How to Choose a Medicare Supplement Plan

Original Medicare can leave seniors vulnerable to high unexpected healthcare expenses. Some 13.5 million seniors have added a Medicare Supplement plan to their basic Medicare coverage.

This guide to Medicare Supplement will help you understand the differences between different Medigap plan types, and guide you to the plan that works best for you.

Getting Started

A Medicare Supplement provides financial security and additional health coverage for people with Medicare. The plan pays for some of the healthcare costs that Original Medicare doesn’t cover. These include out-of-pocket costs like co-pays, coinsurance, and deductibles.

A Medicare supplement is also known as a Medigap plan because it helps to fill the gaps in healthcare costs.

This type of coverage can go by multiple names, which adds to some of the confusion. If you hear: Medicare Supplement, Medicare Supplemental insurance, Medigap, Medigap plan or Medigap policy, it’s all referring to the same thing.

Next, let’s review why roughly 35 percent of seniors on Original Medicare – close to 13.5 million people and growing  – have chosen to buy a Medicare supplement.

Why are 13.5 million seniors buying additional coverage with Medicare Supplement insurance?

Before understanding why Medicare supplement coverage is needed, we’ll first need to explain what Medicare is.

First, What is Medicare?

Before you decide to supplement Medicare, you’ll first need to know what Medicare covers and who is eligible to receive coverage under it. Medicare is a federal program that provides millions of Americans with health coverage. The program gives affordable benefits to people aged 65 years and older (as well as others who meet specific criteria), but there are limitations on those benefits.

As we age, our household earnings become more fixed, while our healthcare needs (and costs) increase. Medicare Part A (which provides hospital insurance) and Medicare Part B (which provides medical insurance) don’t cover everything, and out-of-pocket costs for services that aren’t covered can actually lead to personal bankruptcy. (And plans that pay the Part B deductible aren’t available to anyone newly eligible for Medicare as of 2020.)

That’s where Medicare supplement health insurance comes in.

Medicare Supplement (or “Medigap”) Plans:

A Medicare supplement is private coverage that wraps around Medicare coverage.

• Plans help pay for healthcare expenses beyond what Original Medicare (Part A & Part B) covers.
• Depending on the policy, they’ll cover copayments, coinsurance, deductibles, and emergency care when traveling outside the U.S.
• Unless specified by the private insurer, Medigap plans pay 100% of covered expenses after Original Medicare pays its share.

Buying a Medicare Supplement plan can be a smart decision for both your health and your finances; however, finding and choosing a policy can be overwhelming. This guide will explain the plans available in most states and help you determine which is best for you.

Key Must-Knows about Medicare Supplement Coverage to Get You Started

Medicare Supplement Coverage Is Provided by Private Insurers

• Unlike Original Medicare (Medicare Part A & Part B) which comes from the federal government, Medicare Supplement plans are sold by private companies.

Medicare Supplement Plans Are Standardized

• Medicare Supplement plans are standardized in most states, meaning all plans cover the same basic benefits (they differ in Massachusetts, Minnesota, and Wisconsin).
• This makes it easier to compare options based on premium costs. Make sure you enroll with a company you trust – one with good financial strength and customer service.
• Plans are labeled “A” through “N”. Additional benefits are provided under each of these plans. These additional benefits are also standardized.
• For example, all Plan A policies must provide the same benefits – the only difference between Plan A policies is the insurer and the price.

You Must Have Original Medicare

• You must have Medicare Part A and Part B to enroll in a Medicare Supplement plan. These plans are meant to wrap around your existing Medicare coverage.
• Medicare Supplement plans cannot be used with a Medicare Advantage policy (Medicare Part C).
• If anyone tries to sell you a Medicare Supplement while you’re on Medicare Advantage, they’re breaking the law and you should contact your state Insurance Department. 

Separate Payment from Original Medicare

• You will pay a private insurance company for Medicare Supplement coverage. This payment is separate from your Medicare payment to the federal government.

Individual Plans Only – Not a Family Plan

• Medicare Supplement coverage is available only to individuals. You and your spouse must complete an individual application.

No Prescription Drug Coverage under Medigap

• Medicare Supplement plans sold after Jan. 1, 2006 do not include prescription drug coverage.
• For prescription drug coverage, you’ll want to purchase a separate Medicare Part D policy

Medicare Supplement Covers Costs of Basic Medicare Benefits

• Covers: basic Medicare benefits (including Part A coinsurance, Part B coinsurance & copayment, hospital costs, hospice care, and preventative care). Additional benefits depending on the plan.
• Doesn’t Cover: Long-term care, dental, vision, hearing aid or other types of lifestyle bills typically are not covered.

See Any Doctor That Takes Medicare

• You can choose to see any doctor or healthcare provider that accepts Medicare. This is different from Medicare Advantage plans, which are HMOs or PPOs with networks of healthcare providers (doctors, hospitals, and facilities) that you must use.

Billing and Claims Are Coordinated with Medicare

The billing between Original Medicare and Medigap plans for covered Medicare services and products is automatically coordinated between Medicare and the insurance company. You will not have to file separate claims.

What Are the Healthcare Expenses that Original Medicare Doesn’t Cover?

Original Medicare can leave significant coverage gaps, even when you are enrolled in Part A and Part B. Some of the important coverage gaps include:

Medicare Part A Deductible + Medicare Part B Deductible

Each year, you are responsible for paying the deductible before Original Medicare coverage begins. For 2020, the Part A and Part B deductibles are $1,408 and $198, respectively.

Medicare Part A Coinsurance (for hospital visits and stays)

Once you’ve paid the deductible, Medicare Part A covers only the first 60 days of care. After that, you pay daily coinsurance – for 2020, $362 a day – for the next 30 days. After 90 days, you can use up to 60 lifetime reserve days, with a daily coinsurance of $704 for 2020. After that – unless you have Medigap or other supplemental coverage – you must pay your inpatient care costs in full. 

Medicare Part B Coinsurance (for doctor visits and medical equipment)

Once you’ve paid the Medicare Part B deductible of $183, you are responsible for 20% of everything that Medicare covers.

Foreign Medical Care

Original Medicare normally does not cover any healthcare costs outside of the US and its territories, though it makes exceptions in emergency situations if the closest hospital that can treat you is in a foreign country, or if a foreign hospital that can treat your condition – emergency or not – is closer to your home than a US hospital. Generally, if you are hospitalized while traveling overseas, you are responsible for all the costs. Certain Medigap plan types provide coverage for this.

Great. I’m considering a Medicare Supplement. When do I buy it?

If you buy Medicare Supplement insurance during your 6-month Open Enrollment Period, then it automatically begins when you enroll in Medicare Part B for the first time. For many retirees, this is often when they turn 65. However, if you work past age 65, the clock starts whenever you elect to start your Part B coverage.

If you buy Medicare supplement insurance outside your Open Enrollment Period, you will be subject to “underwriting”. That means you can be denied coverage or charged more due to preexisting health conditions or due to your health history. Some states, though, have guaranteed-issue rules for such plans even after the enrollment period ends. 

Once you have a standardized Medicare Supplement plan, it is guaranteed renewable, even if you have health problems. As long as you pay the premium, your policy cannot be canceled.

Which Medigap Plan Type Is Right for You?

There are 10 different types of Medicare Supplement plans, with each of the different Medigap plan types (Plan A to Plan N) providing different levels of Medicare Supplement benefits.

These benefits can include coverage of:

• Part A or Part B deductibles
• Part A or B coinsurance
• Hospice care coinsurance and copayments
• Skilled nursing care (or post-hospitalization) coinsurance
• Foreign medical emergencies

Plan types are standardized so that plans within each level provide the same exact coverage. The only difference is the carrier and the price. This means, for example, that all Plan A policies – regardless of

the health insurance company – must provide the exact same benefits. This makes it easier for you to simply compare Plan A policies based on your favorite insurer and the price of the plan.

Different Plan Types Provide Different Levels of Coverage

• Plan A is the least comprehensive Medigap plan and generally the most budget-friendly. It contains the core Medigap benefits that all plan types offer.
• Medicare Supplement Plan F is the most popular Medigap plan type and the most comprehensive in its coverage of Original Medicare’s gaps. Because of its extensive coverage, it’s generally the most expensive in terms of the monthly premium cost.

Medicare Supplement Plan A – Basic Coverage with Only the Core Medicare Supplement Benefits

Coverage Summary – Plan A

• Plan A provides supplemental coverage of basic Medicare benefits, such as Medicare Part A coinsurance for hospital and hospice costs, Medicare Part B coinsurance or copayment, and the first 3 pints of blood.
• Plan A is the most basic Medigap plan and that’s reflected in its low monthly premium. This plan works for those looking for minimum coverage and who are able to pay out-of-pocket for Medicare costs as they arise.

If you want some extra coverage beyond what Original Medicare offers, Medicare Supplement Plan A provides the basics:

• Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are exhausted;
• Part B coinsurance or copayment
• Your first 3 pints of blood
• Part A hospice care coinsurance or co-payment.

Choose Plan A if:

You do not expect a lot of medical expenses and want to keep your Medicare supplement premiums low.

Avoid Plan A if:

You require some extra healthcare. You may wind up paying more out-of-pocket with a Plan A policy.

What’s the premium cost?

It varies by carrier. 

Don’t confuse Medigap Plan A with Medicare Part A. Part A is your regular Medicare hospital coverage. Plan A is a supplemental product.

Plan A vs the Other Medigap Plan Types

Plan A is the most budget-friendly of the Medigap plan types and provides only the core Medigap benefits.

Medicare Supplement Plan B – The Core Benefits plus the Part A Deductible

Coverage Summary – Plan B

• Plan B provides supplemental coverage of basic Medicare benefits such as Medicare Part A coinsurance and hospital costs, Medicare Part B coinsurance, and hospice care. In addition, it covers 100% of the Medicare Part A deductible.
• Plan B is a lower-premium Medigap plan that is similar to Plan A, but it adds additional coverage for the Medicare Part A hospital deductible. It works for those looking for minimum coverage, and who are able to pay out-of-pocket for Medicare costs as they arise.

Medicare Supplement Plan B is also fairly basic and is nearly identical to Plan A, but with a key difference: Plan B benefits include your Medicare Part A deductible. For 2020, the Part A deductible is $1,408 per benefit period (that means you could potentially save $1,408).¹ 

Choose Plan B if:

You anticipate a few medical expenses but think the extra hospital coverage could come in handy. Again, premiums will likely be lower with Plan A than others, but unexpected medical care may cost you more out of pocket.

Avoid Plan B if:

You think you still require extra healthcare. You may wind up paying more out-of-pocket with a Plan B policy.

What’s the premium cost?

It varies by carrier. 

Don’t confuse Medigap Plan B with Medicare Part B. Part B is your regular Medicare medical coverage. Plan B is a supplemental product.

Plan B vs Other Plans

Medicare Supplement Plan C – The 2nd Most Comprehensive Medigap Plan Type

Coverage Summary – Plan C

• Plan C provides supplemental coverage of basic Medicare benefits, 100% coverage of the Medicare Part A deductible, 100% of the Medicare Part B deductible, 100% of skilled nursing coinsurance, and some foreign travel emergency coverage.
• Plan C is a comprehensive Medigap plan that covers all Medicare-approved healthcare expenses. However, unlike the similar Plan F, it does not cover Medicare Part B excess charges that some non-participating physicians may bill over the Medicare rate.

Part C picks up the cost of out-of-pocket expenses under your Original Medicare plan, except for Medicare Part B excess charges*. You won’t have to pay a single Medicare Part A or Part B copayment or your share of coinsurance; Plan C takes care of it.

*Part B excess charges apply when you use non-participating providers; these charges can be up to 15 percent over the amount non-participating providers are paid.² 

Choose Plan C if:

You want comprehensive coverage to help cut healthcare costs but you do not expect to accrue Part B excess charges.

Avoid Plan C if:

You need support for Part B excess charges.

What’s the premium cost?

It varies by carrier. 

Don’t confuse Medigap Plan C with Medicare Part C. Part C is otherwise known as Medicare Advantage – a private plan that works in place of Original Medicare. Plan C is a product to supplement Original Medicare.

Plan C vs Other Plans

Medicare Supplement Plan D – A Comprehensive Medigap Plan without the Part B Deductible

Coverage Summary – Plan D

• Plan D is one of the more comprehensive plans and covers many of the expense categories not covered by Original Medicare.
• It isn’t as comprehensive as Plan C, Plan G or Plan F. In particular, it has gaps related to the Part B deductible of Original Medicare (non-hospital, Medicare-approved healthcare services ) which will matter if you visit the doctor often.

Plan D provides coverage of basic Medicare benefits, 100% of the Medicare Part A deductible, 100% of the skilled nursing coinsurance, and some foreign travel emergency coverage. It does not cover the Medicare Part B deductible.

Plan D is one of the more comprehensive plan types, although it provides slightly fewer benefits than Plans C, G and F. The primary difference: Plan D doesn’t cover the Part B deductible and Part B excess charges.

Choose Plan D if:

You want fuller coverage but don’t expect to visit the doctor often or don’t require constant medicare services.

Avoid Plan D if:

You require frequent trips to the doctor (and sometimes to non-participating providers) and need regular outpatient services.

What’s the premium cost?

It varies by carrier. Plan D will likely be more than Plans A and B, but should be less expensive than C, F, and G.

Don’t confuse Medigap Plan D with Medicare Part D. Part D is the Medicare prescription drug benefit which provides prescription drug coverage. Plan D is a product to supplement Original Medicare and doesn’t include prescription drug coverage.

Plan D vs Other Plans

Medicare Supplement Plan F – The Most Comprehensive (and Most Popular) Medigap Plan

Coverage Summary – Plan F

• Plan F provides supplemental coverage of basic Medicare benefits, 100% of the Medicare Part A deductible and coinsurance, 100% of the Medicare Part B deductible and coinsurance, 100% of Part B excess charges, 100% of skilled nursing coinsurance, and some foreign travel emergency coverage.
• Plan F provides the most comprehensive coverage of all the standard Medicare Supplement plans. It covers 100% of all Medicare-approved charges as well as any excess charges.
• This plan, though, isn’t available for newly eligible enrollees as of January 2020.

The most popular Medicare Supplement plan, Plan F offers the most comprehensive coverage. Once Medicare pays its share of covered charges for hospital and doctor care, Plan F picks up 100% of the rest— the exception being foreign travel emergency coverage. With Plan F, your total out-of-pocket cost for covered hospital and doctor charges should be $0*.

*You’re still responsible for your insurance premiums.

Choose Plan F if:

You want protection from high out-of-pocket costs associated with hospital and medical care. Plan F may be a good fit if you anticipate a lot of healthcare expenses or simply desire the peace of mind that comes with knowing you have the coverage should you need it.

Avoid Plan F if:

You don’t need comprehensive additional coverage and you don’t want to pay high monthly premiums.

What’s the premium cost?

It varies by carrier. Plan F offers the most robust benefits, so is typically the most costly. High-deductible Plan F should have a lower monthly premium than traditional Plan F.

Plan F vs Other Plans

High-Deductible Plan F – Not Apples-to-Apples with Regular Plan F

Coverage Summary – High-Deductible Plan F

Offers the same benefits as regular Plan F with some exceptions:

• For each year, you must pay for Medicare costs up to an annual deductible – which is $2,340 in 2020;³
• Once you reach the deductible on a high-deductible Plan F, then it is the same exact coverage as a regular Plan F;
• High-deductible Plan F will have lower premiums than regular Plan F; however, it also will cover less.
• This plan, though, isn’t available to newly eligible beneficiaries after the end of 2019.

Choose this variation if you’re looking for comprehensive coverage on the high-end, but can cover the routine costs on your own. Don’t compare High-Deductible Plan F options vs. Regular Plan F. It’s not an apples-to-apples comparison. You should compare H-D Plan F with other H-D Plan F plans.

Medicare Supplement Plan G – A Comprehensive and Popular Medigap Plan Option

Coverage Summary – Plan G

• Plan G provides supplemental coverage of basic Medicare benefits, 100% of the Medicare Part A deductible, 100% of skilled nursing coinsurance, and some foreign travel emergency coverage.
• Plan G is the most comprehensive Medigap plan available to newly eligible enrollees as of 2020. 
• However, Plan G members will still pay an annual Part B deductible of $198 in 2020 for non-hospital, Medicare-approved healthcare services.

Plan G looks a lot like Plan F. It’s nearly as popular, too. The key difference between the two is Plan G doesn’t include your Medicare Part B deductible.

Choose Plan G if:

You want robust supplemental coverage but don’t mind paying your Part B deductible, which amounts to $198 per year.⁴ Beyond that—and your share of foreign travel emergency coverage, should you need it—you will pay $0 for medical expenses covered by original Medicare and Plan G.

What’s the premium cost?

It varies by carrier. Plan G will be more expensive than other Medigap plans because it offers more comprehensive coverage; however, because it does not include Part B deductible benefits, it will cost less in monthly premiums than Part F.

Plan G vs Other Plans

High-Deductible Plan G – Lower Costs, Less Coverage

Coverage Summary – High-Deductible Plan G

Offers the same benefits as regular Plan G with some exceptions:

• For each year, you must pay for Medicare costs up to an annual deductible – which is $2,340 in 2020;⁵
• Once you reach the deductible on a high-deductible Plan G, then it is the same exact coverage as a regular Plan G;
• High-deductible Plan G will have lower premiums than regular Plan G; however, it also will cover less.
• This plan is available to those who are newly eligible for Medicare in 2020.

Choose this variation if you need comprehensive coverage on the high end but not for routine costs. Don’t compare High-Deductible Plan G options vs. Regular Plan G. It’s not an apples-to-apples comparison. You should compare H-D Plan G with other H-D Plan G plans.

Medicare Supplement Plan K – A Less Comprehensive Plan With 50% Cost-Sharing

Coverage Summary – Plan K

• Plan K provides supplemental coverage of basic Medicare benefits, 50% of the Medicare Part A deductible and 50% of the skilled nursing coinsurance. Unlike other Medicare Supplement plans, you will share in both the Medicare Part A and Part B costs, up to the annual $5,880 out-of-pocket limit.
• Plan K has lower monthly premiums, but you would pay a portion of your Medicare covered costs up to a certain out-of-pocket (OOP) limit. Once you reach that limit, Plan K will pay 100% of most out-of-pocket costs for Medicare-approved services, except for the Part B deductible and Part B excess charges.

Plan K splits the bill on covered services. It pays Medicare Part A coinsurance and hospital costs (up to an additional 365 days after Medicare benefits are exhausted) at 100 percent, then covers the following at 50 percent:

• Part B coinsurance or copayment;
• Your first three pints of blood;
• Part A hospice care coinsurance or copayment;
• Skilled nursing facility care coinsurance; and
• Part A deductible.

Plus, there’s a cap on what you’ll owe. If you exceed Plan K’s $5,880 out-of-pocket spending limit, the plan pays for additional covered expenses.

Choose Plan K if:

You want lower monthly premiums and some cost-sharing to help alleviate out-of-pocket healthcare expenses.

Avoid Plan K if:

You’re looking for more hospital coverage and want to further limit your out-of-pocket costs.

What’s the premium cost?

It varies by carrier. Plan K tends to have the lowest monthly premiums.

Plan K vs Other Plans

Medicare Supplement Plan L – Like Plan K but More Coverage with Only 25% Cost-Sharing

Coverage Summary – Plan L

• Plan L provides supplemental coverage of basic Medicare benefits, 75% of the Medicare Part A deductible and 75% of the skilled nursing coinsurance.
• Unlike other Medicare Supplement plans, you will share in both the Medicare Part A and Part B costs, up to the annual $2,940 out-of-pocket limit. Once you reach that limit, Plan L will pay 100% of all Medicare-approved services.

Plan L picks up a portion of covered expenses, too, but picks up more than Plan K. It pays Medicare Part A coinsurance and hospital costs (up to an additional 365 days after Medicare benefits are exhausted) at 100 percent, then covers the following at 75 percent:

• Part B coinsurance or copayment;
• Your first three pints of blood;
• Part A hospice care coinsurance or copayment;
• Skilled nursing facility care coinsurance; and
• Part A deductible.

Again, there’s a cap on what you’ll owe. If you exceed Plan L’s $2,940 out-of-pocket spending limit, the plan pays for additional covered expenses.

Choose Plan L if:

You still want lower monthly premiums but prefer a little added cost-sharing to help alleviate out-of-pocket healthcare expenses.

Avoid Plan L if:

You’re looking for full hospital coverage, want to minimize out-of-pocket costs, and you can afford a higher monthly premium.

What’s the premium cost?

It varies by carrier. Plan L tends to have the second-lowest monthly premiums.

Plan L vs Other Plans

Medicare Supplement Plan M – Comprehensive Coverage but With Part A Cost-Sharing

Coverage Summary – Plan M

• Plan M provides supplemental coverage of basic Medicare benefits, 50% of the Medicare Part A Deductible, 100% of skilled nursing coinsurance, and some foreign travel emergency coverage.
• Plan M covers all basic Medicare benefits with different cost-sharing amounts for other Medicare services. It is one of the less costly plan types.
• Plan M pays 50% of the Medicare Part A deductible but does not pay the Medicare Part B deductible or excess charges.

Plan M provides coverage of basic Medicare benefits, 50% of the Medicare Part A deductible, 100% of the skilled nursing coinsurance, and foreign travel emergency coverage. It does not cover the Medicare Part B deductible.

Plan M is very similar to Plan D, except that it only covers 50% of the Part A deductible (Plan D covers 100% of it). It means that you would be responsible for up to $704 of the total $1,408 Part A deductible for 2020.

This amount resets each year. Plan M is one of the more budget-friendly plan types.

Choose Plan M if:

You are looking for budget-friendly supplemental coverage, but want to get fuller coverage than Plans A, B, K and L.

Avoid Plan M if:

You’re looking to get all of your Medicare Part A deductible covered. Also, if you require frequent trips to the doctor (and sometimes to non-participating providers) and need regular outpatient services, Plan M isn’t right for you.

What’s the premium cost?

It varies by carrier. Plan M will likely cost more than Plans A, B K and L, but should be less expensive than the comprehensive types such as C, F and G.

Plan M vs Other Plans

Medicare Supplement Plan N – A Comprehensive and Popular Medigap Plan Type with Some Cost-Sharing

Coverage Summary – Plan N

• Plan N provides supplemental coverage of basic Medicare benefits (subject to $20 office copay and $50 ER copay), 100% of the Medicare Part A deductible, 100% of skilled nursing coinsurance, and some foreign travel emergency coverage.
• Plan N covers basic Medicare benefits and has different cost-sharing amounts for other services. Plan N does not pay the Medicare Part B deductible or excess charges.

Plan N combines comparably low premiums with fairly comprehensive coverage. It does not include benefits for your Medicare Part B deductible or Part B excess charges. However, it covers everything else at 100 percent—the exceptions being foreign travel emergency coverage, which is covered at 80 percent, and some aspects of Part B coinsurance, such as a copayment of up to $20 for some office visits and an up to $50 copayment for emergency room visits that don’t lead to inpatient admission.

Choose Plan N if:

You still want lower monthly premiums but prefer a little added cost-sharing to help alleviate out-of-pocket healthcare expenses.

Avoid Plan N if:

You require frequent trips to the doctor (and sometimes to non-participating providers) and need regular outpatient services.

What’s the premium cost?

It varies by carrier. In terms of premium and coverage, Plan N tends to fall somewhere in the middle.

Plan N vs Other Plans

Next Steps

Ultimately, it’s all about striking the balance between affordability and benefits. You will need to assess your financial situation and healthcare needs and select a plan with reasonable monthly premiums and benefits that reduce out-of-pocket spending