Medigap: Pros and Cons

Medicare Supplemental Insurance (AKA Medigap) enhances Original Medicare to significantly extend hospital, skilled nursing, and travel coverage and definitely has both Pros and Cons. Medigap can help pay for Medicare deductibles and copays but it is not inexpensive. Should you buy Medigap? Check out our Pros and Cons of Medigap list first.

Medigap Pros and Cons

Scroll down for a more detailed explanation of each point above.

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What is Medigap?

You have seen the pros and cons list above but what exactly is Medigap? Medigap is additional insurance offered by private companies that you can buy to fill in the “gaps” of Original Medicare.

While Original Medicare covers much of your medical costs, it still requires you to pay many fees such as coinsurance and deductibles. These fees can add up which leads many retirees to not be able to afford them. (Source: Medicare.gov)

There are 10 different standardized Medigap plans that can help pay some or all of these costs. However, some are more popular than others. Medigap’s most popular plans usually offer better coverage at a better cost than other Medigap plans. Currently, the majority of our clients are purchasing Plan G based on its robust benefits and fair pricing. You can check out the price in your area with our Senior65.com  instant Medigap quote.

Medigap can extend your Medicare benefits by adding 365 days of hospitalization coverage and offering benefits not available under Original Medicare such as $50,000 of Foreign Travel Emergency.

So what is Medigap Insurance? It is highly regulated and standardized insurance that pays the medical fees (gaps) that Medicare doesn’t. Medigap insurance companies will not be involved in your health decisions. You want to think of your Medigap policy as your “silent secondary payer” to Medicare. The Medigap insurance provider cannot approve or decline services that take place in America.  If Medicare says your medical treatment is approved and pays its 80% then your Medigap plan will pay the remaining 20% no questions asked. Your Medigap plan will not be “managing” your health benefits, just paying the portions that Medicare does not.   Want more? Check out our article called What does Medigap cover?

What’s the downside of Medigap?  Keep reading to learn about somewhat expensive pricing and other disadvantages of Medigap.

How Expensive is Medigap?

Here is an article on Medigap’s average cost, but your price will also depend on many different variables such as your age, zip code, and which plan you select. You can get an instant Medigap quote by clicking the button below.  Medigap can seem expensive to some but compared to what you may have been paying before you were 65, it may seem like a bargain.  Get a Medigap quote below in less than 30-seconds to see how much it will cost in your area.

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Medigap Pros in Detail

Here we go over the advantages of Medigap in more detail

1. Medigap Plans cover all or part of Medicare additional fees
   • Medicare passes on deductibles and coinsurance fees to patients.  A Medigap plan could pay some or all of these fees. Plan F does the best job at covering those fees but it is no longer available to those new to Medicare. Check out Medigap Plan G as this is the new “most popular” by recent enrollment Medigap policy.
2. Plans are easy to compare
   • Since Medigap plans are regulated, each company has to offer the same benefits and access to the same doctors for the same plan. So a standard Plan G is the same no matter who offers it.  This makes it easy to compare who has the best price. Remember you can get an instant Medigap comparison quote from top insurance providers without entering your contact information.
3. Guaranteed 6-month enrollment period when 1st eligible
   • All Medigap plans will approve you, regardless of your health condition, if you apply when you are over 65 and first enrolled in Medicare Part B.  You can wait up to six months to enroll in a plan without answering health questions (although most of our clients enroll when they first turn 65).
4. All plans offer an additional 365 days in the hospital
   • Medicare only covers a portion of hospital costs and if you are in the hospital for a long period of time, they stop paying altogether.  Medigap plans will pay 100% of the covered hospital fees that Medicare doesn’t and cover an additional year of hospital coverage.
5. Some plans offer extras like excess charges, foreign travel, and Silver Sneakers program
   • Doctors are legally allowed to charge you up to 15% in excess charges.  Medicare will not pay those fees but many Medigap policies like Medigap Plan G will pay 100% of excess charges.
   • Medicare has no coverage for care when traveling abroad. Some Medigap policies (like Plan F, Plan G, and Plan N) cover up to $50,000 of foreign travel emergency expenses.
   • Some insurance providers offer extra benefits like a gym membership (Silver and Fit or Silver Sneakers) at no extra charge.
6. Nationwide coverage
   • Medigap* has no doctor or facility network. Instead, they use the same network that Medicare does so any doctor that accepts Medicare will accept Medigap!
   • Medicare’s network is the largest doctor and facility network in the nation. According to the Kaiser Family Foundation, nearly 90% of all non-pediatric doctors accept Medicare nationwide (source). Remember if a doctor accepts Medicare, they MUST accept a standard Medigap plan.

*Note: In some states you can purchase a Medigap Select plan that typically costs less and works with a smaller network of doctors.  These plans are fairly rare and not popular with our Senior65.com clients.

Medigap “Cons” in Detail

Here we go over the disadvantages of Medigap plans listed above in more detail.

1. Medigap Monthly Medigap premiums can be pricey
   • Medigap plans are not inexpensive and can cost well over $100 a month.  This price is dependent on your age, zip code and the plan you pick so the best way to find out how much it costs is to get a quote
   • Get an instant Medigap quote here
2. Medigap can be difficult to switch once enrolled
   • Once you are enrolled in a Medigap plan, there typically is no annual switching period. Note: Some states have added annual Medigap switching periods
   • If you want to switch plans you often have to apply and answer health questions before approval
   • There are special rules that allow some people to switch plans without Medical underwriting.
3. May not be able to enroll in Medigap after the initial enrollment period
   • If you missed your initial enrollment period and have a pre-existing condition you may not be able to enroll in a Medigap plan.
   • Use our Senior65 deadline calculator so you don’t miss your initial Medigap Open enrollment period.
   • Check out this link if you missed your initial Medigap enrollment.
4. Not all Medigap plans cover Medicare deductibles
   • The Medicare Part A hospital deductible is $1,676 and a few Medigap plans like Medigap plan A will not cover your Medicare hospital deductible.  Medigap plan G DOES cover the hospital deductible.
   • The Medicare Part B Medical deductible is
5. Medigap does not include drug coverage
   • No Medigap plan covers prescription drugs at the pharmacy
   • You will need to purchase a Medicare Part D drug plan to get that coverage.
6. Medigap doesn’t cover elective surgeries
   • Medicare doesn’t cover elective surgeries so Medigap does not as well
   • A good rule of thumb is “If Medicare doesn’t cover it, then Medigap will not as well.”  The exception to this rule is a foreign travel emergency.

Alternatives to Medigap?

So after checking out the list below, you may still be wondering “Is medigap worth it?”  We believe the answer is yes because it does a great job at protecting your wealth against the high bills that Medicare passes on to patients.

Many people who are not comfortable with Medigap’s monthly premium consider Medicare Advantage (MA). Unlike Medigap, MA replaces your Original Medicare. It doesn’t fill in all the gaps but it is usually less expensive. You might want to check out Medigap vs Medicare Advantage, to decide which plan is right for you. To find out why people select Medigap, read our newest article why select Medigap over Medicare Advantage.

For further questions call Senior65.com 800-930-7956. There is no charge for our services and no one can offer the same Medigap plan for less than we can.