Medicare Questions & Answers: Medicare Supplement
Medicare Supplement Q&A
Showing 56 questions
Can I change my Supplemental/Medigap plan at any time?
Yes, in Washington State, you can change your Medicare Supplemental (Medigap) plan at any time during the year, but there are specific rules depending on your current plan. Unlike most states, Washington has a unique "Right to Change" law that offers year-round guaranteed issue for existing Medigap policyholders, meaning you can switch plans without medical underwriting in certain cases. Here’s how it works:If you have Medigap Plan A: You can only switch to another Plan A offered by a different insurer without undergoing medical underwriting. You’re limited to staying within the same plan letter.
If you have Medigap Plans B through N: You can switch to any other plan between B and N (e.g., from Plan G to Plan N, or Plan B to Plan F) at any time, also without medical underwriting. This gives you more flexibility to adjust coverage or premiums.
Key Conditions: You must already be enrolled in a Medigap plan to use this rule. If you’re coming from Original Medicare alone or a Medicare Advantage plan, you can’t switch to a Medigap plan under this guaranteed issue provision—you’d need to apply normally, which might involve health questions outside your initial 6-month Medigap Open Enrollment Period or a Special Enrollment Period.
Practical Steps: To switch, contact the new insurance provider, apply for the desired plan, and, once approved, cancel your old plan. There’s no specific enrollment window like the Annual Enrollment Period (October 15–December 7) that applies to Medicare Advantage or Part D—Washington’s rule lets you do this anytime.
This flexibility is a big perk in Washington compared to most states, where switching outside specific periods often requires passing medical underwriting, risking denial or higher rates due to health conditions. Just make sure the new plan fits your needs—compare benefits and premiums carefully with your Medicare Insurance broker, as costs can vary by insurer even for the same lettered plan.
Can I switch from a Medicare Advantage plan to a Supplemental/Medigap plan during the Annual Enrollment Period without answering health questions?
Maybe. How long did you have a Medicare Advantage plan?If you are still in your first year of Medicare Advantage coverage and you previously had a Medicare Supplement plan that you dropped to join the Medicare Advantage plan, you may exercise your 'Trial Right' Special Enrollment Period to return to your Medicare Supplement plan with no medical questions. If that plan is no longer available, you may choose another Medicare Supplement insurance company and enroll without Medical Underwriting, within certain guidelines.
If you enrolled directly into a Medicare Advantage plan during your Initial Enrollment Period and are leaving that plan within the first 12-months of coverage, you may also choose to return to Original Medicare and enroll with a Medicare Supplement plan without Medical Underwriting, again, subject to certain guidelines.
This process can be a bit tricky because you must first drop the Medicare Advantage plan and return to Original Medicare before you may enroll for a Medicare Supplement plan, and this can take some time. The Annual Enrollment Period is from October 15 - December 7 each year, and it is a very busy time of year for Social Security and Medicare, as most Medicare beneficiaries need to review and make changes to their plans during that time of year. It is possible that you could leave your Medicare Advantage plan and go back to Original Medicare only to have your Special Enrollment denied by the insurance company and find yourself without a Supplement plan while also outside of the Annual Enrollment Period, so also unable to re-enroll in your Medicare Advantage plan. If you want to do this, be prepared to start the process in October to allow enough time for the disenrollment and re-enrollment. You do not want to wait until the end of November or beginning of December to start this process.
My neighbor says I'm crazy for paying for a Medigap plan when Medicare Advantage is "free." What should I tell him?
When choosing between a Medicare Advantage Plan and a Medicare Supplement Plan (Medigap), there are no right or wrong answers. The best choice depends on each individual's financial and health needs.Medicare Advantage Plans (also known as Part C) replace Original Medicare (Part A and Part B). Many of these plans offer additional benefits, such as coverage for prescription drugs, dental, vision, and hearing services. While some Medicare Advantage Plans have no extra monthly premium, individuals must continue to pay their Part B premium, which is $185 in 2025. These plans also feature a maximum out-of-pocket limit, which helps protect you from high costs if you are hospitalized or require expensive medical procedures. Most Medicare Advantage Plans are available as either PPOs (Preferred Provider Organizations) or HMOs (Health Maintenance Organizations). If you choose a Medicare Advantage Plan, you will need to use in-network providers. Be aware that there are copayments and coinsurance costs associated with these plans.
Medicare Supplements (or Medigap plans) work alongside Original Medicare (Parts A and B). Original Medicare typically covers 80% of medical expenses, while a Medicare Supplement plan covers the remaining 20%. When you choose a Medigap plan, you still need to pay your monthly Part B premium of $185 (in 2025), in addition to the monthly premium for the Medicare Supplement plan. Although the total of these premiums can add up, the only out-of-pocket expense is the one-time Part B deductible of $257 (for 2025). All other copayments and coinsurance are covered by your Medicare Supplement plan.
In summary:
- A Medicare Advantage Plan generally costs less each month, but you will incur copayments or coinsurance whenever you visit a doctor or undergo a procedure. This means you are paying for care as you receive it.
- A Medicare Supplement Plan has a higher monthly premium, but your medical expenses are known. This means you are paying for care in advance.
I went with Medigap because I travel a lot, but now I'm paying a fortune in premiums. Did I make a mistake?
Not a mistake—more like a trade-off. Let’s walk it through so you can see the moving parts:Why Medigap Made Sense for You
Travel Flexibility: Medigap pairs with Original Medicare, which is accepted almost anywhere in the U.S. You don’t have to worry about “in-network” versus “out-of-network” like you do in Medicare Advantage. For frequent travelers, that freedom is golden.
Predictable Coverage: Most Medigap plans cover the Part A and Part B deductibles, coinsurance, and other gaps. If you land in a hospital in another state, you’re not stressing about surprise bills.
Why It Feels Expensive
Premiums Are High: Depending on your age, state, and the plan (G, N, etc.), Medigap can easily run $150–$300+ per month on top of Part B and Part D.
You’re Paying for Peace of Mind: The big premium is an “insurance policy on your insurance.” Even if you don’t use much care now, you’re covering the what-ifs of travel, hospitalizations, or chronic care.
Would Advantage Have Been Cheaper?
Yes, usually on the front end. Many Medicare Advantage plans have $0 or low premiums. You’d still pay Part B, but you’d save that Medigap premium.
But: you’d be stuck using networks, needing referrals in some cases, and watching for prior authorizations. If you landed in an out-of-network hospital while traveling, you could be on the hook for big bills.
The Middle Ground
If premiums are the pain point, you could explore Medigap Plan N (lower monthly premium, but you pay a copay here and there).
Or, if you don’t travel quite as much anymore, a Medicare Advantage PPO with a national network might balance cost and flexibility.
What's the financial risk of sticking with Original Medicare without a Medigap plan?
Sticking with Original Medicare (Parts A and B) without a Medigap (Medicare Supplement) plan can expose you to significant out-of-pocket costs because Medicare doesn’t have an annual limit on what you might pay for covered services. You’re responsible for 20% of all Part B expenses — including doctor visits, outpatient care, surgeries, and medical equipment — after meeting your deductible. If you face a serious illness or require frequent treatments such as chemotherapy, dialysis, or hospital stays, those 20% coinsurance payments can add up quickly and create major financial strain.In addition, Original Medicare doesn’t cover many common healthcare needs such as prescription drugs, routine dental or vision care, or extended stays in skilled nursing facilities beyond the limited covered period. Without a Medigap plan to help fill those coverage gaps, beneficiaries are essentially “self-insuring” against potentially high medical bills, making them financially vulnerable in the event of unexpected or chronic health issues.
Do I have to answer health questions when switching from one Supplemental/Medigap plan to another?
Medigap plans are underwritten in most states once you’re outside your initial enrollment window (usually 6 months after you turn 65 and enroll in Part B). That means:• Insurance companies can ask about your health
• They can deny coverage, charge more, or exclude pre-existing conditions
You don’t need to go through underwriting if:
1. You’re in your Medigap Open Enrollment Period (the 6-month window after you enroll in Medicare Part B).
2. You qualify for a guaranteed issue right, such as:
• Your current Medigap plan ends or stops covering your area
• You move out of your plan’s service area (for Medicare SELECT)
• You lose other creditable coverage (like employer or union coverage)
• You’re within 12 months of trying a Medicare Advantage plan and want to switch back to Medigap (the “trial right”)
If you’re switching Medigap plans just because of cost or benefits, and you’re outside of those protected periods, expect to answer health questions — and possibly be declined.
I applied for a Medigap plan and got denied because of my health history-how is that even legal when I've paid into Medicare for years?
Medigap plans, also known as Medicare Supplement Insurance, are private insurance policies designed to cover healthcare costs not included in Original Medicare. While Medicare itself is a federal program with standardized benefits, Medigap plans are offered by private insurers, and their rules can vary depending on state laws and circumstances.Medical Underwriting Outside Guaranteed Periods
If you apply for a Medigap plan outside your guaranteed issue period (when you turned 65), insurers are generally allowed to use a process called "medical underwriting." Medical underwriting enables them to evaluate your health history and decide whether to approve your application, decline coverage, or adjust premiums. This practice is permitted under federal law because Medigap plans are private insurance products, and insurers have the right to assess risk when determining eligibility outside federally protected periods.
State Regulations
While federal law sets the baseline for Medigap protections, states may have additional regulations that expand consumer rights. For example, some states prohibit medical underwriting entirely or allow open enrollment periods for Medigap plans beyond the federally mandated timeframe. If you were denied coverage, it may be worth investigating whether your state offers extended protections.
What You Can Do
If you have been denied a Medigap plan due to your health history, here are steps you can take:
• Check whether you were within a guaranteed issue period at the time of your application. If so, you may be able to appeal the denial.
• Consult your state’s Department of Insurance to learn about any state-specific rules that might apply.
• Look for alternative forms of coverage, such as Medicare Advantage plans, which may provide similar benefits without medical underwriting.
• Seek advice from a licensed Medicare counselor or broker who can help you navigate your options.
Can I be denied for a Medicare Supplement plan?
Yes — in most situations you can be denied. Here’s how it works:When you CANNOT be denied (Guaranteed Issue):
Your strongest protection is during your Medigap Open Enrollment Period — the 6 months starting the month you turn 65 and enroll in Part B. During this window, insurers must:
• Accept you regardless of health conditions
• Charge you the same rate as healthy applicants
• Sell you any plan they offer in your state
You also have guaranteed issue rights in specific situations after that window, including:
• Your MA plan leaves your area or you move out of its service area
• You lose employer coverage
• Your Medigap insurer goes bankrupt
• You’re in a trial right period returning to Original Medicare
When you CAN be denied:
Outside of those windows, insurers in most states can use medical underwriting — meaning they can:
• Deny you outright based on health history
• Charge you significantly higher premiums
• Exclude pre-existing conditions for up to 6 months
I have Original Medicare, a Medigap Plan G, and a Part D plan, but I'm still facing high costs for my specialty medication. What options exist for someone in my situation?
Your costs will be capped at $2100 in 2026, but if you have a high monthly cost early in the year you do have an option called the Medicare Prescription Payment Plan (MP3). The MP3 doesn’t reduce your drug cost, but it spreads it out.For example, if you have a drug that will cause you to hit the $2100 limit in the first couple of months of the year, if you sign up at the start of the year, you would pay $175 per month through the end of the year. You’re still paying $2100, but not all at once. Obviously the earlier the better for this idea. Reach out to your plan’s customer care number for more information.
You can press your doctor for any alternative meds (generics or biosimilars) that are lower cost but still treat the same conditions. You can also ask about free samples, or if a higher dosage can be prescribed which you then split in half each day.
If you have limited income, you have some additional options;
1. Extra Help (details at https://www.ssa.gov/medicare/part-d-extra-help). Depending on your income, you can reduce or eliminate your copays and deductibles if you qualify.
2. Manufacturer assistance. Needymeds.org and RxAssist.org have directories you can use to find assistance programs. These are also normally income or needs based.
3. Many states have a State Pharmaceutical Assistance Program (SPAP) which can help you. If you qualify you may even get a Special Election Period to change your Part D plan too.
You can also look at discount card programs like GoodRX or RxSaver.
There are alternative pharmacies like CostCo, Mark Cuban’s Cost Plus Drugs, and I think even Amazon is developing an alternative pharmacy.
Lastly, you should always shop for coverage during annual enrollment. You may find a plan with a lower deductible, or a flat Tier 3 copay vs a percentage coinsurance. Your agent can help you with that process, or you can go to medicare.gov or the carrier’s website to compare costs.
I'm enrolled in a Medigap Plan F, and I'm not sure how my emergency room visits are handled. Is there a copay I should expect?
With Original Medicare + Medigap Plan F, emergency room care is typically billed under Part B (unless you’re admitted as an inpatient, then it shifts to Part A). Plan F pays both the Part B deductible/coinsurance and the Part A deductible/coinsurance, so for Medicare-approved ER services you generally have no copay or out-of-pocket.Exceptions: costs for non-covered items (often self-administered drugs given in the ER—submit receipts to your Part D plan), care from opt-out providers, foreign travel emergencies (Plan F pays 80% after a $250 deductible, up to a lifetime cap), and SELECT versions of Plan F (must use network hospitals). If you’re unsure whether you have a standard or SELECT Plan F, check your card or call the insurer.
I just moved from New York to Florida and have Original Medicare with a New York Medigap plan. Do I need to change my coverage?
No—Original Medicare (A & B) works nationwide, so you don’t need to change that.You can usually keep your New York Medigap (if it’s not a Medicare SELECT policy), but notify the insurer of your new Florida address and ask about any premium/residency changes.
If it is Medicare SELECT, moving out of area gives you a 63-day guaranteed-issue right to switch to a standard Florida Medigap.
Your Part D drug plan (and any Medicare Advantage plan) is region-specific, so your move triggers a Special Enrollment Period to choose a Florida plan.
What's your go-to strategy for helping someone decide between Medicare Advantage and Medigap?
Here is the updated response:My go-to approach is to start with a simple education session before ever talking about specific products. I literally pull out a piece of paper and walk through the basics so the person in front of me can see exactly how Medicare works, what the gaps are, and why those gaps matter. When people can look at it visually and follow along, the whole thing starts to make a lot more sense. From there I assess their full picture, including their budget, their health situation, how often they use their coverage, and which doctors and medications matter most to them. Honestly, if someone can afford a Medigap policy, that is usually my first preference because the freedom, predictability, and access it provides are hard to beat, especially as people get older and start using their coverage more frequently. But the reality is that the monthly premium for a supplement plus a standalone Part D plan is out of reach for some people, and putting someone in a plan they cannot comfortably afford does not serve them well. In those cases, the goal shifts to finding the best possible Medicare Advantage plan for their specific needs, making sure their doctors are in network, their medications are covered, and their out-of-pocket exposure is manageable. There is no one size fits all answer, and anyone who tells you otherwise is not giving you the full picture. The best plan is the one that fits your life and your budget, and that looks different for everyone.
How can I save money on my Medicare Supplement?
Saving money on a Medigap plan is mostly about comparing prices for the exact same coverage. Because these plans are standardized, a Plan G with one company has the same benefits as a Plan G with another.Here are the fastest ways to lower your costs:
Apply for a Household Discount: Most carriers offer 5% to 12% off your premium if you live with another adult (like a spouse or roommate), even if they aren't on your specific plan.
Switch to Plan N: If you have Plan G or F, switching to Plan N can save you significantly on monthly premiums. You’ll just pay small copays (up to $20) for some office visits.
Consider High-Deductible Plan G: This offers the same coverage as standard Plan G but with a much lower premium. You pay a set deductible (about $2,870 in 2026) before the plan starts paying.
Shop Your Rate Annually: Prices change every year. If you are in relatively good health, you can often switch companies to get a lower rate for the same "letter" plan.
Check for the "Birthday Rule": Some states allow you to switch plans around your birthday without answering any health questions. This is a great way to move to a cheaper carrier if you have pre-existing conditions.
Which Medicare Supplement plan (Medigap) offers the best value for most seniors, and why?
For most seniors Plan G offers the best overall value because it covers nearly everything Original Medicare does not, including the Part B coinsurance, skilled nursing facility coinsurance, and foreign travel emergency coverage, with the only out of pocket exposure being the annual Part B deductible which is $257 in 2025. Plan N is worth considering for healthier seniors who want a lower monthly premium and are comfortable with small office visit copays and potential exposure to excess charges. Plan G gives you the most predictable cost structure of any plan currently available to new Medicare enrollees, which is why it has become the most popular Medigap option. That said, the best value depends on your health, how often you use your coverage, and what you can comfortably afford in monthly premiums. An independent agent can run a side by side comparison of premiums from multiple carriers so you are not overpaying for the same coverage.
Is paying for a high-end Medicare Supplement plan really worth it, or is it overkill?
Great question—and one I hear all the time.Suppose you’re looking at Medicare Supplement plans (also called Medigap). In that case, you’ve probably noticed that plans like Plan G (and the legacy Plan F, if you were eligible for Medicare before 2020) come with some pretty impressive coverage… and a higher price tag. So the real question becomes:
Is it worth the money?
Let’s break it down.
According to the 2025 Medicare & You guide, high-end Medigap plans help pay for almost all the out-of-pocket costs that Original Medicare doesn’t cover—like the 20% coinsurance for doctor visits, hospital stays, and skilled nursing.
Plan F covers everything, including the Medicare Part B deductible. But it’s only available to people who were eligible for Medicare before January 1, 2020.
Plan G is the next best thing—it covers everything except the annual Part B deductible (which is $257 in 2025).
High-Deductible versions of Plan F or G are available too. These plans have a lower monthly premium, but you have to pay the first $2,870 out of pocket in 2025 before the plan starts covering your costs.
Here’s who it’s worth it for:
You want predictable costs and maximum peace of mind.
You see doctors often, expect surgeries or specialist care, or just want to avoid surprise bills.
You can afford the premiums and don’t want to worry about “what if” scenarios.
If you want the "set it and forget it" option—no guessing, no worrying—then yes, a high-end Medigap plan like Plan G is absolutely worth it. You’ll pay a bit more each month, but you’ll have rock-solid coverage and very few surprise expenses.
But if you’re healthy, budget-conscious, and okay with a little financial exposure? There are other Medigap options that may fit your needs better.
Still not sure what’s right for you? That’s what I’m here for.
Let’s talk through your options and figure out the best plan for your life, not just your wallet.
I'm on Medigap Plan G, and I'm curious how my upcoming knee replacement surgery will be billed. Does the plan cover it all after my deductible?
1. Original Medicare Pays First: First, Medicare determines if the knee replacement is medically necessary. If approved, Medicare pays its share of the Medicare-approved amount for the costs.2 .Part A or Part B Coverage:
If the surgery is an inpatient procedure (requires an overnight hospital stay), Medicare Part A covers the hospital costs. Plan G will cover your Part A deductible and any coinsurance.
If the surgery is an outpatient procedure (most knee replacements are now outpatient), Medicare Part B covers the surgeon's fees, facility charges, and other related services. You are responsible for meeting the annual Part B deductible.
3. Medigap Plan G Pays Second: After Medicare pays its portion, your Medigap Plan G policy kicks in to cover the remaining costs (the "gaps"). Plan G covers the 20% coinsurance that Original Medicare leaves you responsible for once you meet the Part B deductible.
4. Minimal Out-of-Pocket Costs: Once you've paid your annual Part B deductible (which is $257 in 2025), Plan G covers 100% of all remaining Medicare-approved Part B charges and all Part A deductibles and coinsurance. This means your additional out-of-pocket expenses for the surgery and recovery should be minimal or non-existent, aside from your monthly Medigap premiums.
What's the best way to compare my current Medicare supplement plan to a Medicare advantage plan?
What's the difference between Medicare Supplement and Medicare Advantage plans? Many people think these things are the same, but they're actually quite different. A Medicare Advantage plan is typically either an HMO or PPO type of plan, where you have to worry about doctors and hospitals being in-network. They usually have a lower premium than a Medicare Supplement, and depending on where you're at, certain service areas have a zero premium plan that doesn't cost you anything above and beyond what you would normally pay for just the Part B premium.
Medicare Advantage plans typically include prescription drugs. They do have a maximum out-of-pocket, referred to as MOOP, of $9,350, so that is your worst-case scenario. Even if something catastrophic were to happen, they will give you some coverage, usually for dental, vision, and hearing, but it's typically not comprehensive—more preventative. For dental, things like checkups and cleanings are covered, and sometimes they will offer a rider to give you more comprehensive dental.
Medicare Advantage plans are locked in for one year, and you can only get the plans that are in your service area. A Medicare Supplement will have a higher premium, but you do get better coverage. You don't have to worry about networks; you can go to any doctor or hospital that you want. Medicare Supplements do not include prescription drugs, so you probably also want to get a standalone prescription drug plan. Medicare Supplements also won't give you anything towards dental, vision, and hearing, but again, you can get a standalone dental, vision, and hearing plan.
Medicare Supplements can be changed at any time throughout the year, unlike Medicare Advantage and prescription drug plans, which lock you in for the year and you can't change them until the end of the year for a January 1st effective date. The first time you get a Medicare Supplement, you will get a guaranteed issue, so you don't have to answer health questions. But after that, if you want to change to a different plan or a different carrier, you will need to go through health underwriting and answer health questions, and there are no service areas that you have to worry about.
Can I get a Medigap plan with Guaranteed Issue if I'm losing my employer coverage?
Often, yes, but it depends on what type of employer coverage you are losing and whether you have (or are enrolling in) Medicare Part B.If you are losing employer/union coverage that supplements Original Medicare (including many retiree plans or COBRA): You generally have a federal Medigap “guaranteed issue” right. That means you can buy a Medigap policy without medical underwriting, and you typically must apply within 63 days of the coverage ending (or the date you are notified it is ending, depending on timing).
If you are losing active employer coverage and you are enrolling in Part B now: You may not be using “guaranteed issue,” but you typically get a 6‑month Medigap open enrollment period starting when Part B becomes effective, during which you can usually buy any Medigap plan sold in your state without underwriting.
If you are voluntarily dropping employer coverage that you could keep: You often do not get a guaranteed issue right.
Also, Medigap generally requires that you have Original Medicare (Part A and Part B), and guaranteed issue rights and plan availability can vary by state.
If Medicare Supplement (Medigap) plans are better for long-term coverage, why don't more people choose them?
First, one has to define “better”. What is “better”?• No networks.
• Less prior authorizations.
• More financial protection if something serious happens.
• Standardized...A Plan G is a Plan G no matter where you live. They don’t change from year-to-year.
After that, the main reasons why more people don’t choose them are as follows:
1. The 800# TV ads from the corrupt, publicly traded e-brokers. The ads and agents that represent these companies do not give full disclosure about ALL the options and pros and cons of each option that a Medicare beneficiary has. Unfortunately many people that have enrolled into Medicare Advantage over the last 5 years or so have little to no clue what they have and the pros and cons that go along with it.
2. Almost 20% of Medicare beneficiaries also receive Medicaid, therefore they have no need for a Medicare Supplement.
3. Many people can’t afford the escalating premiums. For those that can’t, they need to seriously consider a High-Deductible Plan G. It is “The Best Alternative To Medicare Advantage.”
4. Then you have a large percentage of Medicare beneficiaries that have group retiree coverage in place of or in addition to their regular Medicare. These would include those who have retired from federal, state, and local government, as well as those in the military that have Tricare for Life.
5. Lastly, there are people that have truly weighed their options and prefer Medicare Advantage over a Medicare Supplement because of the $0 to low premiums and the extra benefits (dental, vision, etc.). And they are willing to deal with copays, networks, and annual changes. From my experience and research, the vast majority of people that have a Medicare Advantage plan are satisfied to very satisfied with their plans.
So, “better" depends on each Medicare beneficiary's specific needs, philosophy, and budget.
I hope that helps.
Regards,
Chris
Are Medicare Supplement plans the same thing as "Medicare Secondary Insurance"?
Yes, “Medicare Supplement” and “Medicare Secondary Insurance” usually mean the same thing.Both refer to insurance that pays after Medicare — helping cover costs like deductibles, copays, and coinsurance that Medicare doesn’t fully pay. The official name is Medicare Supplement Insurance (or Medigap), but a lot of people casually call it “secondary insurance” because it acts after Medicare pays first.
Quick tip: Not all “secondary insurance” is a Medigap plan — some people might have secondary coverage through a retiree plan, Medicaid, or an employer too. But if you’re buying it yourself specifically to fill Medicare’s gaps, it’s a Medicare Supplement.
I missed my Medigap window by a few months and now no one will cover me without underwriting. Why isn't this rule more well known?
You’re not alone — this is a common source of frustration, and the rules around Medigap open enrollment aren’t as well known as they should be. Here’s why it happens and what to know:Why the Medigap window is so strict
Open Enrollment Period is limited
Starts the month you turn 65 and enroll in Part B, and lasts 6 months.
During this window, insurance companies cannot deny you coverage or charge higher premiums due to health conditions.
After the window ends
Insurers can require medical underwriting, meaning they can:
Deny coverage for pre-existing conditions
Charge higher premiums
This is why missing the window by even a month can make coverage much harder to get.
It’s not widely advertised
Most seniors hear about Medicare Part A/B enrollment, but Medigap rules are less emphasized by Social Security, Medicare, and employers.
Many people only learn about it when trying to switch plans or retire — by then, it’s often too late.
Ways to navigate now
Check for guaranteed-issue rights:
Some states have birthday rules or allow switching if you lose other coverage or your MA plan changes.
Consider Medicare Advantage:
If you can’t get Medigap without underwriting, you can enroll in an MA plan instead, which doesn’t require medical underwriting.
Appeal or ask about exceptions:
Sometimes insurers offer coverage if you have recent job-based insurance loss or other special circumstances.
Bottom line:
The strict window exists to protect insurers from high-risk enrollments, but it can be harsh on seniors who miss it. Awareness is low because most educational materials focus on Part A/B, not Medigap timing.
I'm on a supplemental Plan N, and I'm curious if my recent MRI is covered or if I'll get stuck with a big bill.
With your Medicare Supplement Plan N, your recent MRI is covered under Medicare Part B as long as it’s deemed medically necessary, but you’ll need to meet the 2025 Part B deductible of $257 first, and then Plan N picks up the 20% coinsurance—though you might face a small copay, up to $20, if it’s done in a doctor’s office. Unlike Plan G, which also covers the Part B coinsurance but skips those copays and fully handles excess charges if a provider bills above Medicare’s rate, Plan N leaves you responsible for any excess, though that’s rare with MRIs since most imaging centers stick to Medicare-approved amounts. I’ve seen beneficiaries caught off guard by these details, so double-check your provider’s billing with your Explanation of Benefits to avoid surprises—either way, your bill should stay manageable compared to having no supplement at all.
Which is better: a Medicare Advantage Plan or a Medigap policy?
Neither a Medicare Advantage plan nor a Medigap policy is inherently "better"; the right choice depends on your individual needs and preferences. Medicare Advantage plans are private, bundled alternatives to Original Medicare that often include drug coverage, vision, dental, and hearing benefits, but restrict your choice of providers to a plan network. Medigap policies, on the other hand, are supplemental to Original Medicare and cover out-of-pocket costs like deductibles and copayments, providing freedom to see any provider who accepts Medicare but without the bundled extra benefits of Advantage plans.Choose Medicare Advantage if:
You want bundled benefits: These plans can combine your Part A, Part B, and Part D (prescription drug) coverage, plus extras like vision, dental, and hearing care, all into one plan.
You prefer lower monthly premiums: Advantage plans often have low or even $0 monthly premiums, though you'll still pay copays or coinsurance for services.
You don't mind a limited provider network: You must use providers within the plan's network for your care, so it's important to ensure your doctors are in the network.
Choose a Medigap Policy if:
You value freedom of choice: Medigap plans allow you to see any doctor or hospital that accepts Original Medicare, regardless of location or network restrictions.
You want predictable costs: Medigap policies help cover the remaining out-of-pocket costs that Original Medicare doesn't pay, such as deductibles, copayments, and coinsurance.
You prefer to keep Original Medicare: Medigap is a supplement to Original Medicare, whereas Medicare Advantage plans are a replacement for it. You can also buy a separate Part D plan for prescription drugs.
In your experience, what are the best Medicare Supplement insurance companies and why?
In review of Medicare supplement insurance companies, several factors such as financial stability, customer service, plan options, and pricing play an important role in determining the best providers. Some highly rated companies include AARP/UnitedHealthcare, Mutual of Omaha, and Anthem Blue Cross Blue Shield. AARP/UnitedHealthcare has an extensive network and coverage options, available to a wide demographic with user-friendly resources and competitive pricing. Mutual of Omaha has strong financial ratings and a variety of plans, offering additional benefits that appeal to many seniors. Anthem Blue Cross Blue Shield has a great presence in multiple states, providing various plans and a solid customer support system.In addition to company reputation and coverage options, premium affordability and claims process efficiency are important aspects that help the consumers choice. Companies like Cigna and Humana have gained a foothold for their competitive premiums and streamlined claims processes, which means policyholders can access care without undue hassle. Another important consideration is the availability of additional perks such as wellness programs and telehealth services, which can enhance the overall value of a Medicare supplement plan. In the end, the best Medicare supplement insurance company will depend on an individuals needs and preferences, which means beneficiaries must thoroughly research and compare options to find a plan that meets their healthcare requirements and financial situation.
What is Guaranteed Issue for Medicare Supplement plans, and when does it apply?
Guaranteed Issue (GI) for a (Medigap/Medicare Supplement) plan means an insurance company must sell you a policy, cannot deny you coverage, cannot charge you more because of health conditions, and cannot impose waiting periods for pre-existing conditions. Medigap works alongside **Original Medicare** to help cover out-of-pocket costs like deductibles and the 20% Part B coinsurance. The strongest GI protection occurs during your one-time, six-month Medigap Open Enrollment Period, which begins when you are age 65 or older and enrolled in Medicare Part B.You may also qualify for Guaranteed Issue in certain special situations, such as losing employer coverage, your **Medicare Advantage** plan leaving Medicare or your service area, or exercising a 12-month “trial right” after first joining Medicare Advantage. In these cases, you typically have 63 days to apply for certain standardized Medigap plans without medical underwriting. Outside of these protected periods, insurers in most states can require health screening and may deny coverage or charge higher premiums.
With the supplements being so expensive in climbing in price every year, what is your take on hospital indemnity policies added with advantage policies?
My take on hospital indemnity policies paired with Medicare Advantage plans is that it's ABSOLUTELY something I recommend and encourage to *all* of my Medicare Advantage clients, every time.In fact, Medicare itself *allows* us to discuss the following coverage with our clients in the Medicare Scope of Appointment form that must be signed by the beneficiary every year as a compliance requirement.
Medicare Advantage, Medicare Supplement, Prescription Drug Plans, Dental, Vision, Hearing & Hospital Indemnity Plans.
The copays and coinsurance costs on a Medicare Advantage plan are generally really low for doctor visits, lab work, x-rays and urgent care, but the costs for ambulance, outpatient surgery, inpatient hospitalization and skilled nursing facility coverage add up really quickly in the event of medical events.
I make it a practice to keep track of the copays on the plans my clients select for their Medicare Advantage plans, and pair a thorough, robust, budget-friendly hospital indemnity plan for them. It's rare that my clients ever regret adding that coverage. I've heard from numerous clients who did *not* add it, that they regret the copays they've been charged after a sudden medical event.
Can my Medigap insurer terminate my policy?
In almost every situation, a Medigap insurer cannot cancel your policy as long as you keep paying your premiums and you didn’t commit fraud on your application. Federal law requires Medigap plans to be guaranteed renewable, which means the company has to keep your coverage in force.There are only a few situations where a Medigap company is allowed to end your policy:
• You stop paying your premiums.
If the payment goes past the grace period (usually about a month), they can cancel it.
• You gave false information when you applied.
If the insurer can prove you intentionally misrepresented something important on your application, they can terminate the policy.
• The insurance company goes bankrupt or stops selling Medigap plans altogether.
If they pull out of the Medigap market in your state, they can drop all policies—though you get special rights to switch to another plan without medical underwriting.
Outside of these situations, a Medigap insurer cannot drop you because of your age, your health, a new diagnosis, or because your medical care has gotten expensive.
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I was already scheduled for total knee replacement when I took out my policy, will my supplemental plan G still pay?
Yes, Medicare Supplement Plan G will likely still pay for your scheduled total knee replacement, but with a potential pre-existing condition waiting period. While Medigap plans don't cover the cost of the surgery itself, they do help with out-of-pocket costs like deductibles, coinsurance, and excess charges.Explanation:
Medigap and Pre-existing Conditions:
Medigap policies, including Plan G, often have a waiting period for pre-existing conditions. This means they may not cover expenses for treatment of a condition you already had when you enrolled in the policy, for a certain period (usually 6 months).
Waiting Period and Guaranteed Issue:
If you have a guaranteed issue right (meaning you're eligible to enroll in any Medigap policy without having to prove good health), the waiting period for pre-existing conditions doesn't apply, according to Medicare.gov.
Creditable Coverage:
If you had at least 6 months of prior creditable coverage (like another health insurance policy), the waiting period for pre-existing conditions may be shortened, according to Cigna.
Plan G and Knee Replacement:
Plan G, like other Medigap plans, helps cover the 20% coinsurance you'd owe after Medicare pays its share, as well as deductibles and other costs. It does not cover the full cost of the surgery itself.
Medicare Part A & B:
Original Medicare (Part A and B) generally covers knee replacement surgery if it's deemed medically necessary. Part A covers inpatient hospital costs, and Part B covers outpatient procedures and surgeries.
Plan G and Out-of-Pocket Costs:
Plan G will help reduce the out-of-pocket costs you'd have for your knee replacement, even if you have a pre-existing condition waiting period, according to Medicare.gov.
In short: You can likely enroll in Plan G, and it will help cover some of your out-of-pocket costs for the knee replacement, but you may have a waiting period for pre-existing conditions before your Plan G covers expenses for treatment of your knee issue.
How does Medigap Plan K compare to Plan G for someone on a tight budget?
Medigap Plan K and Plan G differ significantly in coverage and cost structure, which is important to consider for individuals managing a limited budget.Medigap Plan K offers lower monthly premiums but provides only partial coverage for many out-of-pocket Medicare costs. Specifically, Plan K covers 50% of certain benefits such as Part B coinsurance, blood (first 3 pints), hospice care coinsurance, skilled nursing facility coinsurance, and Part A deductible. It does not cover the Part B deductible or excess charges. Importantly, Plan K has an annual out-of-pocket limit ($7,060 in 2024); once this is reached, the plan covers 100% of covered services for the rest of the year. This limit helps protect against catastrophic expenses but means higher routine out-of-pocket costs.
Medigap Plan G, in contrast, offers more comprehensive coverage, including 100% of Part A and B coinsurance, skilled nursing facility coinsurance, hospice care coinsurance, and the Part A deductible. Plan G does not cover the Part B deductible, but after that is paid, nearly all Medicare-approved costs are covered. Plan G generally has higher monthly premiums but minimal out-of-pocket expenses.
Summary for someone on a tight budget:
Plan K: Lower premiums, higher out-of-pocket costs, but a cap for catastrophic expenses.
Plan G: Higher premiums, lower and more predictable out-of-pocket costs.
Choosing Plan K may be suitable if minimizing monthly expenses is the top priority and you are comfortable with potentially higher healthcare costs throughout the year, up to the annual limit. Plan G is preferable if you can afford higher premiums and want more predictable, lower out-of-pocket costs.
For detailed plan information, please consult official Medicare resources:
https://www.medicare.gov/supplements-other-insurance/how-to-compare-medigap-policies
Reference: Medicare.gov - How to compare Medigap policies
I've got Medigap Plan C, and I'm curious if my recent bloodwork is included or if I need to budget for extra costs.
in Original Medicare — it doesn’t determine what’s covered. That’s Medicare Part B’s job.So the real question is: did Medicare Part B cover your bloodwork?
Generally yes, if:
• A doctor ordered it as part of diagnosing or monitoring a condition
• It was done at a Medicare-approved lab
• It was deemed medically necessary
If Part B covers it, here’s what Plan C picks up:
• The Part B deductible ($283 in 2026) — Plan C covers this
• The 20% coinsurance after the deductible — Plan C covers this too
• Your out-of-pocket cost: $0 once the deductible is met for the year
Where you might still owe money:
• Tests ordered outside a Medicare-approved lab
• Panels that aren’t considered medically necessary (some wellness screenings fall here)
• Any tests your doctor added that Medicare deems not medically necessary — the lab should give you an Advance Beneficiary Notice (ABN) before running those
Quick action step: Call your lab or check your Medicare Summary Notice (MSN) at MyMedicare.gov — it’ll show exactly what was billed, what Medicare approved, and what (if anything) remains.
How do I know if a Medigap policy is right for me, and what's the best time to buy one?
Medigap (a Medicare Supplement) is often a good fit if you want:- Predictable costs: fewer surprise bills when you have tests, procedures, or hospital stays.
- Freedom to choose doctors: you can generally see any provider nationwide who accepts Medicare (no plan networks).
- Less hassle with referrals/prior authorizations than many Medicare Advantage plans.
- Travel flexibility: helpful if you travel often or live in more than one state.
- Peace of mind if your health changes: you’re less exposed to per-visit copays and plan changes.
Medigap may be less ideal if:
- You’re comfortable with networks and copays to keep monthly premiums lower, or
- You mainly want extra benefits like routine dental/vision (more common with Medicare Advantage).
Best time to buy one:
- The best time is your Medigap Open Enrollment Period: the 6 months that start when you’re 65+ and enrolled in Medicare Part B. During this window:
- You can buy any Medigap plan sold in your state with no health questions, and
- You can’t be charged more due to medical conditions.
After that window, you can still apply, but in many states you may face medical underwriting (possible higher premiums or denial), unless you qualify for a special guaranteed-issue right.
Also, some states have a “birthday rule” (or similar annual window) that lets you switch Medigap plans around your birthday with reduced or no underwriting (rules vary by state).
Are there plans that allow me to continue to travel anywhere and be covered?
While coverage outside of the United States is limited, there are plans that allow you to continue to travel anywhere within the U.S. and still be covered. A Medicare Supplement plan, or Standard Medigap plan, doesn't have it's own restricted provider network and allows for you to see any doctor that accepts Original Medicare, no referral required. A Medicare Advantage plan, or Part C plan, typically has a restricted provider network, and may allow you to use in or out-of-network providers without a referral (PPO) or may require you to stay in-network for covered services and require referrals (HMO). While a Medicare Advantage plan may seem like the lesser option in terms of travel flexibility, it is always a good idea to check a Medicare Advantage plan's Evidence of Coverage documents for included 'visitor' or 'travel' benefits. Many major insurance carriers now offer with their PPO plans a supplemental benefit or 'visitor' or 'travel' program that is available within the United States that will allow you to stay enrolled in the plan when you’re in the visitor/travel area and outside of the plan’s service area for a specified amount of time. Under the visitor/travel program or benefit, you can typically get all plan‑covered services at in‑network cost sharing when you see a network provider. In most cases, when you receive non‑urgent/non‑emergency care from an out‑of‑network provider (a provider who is outside of your Medicare insurance plan's network), your share of the costs for your covered services may be higher.What states have the Medigap "birthday rule" and what is it?
A Medigap “birthday rule” provides current Medigap enrollees with a short, guaranteed-issue window each year around their birthday to switch plans without undergoing medical underwriting (usually to the same or lesser benefits; exact rules vary by state).States with birthday rules (as of Sept 2025):
CA: 60 days from the first day of your birth month; equal or lesser benefits; can change carriers.
California Department of Insurance
OR: 30 days from the first day of your birth month; equal or less; can change carriers.
Oregon SHIBA
ID: 63 days after your birthday; equal or less; can change carriers.
Idaho Department of Insurance
IL: 45 days after your birthday (ages 65–75); equal or less; same carrier or affiliate.
MD: 30 days after your birthday; equal or less benefits.
NV: 60 days from the first day of your birth month; equal or less; can change carriers.
Nevada Division of Insurance
LA: 63 days after your birthday; equal or lesser; generally same carrier/affiliates.
OK: 60 days after your birthday; similar/equal or lesser; can change companies.
Oklahoma Insurance Dept.
KY: 60 days after your birthday; same benefits; can change carriers.
UT (effective May 7, 2025): 60 days after your birthday; equal or lesser; same insurer only.
Utah Legislature
+1
VA (effective July 1, 2025): 60 days after your birthday; same letter plan with any insurer.
Virginia SCC
WY (effective June 4, 2025): 63 days after your birthday; equal or less; can change plan/carrier.
Wyoming DOI
IN (effective Jan 1, 2026): 60 days after your birthday; same letter plan with any insurer.
LegiScan
+1
Related protections: Missouri has an anniversary rule (60-day window around your policy anniversary to switch to a same-letter plan, often with a new carrier); Washington lets you switch anytime to equal/lesser benefits with the same insurer; CT & NY have year-round Medigap guarantee
A Medicare supplement broker told me something about "extra lifetime reserve hospital days". What are those and how do they work?
Lifetime reserve days are a one-time backup supply of 60 additional hospital days that Original Medicare gives you to use after you've exhausted your standard inpatient benefit in a single benefit period.How the standard benefit works first. Medicare covers inpatient hospital stays in "benefit periods." Within each benefit period, you get up to 90 days of covered hospital care. Days 1–60 have no daily coinsurance (just the Part A deductible), and days 61–90 come with a daily coinsurance charge ($816/day in 2026). Once you've used those 90 days in a single benefit period, you've hit the wall — that's where lifetime reserve days kick in.
What lifetime reserve days are. The extra 60 days are a pool that sits on top of your standard 90-day benefit. They are not renewable — you get exactly 60 of them across your entire lifetime, to be used however and whenever you need them. In 2026, each lifetime reserve day comes with a $1,632 daily coinsurance (double the days 61–90 rate), which you pay out of pocket.
How they're used. They kick in automatically on day 91 of a continuous hospital stay within a single benefit period, unless you explicitly opt out in writing. Once used, those days are gone permanently — even if you later switch Medicare plans or take a break in coverage.
You can decline to use them. If you'd rather preserve your lifetime reserve days — say, because you have a Medigap policy that would cover the gap differently, or you want to save them for a potentially longer future stay — you can submit a written request to the hospital to not use them. The hospital is then required to issue you a denial notice, which you can use to appeal or to trigger other coverage.
Why they matter less with Medigap. Most Medigap supplement plans (Plans A, B, C, D, F, G, etc.) cover the lifetime reserve day coinsurance, and some cover an additional 365 hospital days beyond Medicare's limits entirely. So if you have a supplement, the $1,632/day charge may be fully covered anyway.
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What are the pros and cons of Medicare Supplement Plan G VS Medicare Supplement Plan N?
Plan G is the more comprehensive option, while Plan N usually has the lower premium. The tradeoff is that Plan N adds some cost-sharing, so it can be cheaper for lighter users but less predictable if you see doctors often.Plan G advantages
• Fewer out-of-pocket costs once you pay the Part B deductible.
• No copays for routine office visits or most other covered services.
• Covers Part B excess charges, which can matter if you see a provider who bills above Medicare’s approved amount.
Plan G drawbacks
• Usually has a higher monthly premium than Plan N.
• You may pay more overall if the premium difference is large and you use little care.
• It can feel like you are paying for protection you may not fully use.
Plan N advantages
• Lower monthly premium is the main appeal.
• Good fit for people who want solid supplemental coverage but are comfortable with some cost-sharing.
• Can be a strong value if you do not have frequent office visits or ER use.
Plan N drawbacks
• You may pay up to about a $20 copay for office visits and about a $50 copay for non-admitted ER visits.
• It does not cover Part B excess charges.
• If you use care often, the lower premium can get eaten up by copays.
Practical way to choose
Choose Plan G if you want simpler budgeting, more complete coverage, or you see specialists frequently. Choose Plan N if the premium savings are meaningful and you are okay with some copays and a bit more variability in yearly costs.
One important point: both plans are Medigap plans, so they work with Original Medicare and do not include Part D drug coverage, dental, or vision by themselves.
I have Medicare A and B, which was secondary to my large group health plan. My spouse passed away in late June 2025, and his company is providing COBRA coverage for six months, through January. If I wait until then, will I still have guaranteed issue for a Medicare supplement, or do I have only 63 days from June 30 (until Sept 1) to enroll? I'm in CO
You have a Guaranteed Issue right to enroll in a Medicare Supplement plan when your COBRA coverage ends in January. Since you're losing employer-sponsored coverage, you're eligible for a 63-day window to enroll in a Medigap plan without medical underwriting. This means you can choose from specific plans (A, B, C, D, F, G, K, or L) without being denied coverage or charged more due to pre-existing conditions .Key Points:
• Guaranteed Issue Window: You have 63 days from the date your COBRA coverage ends (January) to enroll in a Medigap plan.
• Eligible Plans: You can choose from Plans A, B, C, D, F, G, K, or L, depending on your eligibility and plan availability.
• No Medical Underwriting: Insurance companies can't deny you coverage or charge more based on your health status during this period.
Action Steps:
• Mark Your Calendar: Note the end date of your COBRA coverage (January) and plan to enroll in a Medigap plan within the 63-day window.
• Gather Documents: Prepare proof of coverage termination, such as a letter from your insurer or a disenrollment notice.
• Compare Plans: Research and compare Medigap plans from different insurance companies to find the best fit for your needs .
Does Medicare cover SilverSneakers gym memberships?
Quick answer: not through Original Medicare — but often yes through Medicare Advantage.Original Medicare (Parts A & B) does not include SilverSneakers, but many Medicare Advantage (Part C) plans and some Medigap plans do — at no additional cost beyond plan premiums.
About 95% of Medicare Advantage plans include some form of fitness benefit.
What SilverSneakers includes:
Access to roughly 14,000 locations nationwide, fitness equipment, group classes (yoga, tai chi, water aerobics, Zumba, strength & balance), plus pools, tennis courts, and walking tracks where available.
Can you change Medicare Supplement plans at any time?
Changing Medicare Supplement (Medigap) PlansThe short answer is: not always freely — it depends on your situation and timing.
Guaranteed Issue Rights (Best Time to Switch)
You have the strongest protections during specific windows when insurers must sell you a plan at the best available rate, regardless of health:
Initial Enrollment Period — the 6-month window starting when you're 65+ and enrolled in Medicare Part B. This is the best time to buy any Medigap plan.
Special Enrollment Periods — triggered by specific life events, such as losing other coverage (employer plan, Medicare Advantage, etc.).
Outside of Guaranteed Issue Periods
Outside those windows, you can technically apply to switch plans at any time, but:
Insurers can use medical underwriting — meaning they can review your health history and deny you coverage or charge higher premiums based on pre-existing conditions.
Only exception: A few states (like New York, Connecticut, Massachusetts, and California) have stronger consumer protections that allow more open switching.
If I have Medigap or secondary insurance, does it cover my Medicare Part A and Part B deductibles?
It depends on what type of coverage you have.If you have a Medicare Supplement (Medigap) plan, most of them will cover your Part A hospital deductible. When it comes to the Part B deductible, only certain older plans like Plan F or Plan C cover it. If you became eligible for Medicare after 2020, your plan will not cover the Part B deductible. For example, Plan G covers everything except that Part B deductible.
If you just have secondary insurance, like from an employer or retirement plan, it may cover some or all of your deductibles, but every plan is different so you would need to check the details of that specific coverage.
The simple way to think about it is this: most Medicare Supplement plans cover the big costs, but you may still have a small out-of-pocket amount depending on your plan.
What is the cost and value of a supplemental plan, and what plans are available?
This is a big question with a LOT of variables.First, there are two pathways for supplemental medicare coverage: a medigap plan, or a medicare advantage plan. Which option is right for you depends on a lot of factors. But in general:
Cost:
Medigap plans will always have a premium tied to them. What the premium is depends on several factors and on the plan you choose. A high deductible plan G will have a much lower premium than a standard plan G, for example.
Medicare advantage plans are USUALLY (but not always) premium free so there could be no additional cost beyond your part B Premium.
In both cases you must continue to pay your part B premium in addition to any plan premiums to remain eligible.
Value:
The value of a Medigap plan is flexibility. There are no networks, so if a doctor accepts medicare, they accept your medigap plan. What your copayments or coinsurance would be depends on the plan you select. For example, if you choose a standard plan G, you pay the Medicare Part B deductible ($283 in 2026) and the plan pays the rest of your medical expenses. The coverage is simple. You do need to pick up a standalone Medicare Part D plan for prescription drug coverage, and there is no preventive dental, vision or hearing coverage.
A medicare advantage plan will typically include your part D coverage, as well as basic dental, hearing and vision coverage. Often you will get some comprehensive dental, a copay or stipend for hearing aids, and a stipend for eyewear. You will have a medical network (an HMO or PPO) which means you have to work with doctors in that network, and while there’s typically no premium, you will have copays for most services and those will vary by carrier and by plan within a carrier.
What plans are available?
This is going to depend on your location. Most areas have the same medigap plans available, but medicare advantage options differ by county. So, you would need to talk to an agent or go to medicare.gov to see all your options.
Do you have to renew your Medicare Supplement plan every year?
No, you do not have to renew your Medicare Supplement (Medigap) plan every year. Your policy is guaranteed renewable, meaning it automatically rolls over annually as long as you pay your premiums on time. The insurance company cannot cancel your coverage due to health issues or age. Keep the following in mind: Premium changes: While the plan continues, your premium may increase over time. Medicare supplement plans must offer the same coverage, regardless of the company that offers them. It is possible to change plans/companies to lower your rate. Changing plans: Unlike Medicare Advantage or Part D plans, you cannot simply swap Medigap plans during the fall Annual Enrollment Period (AEP). If you want to switch to a different Medigap policy, you generally have to pass medical underwriting, unless you qualify for a specific Guaranteed Issue Right.
My parents, ages 90 and 91, can no longer afford their Medicare Supplement Plan F and do not qualify for Medicaid. What happens if they cannot pay the 20% not covered by Medicare after cancelling the supplement?
Since they do not qualify for Medicaid, dropping all supplemental coverage is highly dangerous. Instead, the best path forward is looking into Medicare Advantage.Many Medicare Advantage plans have $0 monthly premiums. Your parents will have to pay copays as they use the plan, but the plans have Maximum Out-of-Pocket (MOOP) limits. Once they hit that limit in a calendar year, the plan covers 100% of their medical costs, giving them the exact financial safety net they need without the heavy monthly premium of a Plan F.
They can enroll during the Annual Enrollment Period with no underwriting.
What are the worst Medicare Supplement insurance companies to avoid?
There usually isn’t a “worst” Medicare Supplement company in terms of coverage, because the plans themselves are standardized by Medicare. A Plan G is a Plan G no matter which company you buy it from, and Medicare is the one approving claims, not the supplement company. What really matters is picking a carrier that’s more likely to keep rate increases reasonable over time, even if they aren’t the absolute cheapest upfront. A good local broker should have enough experience with the various plans to let you know which ones to avoid.
Do you need a scope of appointment to discuss Medicare Supplement plans?
If we're discussing original Medicare, such as supplements to Medicare (Plan G, Plan N etc.) then no. These plans are not regulated by the federal government. We are free to discuss pricing, carrier comparisons and underwriting. These are regulated more at the state level.A scope of appointment is required if we're discussing Medicare Advantage (Part C) or prescription plans (Part D). These are federally regulated by the Centers for Medicare & Medicaid Services (CMS), which mandates documenting the scope of the conversation before the appointment.
If I already have part A and am already terminal on hospice care, do I need to get on part B and go through the MAPD/MedSup enrollment process?
Medicare Part A covers 100% hospice related services. Some of these services include nursing care, medical equipment (such as oxygen, hospital beds and wheelchairs), hospice aide services, counseling, and respite care.The only exceptions that are not covered by Medicare are co-pays for prescription medication dealing with pain management. These co-pays are limited to a $5 charge. If respite care is used, there is a 5% co-insurance.
Respite care is where relief is provided for primary caregivers. This allows a break for caregivers while making sure their person is still safe. Respite care is covered up to 5 days at a time.
Whether or not you should get on Part B depends on your prognosis from your doctor. Hospice care is designed to support individuals with a life expectancy of six months or less if their illness follows its natural course. Hospice can be extended as long as the patien continues to meet eligibility standards. Recently, former President Carter was in hospice for 22 months before he passed away in December 2024.
Overall statics show the median length of hospice care in the US is 18 days. 50% of patients pass away in the first three weeks. Up to 15% of patients survive longer than 6 months. With those statistics in mind, I would suggest to someone that they go through the Part B process only if they have a complete understanding of their remaining life expectancy from their doctor.
Some people will stay enrolled in Part B and Advantage or Supplement Plans if they need medical care or prescriptions unrelated to the hospice diagnosis. Obviously you want to have coverage if you have needs for non-medical care or prescriptions. Conversely, I suspect someone on hospice is not going to have a need to see an orthopedic surgeon. My best advice is use common sense based on your current condition.
Can I change my Medicare plan after open enrollment ends?
The Short answer is yes, but the long answer requires me to go into more detail.If you just turned 65 and used your open enrollment option on a plan, then you need to wait till the Annual enrollment, which starts 10/15 of each year and ends on 12/7, to make changes. These changes are for Medicare Advantage (Part C) and Drug plan Changes (Part D).
-If you have opted for a Medicare supplement (Medigap plan), those have an open enrollment of 6 months from when you got your Part B, and in some states (like CA and OR), a recurring open enrollment around your birthday every year.-
If you have a Medicare Advantage plan, you can also make a one-time change during the first 3 months of each year (Jan 1 through March 31), called the Open enrollment for Medicare Advantage plans.
Lastly, you can change Medicare supplement plans from one plan to another whenever you want as long as you medically qualify. That is because they are medically underwritten policies. This will save you money if you switch from time to time (like care and home insurance). Finally, there are Special election periods for Medicare Advantage and Drug plans where you can change throughout the year due to special circumstances, and this is like if you moved or have a chronic condition.
All in all, call me Dave Boehm (Medicare Dave) so I can help you navigate this and get you into the right plan for you.
Is just Medicare Part A and Part B enough coverage, or do I need supplemental insurance?
I don't recommend that anyone just have part A and B alone. There are some significant gaps in coverage, and no maximum out of pocket cost.Adding a supplemental plan can be the best approach to cover those gaps, for most seniors, as the premiums are predictable and your retirement savings is protected against significant out of pocket costs. Seniors with Medicare plus a Medicare Supplement can see any Medicare doctor in the country, or go to any hospital, without worrying about networks or approvals.
Medicare Advantage can also help limit out of pocket costs and will cost less in the short term. However, advantage plans are known as "managed care" meaning that you have to stay within a network, they can require referrals and pre-approvals, plus you'll pay cost sharing (co-pays, co-insurance) up to a maximum out of pocket limit that must be reached before you're covered in full. Out of pocket limits will typically average $5000 to $7000 in network and much higher if any of your providers was an out of network provider.
For most seniors, the predictable costs, freedom of choice, and limited out of pocket exposure makes a Medicare Supplement plan the best long term choice.
Can a Medicare Supplement insurer cancel my Medigap policy?
Only in certain circumstances can a Medicare Supplement insurer cancel your Medigap policy.-If you fail to pay your monthly premium(s)
-Material misrepresentation/fraud on your application
-Insurer files for bankruptcy
-If you move out of the service area in which the insurer provides coverage
If the insurer files for bankruptcy and you lose coverage through no fault of your own you have 63 days to get a new Medigap policy with guaranteed issue rights meaning no questions asked about health conditions.
What happens to my Medigap plan if I move to another state?
Typically, your Medigap or Medicare Supplement plan would be the same exact coverage as the plans are standardized by the federal government. However, there are three states where the standardization rules are different. What that means is if you move to or from these states, the standardization would be different. The three states are Massachusetts, Minnesota, and Wisconsin. What you will want to know is if you current insurance carrier will continue to offer insurance in the new state that you are moving to. Also, please be aware that your premium or rate can change from state to state as you change your address.Do doctors prefer Medigap or Medicare Advantage plans?
Most doctors that I talk with prefer their clients to have Medigap. It's easier for them from a billing standpoint, and they don't have to constantly wait for pre-approvals before they can provide care. With Medigap, they know that if Medicare pays, the Medigap plan is going to pay as well so they can recommend treatments with confidence.Which Medigap plans cover foreign travel emergencies, and how much do they pay?
You did say a MEDIGAP plan, so i am taking that into consideration and not addressing a Medicare Advantage plan.Dependent on what state you live in ....Medigap plans C, D, F, G, M, and N are the currently available or common plans that provide coverage for foreign travel emergencies.(WI AND MN WE DO NOT HAVE ALL THESE PLAN OPTIONS.) These plans typically pay 80% of billed charges for medically necessary emergency care after you meet a $250 annual deductible. There is a $50,000 lifetime limit on this benefit.
KEY DETAILS OF FOREIGN TRAVEL COVERAGE
* Eligibility Period: Coverage applies only if the emergency care begins during the first 60 days of your trip.
* Conditions: The care must be considered medically necessary and must not be otherwise covered by Original Medicare.
* What is Not Covered: Medigap plans do not cover medical evacuation or repatriation.
* Availability Note: While Plans C and F are no longer available to new Medicare beneficiaries (those who became eligible for Part B on or after January 1, 2020), individuals who already have them may retain their coverage.
IMPORTANT CONSIDERATIONS
* Because Medigap plans have a lifetime limit and do not cover medical evacuation, many travelers choose to purchase separate travel insurance for more comprehensive protection. Always confirm the specific benefits with your insurance company before traveling outside the U.S.
Are Medicare Supplement plans worth the cost?
The true value of a Medicare Supplement plan, regardless of the carrier someone may elect to have their plan with, is the freedom to be treated anywhere in the United States that accepts Medicare. Someone would never have to deal with a service being "out of network". As long as the Dr. or Facility accepts Medicare, then they will accept the Medicare Supplement. It will fill in the 20% gap after Medicare pays 80% and that is why they are also called Medigaps. Many people value that freedom more than others.Although there are many zero premium Medicare Advantage plans, they will be a little more restrictive on Dr's and Specialists that can be seen and will usually have copays associated with the different services the plan covers. Great question!
What is the difference between secondary insurance and supplemental insurance for Medicare?
“Supplemental insurance” usually refers specifically to Medigap, which is designed to work with Original Medicare and pay deductibles, coinsurance, and gaps. It follows standardized benefits and only works with Original Medicare.“Secondary insurance” is a broader term — it means any coverage that pays after Medicare, including Medigap, Medicaid, employer retiree plans, or other coverage.
So, all Medigap plans are secondary insurance, but not all secondary insurance is Medigap.
What's your go-to strategy for helping someone decide between Medicare Advantage and Medigap?
I simplify the plans by framing the choice as pay now or pay later. Medigap means paying a higher monthly premium for predictable, zero-stress medical bills and robust coverage. Medicare Advantage offers a low monthly premium but you pay as you go when you see a doctor or have a hospital stay - often with surprise bills.To find the right fit, we look at your budget, travel plans (are you a snowbird?), and whether you want total freedom seeing any doctor that accepts Medicare or don't mind staying in a local network. I also make sure you understand that turning 65 is the one time you can get a Medigap plan without underwriting. Switching down the road isn't always guaranteed if your health changes.
Finally, we plug your actual doctor list and prescriptions into our comparison tool to get a side-by-side comparison to confidently make your own choice.
Can I use HSA funds to pay Medicare Supplement (Medigap) premiums?
HSA funds cannot be to pay Medicare Supplement (Medigap) premiums. However, if you are age 65 or older, you can use HSA funds tax-free to pay eligible Medicare premiums, including Medicare Part A (if you pay one), Part B, Part D, and Medicare Advantage (Part C) premiums. Medigap premiums are specifically excluded by IRS rules.
Do you have to renew your Medicare Supplement plan every year?
No, you do not have to renew your Medicare Supplement plan every year. Medicare Supplement plans are desinged to automatically renew each year as long as you continue to pay your premiums on time. You do not need to reapply or renew your policy annually.I do, however, suggest reviewing your coverage each year to ensure it still meets your healthcare needs and budget. Your premium and plan costs can change over time, and depending on your situation, you may have other coverage options worth considering.
Also, you can change your Medicare Supplement plan anytime during the year, you don't have to wait until your anniversary date. Some states have Birthday or Anniversary Rules allowing you to change without answering health questions.
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