What is Medicare Supplement (Medigap)?
Original Medicare (Parts A & B) covers most of your healthcare costs—but not all. You're responsible for deductibles, copays, and coinsurance that can add up to thousands per year. There's also no out-of-pocket maximum with Original Medicare, meaning your costs could be unlimited.
Medicare Supplement insurance (also called Medigap) is private insurance specifically designed to fill these gaps. When Medicare pays its share, your Medigap plan pays most or all of what's left—giving you predictable, low out-of-pocket costs.
How Medicare Supplement Works
- 1. You go to any doctor that accepts Medicare (no networks!)
- 2. Medicare pays its share of approved costs
- 3. Your Medigap policy pays most or all of the rest
- 4. You pay little or nothing out-of-pocket
Standardized Plans: A Through N
Medicare Supplement plans are standardized by the federal government. Each plan letter (A, B, C, D, F, G, K, L, M, N) offers the same benefits no matter which insurance company you buy from. The ONLY differences between carriers are price and customer service.
Important: Plan F is No Longer Available
If you became eligible for Medicare on or after January 1, 2020, you cannot purchase Plan F or Plan C. These plans covered the Part B deductible, which is no longer allowed for new enrollees. Plan G is now the most comprehensive option available.
Comparing Medicare Supplement Plans
Here are the most popular Medigap plans and what they cover:
Most Popular Choice
Plan G covers nearly everything EXCEPT the Part B deductible ($240 in 2024). Once you meet that deductible, Plan G covers 100% of your Medicare-approved costs for the rest of the year.
What Plan G Covers:
- ✓ Part A deductible ($1,632)
- ✓ Part A copays/coinsurance
- ✓ Part B copays/coinsurance (after deductible)
- ✓ Part B excess charges
- ✓ First 3 pints of blood
- ✓ Skilled nursing coinsurance
- ✓ Foreign travel emergency (80%)
What You Pay:
- • Monthly premium ($150-250 typical)
- • Part B premium ($174.70)
- • Part B deductible ($240/year)
- • Separate Part D for prescriptions
Lower Premium Option
Plan N has lower premiums than Plan G but requires small copays: up to $20 for doctor visits and up to $50 for ER visits (waived if admitted). Good for people who don't go to the doctor frequently.
What Plan N Covers:
- ✓ Part A deductible ($1,632)
- ✓ Part A copays/coinsurance
- ✓ Part B coinsurance (with copays)
- ✓ First 3 pints of blood
- ✓ Skilled nursing coinsurance
- ✓ Foreign travel emergency (80%)
- ✗ Does NOT cover Part B excess charges
What You Pay:
- • Monthly premium ($120-180 typical)
- • Part B premium ($174.70)
- • Part B deductible ($240/year)
- • Up to $20 copay per office visit
- • Up to $50 copay per ER visit
- • Separate Part D for prescriptions
Lowest Premium, High Deductible
High-Deductible Plan G has very low premiums but requires you to pay a high deductible ($2,800 in 2024) before the plan pays anything. After that, it covers 100%. Best for very healthy people who rarely need care.
How It Works:
- • Pay ALL costs until you reach $2,800
- • After deductible: 100% coverage
- • Same benefits as regular Plan G after deductible
What You Pay:
- • Monthly premium ($40-70 typical)
- • Part B premium ($174.70)
- • All costs up to $2,800 deductible
- • After deductible: minimal costs
- • Separate Part D for prescriptions
Detailed Plan Comparison Chart
Here's what each Medicare Supplement plan covers. Remember: all companies offer the same benefits for each plan letter—only price and service differ.
| Benefit | A | B | D | G | K | L | M | N |
|---|---|---|---|---|---|---|---|---|
| Part A coinsurance & hospital | 100% | 100% | 100% | 100% | 100% | 100% | 100% | 100% |
| Part B coinsurance | 100% | 100% | 100% | 100% | 50% | 75% | 100% | 100%** |
| Blood (first 3 pints) | 100% | 100% | 100% | 100% | 50% | 75% | 100% | 100% |
| Part A hospice coinsurance | 100% | 100% | 100% | 100% | 50% | 75% | 100% | 100% |
| Skilled nursing coinsurance | No | No | 100% | 100% | 50% | 75% | 100% | 100% |
| Part A deductible | No | 100% | 100% | 100% | 50% | 75% | 50% | 100% |
| Part B deductible | No | No | No | No | No | No | No | No |
| Part B excess charges | No | No | No | 100% | No | No | No | No |
| Foreign travel emergency | No | No | 80% | 80% | No | No | 80% | 80% |
| Out-of-pocket limit | N/A | N/A | N/A | N/A | $6,940 | $3,470 | N/A | N/A |
** Plan N pays 100% of Part B coinsurance, except up to $20 copay for office visits and up to $50 copay for ER visits (waived if admitted)
Medicare Supplement Costs
Medicare Supplement premiums vary based on several factors. Understanding how companies price plans helps you find the best value:
Community-Rated (No-Age-Rated)
Everyone pays the same premium regardless of age. Rates increase for everyone at the same time. Fair for older enrollees.
Issue-Age-Rated
Premium based on your age when you first buy the policy. Rate doesn't increase because you get older (only general increases).
Attained-Age-Rated (Most Common)
Premium increases as you get older. Starts lower but increases annually with age. Most Texas carriers use this method.
- • Age: Premiums generally increase with age (except community-rated plans)
- • Gender: Women often pay less than men (women statistically use less healthcare)
- • ZIP code: Location affects rates based on regional healthcare costs
- • Tobacco use: Smokers may pay 15-30% more
- • Household discount: Some companies offer discounts if both spouses have policies
| Age | Monthly Premium Range |
|---|---|
| 65 | $130-180 |
| 70 | $150-200 |
| 75 | $170-230 |
| 80 | $200-270 |
Rates vary by carrier, ZIP code, gender, and tobacco use. These are estimates only.
When to Buy: Open Enrollment Period
The BEST time to buy a Medicare Supplement plan is during your Medicare Supplement Open Enrollment Period. This is your guaranteed issue period—you can't be denied or charged more due to health conditions.
Critical: Don't Miss Your Open Enrollment!
Your Medicare Supplement Open Enrollment Period lasts 6 months, starting the first day of the month you're both 65 or older AND enrolled in Medicare Part B.
During this period, insurance companies MUST sell you any Medigap policy they offer, regardless of your health. They can't charge you more, deny you coverage, or exclude pre-existing conditions. After this period ends, you may be subject to medical underwriting.
What Happens If You Miss Open Enrollment?
After your 6-month open enrollment period ends, insurance companies in most states can:
- • Use medical underwriting (review your health history)
- • Deny you coverage altogether
- • Charge you significantly higher premiums
- • Exclude coverage for pre-existing conditions (for up to 6 months)
Some states have additional guaranteed issue rights. Contact me to discuss your situation if you've missed your open enrollment.
Medicare Supplement vs. Medicare Advantage
Not sure whether to choose Medicare Supplement or Medicare Advantage? Here's a direct comparison:
| Factor | Medicare Supplement | Medicare Advantage |
|---|---|---|
| Works with | Original Medicare | Replaces Original Medicare |
| Doctor choice | Any Medicare doctor nationwide | Must use plan's network |
| Referrals | Never required | Often required (HMO plans) |
| Monthly premium | $120-250+ (plus Part B) | Often $0-50 (plus Part B) |
| Out-of-pocket costs | Very low once premium is paid | Copays for each service |
| Drug coverage | Separate Part D plan needed | Usually included |
| Dental/vision | Not included | Often included |
| Travel coverage | Nationwide + foreign emergency | Limited outside service area |
| Plan changes yearly | No (guaranteed renewable) | Yes (benefits/costs can change) |
Choosing an Insurance Company
Since all companies offer the same benefits for each plan letter, your choice comes down to:
- Price - Premiums vary significantly by carrier for the same coverage
- Financial stability - Choose A.M. Best rated companies
- Customer service - Claims processing, phone support, online tools
- Rate increase history - Some companies raise rates more frequently/aggressively
As an independent agent, I can compare rates from all major carriers in Texas and help you find the best combination of price and service.
Who Benefits Most from Medicare Supplement?
Medicare Supplement plans are ideal if you:
- Want complete freedom to see any Medicare-accepting doctor nationwide
- Have specialists you see regularly
- Travel frequently or spend time in multiple states
- Prefer predictable, low out-of-pocket costs (even with higher premiums)
- Want coverage that doesn't change year-to-year
- Don't want to deal with referrals or prior authorization
- Have complex health conditions requiring frequent care
Get Expert Medicare Supplement Help
Choosing the right Medicare Supplement plan and company requires comparing dozens of options. I can help you:
- Determine your open enrollment period and timeline
- Compare all Medigap plans and explain the differences
- Get quotes from every carrier in Texas
- Understand pricing methods and rate increase history
- Calculate your total annual costs (premiums + out-of-pocket)
- Apply for coverage during your guaranteed issue period
Compare Medicare Supplement Plans
Let's discuss your healthcare needs and compare Medigap plans from all Texas carriers. Free consultation, no obligation. Act during your open enrollment period for guaranteed issue.