#medigap

Guest post by Danielle Roberts

Medicare is a federal health insurance program that covers people aged 65 and older and people with certain disabilities. It has several parts that provide inpatient care, outpatient care, and prescription medications.

In general, Medicare will cover any care that is deemed medically necessary by a doctor who is contracted with Medicare. Part A provides for inpatient hospital stays, short-term skilled nursing facility care, and hospice care. Part B covers preventive care, doctor visits, lab-work, diagnostic imaging, durable medical equipment, ambulance, emergency, cancer treatments, dialysis and more. 

While Medicare covers the bulk of the costs of your care, you are responsible for Part A and B deductibles, coinsurance and copays. Medigap plans can be purchased to help you pay for these items.

Medicare beneficiaries also have the option to purchase a Part D drug plan, which will help to pay for the cost of retail outpatient drugs. Most formularies cover important medications related to dementia treatment.

Something Medicare does not cover is custodial care or long-term care. If a patient enters a skilled nursing facility after a hospital stay, Medicare will only pay for up to 100 days of care. This care is designed to be rehabilitative, with the goal being to return the patient to independent living after the care.

If a patient with a dementia is in decline and not expected to recover and assume the regular activities of daily living, then that patient would need to move into long-term care, which is not covered by Medicare. Beneficiaries can private pay for their care, or if their assets and income is below a certain level, they can qualify for Medicaid to help pay for this care. Visit with your local elder law attorney to learn more. 

When selecting a Medigap policy, it’s important to compare offerings from multiple insurance companies, especially if you’ve already chosen a specific standardized plan. While policies with the same letter designation provide identical benefits, premium costs can differ between insurers. For example, Policy A from Company 1 offers the same coverage as Policy A from Company 2, but the two…

As we age, having comprehensive health insurance becomes more essential than ever. While Medicare covers a large portion of your healthcare costs, it doesn’t pay for everything. That’s where Medicare Supplement Insurance Plans, also known as Medigap, come into play. These plans are designed to "fill the gaps" left by Original Medicare, providing seniors with enhanced financial protection and peace of mind.

At HCAG Insurance for Seniors, our mission is to simplify the Medicare process and help you choose the best plan for your health and budget. If you're considering a Medigap plan, this guide will walk you through everything you need to know.

What is a Medigap Plan?

A Medigap plan is a type of health insurance sold by private insurance companies to complement Original Medicare (Parts A and B). It helps pay for out-of-pocket costs such as:

Copayments

Coinsurance

Deductibles

Emergency care while traveling abroad

These supplemental plans are standardized and labeled A through N (Plan C and F are not available to those new to Medicare after January 1, 2020). Although the benefits are standardized, premiums and additional features can vary by insurer and location.

Why Consider a Medigap Plan?

While Original Medicare covers around 80% of healthcare costs, the remaining 20%—which includes hospital stays, doctor visits, and specialized care—can quickly add up. Medigap plans offer:

Predictable costs: You’ll know exactly what you’re responsible for each month.

Freedom of choice: Visit any doctor or hospital that accepts Medicare nationwide.

No referrals required: You don’t need a referral to see a specialist.

Extended travel coverage: Some Medigap plans cover emergency medical care outside the U.S.

Medigap coverage ensures that you won’t be burdened with unexpected medical expenses, making it ideal for those who want peace of mind and budget stability.

How Does Medigap Work with Medicare?

Medigap plans work in conjunction with Original Medicare. First, Medicare pays its share of the approved healthcare costs, and then your Medigap plan covers the remaining costs based on your specific plan.

It’s important to note:

Medigap does not work with Medicare Advantage Plans (Part C).

You must have Medicare Parts A and B to purchase a Medigap plan.

Medigap plans only cover one person. If both spouses want coverage, each must purchase a separate plan.

Choosing the Right Medigap Plan

Choosing the best Medigap plan depends on your individual needs, health status, and budget. Some key factors to consider include:

Plan benefits: Determine which expenses each plan covers and match that with your healthcare usage.

Monthly premiums: These vary by provider and geographic location.

Household discounts: Some insurers offer discounts if two or more people from the same household enroll.

Underwriting requirements: Outside of your initial enrollment period, you may need to answer health questions and undergo underwriting.

When to Enroll in a Medigap Plan

The best time to enroll in a Medigap plan is during your Medigap Open Enrollment Period—a six-month period that begins the month you turn 65 and are enrolled in Medicare Part B. During this time:

You can buy any Medigap plan sold in your state.

You can’t be denied coverage or charged more due to pre-existing conditions.

If you miss this window, insurers can use medical underwriting, and your application could be denied or cost more based on your health.

How HCAG Insurance for Seniors Can Help

At HCAG Insurance for Seniors, we understand how confusing Medicare choices can be. That’s why we offer free, personalized consultations to guide you through your options. We’ll help you:

Compare available Medigap plans in your area

Understand premium structures

Evaluate plan benefits based on your medical needs

Navigate enrollment without stress

Our team is committed to helping you make informed decisions that bring long-term value and security.

Final Thoughts

A Medicare Supplement Insurance Plan is more than just an add-on—it’s a vital component of a solid healthcare strategy for seniors. By filling in the coverage gaps left by Original Medicare, Medigap ensures that your golden years remain healthy and financially secure.

For many Medicare beneficiaries, a pressing question in 2025 is whether to add supplemental insurance—commonly known as Medigap—to cover the gaps left by Original Medicare. As healthcare costs continue to rise and policy adjustments occur, understanding your options becomes essential. Understanding Original Medicare and Its Limitations Original Medicare consists of Part A (hospital insurance)…

With the complexities of Medicare, many individuals are left wondering how to manage their healthcare costs effectively. Medigap insurance plays a vital role in providing the necessary support to fill the gaps left by Original Medicare.

The Role of Medigap Insurance

Medigap is a type of Medicare Supplement insurance that helps pay for costs not covered by Original Medicare. These costs can include co-payments, coinsurance, and deductibles, which can accumulate and lead to financial strain. By enrolling in a Medigap plan, beneficiaries can reduce their overall healthcare expenses.

Financial Security with Medigap

One of the primary advantages of having a Medigap policy is the financial security it offers. With coverage for various out-of-pocket expenses, beneficiaries can manage their healthcare costs more effectively. This security allows individuals to focus on their health rather than worrying about unexpected bills.

Conclusion