What is Medigap (Medicare Supplement insurance)?
A private policy that pays the share Original Medicare leaves you. Standardized by law, priced by the company, and only available on your terms during one window.
Medigap, also called Medicare Supplement insurance, is a private policy that pays the costs Original Medicare leaves behind. It exists to solve one specific problem.
The problem it solves
Original Medicare covers about 80 percent of most services after you meet the Part B deductible. You are responsible for the other 20 percent, and there is no cap on it. Twenty percent of a routine visit is small. Twenty percent of a cancer treatment or a long hospitalization is not.
A Medigap policy pays that share, so your costs become predictable.
The unusual thing about Medigap
The plans are standardized by federal law. A Plan G from one company covers exactly the same things as a Plan G from any other company. There is no fine print to compare, no network to check, no formulary.
This is genuinely unusual in insurance, and it changes how you shop. Since the coverage is identical, you are comparing price, the company's rate increase history, and service. Nothing else. See why identical plans cost different amounts.
How it works day to day
- You see any doctor in the country that accepts Medicare.
- The provider bills Medicare.
- Medicare pays its share and forwards the balance to your Medigap company automatically.
- The supplement pays its share.
- With a comprehensive plan, you often see no bill at all.
There are no networks, no referrals and very little prior authorization. That simplicity is the main thing you are buying.
What it does not include
- Prescription drugs. You need a separate Part D plan.
- Dental, vision and hearing. Medicare does not cover these, so there is nothing for the supplement to pay.
- Long term custodial care.
- Anything Medicare itself does not cover.
A supplement fills gaps in what Medicare covers. It cannot cover something Medicare never covered. See what Medigap does not cover.
You cannot have both
Medigap pairs only with Original Medicare. You cannot hold a supplement and a Medicare Advantage plan at the same time, and a supplement pays nothing while you are in an Advantage plan.
It is one path or the other. See the comparison.
The window that decides everything
Your Medigap open enrollment runs six months from the month your Part B starts, at or after 65. During it, no company in Texas can decline you or charge you more for your health history.
After it closes, Texas insurers can ask health questions and say no. This window opens once and does not come back, which makes it the most consequential six months in Medicare.
See the enrollment window in detail.
Common follow-up questions
Is Medigap the same as Medicare Advantage?
No, they are opposites. Medigap supplements Original Medicare. Advantage replaces how you receive it. You can only have one.
Does Medigap cover prescriptions?
No. Supplements sold today do not include drug coverage. You add a standalone Part D plan.
Do I need a referral with a supplement?
No. Any provider that accepts Medicare, no network, no referral.
Want this looked at properly?
We are an independent agency in McAllen serving Hidalgo, Cameron and Starr counties. No cost to talk it through.
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Does Medigap cover the 20 percent Medicare does not pay?
Medigap