Medigap Plans Explained: Complete Guide to Medicare Supplement Insurance

Medigap, also known as Medicare Supplement Insurance, helps fill the "gaps" in Original Medicare coverage. This guide explains how Medigap works, compares available plans, and helps you decide if a supplement policy is right for you.

What Is Medigap?

Medigap policies are private insurance plans that help pay some of the out-of-pocket costs that Original Medicare doesn't cover:

Part A coinsurance and hospital costs
Part B coinsurance or copayments
Part A hospice care coinsurance
Blood (first 3 pints)
Part B deductible (on some plans)
Skilled nursing facility coinsurance
Foreign travel emergency coverage

Important: Medigap only works with Original Medicare. You cannot use a Medigap policy with Medicare Advantage.

How Medigap Works

Here's the basic structure:

1. You pay your Medicare Part B premium 2. You pay your Medigap monthly premium 3. When you receive Medicare-covered services: - Medicare pays its share (80% of Part B services) - Medigap pays some or all of the remaining 20%

Available Medigap Plans in 2026

Insurance companies can only sell standardized Medigap plans, labeled with letters. Each lettered plan offers the same benefits regardless of which company sells it.

Plan Comparison Chart

| Benefit | Plan A | Plan B | Plan C | Plan D | Plan F | Plan G | Plan K | Plan L | Plan M | Plan N | |---------|--------|--------|---------|--------|---------|--------|--------|--------|--------|--------| | Part A coinsurance | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 50% | 75% | ✓ | ✓ | | Part B coinsurance | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 50% | 75% | ✓ | ✓** | | Blood (first 3 pints) | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 50% | 75% | ✓ | ✓ | | Part A hospice | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 50% | 75% | ✓ | ✓ | | Skilled nursing | ✗ | ✗ | ✓ | ✓ | ✓ | ✓ | 50% | 75% | ✓ | ✓ | | Part A deductible | ✗ | ✓ | ✓ | ✓ | ✓ | ✓ | 50% | 75% | 50% | ✓ | | Part B deductible | ✗ | ✗ | ✓ | ✗ | ✓ | ✗ | ✗ | ✗ | ✗ | ✗ | | Part B excess | ✗ | ✗ | ✗ | ✗ | ✓ | ✓ | ✗ | ✗ | ✗ | ✗ | | Foreign travel | ✗ | ✗ | 80% | 80% | 80% | 80% | ✗ | ✗ | 80% | 80% |

*Plans C and F are only available if you became Medicare-eligible before January 1, 2020 **Plan N requires copays: up to $20 for office visits, up to $50 for ER visits not resulting in admission

Medigap Pricing Methods

Insurance companies use three pricing methods:

Community-Rated (No-Age-Rated)

Same premium for everyone regardless of age
Your premium won't increase just because you get older
May start higher but grows more slowly

Issue-Age-Rated

Premium based on your age when you buy the policy
Premium doesn't increase due to aging (but can increase for other reasons)
Buying younger means lower lifetime premiums

Attained-Age-Rated

Premium based on your current age
Increases as you get older
Usually starts lowest but can become expensive over time

Recommendation: Look for community-rated or issue-age-rated policies for more predictable costs over time.

The Medigap Open Enrollment Period

Your Medigap Open Enrollment Period is crucial:

When: Starts the first day of the month you're 65 or older AND enrolled in Part B
Duration: 6 months
Benefit: During this time, insurers cannot:

- Deny you coverage - Charge more due to health conditions - Make you wait for pre-existing conditions

Warning: After your Medigap OEP ends, insurers can:

Deny your application
Charge higher premiums based on health
Exclude coverage for pre-existing conditions

Medigap vs Medicare Advantage

| Factor | Medigap | Medicare Advantage | |--------|---------|-------------------| | Monthly premium | Higher | Usually lower/$0 | | Out-of-pocket costs | Lower/predictable | Higher/variable | | Doctor choice | Any Medicare doctor | Network restrictions | | Extra benefits | None | Dental, vision, etc. | | Prescription drugs | Need separate Part D | Usually included | | Best for | Travelers, specialists | Budget-conscious, local care |

Florida Medigap Considerations

Competitive Market

Florida's large senior population means:

Many insurance companies compete for business
Rates tend to be competitive
More plan options available

Birthday Rule

Florida has a "birthday rule" that allows you to switch to a comparable Medigap plan from another insurer within 30 days of your birthday without medical underwriting.

Household Discounts

Many Florida insurers offer discounts if:

You and your spouse both have Medigap policies
You're a non-smoker
You pay premiums annually

When to Buy Medigap

The best times to purchase Medigap:

1. During your Medigap OEP (best option): Guaranteed acceptance 2. During your birthday month (Florida): Can switch plans without underwriting 3. When leaving employer coverage: May have guaranteed issue rights 4. When dropping Medicare Advantage: Within 12 months of joining, you have guaranteed rights

Questions to Ask Before Buying

1. What is the monthly premium? 2. How does the company price policies (community, issue-age, or attained-age)? 3. What discounts are available? 4. What is the company's history of rate increases? 5. How financially stable is the insurance company? 6. What is the claims process like?

Get Personalized Help

Choosing a Medigap plan involves comparing prices from multiple insurers. A licensed Medicare advisor can:

Compare rates from all major carriers
Find available discounts
Help you understand your options
Assist with enrollment at no cost

Schedule a free consultation to find the right Medigap plan for your needs.