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Medicare supplement







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Medicare Supplement FAQs

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1. What Is A "Modernized" Medicare Supplement Plan?

Medicare Supplement plan choices changed as of June 1, 2010 and plans offered on or after that date are called "modernized" plans. Certain prior plans (E. H, I and J) were eliminated and Plans D and G were modified. These eliminated and changed plans were "grandfathered," and beneficiaries with those plans have been allowed to retain them. In most instances it's in the best interest of beneficiaries to keep their grandfathered plans rather than to purchase a "modernized" plan.

2. What Plans Are Available?

The chart below shows basic information about the different benefits Medigap policies cover in 2018.

Yes = the plan covers 100% of this benefit
No = the policy doesn't cover that benefit
% = the plan covers that percentage of this benefit
N/A = not applicable

* Plan F also offers a high-deductible plan. If you choose this option, this means you must pay for Medicare-covered costs up to the deductible amount of $2,300 before your Medigap plan pays anything.

** After you meet your out-of-pocket yearly limit and your yearly Part B deductible, the Medigap plan pays 100% of covered services for the rest of the calendar year.

*** Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don't result in inpatient admission.

Starting January 1, 2020, Medigap plans sold to new people with Medicare won’t be allowed to cover the Part B deductible. Because of this, Plans C and F will no longer be available to people new to Medicare starting on January 1, 2020. If you already have either of these 2 plans (or the high deductible version of Plan F) or are covered by one of these plans before January 1, 2020, you’ll be able to keep your plan. If you were eligible for Medicare before January 1, 2020, but not yet enrolled, you may be able to buy one of these plans.

You live in Massachusetts, Minnesota, or Wisconsin

If you live in one of these 3 states, Medigap policies are standardized in a different way.

3. What Providers Are Covered?

Unless an individual purchases a "SELECT" plan (see question 4), s/he is eligible for treatment by ANY provider who accepts Medicare anywhere in the U.S.  

Providers who accept Medicare but don't take Medicare assignment (payment directly from Medicare), are permitted to charge up to 15% (this is called an"excess charge")  or 5% in NY of the Medicare allowable charge.  Plans F and G cover excess charges; Plans A, B, C, D, K, L, M, and N do not.

4. What is a Medicare SELECT Plan?

Medicare SELECT is a type of Medigap policy sold in some states that requires you to use hospitals and, in some rare cases, doctors within its network to be eligible for full insurance benefits (except in an emergency). Any of the standardized plans (see question 2) can come in a SELECT version.

If you have a SELECT plan and don't use a Medicare SELECT hospital or doctor (if applicable) for non-emergency services, you'll have to pay some or all of what Medicare doesn't pay.  Medicare will pay its share of approved charges no matter which hospital or doctor you choose provided the provider accepts Medicare.

A SELECT plan is less expensive than a standardized plan with the same letter designation. 

SELECT plans are offered by only some carriers and only in certain states and zip codes. When these plans are offered, they're usually restricted to certain zip codes and plans, and only a small number of hospitals are usually included in the network.

5. When Can Medicare Supplement Plans Be Purchased?

Medicare Supplement policies can generally be purchased at any time and, unlike Medicare Advantage or Part D prescription drug plans, do not have "lock in" provisions that prevent individuals with such plans from changing plans or carriers. You cannot be charged extra or refused coverage during the Medigap Open Enrollment period (a period that lasts 6 months and begins on the first day of the month in which the beneficiary is both 65 or older and enrolled in Medicare Part B).

Unless a beneficiary has a guaranteed issue right or buys a Medicare Supplement during the Medigap Open Enrollment Period, Medicare Supplement plans utilize medical underwriting, which means that you can be rejected or charged extra for a health condition. Individuals with Medicare Advantage plans can buy Medicare Supplement plans during the Annual Election (Enrollment) Period that runs from October 15--December 7 for a January 1 effective date, and the Medicare Supplement carrier can utilize medical underwriting unless the individual is in the Medigap Open Enrollment period.

A new Open Enrollment period has been designated to begin January 1, 2019 and end March 31, 2019.  During that period, individuals who have Medicare Advantage or Medicare Advantage Prescription Drug plans can elect to return to Original Medicare (Parts A and B) and also purchase a Medicare Supplement and/or stand-alone Part D plan.  Unless such an individual has what is called a "guaranteed issue right"  (such as what is called a Medicare "trial right") plans bought outside of the Medigap Open Enrollment Period are subject to medical underwriting.

Medical underwriting requirements, which apply in situations other than open enrollment and guaranteed issue, differ between each carrier.  However, all plans with the same letter designation provide the same level of benefits.

See question 6 for a discussion of "trial rights" which give Medicare Advantage beneficiaries the right to buy Medicare Supplement plans under two different sets of conditions.

6. What is a "Trial Right"?

You have a guaranteed issue (i.e. a right to buy a Medicare Supplement policy with no underwriting) if:

1.  You joined a Medicare Advantage plan when you were first eligible for Medicare Part A at age 65 (note that you must have enrolled as of the first of the month you were first eligible for Medicare Part A at age 65 or you don't qualify for this trial right)) and within the first year of joining, you decide you want to change to Original Medicare; or

2.   You dropped a Medigap policy to join a Medicare Advantage Plan (or to switch to a Medicare SELECT policy) for the first time, you've been in the plan less than a year, and you want to switch back.

You have different rights to buy certain Medigap policies, depending on which "trial right" you're exercising. 

If you have the first trial right, you can buy any Medigap policy that's sold in your state by any insurance company.  

If you have the second trial right, you have the right to buy the Medigap policy you had before you joined the Medicare Advantage Plan or Medicare SELECT policy, if the same insurance company you had before still sells it. If your former Medigap policy isn't available, you can buy Medigap Plan A, B, C, F, K or L that's sold in your state by any insurance company.

Click here for details about trial rights.

Note: The above are minimum standards for trial right requirements and are contained in the Choosing a Medigap Policy publication.  Some states have liberalized these requirements, and some carriers provide an additional 12 months under certain circumstances.  Please call us at 877-734-3884 to discuss what trial rights may apply to your particular state and situation.

7. What Will Happen to Medicare Supplement Plans C and F in 2020?

Here's what you need to know about the Medicare Access and CHIP Reauthorization Act of 2015  which eliminates Plans F and C ONLY for those with Medicare Part A effective dates on or after January 1. 2020:

  • Anyone eligible for Medicare Part A before January 1, 2020 can enroll in a Plan F or C even after 2020 and can keep their plan as long as they choose.
  • Anyone who becomes eligible for Medicare Part A on or after January 1, 2020 will NOT be able to purchase either a Plan F, Hi Deductible Plan F, or Plan C.  Plan G (the same as Plan F except the insured is responsbile for the Part B deductible) will continue to be available in addition to all the other options (i.e. Plans A, B, D, K, L, M and N), and a new Hi Deductible Plan G  may become available.
  • Insureds ALREADY enrolled in Plans F, HI-F. or C don't need to take any action.  Plans F, Hi-F and C will still be available for consumers eligible to purchase them in 2020 and beyond.