How to Evaluate Supplemental Plans

Choosing a Medicare Supplement (Medigap) plan isn't just about choosing the plan with the lowest premium or the most coverage. It's about finding the right fit for your specific health situation, your budget, and how you use healthcare. Here's a framework to help you think through the evaluation.

1. Start With Your Health Needs

Look at how often you use healthcare.

• How many doctor visits, specialist appointments, or procedures do you typically have in a year?

• Do you take regular prescriptions?

• Have you had or do you anticipate any significant medical events?

Your actual usage pattern matters more than any general recommendation.

2. Understand What Each Plan Letter Covers

Medigap plans are standardized by the federal government. For example:

• Plan G from one insurer offers the same core benefits as Plan G from any other insurer. 

• The ten plan letters differ in which gaps they fill. 

  • Plan G covers the Part A deductible and 100% of Part B coinsurance after your Part B deductible. 

  • Plan N covers Part B coinsurance in most cases but may require small copays for some visits. 

  • Plan A offers the most basic coverage. 

• Knowing what each plan letter actually covers is essential before comparing prices.

• Your SGIA Benefit Consultant can help you make this determination.

3. Compare Total Costs, Not Just Premiums

A lower premium plan may leave you with higher out-of-pocket exposure. A higher premium plan may offer more predictable costs throughout the year. 

Think about the total picture, premium plus potential cost-sharing, not just the monthly number. For example:

• Someone who rarely needs care, a less comprehensive plan may make financial sense. 

• Someone with frequent medical needs, a higher-coverage plan may save money overall.

4. Know the Enrollment Timing Rules

Your Medigap Open Enrollment Period, the six months beginning when you turn 65 and are enrolled in Part B, is the best time to enroll.

• During this window, insurers cannot deny you coverage or charge higher premiums due to your health status. 

• Outside of this window, most states allow insurers to use medical underwriting, which may affect your eligibility and cost. 

• Some states have additional protections, including birthday rules (more on that next week).

5. Consider Prescription Drug Coverage Separately

Medigap plans do not include prescription drug coverage. If you enroll in a Medigap plan, you'll need a separate Part D plan to cover your medications. 

• Your specific drug needs should be part of the conversation when making coverage decisions, and the SGIA Benefit Consultants can help you evaluate Part D options alongside your Medigap choice.

Evaluating supplemental plans is not a one-time task. Coverage needs change, and so do plan offerings. 

SGIA Medicare Consulting helps clients review their options, whether they're new to Medicare or reconsidering their current coverage. Visit sgiamedicare.com to work through your plan evaluation with our team.