As we step into retirement, health becomes a top priority. Medicare provides a solid foundation, but it doesn’t cover everything. Deductibles, copayments, and coinsurance can quickly add up — especially if you need hospitalization or long-term treatment.
This is where Medigap — also called Medicare Supplement Insurance — comes in. It is designed to fill the “gaps” in Original Medicare, helping you:
- Reduce financial stress: Covers costs that Medicare doesn’t pay.
- Plan your budget with confidence: Fixed monthly premiums make expenses predictable.
- Keep freedom of choice: See any doctor or hospital that accepts Medicare, nationwide.
- Enjoy peace of mind: Focus on living your retirement instead of worrying about medical bills.
Real-Life Example
Mary, age 68, was hospitalized for 5 days with pneumonia:
- Without Medigap:
- Part A deductible: ~$1,600
- 20% coinsurance for doctor, lab, and medication costs: ~$1,200
- Total out-of-pocket cost: ~$2,800 for just one hospital stay.
- With Medigap Plan G:
- Monthly premium: about $150
- Only pays the Part B deductible: $240/year
- Total out-of-pocket cost: just $240 for the entire year.
Result: Mary protects her retirement savings and avoids unexpected medical bills.
Understanding Medigap Plans A–N
Medigap offers plans from A through N (except Massachusetts, Minnesota, and Wisconsin, which have their own systems). Each letter represents a standardized benefit package — the coverage is identical regardless of which insurance company you buy it from.
| Medigap Plan | Key Benefits | Best For |
|---|---|---|
| Plan A | Basic coverage: Part A & B coinsurance, first 3 pints of blood, hospice care | Retirees who want the lowest premium and don’t mind paying more out-of-pocket |
| Plan B | Plan A + Part A deductible | Retirees who want better hospital protection |
| Plan C | Plan B + Part B deductible, skilled nursing facility coinsurance, foreign travel emergency | Only for those first eligible for Medicare before Jan 1, 2020 |
| Plan D | Same as Plan C but no Part B deductible | Retirees who want broad coverage but are not eligible for Plan C |
| Plan F | Covers 100% of all Medicare gaps — $0 out-of-pocket | Only for those first eligible before Jan 1, 2020 |
| High-Deductible Plan F | Same as Plan F but with ~$2,800 annual deductible for a much lower premium | Healthy retirees who want full coverage at a lower monthly cost |
| Plan G | Covers everything Plan F does except Part B deductible | The most popular plan for new Medicare enrollees |
| High-Deductible Plan G | Plan G with ~$2,800 deductible | Low premium option for healthy retirees |
| Plan K | Covers 50% of most benefits (100% Part A coinsurance) with $7,060 out-of-pocket limit | Budget-minded retirees who want catastrophic coverage |
| Plan L | Covers 75% of most benefits with lower $3,530 out-of-pocket limit | Retirees looking for mid-level coverage |
| Plan M | Covers 100% of most benefits but only 50% of Part A deductible | Retirees who rarely need hospitalization |
| Plan N | Same as Plan G but requires $20 doctor copay, $50 ER copay (if not admitted), and does not cover excess charges | Popular for healthy retirees who want lower premiums |
📌 You only need one plan, not all of them. The most popular today are Plan G and Plan N.
When to Buy Medigap
- Medigap Open Enrollment Period (OEP): This is the best time to buy. It lasts 6 months starting the month you’re both 65+ and enrolled in Medicare Part B. During OEP, you cannot be denied or charged more for pre-existing conditions.
- If still working: You can delay Part B and Medigap until you retire without penalty.
- Buying later: You may face medical underwriting, higher premiums, or denial.
- Losing group coverage: You may qualify for a Special Enrollment Period with guaranteed issue rights.
State-Specific Medigap Rules
| State | Special Rules |
|---|---|
| Massachusetts | Core, Supplement 1, Supplement 1A only |
| Minnesota | Basic and Extended Basic + optional riders |
| Wisconsin | Basic plan + optional riders |
| California, Oregon, Idaho, Illinois, Nevada, Louisiana | Birthday Rule: Switch to equal/lesser plan around your birthday without medical underwriting |
| Washington (WA) | Switch to Plan G or A anytime, no underwriting |
| New York, Connecticut, Vermont, Maine | Community Rating: Premiums don’t rise with age, year-round guaranteed issue |
| Missouri | Anniversary Rule: Switch to equal plan with same insurer within 30 days of policy anniversary |
Explaining Key Rules
- Birthday Rule: Lets you switch to a plan with equal or lesser benefits within 30–63 days of your birthday each year, no medical questions asked.
- Community Rating: Insurers must charge the same premium to everyone regardless of age or health.
- Anniversary Rule: Allows you to switch to the same coverage plan with your current insurer within 30 days before or after your policy anniversary — no underwriting required.
Key Takeaways for Retirees
- Buy during your 6-month OEP to get the best rates and avoid underwriting.
- Choose only one plan that matches your health needs and budget (Plan G and Plan N are most popular).
- Know your state rules — they can help you switch plans later without being penalized.
-Phan Trần Hương-
Further Reading