Medicare pays first
The policy normally responds only after Original Medicare processes an approved Part A or Part B claim. It cannot make a noncovered service Medicare-covered.
Medigap policy service • 2027 planning
Medicare Supplement Policies: 2027 Guide
Medicare Supplement policies are private insurance contracts that work after Original Medicare pays its share of approved Part A and Part B costs. Also called Medigap, these policies pay specified deductibles, copayments, or coinsurance according to a standardized benefit letter. They do not replace Original Medicare.
Most policy comparisons have two layers. First, choose the standardized letter whose benefits fit the person’s cost-sharing preferences. Second, compare companies selling that letter for premium, rating method, applicant eligibility, underwriting, policy administration, and effective date. A Plan G from one company has the same standardized basic benefits as a standard Plan G from another company in most states, but the prices can differ.
If you searched for Medicare Supplement policies “near me,” use your permanent state and ZIP code to identify policies, premiums, under-65 rules, and purchase protections. Standard Medigap generally does not use a Medicare Advantage-style county physician network, although Medicare SELECT policies can require specified providers for full benefits.
2027 planning status: This page was substantively reviewed on August 25, 2026. Final 2027 premiums, annual deductibles or limits, policy availability, underwriting practices, and state protections must be confirmed for the applicant and effective date. Do not treat a 2026 amount or insurer practice as a confirmed 2027 term.
The Wellcare pathway is carrier-specific and concerns current Medicare Advantage options. It does not quote, compare, or enroll anyone in Medigap and is not an all-carrier comparison. The Blake Insurance Group form requests contact and a Medicare review; it is not a policy application or enrollment. Assistance depends on licensing, appointments, certifications, eligibility, and the intended effective date.
Original Medicare remains the primary coverage
When a covered claim is processed, Medicare generally determines whether the service is covered and pays its portion of the Medicare-approved amount. The Medigap insurer then receives the claim information and pays according to the selected policy. The policyholder remains responsible for any amount not paid by Medicare or the Medigap policy.
A Medigap policy covers one person. Spouses need separate policies if both want Medigap. A modern policy also does not include outpatient prescription drug coverage, so a compatible stand-alone Part D plan or other creditable drug coverage may be needed.
Quick facts
Understand the contract before comparing premiums
Each person needs a policy
Medigap is individual coverage. One spouse’s policy does not pay the other spouse’s healthcare costs, even when both share a household.
The letter controls benefits
In most states, the standardized letter—not the company name—determines the basic benefit package. Premium and administration remain company-specific.
This table separates the policy’s job from Original Medicare, Part D, and Medicare Advantage. The distinctions prevent a common mistake: comparing products that perform different roles as though they were interchangeable.
| Topic | How Medigap generally works | What to verify |
|---|---|---|
| Coverage foundation | Supplements Original Medicare Part A and Part B. | Both Medicare effective dates, current coverage, other payers, and whether the person will remain in Original Medicare. |
| Policyholder | Covers one person rather than a couple or family. | Separate eligibility, application, premium, policy number, and effective date for each spouse. |
| Benefits | Uses standardized lettered benefit designs in most states. | Exact letter, standard versus high-deductible or SELECT form, state standardization, and official outline of coverage. |
| Claims | Usually receives claim information after Medicare processes the service. | Medicare Summary Notice, insurer explanation, crossover status, provider billing, and remaining member responsibility. |
| Providers | Standard Medigap generally follows Original Medicare provider participation. | Whether the provider accepts Medicare and the patient, accepts assignment, and whether Medicare SELECT network rules apply. |
| Prescription drugs | Policies sold after 2005 do not include modern outpatient Part D coverage. | Compatible stand-alone Part D plan, medications, pharmacy network, formulary, and other creditable drug coverage. |
| Renewal | Modern policies are generally guaranteed renewable while premiums are paid. | Premium notices, payment status, address changes, policy form, and special rules for certain policies issued before 1992. |
| Purchase rights | Open enrollment and specific guaranteed-issue situations can restrict medical underwriting. | Age, Part B date, state, notices, prior coverage, disability status, application deadline, and effective date. |
Medigap must follow federal and state laws. The front of a compliant policy should identify it as Medicare Supplement Insurance. Do not treat a hospital indemnity policy, employer retiree plan, Medicaid coverage, Medicare Advantage plan, or stand-alone Part D plan as Medigap simply because it helps with healthcare expenses.
Standardized coverage
The benefit letter defines which Medicare gaps are filled
Most states use standardized Plans A–D, F, G, and K–N. Massachusetts, Minnesota, and Wisconsin use different standardization systems. Not every insurer sells every letter, and an available standardized design is not automatically available to every applicant outside protected purchase periods.
The official benefit chart compares Part A hospital coinsurance and additional days, Part B coinsurance, blood, hospice cost sharing, skilled nursing facility coinsurance, the Part A deductible, the Part B deductible for eligible legacy plans, Part B excess charges, and foreign-travel emergency coverage. Some plans cover a benefit fully, some partially, and some not at all.
| Policy group | Coverage approach | Policy review question |
|---|---|---|
| Plan A | Provides the standardized core benefits and serves as the baseline design. | Which Original Medicare gaps remain, and is the premium difference for a broader letter worthwhile? |
| Plans B and D | Add specified benefits beyond Plan A. Medigap Plan D is not Medicare Part D drug coverage. | Does the official benefit chart match the person’s hospital, travel, and cost-sharing priorities? |
| Plan G | Provides broad standardized benefits but does not cover the Part B deductible. | How does its premium compare with other eligible designs and companies for the applicant? |
| Plans K and L | Use percentage cost sharing for certain benefits and include annual out-of-pocket limits. | What are the official 2027 limits, and can the applicant manage the member share before reaching them? |
| Plans M and N | Use different member cost-sharing structures. Plan N includes specified copayments and no Part B excess-charge coverage. | How do provider assignment, expected visits, travel, and premium differences affect the fit? |
| Plans C and F | Include the Part B deductible within their standardized benefits. | Was the applicant eligible for Medicare before January 1, 2020, and is the policy available and worth its premium? |
| High-deductible F or G | Policy benefits begin after the applicable annual high deductible is met. | What is the official 2027 deductible, what counts toward it, and can the applicant fund a higher-use year? |
Medigap usually pays only when the standardized benefit applies
A broad policy does not mean every bill is covered. If Medicare denies a service because it is not covered or not medically necessary, Medigap generally does not create coverage merely because the provider billed it. A limited foreign-travel emergency benefit is an example of a standardized benefit that can operate outside ordinary Original Medicare domestic coverage, subject to its own terms.
What Medigap generally does not cover
- Long-term custodial care or routine nursing-home living expenses.
- Routine dental care, routine vision care, eyeglasses, or hearing aids.
- Private-duty nursing.
- Modern outpatient prescription drug coverage under policies sold after 2005.
- Medicare Advantage premiums, deductibles, copayments, or coinsurance.
- Services that do not meet the policy and Medicare coverage requirements.
Optional company programs or discounts should not be confused with standardized insurance benefits. They may change or end under their terms. Compare the guaranteed policy benefits first, then evaluate any additional service separately and only when documented.
Claims and policy administration
Track Medicare’s decision before questioning the Medigap payment
For many Part B claims, the policyholder authorizes the Medigap insurer to receive claim information directly from Medicare. Medicare processes the claim first, and the insurer pays the provider or policyholder according to the policy. Some insurers also provide this crossover process for Part A claims.
A claim may appear on a Medicare Summary Notice before the Medigap payment is visible. Match the patient, provider, date of service, Medicare-approved amount, Medicare payment, standardized benefit, insurer explanation, and any bill from the provider. Do not pay a confusing balance solely because one document arrived before another.
A practical claim-review sequence
Read Medicare’s determination
Confirm whether Medicare approved the service, the approved amount, the Medicare payment, and the beneficiary responsibility shown on the Medicare Summary Notice.
Match the policy benefit
Use the policy and outline of coverage to identify whether the remaining deductible, coinsurance, copayment, excess charge, or other category is covered.
Check claim crossover
Determine whether Medicare forwarded the claim data to the Medigap insurer. Keep the provider’s claim reference and insurer correspondence.
Compare every explanation
Match the insurer’s payment or denial with Medicare’s determination. A processing delay, coding issue, noncovered service, or missing crossover can create different next steps.
Contact the correct party
Ask the provider about coding or duplicate billing, Medicare about its coverage decision, and the insurer about policy payment. Record dates, names, and reference numbers.
Participating providers and assignment affect billing
A Medicare-participating provider accepts assignment for all Medicare patients. This means the provider agrees to the Medicare-approved amount as full payment for covered services, subject to the beneficiary’s deductible and coinsurance. A provider may accept Medicare without participating in every case, or may opt out. Confirm participation, assignment, and new-patient status for the planned service.
If the insurer does not receive Part B claim information directly, Medicare advises asking whether the doctor participates in Medicare. When a participating doctor is involved, the Medigap insurer is required to pay the doctor directly if the policyholder requests it. Follow the insurer’s claim-submission instructions rather than sending personal information through an unapproved channel.
Guaranteed renewable does not mean guaranteed premium
Modern Medigap policies are generally guaranteed renewable as long as premiums are paid. The company cannot ordinarily cancel coverage solely because the policyholder’s health worsens or claims increase. Certain policies purchased before 1992 can have different renewal rules in some states.
Renewability does not freeze the premium. An insurer can request or implement lawful rate changes under applicable rules, and discounts can end when eligibility conditions change. Keep premium notices, automatic-payment confirmations, policy amendments, and address records. Report a move because premium and separate Part D eligibility may change.
Premiums and total cost
The policy premium is only one part of the budget
A person with Medigap generally pays the applicable Medicare Part B premium, a separate Medigap premium, and a separate Part D premium when stand-alone drug coverage is selected. The household also pays any deductible, copayment, coinsurance, excess charge, foreign-travel amount, prescription expense, or noncovered service left by the selected arrangement.
Companies can charge different premiums for the same standardized letter. Compare the same letter, policy type, applicant, and effective date. A standard Plan G should not be price-compared with high-deductible Plan G as though they create the same annual risk.
| Cost factor | What to record | Common mistake |
|---|---|---|
| Official premium | Applicant-specific quote, plan letter, policy type, state, ZIP code, effective date, and payment frequency. | Using an online estimate or another person’s rate as a guaranteed 2027 premium. |
| Rating method | Whether the insurer describes the policy as community-, issue-age-, or attained-age-rated and how state rules apply. | Assuming any rating method prevents inflation, claims-trend, or other approved increases. |
| Discounts | Eligibility, amount, duration, household definition, payment requirement, and conditions that end the discount. | Treating a conditional discount as a permanent standardized benefit. |
| Remaining medical costs | Part B deductible, copayments, excess charges, high deductible, percentage sharing, or benefits absent from the selected letter. | Calling the policy “full coverage” and omitting amounts the member can still owe. |
| Part D | Separate premium, deductible, formulary, pharmacy network, utilization rules, and medication estimates. | Assuming Medigap Plan D provides Medicare Part D drug coverage. |
| Noncovered services | Expected dental, vision, hearing, long-term care, foreign care, and other expenses outside the policy. | Evaluating only Medicare-covered services when the household budget includes more. |
Ask how age is used in pricing
Community-rated policies generally do not base the individual’s premium on age. Issue-age-rated policies use age when purchased and do not increase solely because the policyholder ages. Attained-age-rated policies use current age and can rise as the person gets older. All three can change for inflation and other lawful reasons. State law and insurer practice control which methods are available.
Model routine and high-use years
A routine-year estimate should include recurring visits, current prescriptions, premiums, and known services outside Medigap. A higher-use estimate can include hospitalization, surgery, rehabilitation, skilled nursing coinsurance, imaging, medical equipment, infusion, or dialysis. The goal is to understand the tradeoff between predictable premium and possible point-of-service spending.
Do not select a policy from premium alone
A lower premium can accompany a different letter, a high deductible, a Medicare SELECT network, a conditional discount, or a rating structure that changes over time. Read the policy type and benefit design before treating two quotes as comparable.
Eligibility and enrollment
A policy application and a Medicare election are different processes
A person generally must have Original Medicare Part A and Part B to buy Medigap. Joining Medicare Advantage changes how Part A and Part B benefits are received and makes Medigap incompatible as supplemental medical coverage. It is generally illegal to sell Medigap to someone known to have Medicare Advantage unless that person is validly returning to Original Medicare and the Advantage coverage will end before Medigap begins.
The federal Medigap Open Enrollment Period lasts six months
The period begins the first month someone is both age 65 or older and enrolled in Part B. During this one-time window, an insurer cannot use medical underwriting to deny a policy it sells to the applicant or charge more because of health problems. It does not repeat during Medicare’s annual fall Open Enrollment Period.
After the window, medical underwriting may apply where permitted unless the applicant has a guaranteed-issue right or broader state protection. Under-65 access varies because federal law generally does not require insurers to sell Medigap to people under 65. State insurance department rules must be checked for disability- or End-Stage Renal Disease-based Medicare eligibility.
Pre-existing-condition waiting periods are separate from acceptance
In limited circumstances, an insurer may impose a waiting period of up to six months for coverage related to a pre-existing condition, even when it must issue the policy. Prior health coverage and state rules can affect the permitted waiting period. Ask the insurer to explain the exact condition, lookback, prior-coverage credit, start date, and end date in writing.
Do not describe a waiting period as a denial of all policy coverage. The policy can pay other covered claims while a specific pre-existing-condition limitation applies. Original Medicare continues to process covered services under its rules.
Guaranteed-issue rights require proof and deadlines
Specific events can require insurers to sell certain policies without health-based denial. Examples can include loss of defined supplemental coverage, certain Medicare Advantage plan terminations or moves, company failure, or a qualifying trial right. The event determines the allowed letters, proof, and application period.
Keep termination notices, plan letters, envelopes, emails, move records, coverage certificates, Medicare dates, and application receipts. A common federal protection can allow applying before coverage ends and no more than 63 days afterward, but the exact event controls. Resolve the Medigap right and any Part D election before ending current coverage.
Information to prepare for a policy review
- Medicare card and Part A and Part B effective dates.
- Date of birth, permanent state and ZIP code, and requested effective date.
- Current Medigap, Medicare Advantage, employer, retiree, COBRA, Medicaid, VA, TRICARE, or other coverage.
- Notices that may establish open-enrollment, guaranteed-issue, move, loss-of-coverage, or trial rights.
- Preferred standardized letters, household budget, travel pattern, and risk tolerance.
- Complete prescription list and preferred pharmacies for the separate Part D review.
- Official quotes, applications, insurer correspondence, payment records, and effective-date confirmation.
Replacement and consumer protections
Do not cancel an existing policy before the replacement is secure
Outside open enrollment or a guaranteed-issue right, an insurer may use underwriting where allowed. Applying for a new policy does not cancel the old one and does not guarantee acceptance. Compare benefits, premium, rating method, waiting-period rule, effective date, and any lost legacy benefit before signing replacement paperwork.
Use the 30-day free-look period correctly
When replacing one Medigap policy with another, Medicare provides a 30-day free-look period. Keep the old policy until the new policy is issued, reviewed, and accepted as the intended replacement. The policyholder may need to pay both premiums during the overlap. Follow written cancellation instructions after deciding which policy to keep.
An older policy issued before standardized designs changed may contain benefits no longer sold. Once canceled, it may not be recoverable. A replacement should never be justified solely by a lower first-month premium without documenting the benefit differences and purchase rights.
Recognize prohibited sales practices
- Pressure, deception, or false statements intended to make someone switch policies.
- Selling a second Medigap policy without the required written intent to replace the existing policy.
- Calling Medicare Advantage a Medigap policy or selling it after the person says they want Original Medicare with Medigap.
- Claiming a private policy or seller is Medicare, represents Medicare, or has federal approval or recommendation.
- Selling a policy that cannot legally be sold in the applicant’s state.
- Using family-history questions or requiring a genetic test in a Medigap sale.
Verify that the insurance company and producer are licensed in the state and that the policy can legally be sold there. Keep the outline of coverage, application copy, replacement notice, policy, premium receipt, and all written representations. Contact the state insurance department for licensing, complaint, or state-right questions.
Related Medicare guidance
Frequently asked questions
Medicare Supplement Policy FAQs
What is a Medicare Supplement policy?
It is private insurance that works with Original Medicare and pays specified Part A and Part B cost sharing according to a standardized benefit design. It is also called Medigap.
Does Medigap replace Original Medicare?
No. Original Medicare remains primary and processes covered claims first. The Medigap policy pays next according to its terms and standardized benefits.
Can one policy cover both spouses?
No. Medigap is individual coverage. Each spouse needs a separate application, policy, premium, and effective date if both want coverage.
Are Medicare Supplement policies standardized?
Yes, in most states. The same letter provides the same standardized basic benefits across companies. Massachusetts, Minnesota, and Wisconsin use different standardization systems.
What do Medicare Supplement policies cover?
Depending on the letter, they can cover specified Part A or Part B deductibles, copayments, coinsurance, excess charges, skilled nursing coinsurance, or limited foreign-travel emergency costs.
What does Medigap generally not cover?
It generally does not cover long-term custodial care, routine dental or vision care, hearing aids, eyeglasses, private-duty nursing, modern outpatient prescriptions, or Medicare Advantage cost sharing.
Does Medigap include Part D prescription coverage?
Policies sold after 2005 do not include modern outpatient drug coverage. A compatible stand-alone Part D plan or other creditable prescription coverage may be needed.
How are Medigap claims paid?
Medicare normally processes a covered claim first. Most policies receive Part B claim information directly from Medicare, then pay the provider or policyholder according to the policy.
What should I do if a provider bills me before Medigap pays?
Compare the bill with the Medicare Summary Notice and insurer explanation. Confirm claim crossover and contact the correct party before assuming the entire balance is due.
Is a Medigap policy guaranteed renewable?
Modern policies are generally guaranteed renewable while premiums are paid. Certain policies bought before 1992 can have different rules in some states. Renewability does not freeze the premium.
Can a Medigap premium increase?
Yes. Premiums can change under applicable rating and state rules. Age under attained-age rating, inflation, healthcare costs, approved rate actions, or ending discounts may affect the amount.
When is the Medigap Open Enrollment Period?
It generally lasts six months beginning the first month someone is both age 65 or older and enrolled in Part B. It is generally a one-time federal period.
Does Medigap open enrollment repeat every fall?
No. Medicare’s October 15–December 7 Open Enrollment Period concerns Medicare Advantage and Part D elections. It does not create a new federal Medigap open-enrollment right.
Can a Medigap insurer use medical underwriting?
Outside open enrollment or a guaranteed-issue protection, underwriting may apply where allowed. State laws can provide broader rights, so residence and timing matter.
Can a pre-existing-condition waiting period apply?
In limited circumstances, a waiting period of up to six months can apply to coverage related to a pre-existing condition. Prior coverage and state law may affect it. Request written details.
Can I use any doctor with Medigap?
Standard Medigap follows Original Medicare, but no policy guarantees every provider accepts Medicare, the patient, or the service. Medicare SELECT can require specified providers for full benefits.
Can I have Medicare Advantage and Medigap together?
No. Medigap supplements Original Medicare and cannot pay Medicare Advantage premiums or cost sharing. A future Medigap date may be arranged when someone validly returns to Original Medicare.
Can I replace my current Medigap policy?
You can apply, but underwriting may apply outside protected periods. Confirm written acceptance and use the 30-day free-look period before canceling the existing policy.
Are final 2027 policy premiums available?
Not necessarily. Obtain an official applicant-specific quote for the intended effective date. Do not treat 2026 premiums, deductibles, limits, or policy lists as confirmed 2027 terms.
Does the Wellcare button offer Medigap policies?
No. It is a carrier-specific pathway for current Wellcare Medicare Advantage options. It does not quote or compare Medicare Supplement policies and is not an all-carrier comparison.
Does the Blake Insurance Group form submit an application?
No. It requests contact and a Medicare review. Policy issuance requires a separate authorized application, eligibility confirmation, underwriting when applicable, premium payment, and effective-date confirmation.
Review the policy, not just the plan letter
Confirm your purchase rights, compare eligible standardized benefits, obtain official same-letter quotes, understand claims and rating, pair the policy with Part D, and coordinate every effective date before replacing coverage.
The review form is not an application. The Wellcare pathway concerns carrier-specific Medicare Advantage options and does not compare or enroll anyone in Medigap.