Medicare Questions & Answers: Medicare Supplement
Medicare Supplement Q&A
Showing 50 questions
Can I change my Supplemental/Medigap plan at any time?
Medicare Supplement plans can be changed anytime, however, they may be subject to underwriting depending upon the time period that you’re trying to enroll.
Can I switch from a Medicare Advantage plan to a Supplemental/Medigap plan during the Annual Enrollment Period without answering health questions?
The short answer is no. However, there are always exceptions such as a Special Enrollment Period (SEP) to make a change or within your 12-month trial right period, or you are involuntarily terminated from your Medicare Advantage plan due to moving out of the plan service area, gaining eligibility due to age (turning 65), to name a few. In these cases, I want to discuss the change and ensure we cover all available SEP options.
My neighbor says I'm crazy for paying for a Medigap plan when Medicare Advantage is "free." What should I tell him?
Medicare Advantage Plans are not FREE. They may have a $0 premium. However, you must continue to pay your Medicare part B premium to qualify for a Medicare Advantage Plan.
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I went with Medigap because I travel a lot, but now I'm paying a fortune in premiums. Did I make a mistake?
You can can change to a Medicare advantage plan during Annual Enrollment. The premium is $0 but you will have copays and a book or doctors.
Do I have to answer health questions when switching from one Supplemental/Medigap plan to another?
In most cases, yes, you will have to answer health questions when switching from one Supplemental/Medigap plan to another. However, there are certain situations where you may qualify for guaranteed issue rights, which means you can switch plans without having to answer medical questions or go through underwriting.Guaranteed issue rights typically apply if you’re losing other coverage, moving out of your plan’s service area, or switching within your Medigap trial period, among other special circumstances. It’s always best to review your specific situation to determine whether you qualify for guaranteed issue or if underwriting will be required.
What's the financial risk of sticking with Original Medicare without a Medigap plan?
A specific example: I've got a client at CMC who had some heart issues. The bill was $65,000. Thankfully, they have a Medigap policy, which will pay all of their 20% for them. Had they not had the Medicare Medigap supplement policy, they'd be paying $13,000 out of pocket, and I don't know who has that just laying around.
So please, before you make any decisions or non-decisions on Medicare, Original Medicare, Supplement, or Medicare Advantage, speak to someone like myself who deals with it every single day with clients and has real-life experience and real stories to tell about horror stories from making the wrong decisions.
I would be glad to help you. We'll go over the pros and cons of Original Medicare, sticking with that, or doing a Medicare supplement to add to A and B that will pay all of your out-of-pocket costs, or even going to a Medicare Advantage plan, which I believe would be better than sticking with just Original Medicare. Anyway, we're here to help. My office is right on Kelly Street in Manchester, Tony Capraro State Farm. Have a great weekend!
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?
How Medicare Part D covers expensive medications:Formulary:
Each Part D plan has a formulary (list of covered drugs) organized into tiers (generic, preferred brand, non-preferred brand, specialty drugs, etc.).
Expensive medications are usually placed in the specialty tier, which often has higher cost-sharing (a percentage, not a flat copay).
Cost Stages During the Year:
Part D plans have four payment stages each year:
Deductible Stage:
You pay 100% of your drug costs until you meet the deductible (maximum $545 in 2024; this may be slightly different in 2025).
Initial Coverage Stage:
After meeting the deductible, you pay a copay or coinsurance (often 25%) until total drug costs reach a certain amount (around $5,030 in 2024).
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?
Medicare and a Medicare supplement are 2 completely different things. Medicare is what you paid into. A Medicare supplement is from a private insurance company. They have underwriting questions that you have to be able to answer correctly or they can deny you. They are completely separate things. The supplement works with Medicare to pay what Medicare doesn't pay. Medicare is what you paid into all these years. A Medicare supplement is something you have to purchase. Different companies have different questions so depending on your health situation, you may or may not be able to by one. Hope this helps explain.Cleo Martin
Can I be denied for a Medicare Supplement plan?
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, you will simply be re-calculated at the Florida rate. You may however, want to look at the Medicare Advantage plans in Florida as they are some of the most cost effective Medicare Advantage plans in the nation.
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?
If you have a Medigap plan F there would be no copayment for emergency room visit, but if you are travelling internationally that is a different story. Plans provide 80% to a lifetime maximum of $50,000 in coverage after the first $250 deductible each calendar year
What's your go-to strategy for helping someone decide between Medicare Advantage and Medigap?
To help someone choose between Medicare Advantage and Medigap, I ask:Health Usage: Frequent doctor visits or chronic conditions? → Medigap.
Budget: Want low monthly premiums? → Medicare Advantage. Prefer predictable costs? → Medigap.
Doctor Choice & Travel: Want nationwide coverage and keep any doctor? → Medigap. Okay with networks? → Medicare Advantage.
Drug Coverage: Want it included? → Medicare Advantage. Don’t mind a separate plan? → Medigap.
Simplicity: Want one bundled plan? → Medicare Advantage. Don’t mind piecing it together? → Medigap.
It's important to have a conversation going over all of this and find out what fits best for each individual. There are lots of plans out there with different benefits. Not all may fit your needs.
How can I save money on my Medicare Supplement?
If you're on a Medicare Supplement or considering a Medicare Supplement you might have noticed that supplement rates have gone up every year for the last three years. The reason that they have gone up is that Medicare raised all its deductibles and copayments for Medicare Parts A and Part B. There is a solution to keep from paying the insurance companies thousands of dollars each year for services you are not using. I will try to explain an alternative that will lower your monthly premiums 75 percent or more of what you are currently paying. The solution is to purchase a HDF or HDG supplement. You may have not heard of a HDF or HDG supplement, that is because there are only a handful of companies that offer the HDF or HDG supplement. The HD stands for "High Deductible", it is the maximum annual deductible you would have to pay out of pocket in a calendar year. After all copayments reach the deductible, Part A and Part B would be covered 100%, meaning that you would have no more out of pocket cost for the rest of the year. The annual deductible is set by the federal government and for 2024 is currently $2800.
Which Medicare Supplement plan (Medigap) offers the best value for most seniors, and why?
Plan G is usually the best value for most seniors. It covers almost everything except the Part B deductible, making it a solid choice for predictable costs and great coverage. It’s popular because it offers the most benefits without the high premiums of Plan F. (Which is only available for those eligible for Medicare before 1/1/2020) Plus, once the deductible is paid, there are no copays or surprise bills.
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?
Yes. As long as the facility where you have the surgery accepts Medicare assignment, you will only be responsible for the Part B annual deductible ($257 for 2025). Once you pay the Part B annual deductible, Medicare will pick up 80% of the remaining bill, and your Medigap Plan G will pick up the other 20%.
Is paying for a high-end Medicare Supplement plan really worth it, or is it overkill?
The answer depends on your specific situation. In general, Medicare pays for approximately 80% of your medical expenses, not including deductibles. The high-end Medicare Supplement plans pick up nearly all of the remaining 20% (in the case of the Plan G, you pay one small deductible.) Depending on the procedures or extent of care, this could still be a large financial liability. So, each person must decide if the premium for these plans is worth the potential risk of incurring even this portion of any medical bills. For many of my clients, paying this premium gives them the peace of mind that those bills will be covered, if and when they need them, even if they don't need a lot of care at this time. To balance out this premium cost, Medicare Supplement plans give you the freedom to go to any Medicare provider in the whole nation. If you reside in a different state for several months out of the year, Medicare Supplement plans suite well. The flexibility and peace of mind of Medicare Supplement plans may be worth the premium cost.
What's the best way to compare my current Medicare supplement plan to a Medicare advantage plan?
The best way to compare is to find an independent broker that you trust and whom others trust. Being fully independent allows us to show you most (or all) of the plans in your area and also to compare your current plan to a Medicare Advantage plan. They are very different plans with unique nuances and having a broker that doesn’t cost you anything is a smart way to shop!
Can I get a Medigap plan with Guaranteed Issue if I'm losing my employer coverage?
You will be considered “guaranteed issue” as long as your employer coverage is considered credible coverage, which in most cases it is. There are a few other instances where you can be considered guaranteed issue.
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?
The first thing that comes to mind is that you probably did not meet with a long-time Medicare professional agent who knows the ins & outs of its very quirky rules. In my opinion, enrolling with Medicare yourself online means that you may be bypassing the rules concerning the different periods during the year when one can enroll AND make changes.The only thing for you to do at this point is to enroll with a Medicare Advantage plan temporarily (you HAVE the right to do this at anytime since you've never enrolled before by picking up Medicare Part B with a monthly premium). Then, when the Open Enrollment begins on October 15th thru Dec. 7th (to become effective on Jan. 1st of the following year), you have what is known as "a trial right", meaning since you have your very 1st Medicare plan for less that 12 months, you will be able to apply for a Medigap (a.k.a., Med. Supp.) without having to answer any medical questions concerning pre-existing conditions.
Using any online information only yields the more well-known tenets of Medicare. The best advice I could ever give anyone regarding THE most important aspect of your life: HEALTH, is to be certain to get a 2nd & even 3rd opinion from an independent rep who is also known as a broker. However, in using a "Captive Agent": one who only has allegiance to one insurance firm, is foolhardy since all companies who offer Medicare-compliant Advantage plans can vary the rules to a certain extent. Though I truly hope that most agents are honest/reliable and can cover the gamut of the regulations, as an instructor myself, I will deliberately "over"-emphasize the more important areas/rules to all of my clients. Good luck and if needed, call 1-800-MEDICARE so that the person on the other end who's trained for this, confirms what a trial right means.
Are Medicare Supplement plans the same thing as "Medicare Secondary Insurance"?
Yes. Medicare supplement plans are often referred to as Medigap plans. These plans work in conjunction with your traditional Medicare, but do not take the place of traditional Medicare, as Medicare Advantage plans do.If Medicare Supplement (Medigap) plans are better for long-term coverage, why don't more people choose them?
What we do here is explain to our clients both the advantages and disadvantages of Medicare Supplement and Medicare Advantage. Whatever makes better sense for the client, we help them with that. So, work with someone who can offer you both Medicare Supplement and Medicare Advantage. More importantly, work with someone who's dealt with it for years and knows the good and bad about both plans. We would love to help you. Please, these decisions are way too important to take by chance or wait until the last minute. Let us help you. We'd be glad to.
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?
There is no cookie cutter answer for this question so it's one of the most confusing, and requires the most amount of interviewing and planning to give someone the most concise answer. For example, I have met with people who were turning 65 that wanted a Medicare supplement. But after meeting with them, we found out that they were eligible for federal and state assistance that would not require them to pay for a Medicare supplement. So they were very relieved to know that they did not have to take out a Medicare, supplement and They were also not going to be required to pay the $185 monthly Medicare, part B premium. Make sure you are meeting with a unbiased Insurance agent face to face l. This can help alleviate a lot of concerns and making sure you're getting the most concise planning for your healthcare as you age.What is Guaranteed Issue for Medicare Supplement plans, and when does it apply?
Guaranteed issues for Medicare supplement plans ensure you can purchase a Medicare supplement/Medigap plan that picks up the gaps that Medicare Part A and B leave behind. A guaranteed issue means you do not have to be questioned about your health conditions with the insurance underwriters, and the policy will not be denied. Guaranteed issue applies to the six months around your 65th birthday. Three months before your 65th birthday, the month of your 65th birthday, and three months after your 65th birthday, you have the right to get a guaranteed issue policy for your Medigap plans. After that, there are some special guarantee issues when retiring from a group insurance plan, but that would be for another discussion.
With the supplements being so expensive in climbing in price every year, what is your take on hospital indemnity policies added with advantage policies?
I believe adding a hospital indemnity plan may be a great solution to protect yourself from high copays for inpatient hospital stays and even ambulance copays. If approved for an indemnity plan, the cost are typically much lower than a Medicare Supplement and are often coupled with $0 premium Medicare Advantage Plan which is very affordable for those trying to stay within a specific budget yet still have peace of mind that a hospital stay will not hurt your wallet too much.
In your experience, what are the best Medicare Supplement insurance companies and why?
The best Medicare Supplement companies varies from region to region, even the large ones are not everywhere, so it makes no sense to compare and contrast by name , rather the best choice is the one that strikes a balance between cost, coverage and added values.
Can my Medigap insurer terminate my policy?
In a single word.. no.With explanation medigaps are guaranteed renewable which means as long as you pay your premiums and and was honest on your application you cannot be canceled.
So unless the insurer goes belly up your medigap cannot be cancelled.
I was already scheduled for total knee replacement when I took out my policy, will my supplemental plan G still pay?
Yes. Once the policy is issued it will pay secondary to any claims paid by medicare. If you enrolled in Plan G during your Medigap Open Enrollment Period (the 6 months after enrolling in Part B at 65+), no pre-existing condition limitations apply—your surgery would be covered.
How does Medigap Plan K compare to Plan G for someone on a tight budget?
Medigap Plan K differs from Medigap Plan G in the following ways: Plan K covers only 50% of coinsurance/copayment costs for benefits such as Part B cost share; blood; Part A hospice; skilled nursing; and Part A deductible. Plan K offers no coverage for costs such as Part B deductible; Part B excess charges; and foreign travel emergency. With an out-of-pocket limit of $7220 in 2025, careful consideration should be taken by an individual on a tight budget to ensure that the premium savings is worth the additional financial exposure. A standard High-Deductible plan G or F may be a better alternative. For more information on your specific situation, please call me directly.
Are there plans that allow me to continue to travel anywhere and be covered?
If you are going to be traveling quite a bit then I would recommend that you do a medicare supplement to utilize the lack of networks. A supplement G or N would be a great option (along with an appropriate drug plan) to get you coverage while traveling the United States. There are some PPO plans with good networks that allow you to utilize In/Out of network benefits (you will pay higher copays when out of network). I have several "snow birds" that use their plan both in Indiana and in Florida just the same. It is very important if you are going to go this route to verify that your primary doctors are in-network in both locations (such as snow birds).
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.
If you’ve got Medigap Plan C, that’s actually one of the more solid plans. Since it works alongside Original Medicare, most of the time your bloodwork, if it’s medically necessary and ordered by your doctor should be covered by Medicare Part B, and then Plan C usually picks up the leftover costs like the deductible and coinsurance. So chances are, you’re not paying much, if anything. But it’s always good to double-check with your provider just in case something’s considered non-routine.
How do I know if a Medigap policy is right for me, and what's the best time to buy one?
A Medigap policy is right for you for a number of reasons:1. You are in the younger market like age 65 and that gives you a low premium.
2. You're health is not great, many doc visits, maybe a few chronic conditions requiring on going services.
3. Medigap policies follow Medicare's lead, and Medicare patients are treated everywhere. In other words, Medigap clients don't hear "no" when or if they want to go to a specialist locally or anywhere in the country.
A Medicare supplement broker told me something about "extra lifetime reserve hospital days". What are those and how do they work?
So, simply put, with Medicare Part A, that's your hospital coverage from day zero through 60. You just pay your deductible for the benefit period, which is about $1,600; it's a little more this year. Once you hit day 61, while you're in the hospital, from day 61 through 90, you're paying about $400 a day.
Once you hit day 91, you get into what's called your lifetime reserve days. Basically, you have 60 days that will give you hospital coverage. You are going to pay a little more than $800 a day, and if you use all those days, they are gone for your lifetime.
So, say for instance you're in the hospital and you end up being there for 150 days. You've already used your 60-day benefit or lifetime reserve days, and then five years later you go back to the hospital. The most that you can get Medicare coverage for would be 90 days, 'cause you've already eaten into your lifetime reserve days.
Thank you for listening, hope this helps!
What states have the Medigap "birthday rule" and what is it?
As of July 2025, there will be ten states that will have a "birthday rule" where existing owners of Medigap plans can change plans or change Medigap companies without underwriting. The ten states with the "birthday rule" are, California, Idaho, Illinois, Maryland, Oregon, Nevada, Louisiana, Kentucky, Utah, and Virginia.
What are the pros and cons of Medicare Supplement Plan G VS Medicare Supplement Plan N?
When comparing Medicare Supplement Plan G and Plan N, you’ll find they are very similar. Both plans help cover gaps in Medicare, including hospital costs, skilled nursing, hospice care, and other important benefits. The key difference is in how they handle doctor visits and out-of-pocket costs.Plan G provides the most comprehensive coverage. After you pay your Medicare Part B deductible, Plan G covers everything else with no extra bills—just your monthly premium.
Plan N offers a lower monthly premium, which can save you money, but it comes with small copays: up to $20 for a doctor visit and up to $50 for an ER visit (if you’re not admitted). Plan N also does not cover Medicare Part B excess charges, which are additional fees a provider may charge above Medicare’s approved rate.
The good news is that for most retirees, excess charges aren’t something to worry about. The majority of doctors accept Medicare “assignment,” which means they agree to Medicare’s approved rates and cannot bill you extra. Since excess charges only apply when you see a provider who doesn’t accept assignment—and that’s becoming increasingly rare—most people will never encounter them.
So which plan is right for you? If you prefer predictable costs and the peace of mind of knowing all your doctor visits are fully covered, Medicare Supplement Plan G is the safer choice. If you’re generally healthy, don’t go to the doctor often, and want to save money on premiums, Medicare Supplement Plan N can be a smart option.
At Live Well Benefit Advisors Licensed in SC& NC, we help you compare Medicare Supplement plans so you can choose the coverage that fits both your health needs and your budget.
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 must enroll within 63 days from the termination of your spouse's coverage to qualify for guaranteed issue. You lost your creditable coverage when the plan was terminated. you must Enroll within 63 says
Does Medicare cover SilverSneakers gym memberships?
Original Medicare does not cover SilverSneakers or gym memberships. However, many Medicare Advantage plans and some Medigap plans include SilverSneakers as an extra fitness benefit at no additional cost.If your plan includes it, you can access participating gyms, fitness classes, and online workouts using your SilverSneakers membership ID. Coverage varies by carrier and ZIP code, so you should check your specific plan benefits or use the official SilverSneakers eligibility tool.
Is just Medicare Part A and Part B enough coverage, or do I need supplemental insurance?
Original Medicare (Part A and Part B) is generally not enough coverage for most, as it typically leaves you with 20% coinsurance, high deductibles, and no maximum out-of-pocket limit. Supplemental insurance—such as Medigap or a Medicare Advantage plan—is usually required to cover these gaps and protect against high, unpredictable medical costs.
What are the worst Medicare Supplement insurance companies to avoid?
At this point, I'm sure you have heard about rising cost of premiums across Medicare Supplements. I wouldn't say that there are certain companies to avoid; however, I think there are certain carriers that are more favorable in certain markets. You can start by looking at what's available in your market.If you want to learn more about certain carriers, historical performance, and want help identifying the best solution and carrier for your market, a licensed Medicare Agent will be a great resource for you and will help avoid some of the pitfalls.
For our clients, we complete a comprehensive review and access market analytics on the carrier, plans, and historical performance and share that information with clients as a means to educate, empower, and inspire clients to make informed decisions. The end goal is to enroll in a plan with carrier that is stable and has more predictable performance to avoid the drastic rate swings each year. The coverage is regulated at the federal level and the coverage is the same for ALL carriers, regardless of the logo.
You can also find great information on Medicare.gov and the FREE GUIDE, Choosing a Medigap policy. It has a lot of great information and key concepts to consider when you are selecting a plan and carrier.
If I have Medigap or secondary insurance, does it cover my Medicare Part A and Part B deductibles?
This will depend on which Medigap plan you have. If you have a plan F, yes they will be covered. If you have a plan G, the Part B deductible will not be covered but Part A will be. Other plans vary as well.
Do you need a scope of appointment to discuss Medicare Supplement plans?
Yes. You need a scope of appointment to discuss all of it :) The scope is typically signed before the first appointment.
Do doctors prefer Medigap or Medicare Advantage plans?
Doctors generally accept both types of coverage. Some may have a preference, but what truly matters is choosing the option that best fits your needs. There are many factors that go into deciding which plan is right for you, so it’s important to look at your personal situation and what kind of coverage will serve you best.
Which Medigap plans cover foreign travel emergencies, and how much do they pay?
All medigap plans cover up to 50,000 for foreign emergency visitsI would however recommend getting an international medical plan when you travel outside usa as the medigap plans require you to pay 1st and then wait for reimbursement, on the international medical they will file claim for you
What is the cost and value of a supplemental plan, and what plans are available?
The value of a Medicare supplement is outstanding. They allow you to see any provider that accepts Medicare without regard for network adherence. They also have a low annual deductible before the benefits kick in.The cost for Medicare supplements vary based on your zip code, your gender and your age as well as the carrier. Carriers charge different amounts for the same plans.
There are many plans available. Different locations may have different carriers available. You will see different costs for the same plan name from different carriers. The biggest carriers may not be worth the cost increase compared to a smaller carrier. The best thing to do is to find a local broker that represents multiple carriers. They can quote the different carriers and different costs in your area.
Do you have to renew your Medicare Supplement plan every year?
No. Medicare Supplement (Medigap) plans are generally guaranteed renewable, which means you do not need to reapply or renew your coverage each year as long as you continue paying your premium. The insurance company cannot cancel your policy because of your health or because you've had claims.Your premium may change over time, and the plan's benefits remain standardized by Medicare. While it's a good idea to review your coverage periodically, you can keep your Medicare Supplement plan year after year without annual renewal.
Can I change my Medicare plan after open enrollment ends?
Yes, if you have LIS low income subsidy or extra help. If you moved to a new county or state. If you newly receive Medicaid. If you lose your Medicaid benefits, these all things that open you up to SEP Special Enrollment periods. If need help or advice call us today.
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?
Going without a Medicare supplement can get risky fast because Original Medicare has no cap on the 20% they leave behind. One hospital stay, surgery, or ongoing treatment can create bills that are hard to recover from at their age. Before cancelling Plan F, it’s worth checking whether they could switch to a lower-cost supplement or even another company offering the same coverage for less. A Medicare Advantage plan may also be worth looking at since those plans are required to have a yearly max out-of-pocket limit.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.
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