Medicare Supplement Pros and Cons
Understanding the Advantages and Tradeoffs of Medigap
Medicare Supplement Insurance, also called Medigap, is extra insurance you can buy from a private insurance company to help pay some of your share of out-of-pocket costs in Original Medicare, such as copayments, coinsurance, and deductibles. Medigap works with Original Medicare, not Medicare Advantage.
Like any Medicare coverage option, Medigap has potential advantages and potential tradeoffs. It may be a strong fit for some people and less appealing for others.
This page explains the main pros and cons of Medicare Supplement Insurance so you can better understand how it works.
This page is educational only. We do not recommend any specific Medigap plan letter, insurance company, premium, or coverage choice.
First, What Is Medicare Supplement Insurance?
Medicare Supplement Insurance is private insurance that works alongside Original Medicare.
Original Medicare includes:
Medicare Part A — hospital insurance
Medicare Part B — medical insurance
Original Medicare helps pay for many covered healthcare services, but it does not pay for everything. You may still owe deductibles, copayments, coinsurance, and other out-of-pocket costs.
Medigap is designed to help pay some of those remaining costs after Original Medicare pays its share. Medicare.gov explains that if you have a Medigap policy and receive covered care, Medicare pays its share of the Medicare-approved amount first, and then the Medigap policy may pay the amount owed under your policy.
A simple way to remember it:
Original Medicare pays first. Medigap may help pay some of the remaining approved costs.
Medicare Supplement Is Not Medicare Advantage
Before discussing pros and cons, it is important to understand what Medigap is not.
Medigap is not Medicare Advantage.
Medigap is supplemental insurance that works with Original Medicare.
Medicare Advantage, also called Part C, is a different way to receive your Medicare coverage through a private insurance company approved by Medicare.
When you are getting started with Medicare, you can either buy Medigap or enroll in a Medicare Advantage plan, but you cannot have both. You also cannot use Medigap to pay Medicare Advantage copayments, deductibles, or premiums.
A simple way to compare them:
Original Medicare path:
Part A + Part B
Optional Medigap
Optional Part D
Medicare Advantage path:
Part C
Private Medicare-approved plan
Usually includes Part DThis page is not here to say one path is better than the other. It is here to help explain the tradeoffs.
Potential Pros of Medicare Supplement Insurance
Pro #1: Medigap Can Help Reduce Out-of-Pocket Costs in Original Medicare
The main reason people consider Medigap is to help pay some of the costs Original Medicare does not fully cover.
Medigap policies help cover out-of-pocket costs associated with Original Medicare, such as:
Copayments
Coinsurance
Deductibles
Some Medigap policies may also cover certain services Original Medicare does not cover, such as emergency medical care when traveling outside the United States, depending on the policy.
This can make healthcare costs more predictable for some people.
A simple way to think about it:
Medigap may help reduce the amount you pay when you use Original Medicare-covered services.
This does not mean every cost is covered. It means Medigap can help with certain Original Medicare cost-sharing amounts, depending on the policy.
Pro #2: Medigap Works With Original Medicare’s Provider Flexibility
One of the biggest reasons people like the Original Medicare + Medigap path is provider flexibility.
With Original Medicare, you can generally use any doctor or hospital that accepts Medicare anywhere in the United States. Medicare.gov explains that with Original Medicare, you can go to any doctor or hospital that takes Medicare, anywhere in the U.S.
Because Medigap works with Original Medicare, Medigap can pair with that broader provider access.
This may matter if you:
Travel often
Spend part of the year in another state
Want access to doctors in multiple locations
Prefer not to be limited to a local provider network
See specialists who accept Medicare
A simple way to remember it:
Medigap does not create a provider network. It works with Original Medicare.
One exception to understand: some Medigap policies may be Medicare SELECT policies, which can require you to use certain providers. Please note that Medicare SELECT policies may require certain providers and may have lower premiums.
Pro #3: Medigap Can Make Costs More Predictable
Original Medicare by itself does not have a yearly limit on what you pay out of pocket unless you have supplemental coverage, such as Medigap, Medicaid, employer coverage, retiree coverage, union coverage, or you join a Medicare Advantage plan.
Medigap can help make costs more predictable by paying some of your share of covered Original Medicare costs.
For example, instead of paying certain deductibles, copayments, or coinsurance amounts yourself, your Medigap policy may pay some or all of those costs depending on the policy.
This can be helpful for people who want fewer surprises when they receive Medicare-covered services.
A simple takeaway:
Medigap can help reduce uncertainty around some Original Medicare out-of-pocket costs.
The exact level of cost protection depends on the Medigap policy.
Pro #4: Medigap Policies Are Standardized in Most States
In most states, Medigap policies are standardized by letter.
That means policies with the same letter offer the same basic benefits no matter which insurance company sells them. Medicare.gov explains that standardized Medigap policies with the same letter offer the same basic benefits, and in most states there are 10 different types of Medigap plans named by letters.
This can make comparison easier.
For example, if two companies sell the same standardized Medigap plan letter, the basic benefits are the same. The price may differ, but the standardized benefits are the same.
A simple way to remember it:
Same letter. Same basic benefits. Different company or price.
Massachusetts, Minnesota, and Wisconsin standardize Medigap policies differently.
Pro #5: You Can Compare Medigap Policies by Price
Because Medigap policies are standardized in most states, comparing prices can be more straightforward than comparing some other types of insurance.
The benefits in each lettered Medigap plan are the same no matter which insurance company sells it, and price is the only difference between policies with the same plan letter sold by different companies. Premiums can vary widely between companies.
That means if you are comparing the same standardized Medigap plan letter, you can focus heavily on:
Monthly premium
Company reputation
Rate increase history
Customer service
Available discounts
How the company prices policies
A simple takeaway:
Medigap standardization can make comparison easier, but premiums can still vary widely.
Pro #6: Medigap Policies Are Renewable
Once you buy a standardized Medigap policy, you can keep it as long as you continue paying the premiums.
Standardized Medigap policies are automatically renewed each year, even if you have health problems. The company can only drop you in certain situations, such as if you stop paying premiums, were not truthful on the application, or the company goes bankrupt or out of business.
This can provide peace of mind for people who want coverage they can generally keep over time.
A simple way to remember it:
Once you have a standardized Medigap policy, it is generally renewable as long as you pay the premium and follow the policy rules.
Pro #7: Medigap Usually Does Not Require Plan Referrals
With Original Medicare, in most cases, you do not need a referral to see a specialist. Original Medicare generally does not require referrals, while Medicare Advantage may require them depending on the plan.
Because Medigap works with Original Medicare, many people like that they can generally see Medicare-accepting specialists without needing plan referrals.
This can be especially important if you:
See multiple specialists
Want flexibility in choosing doctors
Receive care in more than one location
Prefer not to manage referral rules
This does not mean every service is automatically covered. Medicare rules still apply. But Medigap itself is not typically structured around referrals the way some Medicare Advantage plans may be.
Potential Cons and Tradeoffs of Medicare Supplement Insurance
Con #1: Medigap Has a Separate Monthly Premium
One of the biggest tradeoffs of Medigap is cost.
When you buy a Medigap policy, you pay a monthly premium to the private insurance company. You also continue paying your Medicare Part B premium. Medicare does not pay your Medigap premium. Premium amounts typically increase each year.
That means a person with Original Medicare and Medigap may have several separate monthly costs, such as:
Medicare Part B premium
Medigap premium
Part D prescription drug plan premium, if enrolled
Other out-of-pocket costs not covered by Medicare or Medigap
A simple way to remember it:
Medigap may reduce some out-of-pocket costs when you receive care, but it usually adds a separate monthly premium.
This is one of the biggest tradeoffs to consider.
Con #2: Medigap Does Not Usually Include Prescription Drug Coverage
Medigap is not prescription drug coverage.
Medigap policies sold after 2005 do not include prescription drug coverage. If you want prescription drug coverage, you can enroll in a separate Medicare Part D drug plan.
This is an important difference between the Original Medicare + Medigap path and many Medicare Advantage plans, which often include Part D drug coverage.
A simple way to remember it:
Medigap = helps with some Original Medicare costs
Part D = helps with prescription drugsIf you choose Original Medicare and Medigap, you will usually need to think separately about prescription drug coverage.
Con #3: Medigap Does Not Cover Everything
Medigap can help with some Original Medicare cost-sharing, but it does not cover everything.
Medigap policies generally do not cover:
Long-term care
Routine vision care
Routine dental care
Hearing aids
Glasses
Private-duty nursing
This is important because some people assume Medigap fills every possible Medicare gap. It does not.
A simple takeaway:
Medigap helps with some Original Medicare costs, but it is not complete coverage for every healthcare need.
You may still need to plan for dental, vision, hearing, long-term care, prescription drugs, and other expenses.
Con #4: Timing Matters
Medigap has one of the most important enrollment windows in Medicare.
Under federal law, your Medigap Open Enrollment Period lasts six months. It starts the first month you have Medicare Part B and are age 65 or older. During this time, you can enroll in any Medigap policy offered by an insurance company, and the company cannot deny you coverage due to pre-existing health problems.
After this period ends, your options may be more limited.
Outside your Medigap Open Enrollment Period:
You may have to pay more for a policy.
Fewer policy options may be available.
The insurance company may be allowed to deny you a policy if you do not meet medical underwriting requirements.
A simple way to remember it:
Medigap has a one-time Open Enrollment Period. It does not repeat every year like Medicare Open Enrollment.
This is one of the biggest potential downsides if someone wants to buy Medigap later.
Con #5: Medical Underwriting May Apply Later
Medical underwriting is when an insurance company reviews your health history before deciding whether to sell you a policy, what options are available, or what price you may pay.
During your Medigap Open Enrollment Period, companies cannot use medical underwriting to deny you coverage because of pre-existing health problems. After that window ends, underwriting may apply unless you have a guaranteed issue right or another protection under state law.
This can make Medigap less flexible later.
For example, if you first choose a different coverage path and later decide you want Medigap, you may not have the same rights you had during your initial Medigap Open Enrollment Period.
A simple takeaway:
Medigap can be easier to buy during your initial enrollment window than later.
Con #6: Medigap Does Not Work With Medicare Advantage
Medigap and Medicare Advantage do not work together.
You cannot buy Medigap while you are in a Medicare Advantage plan unless you are switching back to Original Medicare. You also cannot use Medigap to pay Medicare Advantage copayments, deductibles, or premiums.
This means Medigap is not something you add on top of Medicare Advantage.
A simple way to remember it:
Original Medicare + Medigap
OR
Medicare AdvantageThis is one of the most important distinctions in Medicare.
Con #8: Premiums Can Increase Over Time
Medigap premiums can vary widely depending on the company, policy, and location.
Medigap premiums vary depending on the insurance company, the plan, and where you live. Each company decides how it sets premiums, which can affect what you pay now and in the future. Premium amounts typically increase each year.
This is one reason it is important to ask how a company prices its policies.
Medigap premiums may be affected by:
Where you live
The insurance company
The Medigap plan letter
Discounts
Medical underwriting
Whether you have a guaranteed issue right
Whether the policy is Medicare SELECT
Whether a high-deductible option is available
A simple takeaway:
The premium you start with may not be the premium you pay forever.
Medicare Supplement Pros and Cons at a Glance
Potential Pros
Helps pay some Original Medicare out-of-pocket costs
Works with Original Medicare
Can pair with broad Original Medicare provider access
May make healthcare costs more predictable
Policies are standardized by letter in most states
Same letter means same basic benefits
Can be compared by price for the same plan letter
Standardized policies are generally renewable
Usually does not involve plan referrals
Potential Cons and Tradeoffs
Has a separate monthly premium
Does not usually include prescription drug coverage
Does not cover everything, such as routine dental, vision, hearing aids, or long-term care
Timing matters
Medical underwriting may apply later
Does not work with Medicare Advantage
Covers only one person
Premiums can increase over time
May require separate Part D coverage
Who Might Like Medicare Supplement Insurance?
Medigap may appeal to someone who wants the Original Medicare path and wants help with some out-of-pocket costs.
It may be worth understanding if you:
Want to use Original Medicare
Want access to doctors and hospitals that accept Medicare
Travel often within the United States
Want fewer network concerns
Want help paying certain Original Medicare cost-sharing amounts
Are comfortable paying a separate monthly premium
Understand that Part D drug coverage is separate
Are within your Medigap Open Enrollment Period or have a guaranteed issue right
This does not mean Medigap is automatically the right choice. It means the structure may fit people who value provider flexibility and predictable cost-sharing.
Who Might Be More Cautious About Medigap?
Medigap may be less appealing if you want lower monthly premiums, prefer coverage organized through one plan, or want prescription drug coverage included in the same Medicare plan structure.
It may also require extra caution if:
You are outside your Medigap Open Enrollment Period
You may face medical underwriting
You are under 65 and have Medicare due to disability or ESRD
You want dental, vision, hearing, or long-term care coverage included
You are considering Medicare Advantage
You are concerned about premiums increasing over time
Medigap can be useful, but it is not the right fit for every situation.
Medigap vs. Medicare Advantage: A Simple Difference
A lot of confusion comes from comparing Medigap with Medicare Advantage.
Here is the simplest way to understand the difference:
Medigap:
Works with Original Medicare.
Helps pay some Original Medicare out-of-pocket costs.
Usually requires separate Part D drug coverage.
Medicare Advantage:
Replaces Original Medicare as the way you receive Medicare benefits.
Uses a Medicare-approved private plan.
Often includes prescription drug coverage.
May use networks, referrals, and prior authorization.Medigap is supplemental to Original Medicare, while Medicare Advantage is another way to get Medicare coverage besides Original Medicare. You can either buy Medigap or enroll in Medicare Advantage, but you cannot have both.
Questions to Ask Before Choosing Medigap
Before buying a Medicare Supplement policy, consider asking:
Do I have Original Medicare Part A and Part B?
Am I in my Medigap Open Enrollment Period?
Do I have a guaranteed issue right?
Which standardized Medigap policies are available in my state?
What is the monthly premium?
How has the premium changed over time?
Does medical underwriting apply?
Are any discounts available?
Is this a standard Medigap policy or Medicare SELECT?
Do I need a separate Part D prescription drug plan?
Does this fit my healthcare needs and budget?
How does this compare with the Medicare Advantage path?
These questions help you move beyond “pros and cons” and focus on your personal situation.
Common Misunderstandings About Medicare Supplement Insurance
“Medigap is the same as Medicare Advantage.”
No. Medigap works with Original Medicare. Medicare Advantage is another way to receive Medicare coverage. You cannot have both at the same time.
“Medigap replaces Medicare.”
No. Medigap does not replace Medicare. Original Medicare pays first, and Medigap may help pay some remaining costs depending on the policy.
“Medigap includes prescription drug coverage.”
Generally, no. Medigap policies sold after 2005 do not include prescription drug coverage. If you want prescription drug coverage, you can enroll in a separate Medicare Part D plan.
“All Medigap policies are completely different.”
Not in most states. Medigap policies are standardized by letter in most states, meaning the same letter offers the same basic benefits no matter which company sells it.
“I can buy Medigap any time with no health questions.”
Not always. Your Medigap Open Enrollment Period is usually the best time to buy. After it ends, you may have fewer choices, may pay more, or may be denied unless you have a guaranteed issue right or other protection.
“My spouse and I can share one Medigap policy.”
No. A Medigap policy covers only one person. Each spouse would need a separate policy.
Common Questions About Medicare Supplement Pros and Cons
What is the biggest advantage of Medicare Supplement Insurance?
The biggest advantage is that Medigap can help pay some of your share of out-of-pocket costs in Original Medicare, such as copayments, coinsurance, and deductibles.
What is the biggest downside of Medicare Supplement Insurance?
The biggest downside for many people is the separate monthly premium. You pay the Medigap premium in addition to your Medicare Part B premium, and you may also need a separate Part D drug plan premium if you want prescription drug coverage. Medicare.gov notes that Medicare does not pay your Medigap premium.
Does Medigap have provider networks?
Standard Medigap works with Original Medicare, and Original Medicare generally allows you to use any doctor or hospital that accepts Medicare anywhere in the United States. However, Medicare SELECT policies may require you to use certain providers.
Does Medigap cover prescriptions?
Medigap policies sold after 2005 do not include prescription drug coverage. If you want prescription drug coverage, you can enroll in a separate Medicare Part D plan.
Can I have Medigap and Medicare Advantage?
No. You can either buy Medigap or enroll in Medicare Advantage, but you cannot have both.
Are Medigap plans standardized?
In most states, yes. Policies with the same letter offer the same basic benefits regardless of which insurance company sells the policy. Massachusetts, Minnesota, and Wisconsin standardize Medigap differently.
When is the best time to buy Medigap?
For many people, the best time is during the six-month Medigap Open Enrollment Period. It starts the first month you have Medicare Part B and are age 65 or older. During this time, insurance companies cannot deny you coverage due to pre-existing health problems.
The Simple Takeaway
Medicare Supplement Insurance, also called Medigap, can be a helpful option for people who choose Original Medicare and want help paying some out-of-pocket costs.
The potential advantages include lower cost-sharing for covered Original Medicare services, broad provider access through Original Medicare, standardized benefits in most states, and renewable coverage.
The potential tradeoffs include monthly premiums, separate prescription drug coverage, limited coverage for dental, vision, hearing, and long-term care, and important timing rules that can affect your ability to buy a policy later.
The right question is not simply:
“Is Medigap good or bad?”
A better question is:
Does Original Medicare with Medigap fit my doctors, budget, travel habits, prescription needs, and long-term healthcare preferences?
Need Help Understanding Medicare Supplement Insurance?
Medigap can be confusing because timing, premiums, underwriting, standardized plan letters, and prescription drug coverage all matter.
If you are trying to understand how Medicare Supplement Insurance works with Original Medicare, Part D, or Medicare Advantage, we can help connect you with a licensed Medicare professional who can answer questions based on your situation.
Get Medicare help when you’re ready.