If you’re a Colorado resident approaching 65, you’re not alone in trying to figure out Medicare. In fact, over 200,000 of your neighbors have already chosen to pair Original Medicare with a Medigap plan for more predictable healthcare costs. They do this for two main reasons: financial security against surprise bills and the freedom to see any doctor who accepts Medicare. This guide is specifically for you, breaking down the most popular medicare supplement plans colorado residents choose, what you can expect to pay, and how to find the best value from a reputable company right here in our state.
One of the biggest concerns for anyone on Medicare is facing unexpected medical bills. While Original Medicare covers a lot, the 20% you’re often responsible for has no yearly limit, which can create financial uncertainty. Medicare Supplement plans offer a powerful solution by providing a safety net for these costs. By paying a set monthly premium, you gain peace of mind knowing you’re protected from large, surprise bills. Many people who searched for colorado medicare supplement plans 2022 were looking for this very stability. In this article, we’ll explore how these plans provide financial security and help you find the right fit for your budget.
Key Takeaways
- Compare Prices, Not Benefits: Medigap plans are standardized by the government, which means a Plan G from one company offers the same core benefits as a Plan G from another. Your main goal is to find the most competitive monthly premium for the plan you choose.
- Your Enrollment Window is Your Golden Ticket: The best time to buy a Medigap policy is during your six-month Open Enrollment Period, which starts when you turn 65 and have Part B. This is your one-time chance to get any plan you want without being denied or charged more for health reasons.
- Prescription Drugs Require a Separate Plan: Medigap policies do not cover medications you get from a pharmacy. To get coverage for your prescriptions, you must purchase a standalone Medicare Part D plan to work alongside your Original Medicare and Medigap policy.
How Do Medigap Plans in Colorado Work?
If you’re enrolled in Original Medicare (Part A and Part B), you’ve probably noticed it doesn’t cover everything. Those out-of-pocket costs, like deductibles and coinsurance, are often called “gaps” in coverage. That’s where Medicare Supplement plans, also known as Medigap, come in. These are plans sold by private insurance companies that work alongside your Original Medicare to help pay for those remaining costs.
Think of a Medigap plan as a predictable partner to your Medicare coverage. While the federal government standardizes what each type of
How Medigap Fills the Gaps in Original Medicare
A Medigap plan isn’t standalone health insurance. Instead, it complements your Original Medicare coverage. To purchase a Medigap plan, you must be enrolled in both Medicare Part A and Part B. When you receive medical care, Medicare first pays its share of the approved amount. Then, your Medigap plan steps in to pay its portion, which could include deductibles, copayments, or coinsurance.
It’s important to know that you cannot have both a Medigap plan and a Medicare Advantage (Part C) plan at the same time. You have to choose one path. If you value the freedom to see any doctor who accepts Medicare without needing a referral, pairing Original Medicare with a Medigap plan is often an excellent choice.
What Medigap Plans Don’t Cover
Services like long-term care, dental, and vision
While Medigap plans are excellent for covering the costs left over by Original Medicare, it’s just as important to understand what they don’t cover. These plans are designed to supplement hospital and medical insurance, so they generally don’t include benefits for routine dental, vision, or hearing services. Things like eyeglasses, hearing aids, and long-term care in a nursing home are typically not covered. Most importantly, Medigap plans sold today do not include prescription drug coverage. For that, you will need to enroll in a separate Medicare Part D plan to help with the costs of your medications.
Are All Medigap Plans Standardized?
Understanding the rules in Colorado and other states
Yes, and this is one of the best features of Medigap. The federal government standardizes the plans, which means that a Plan G from one insurance company must offer the exact same basic benefits as a Plan G from any other company. This is true for all lettered plans. This rule makes it much easier to compare your options because you don’t have to worry about differences in coverage—only price. The monthly premium for the same plan can vary significantly between insurance companies. Your goal is to find the company offering the most competitive price for the Medigap plan you want.
Why Consider a Medigap Plan?
The primary benefit of a Medigap plan is financial security. Without one, you’re on the hook for 20% of the cost for most services you receive from doctors, and there’s no annual cap on how high your out-of-pocket spending can go. A Medigap plan helps cover these costs, protecting you from unexpected and potentially large medical bills. This makes your healthcare spending much more predictable.
For example, some plans offer very complete coverage. Medigap Plan G, a popular option, covers nearly all of your out-of-pocket costs once you’ve paid your annual Part B deductible. While Medigap plans provide robust coverage for services approved by Medicare, it’s good to remember they don’t typically cover things like routine dental, vision, or hearing care.
Comparing Popular Medigap Plans in Colorado
Medigap plans are standardized, which makes comparing them much simpler. A Plan G from one insurance company offers the same fundamental benefits as a Plan G from another. In Colorado, a few options stand out for their combination of solid coverage and value. Understanding the differences between the most popular plans—G, N, and High-Deductible G—is the first step to finding your perfect fit.
Medigap Enrollment in Colorado: A Snapshot
How many people have Medigap and which plans are most popular
It helps to know what other people in your situation are doing. In Colorado, about one-third of all Medicare beneficiaries—that’s over 207,000 people—have chosen to add a Medigap plan for more predictable healthcare costs. When you look at the numbers, a few clear favorites emerge. The most popular options are Plan F, Plan G, and Plan N. Plan F has long been the frontrunner, with the highest number of enrollees. Plan G follows as a strong second, with Plan N rounding out the top three. This popularity often reflects the level of coverage each plan provides, with many people opting for the most comprehensive Medigap benefits available to them.
A Note on Medigap Plans C and F
You might have noticed that Plan F is the most popular plan in Colorado, but there’s an important rule you need to know about. Due to a change in federal law, Medigap Plans C and F are no longer available to people who became eligible for Medicare on or after January 1, 2020. If you were eligible for Medicare before that date, you can still buy one of these plans if it’s available. For everyone new to Medicare, these two options are off the table. This is why Plan G has become the go-to choice for many new enrollees, as it offers the most similar level of coverage to the old Plan F. The only difference is that with Plan G, you pay the annual Medicare Part B deductible yourself.
Plan G: The Most Popular Choice for a Reason
Think of Plan G as the go-to for predictable health care costs. If you value peace of mind and want to avoid surprise medical bills, this is often the best choice. After you pay your annual Medicare Part B deductible, Plan G covers nearly all of your remaining out-of-pocket costs. This includes your Part A hospital deductible, coinsurance for skilled nursing care, and even Part B excess charges, which are extra fees some doctors can charge. It’s the most comprehensive coverage available to new Medicare enrollees, providing a strong financial safety net for your health needs.
Plan N: Great Coverage with a Lower Premium
If you’d like a lower monthly premium than Plan G and don’t mind some small, predictable costs, Plan N is an excellent option. It offers robust coverage but requires you to pay a small copayment (up to $20) for some doctor’s office visits and a $50 copay for an ER visit that doesn’t result in hospital admission. The main trade-off is that Plan N does not cover Part B excess charges. This means if your doctor charges more than the Medicare-approved amount, you would be responsible for that difference. It’s a great way to balance your budget with strong protection.
High-Deductible Plan G: Is It the Right Fit for You?
For those who are generally healthy or have a healthy savings account, the High-Deductible Plan G offers the lowest monthly premiums. In exchange for these low premiums, you agree to pay for your medical costs out-of-pocket until you meet a set annual deductible. Once you’ve met that amount, the plan kicks in and provides the exact same comprehensive coverage as the standard Plan G for the rest of the year. This plan can be a smart financial choice if you’re comfortable covering the initial deductible in exchange for significant monthly savings.
What Are Medicare SELECT Plans?
A Medicare SELECT plan is a type of Medigap policy that offers the same benefits as a standard plan but with one key difference: it requires you to use a network of specific hospitals and doctors. In exchange for agreeing to use these in-network providers for your routine care, you typically pay a lower monthly premium. This can be a great way to get the security of a Medigap plan at a more budget-friendly price, as long as your preferred providers are part of the plan’s network. It’s important to know that you are always covered for emergency care, even if you’re outside the plan’s service area. To purchase a Medicare SELECT plan, you must be enrolled in both Medicare Part A and Part B, just like with any other Medigap policy.
How Much Do Medigap Plans Cost in Colorado?
Let’s talk about one of the biggest questions on everyone’s mind: How much is this going to cost? When it comes to Medigap plans in Colorado, there isn’t a single price tag. The cost depends on the specific plan you choose, the insurance company you buy it from, and a few personal factors.
One of the most important things to understand is that while Medigap plans are standardized by the government, their prices are not. This means that a Plan G from one company offers the exact same basic benefits as a Plan G from another company—but the monthly premiums can be very different. This is why it’s so important to compare your options. Think of it like buying the same brand of television from two different stores; the product is identical, but the price can vary. We’ll break down what you can expect to pay for your monthly premium, what factors influence that rate, and what other costs you should plan for.
Understanding Your Monthly Premium
In Colorado, monthly Medigap premiums can range anywhere from about $50 to over $210, depending on the plan and your personal details. To give you a more concrete idea, let’s look at an example for the popular Plan G. A 65-year-old non-smoking woman in Fort Collins might find monthly premiums ranging from $105 to $145. For a man of the same age and in the same area, the rates could be between $120 and $165. Remember, these are just examples. Your actual premium will be based on your unique circumstances, but this gives you a realistic starting point for what to budget.
Typical Premium Ranges in Colorado
To give you a clearer picture, let’s look at the typical monthly costs for the most popular plans. For a standard Plan G, a 65-year-old can generally expect to pay between $110 and $160 per month. If you choose Plan N for its lower premium, you’ll likely find rates in the $80 to $120 range, keeping in mind the small copays for doctor visits. For those interested in the High-Deductible Plan G, the monthly savings are substantial, with premiums often falling between $40 and $70. Remember, these are just ballpark figures. Your actual rate is influenced by your age, gender, tobacco use, and even your zip code. Since every company sets its own price for the same standardized plan, it’s always a good idea to compare rates to ensure you’re getting the best deal.
Factors That Affect Your Premium Rate
Insurance companies look at a few key details to set your monthly premium. The primary factors include your age, gender, whether you use tobacco, and your ZIP code. Because costs can vary by location within Colorado, someone in Denver might see different rates than someone in Grand Junction. While the plan benefits are standardized, the prices can be very different between insurance companies for the same exact plan. This is the single biggest reason why shopping around is essential. You could save a significant amount of money each year just by choosing one company over another for the identical plan.
Potential Discounts to Ask About
When you’re comparing Medigap plans, don’t forget to ask about potential discounts. Many insurance companies offer ways to lower your monthly premium, but they aren’t always advertised. You might be eligible for a household discount if you and your spouse both enroll with the same company. Other common savings include discounts for being a non-smoker, paying your premium for the entire year at once, or setting up automatic payments from your bank account. These small discounts can add up to significant savings over time, so it’s always a good idea to inquire about them when you get a quote.
How Insurance Companies Price Medigap Plans
Now that you know what affects your premium, it’s helpful to understand how insurance companies arrive at their prices. While Plan G is always Plan G in terms of benefits, the long-term cost can look very different from one company to the next. This is because insurers use one of three different pricing models, or “rating methods,” to set their premiums. The method they use determines not only your starting rate but also how that rate may change as you get older. It’s a critical piece of the puzzle because a plan that seems like the cheapest option today might become more expensive down the road.
Understanding these pricing structures is key to making a smart long-term decision. The three methods are community-rated, issue-age-rated, and attained-age-rated. Each one works a little differently, and the one that’s best for you depends on your financial planning and expectations for future costs. Because this can get a bit complex, working with an independent agent can be incredibly helpful. At The Big 65, we help people compare these details across different companies to find a plan that fits their budget not just for this year, but for many years to come. It’s about finding a sustainable solution for your healthcare coverage.
Attained-Age vs. Issue-Age vs. Community-Rated
Let’s break down the three pricing methods you’ll encounter. The most common is attained-age-rated, where your premium is based on your current age and will increase as you get older. Next is issue-age-rated, which bases your premium on your age when you first buy the policy. With this model, your premium won’t increase just because you have a birthday, though it can still rise due to inflation. Finally, there’s community-rated, where everyone with the same plan in a certain area pays the same premium, regardless of their age. Understanding which rating method a company uses is essential for predicting your future costs.
Beyond the Premium: What You’ll Pay Out-of-Pocket
Your monthly premium is your most predictable expense, but it’s not the only cost to consider. With most Medigap plans, you’ll also be responsible for paying the annual Medicare Part B deductible. Once you’ve paid that amount for your medical services, your Medigap plan begins to pay its share. It’s also critical to remember that Medigap plans do not cover prescription medications. For that, you will need to enroll in a separate Medicare Part D plan. Factoring in the costs for both your Medigap and Part D plans will give you the most accurate picture of your total health care expenses.
When Can You Enroll in a Colorado Medigap Plan?
When it comes to buying a Medigap plan, timing is everything. The date you apply can be the difference between getting any plan you want and potentially being denied coverage or facing higher premiums. Fortunately, there are specific enrollment windows designed to protect you.
The most critical one is your Medigap Open Enrollment Period—a one-time, six-month window where you are in the driver’s seat. During this period, insurance companies can’t use your health history to turn you away or charge you more. If you miss this key window, you may still have options, but they are tied to specific life events. Let’s walk through these periods so you can feel confident about when and how to apply for the coverage that fits your life.
Don’t Miss Your Medigap Open Enrollment Window
Think of your Medigap Open Enrollment Period as your golden ticket. It’s a six-month window that starts on the first day of the month you turn 65 and are enrolled in Medicare Part B. During this time, insurance companies are required to sell you any Medigap plan they offer. They cannot use medical underwriting, which means they can’t deny you coverage or charge you a higher premium because of your health status. This is why it’s the absolute best time to buy a Medigap policy. If you let this one-time period pass, you lose these federal protections, and an insurer could deny your application based on your health history.
How Guaranteed Issue Rights Protect You
If you miss your Open Enrollment Period, don’t worry—you might have another opportunity to enroll. In certain situations, you may have guaranteed issue rights, also called “Medigap protections.” These rights ensure you can buy a Medigap policy without medical underwriting, even outside of your initial enrollment window. Typically, these rights apply when you lose other types of health coverage. For example, you might qualify if your employer-sponsored group plan is ending, if you move out of your Medicare Advantage plan’s service area, or if you decide to leave a Medicare Advantage plan within your first year. These protections act as a safety net, giving you a chance to get a Medigap plan when your circumstances change.
Medigap vs. Medicare Advantage: Which Path Is Right for You?
When you become eligible for Medicare, you’ll face a key decision: stick with Original Medicare and add a Medigap plan, or choose a Medicare Advantage plan instead? These are two very different ways to get your health coverage, and the right choice depends entirely on your personal needs, health, and budget. Think of it as choosing between two distinct paths. One gives you broad freedom and predictable costs, while the other offers an all-in-one package with potentially lower monthly premiums. Let’s walk through the differences so you can feel confident in your decision.
Key Differences: Coverage, Costs, and Doctor Choice
Medicare Supplement plans, also known as Medigap, are sold by private insurance companies and work alongside your Original Medicare (Part A and Part B). Their job is to fill in the “gaps” by helping pay for costs like deductibles and coinsurance. A great feature of Medigap is that the plans are standardized. This means a Plan G from one company has the same basic benefits as a Plan G from another—only the price changes. This structure gives you the freedom to see any doctor or visit any hospital in the U.S. that accepts Medicare.
Medicare Advantage plans (also called Part C) are an alternative to Original Medicare. They bundle everything—Part A, Part B, and usually Part D prescription coverage—into one plan. Many also include extra benefits like dental, vision, and hearing. The trade-off is that these plans typically operate with provider networks, like an HMO or PPO. This means you’ll need to use doctors and hospitals within that network to get the lowest costs.
How Do You Choose Based on Your Health and Budget?
The best way to decide is to take a close look at your own life. Think about how often you visit the doctor, if you have any chronic health conditions, and what you can comfortably afford for a monthly premium. If you value flexibility and predictable medical bills, a Medigap plan might be the right fit. The best time to enroll is during your six-month Medigap Open Enrollment Period, which starts when you’re 65 and have Part B. During this window, you have guaranteed issue rights, so an insurer can’t deny you coverage based on your health.
On the other hand, if you are in good health, don’t mind using a provider network, and prefer a lower (or even $0) monthly premium, a Medicare Advantage plan could be a great option. Just be prepared for potentially higher out-of-pocket costs when you do need care. The first step is to assess your needs to see which structure aligns better with your health and financial picture.
Common Medigap Myths, Busted
When you start looking into Medicare, it can feel like everyone has an opinion. Friends, family, and neighbors all mean well, but their advice can sometimes add to the confusion. Misinformation about Medigap plans is especially common, making it tough to know what’s true and what’s just noise. Let’s clear the air and look at some of the most persistent myths about Medicare Supplement insurance. Getting the facts straight is the first step toward making a choice you feel good about, ensuring you have the right coverage for your needs without any surprises.
Separating Medigap Fact from Fiction
Let’s tackle these common misconceptions head-on so you can move forward with confidence.
- Myth: Original Medicare covers everything. The truth is, Original Medicare (Part A and Part B) was never designed to cover 100% of your healthcare costs. It leaves you responsible for deductibles, copayments, and coinsurance, which can add up quickly. Medigap plans exist specifically to help pay for these out-of-pocket expenses.
- Myth: You can enroll in a Medigap plan whenever you want. This is one of the most critical misunderstandings. The best time to buy a Medigap policy is during your six-month Medigap Open Enrollment Period. This period starts the month you turn 65 and enroll in Part B. During this window, you have “guaranteed issue rights,” which means an insurance company cannot deny you coverage or charge you more because of pre-existing health conditions. Outside of this period, your options can become much more limited.
- Myth: A Plan G from one company is better than a Plan G from another. Medigap plans are standardized by the government. This means that a Plan G from Company X must offer the exact same core benefits as a Plan G from Company Y. The only differences are the monthly premium you’ll pay and the quality of the company’s customer service.
- Myth: Medicare is free. While Medicare Part A is premium-free for most people who have worked and paid Medicare taxes, almost everyone pays a monthly premium for Medicare Part B. On top of that, you still have those deductibles and coinsurance costs we mentioned earlier.
Myth: You have to change your Medigap plan every year
This is a big one, and it’s completely false. Unlike some other types of insurance that require you to re-enroll each year, your Medigap plan is yours for as long as you want it, provided you keep paying your monthly premium. There’s no annual enrollment period where you’re forced to make a change. This stability is one of the best features of Medigap. However, it’s important to know that while you can apply for a different plan at any time, your ability to get approved isn’t always guaranteed. If you apply outside of your initial Medigap Open Enrollment Period, you will likely have to answer health questions, and an insurance company could deny your application.
So, while you don’t have to change your plan, it can be a smart idea to review it every few years. Why? Because insurance companies can adjust their premiums. The company that offered you the best rate three years ago might not be the most competitive option today. A quick comparison could reveal that you can get the exact same standardized plan from a different company for a lower monthly premium. This doesn’t mean you need to switch, but it empowers you to make sure you’re still getting the best value for your coverage.
How to Find the Best Medigap Plan in Colorado for You
Making a final decision on your Medigap plan can feel like a lot of pressure, but you don’t have to do it alone. With the right information and resources, you can find a plan that fits your health needs and your budget without all the stress. The key is to approach it step-by-step: compare your options, ask for guidance, and reflect on what you truly need from your coverage. This straightforward process will help you feel confident in your choice.
Comparing Plans Online, Made Easy
A great place to start your research is with the official tools designed to help you. The government’s Medicare Plan Finder is a powerful resource that lets you compare Medigap policies available in Colorado. You can see which insurance companies offer specific plans, like Plan G or Plan N, and get a general idea of costs. Think of it as your initial fact-finding mission. It helps you understand the landscape of options before you start narrowing things down. Using this tool can make the variety of plans feel much more manageable and give you a solid foundation for making your decision.
Who Sells Medigap Plans in Colorado?
In Colorado, you’ll find that many of the big names in insurance offer Medigap plans. Companies like AARP/UnitedHealthcare, Cigna, Anthem Blue Cross Blue Shield, and Mutual of Omaha are all major players in the state. Because Medigap plans are standardized, the core benefits of a Plan G, for example, will be identical no matter which company you choose. The primary differences you’ll find are the monthly premium and the company’s approach to customer service. With so many options available, it can feel overwhelming to sort through them all. This is why many people choose to work with an independent agent who can quickly compare quotes from all the top insurance companies for you.
Look Beyond Price: Company Reputation Matters
While it’s tempting to simply choose the plan with the lowest monthly premium, that’s only part of the story. The stability and reputation of the insurance company are just as important. A great price today doesn’t mean much if the company has a history of steep rate increases down the road. You’ll want to choose a company that is financially strong and known for reliable claims processing and helpful customer service. It’s smart to compare different insurance companies not just on their current prices, but also on their long-term value. At The Big 65, we help our clients do this by analyzing a company’s rate increase history and financial ratings, ensuring you find a plan that remains a good fit for years to come.
Where to Find Unbiased, Expert Advice
You are not on your own when it comes to figuring this out. Colorado provides a free counseling service called the State Health Insurance Assistance Program (SHIP) to offer one-on-one help. Their counselors are trained to provide unbiased information and answer your questions about Medicare. Similarly, working with an independent broker gives you access to expert advice at no cost to you. Because we aren’t tied to a single insurance company, our goal is simply to help you find the right plan for your unique situation. We can help you compare the same plan across different carriers to find the most competitive premium.
Key Questions to Ask Before You Enroll
Before you sign up for a plan, take a moment to think about your personal health and financial situation. Since Medigap plan benefits are standardized (every Plan G is the same, for example), the main difference between carriers is the price. Ask yourself: How often do I typically visit the doctor? Do I have any chronic conditions that require regular care? What monthly premium can I comfortably fit into my budget? Answering these questions will help you pinpoint which plan level makes the most sense. This personal assessment is the key to finding coverage that truly serves you for years to come.
Helpful Medicare Resources in Colorado
Making decisions about your health care is a big deal, and you don’t have to do it all by yourself. It’s completely normal to have questions, and thankfully, Colorado has some excellent state-run programs designed to give you clear, reliable answers without a sales pitch. These free resources are available to help you understand your options, protect your personal information, and feel confident in your choices. Think of them as your local support system for all things Medicare. Whether you need someone to walk you through a plan comparison or want to learn how to keep your benefits secure, there are dedicated people ready to assist you. Below are two key programs that every Colorado resident on Medicare should know about.
Get Free, Local Help from Colorado’s SHIP
A fantastic resource right here in Colorado is the State Health Insurance Assistance Program, better known as SHIP. This program is a lifeline for many, offering free, unbiased, one-on-one assistance to help you make sense of your Medicare choices. The counselors at SHIP aren’t trying to sell you anything; their only goal is to help you understand your coverage, compare different plans, and work through any problems you might face. With 17 locations across the state, you can get personalized Medicare counseling from someone in your community. It’s a great place to start if you’re feeling overwhelmed and just want straightforward advice.
Colorado SHIP Contact Information
Getting in touch with a SHIP counselor is simple. You can find a list of local offices and other helpful details by visiting the official Senior Health Care – Medicare page on the Colorado Department of Insurance website. If you prefer to talk to someone directly, you can call their toll-free number at 1-888-696-7213. This line connects you with trained counselors who are ready to answer your questions and help you understand your Medicare options, all without any sales pressure. It’s a fantastic way to get clear, personalized guidance from a trusted local resource.
How to Protect Yourself from Medicare Fraud
Your Medicare card is a key to your health benefits, and it’s important to protect it like you would a credit card. To help you do just that, Colorado has a Senior Medicare Patrol (SMP) program. The SMP’s mission is to empower you, your family, and your caregivers with the knowledge to prevent, spot, and report health care fraud, errors, and abuse. They provide education on how to recognize suspicious activity, like bills for services you never received, and what steps to take if you see it. Being informed is your best defense against fraud and ensures your Medicare benefits are safe.
Colorado Senior Medicare Patrol (SMP) Contact Information
The Colorado Senior Medicare Patrol, or SMP, is a vital resource dedicated to helping you protect your benefits. Its mission is to give you the tools and knowledge to prevent, spot, and report healthcare fraud, errors, and abuse. The program offers education on how to recognize suspicious activities, such as receiving bills for services you never got, and provides clear guidance on what to do if you encounter these issues. Being informed is the best way to keep your Medicare benefits secure. For more detailed information or to get assistance, you can visit the Colorado SMP website, which is managed by the Colorado Division of Insurance.
Do Medigap Plans Cover Prescriptions?
This is one of the most common questions I hear, and the answer is simple: No, Medigap plans do not cover prescription drugs. It’s a point that causes a lot of confusion, so let’s clear it up. Medigap plans, also called Medicare Supplement plans, are designed to work alongside Original Medicare (Part A and Part B). Their job is to help pay for your share of the costs that Medicare doesn’t cover completely. Think of them as filling in the financial “gaps,” like your Part A hospital deductible, your 20% coinsurance for doctor visits under Part B, and copayments for other medical services.
While these plans are fantastic for managing your out-of-pocket medical expenses, their benefits stop there. They were never designed to include coverage for medications you pick up at the pharmacy. This is because Medigap plans were standardized long before the creation of the Medicare Part D prescription drug benefit in 2006. So, if you have a Medigap plan, you have great protection against many hospital and medical bills, but you will still be responsible for the full cost of your prescriptions. To avoid paying for your medications entirely out of pocket, you’ll need to add another piece to your healthcare puzzle. This is where a prescription drug plan comes in.
Why You Still Need a Separate Part D Plan
To get coverage for your medications, you will need to enroll in a separate Medicare Part D plan. These are standalone prescription drug plans sold by private insurance companies and approved by Medicare. Adding a Part D plan to your Original Medicare and Medigap plan creates a comprehensive coverage package, addressing both your medical and prescription needs. It’s essential to understand that you cannot rely on your Medigap policy for drug costs; it simply isn’t part of the coverage.
Remember, you can only pair a Medigap plan with Original Medicare. If you choose a Medicare Advantage (Part C) plan instead of Original Medicare, you are not eligible to purchase a Medigap policy. Most Medicare Advantage plans already include prescription drug coverage, so this setup makes sense. But if you value the freedom of Original Medicare and the security of a Medigap plan, adding a Part D plan is the final step to complete your coverage.
Related Articles
- Your Guide to Colorado Medicare Supplement Plans – The Big 65 – Medicare Insurance Services
- Colorado Medigap Plans: A 2024 Guide – The Big 65 – Medicare Insurance Services
- Medicare Supplements vs Medicare Advantage Archives – The Big 65 – Medicare Insurance Services
- Choosing the Best Medigap Plan for Your Needs – The Big 65 – Medicare Insurance Services
- Medigap Plan G vs. Plan N: Fewer Surprise Medical Bills? – The Big 65 – Medicare Insurance Services
Frequently Asked Questions
If all Plan G policies are the same, why are the monthly premiums so different? This is a fantastic question because it gets to the heart of how to shop for a plan. While the government standardizes the benefits of each Medigap plan, it doesn’t regulate the price. Insurance companies are free to set their own premiums based on their business costs and how they assess risk. Think of it this way: the plan itself is a fixed recipe, but each company decides how much to charge for the final dish. This is why comparing prices is so important—you could pay significantly more or less for the exact same coverage just by choosing a different company.
Can I switch my Medigap plan to a different one later on? While you can apply to change your Medigap plan at any time, your ability to do so isn’t guaranteed after your initial enrollment window. Your Medigap Open Enrollment Period is a one-time, six-month opportunity where you can buy any plan without answering health questions. If you try to switch later, you will likely have to go through medical underwriting. This means the insurance company can review your health history and could deny your application or charge you a higher premium based on pre-existing conditions.
Do I have to worry about finding doctors ‘in-network’ with a Medigap plan? No, and this is one of the biggest benefits of pairing a Medigap plan with Original Medicare. Medigap plans don’t have provider networks. As long as your doctor or hospital accepts Original Medicare—which the vast majority do nationwide—they will accept your Medigap plan, regardless of which insurance company you bought it from. This gives you the freedom to see any Medicare-accepting specialist you choose without needing a referral.
My health is great. Do I really need a Medigap plan right away? It’s smart to think about this, but timing is critical. Your Medigap Open Enrollment Period is a unique, one-time window that is based on your age and Part B enrollment, not your current health. It’s your single best opportunity to get any plan you want with guaranteed acceptance. Waiting until you need more care means you will have missed this protected period, and insurers could then deny you coverage based on your health. Securing a plan when you’re healthy is about planning for predictable costs in the future.
What’s the simplest way to think about the difference between Medigap and Medicare Advantage? Think of it as choosing between two different paths for your health coverage. The first path is Original Medicare plus a Medigap plan. This combination gives you broad freedom to see any doctor who accepts Medicare and provides predictable costs for services. The second path is a Medicare Advantage plan, which is an all-in-one alternative that bundles your benefits and usually includes prescription coverage. This path often has lower premiums but requires you to use a specific network of local doctors and hospitals to keep your costs down.