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Reviewed for accuracy by Lauri Middleton, RN, MSN, licensed Medicare agent · Reviewed for clarity by Karen Orilla · · Meet our reviewers →
Decision 4 of 5
Medigap — on the Original path only
Do I add a Medigap policy to cover the 20 %, and which letter?
This decision only exists on the Original Medicare path. If the plan is leaning towards Medicare Advantage, it can be skipped.
What this is
Medigap is a private policy that pays some or most of what Original Medicare leaves to you — the 20 %, deductibles, some foreign travel. Policies are standardized by letter: a Plan G from one company covers the same things as a Plan G from another; only the price and service differ.
It cannot be combined with Medicare Advantage. And it has a single protected window: the six months from when you are 65 and have Part B.
Medigap (Medicare Supplement)A private policy that pays some or most of the 20 % and other gaps in Original Medicare. Plans are standardized by letter (G, N and so on). It cannot be used with Medicare Advantage. Glossary →Medigap open enrollmentThe six months from when you are 65 and have Part B, when Medigap must be sold to you without health questions. Glossary →Original MedicarePart A and Part B run by the federal government. Any doctor in the U.S. who accepts Medicare; you pay 20 % of most Part B services with no yearly cap unless you add Medigap. Glossary →Coinsurance and copaysYour share of each service: a percentage (coinsurance, like Part B's 20 %) or a flat amount (copay, like $40 for a specialist). Glossary →
Applied to your calendar
Draw a calendar first and this section will use the actual dates.
→After the six months, most states let companies ask health questions and decline; a few states have year-round or birthday rules. A SHIP counselor knows which applies.
→Medigap adds a monthly premium on top of Part B; in exchange, a bad year is capped by the policy rather than by luck.
Medigap has one six-month window with no health questions
It starts the first month you are 65 or older and enrolled in Part B. During those six months a company must sell you any Medigap policy it offers, at the same price as someone in good health. Outside it, rights vary by state.
