Part D plan rather than from modern Medigap policies.
Medigap appears on state health and life-and-health insurance licensing exams, which test who is eligible, what the policies do and don't cover, and how they interact with Medicare and Medicaid. Achievable's insurance prep covers Medigap alongside Medicare and other federal programs.
Key takeaways
- Medigap is private insurance that pays deductibles, coinsurance, and copayments left over by Original Medicare.
- Plans are standardized by letter, so benefits for a given plan letter are identical across insurers.
- Applicants must be enrolled in Medicare Parts A and B, and each policy covers only one person.
- Open enrollment — starting when someone is 65 and enrolled in Part B — guarantees issue regardless of health.
- Medigap doesn't pair with Medicare Advantage and generally excludes long-term care and prescription drugs.