Do You Need Supplemental Insurance With Medicare?

Do You Need Supplemental Insurance With Medicare?

Although the Medicare annual enrollment period (AEP) ended on December 7, you might not be done with tasks related to your coverage just yet.

That's because if you made the switch from Medicare Advantage to Original Medicare, you're now eligible to apply for a Medicare Supplement insurance plan (aka Medigap) if you want one.

Are you wondering what exactly Medicare Supplement insurance is—and whether you truly need it? Keep reading for this important information:

  • What is Medicare Supplement Insurance?
  • Understanding Original Medicare Parts A and B
  • How Medicare Supplement Insurance Helps Cover Gaps
  • Information About Qualifying for Medigap

What is Medicare Supplement Insurance?

Medicare Supplement insurance plans, or Medigap plans, are designed to help beneficiaries of Original Medicare Parts A and B1 control their out-of-pocket costs, such as deductibles, coinsurance, copays, outpatient services and more.2 Members of Medicare Advantage Part C plans cannot purchase Medicare Supplement insurance.

Medigap insurance is meant to add an extra layer of coverage, not replace your Original Medicare plan. You're not obligated to purchase supplemental insurance with Medicare; however, having it can significantly reduce your out-of-pocket health care costs over time.

Let's review Medicare Parts A and B and what they cover so you can decide if a Medicare Supplement insurance plan is right for you.

Understanding Original Medicare Parts A and B

In order to be eligible for Medigap, you first need to be enrolled in Medicare Parts A and B.

Medicare Part A is hospital insurance and covers things like inpatient hospital stays, skilled nursing care, hospice care and limited home health care services. Part A has a yearly deductible ($1,632 per benefit period in 2024), generally does not have a monthly premium and covers up to 60 days of hospitalization. If you're in the hospital longer than 60 days, the daily copay for your hospital care can become expensive and coverage runs out after 150 days. 3

Medicare Part B is medical insurance, which covers medically necessary services and supplies that are needed to diagnose or treat your medical condition, plus preventive services to prevent illness. Part B has a yearly deductible ($240 in 2024), a monthly premium ($174.70 for most people in 2024) and 20% coinsurance.4

How Medicare Supplement Insurance Helps Fill Gaps

If certain health conditions or coverage needs have you concerned about how you'll pay for out-of-pocket costs, then you'll want to consider obtaining a Medigap policy.

Medigap insurance is provided through private insurance companies and pays for some or all of the associated health care costs that aren't included in Original Medicare coverage. Medigap can help limit or eliminate your copay, coinsurance and deductibles.

If you need preventive care services, certain Medigap policies can help cover the costs for those as well, in addition to at-home recovery or hospice care services. Or perhaps you want to make sure any potential health issues or emergencies are covered while you're traveling outside of the U.S. If so, you can purchase a supplemental insurance plan that will help pay for those costs, should they arise.

Medicare Supplement insurance plans are standardized, meaning that the benefits of each policy must remain the same across all insurance providers. The only difference will be the cost of the plan. Massachusetts, Minnesota and Wisconsin offer different standardized plans, however, so if you are a resident of one of those states, it's a good idea to research the differences to ensure you're choosing the right policy.

Information About Qualifying for Medigap

The best time to buy a Medicare Supplement insurance plan is during your six-month open enrollment period that begins the month you're 65 or older and enrolled in Medicare Part B. That's because during this period, insurers cannot deny you coverage and they must sell you a policy at the best possible rate regardless of your health.

If you're not new to Medicare and you just switched from Medicare Advantage to Original Medicare during the AEP, you can still apply for a Medicare Supplement insurance plan. However, because you're outside your Medigap open enrollment period:5

  • You may have to pay more for a policy.
  • Fewer policy options may be available to you.
  • You'll have to undergo medical underwriting and the insurance company is allowed to deny you a policy.

In some cases, you might be able to purchase a Medigap policy outside of your enrollment period with guaranteed-issue rights. However, you must be experiencing certain circumstances, such as if your Medicare Advantage plan discontinues your coverage or your Medigap company goes bankrupt. Under circumstances like these, you have guaranteed-issue rights within 63 days of when you lose coverage where an insurance company cannot deny you a Medigap policy.6

Get Support From a Medicare Specialist

It's important to explore all your health insurance options so you can make the right decision for your retirement without feeling overwhelmed. If you have further questions, you can speak to a Medicare insurance specialist and learn more about which Medigap plan best fits your financial and health care needs.

Keep reading! Get 6 tips for budgeting for Medicare

1Centers for Medicare and Medicaid Services, Get Medigap Basics, https://www.medicare.gov/health-drug-plans/medigap/basics, 2023.

2Centers for Medicare and Medicaid Services, Compare Medigap Plan Benefits, https://www.medicare.gov/health-drug-plans/medigap/basics/compare-plan-benefits, 2023.

3Centers for Medicare & Medicaid Services, 2024 Medicare Parts A & B Premiums and Deductibles, https://www.cms.gov/newsroom/fact-sheets/2024-medicare-parts-b-premiums-and-deductibles, 2023.

4Ibid.

5Centers for Medicare and Medicaid Services, Get ready to buy, https://www.medicare.gov/health-drug-plans/medigap/ready-to-buy, 2023.

6Medicare Interactive, Medigap purchasing details: enrollment periods, guaranteed issue, and more, https://www.medicareinteractive.org/get-answers/medicare-health-coverage-options/supplemental-insurance-for-original-medicare-medigaps/medigap-purchasing-details-enrollment-periods-guaranteed-issue-and-more, 2023.

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