Medigap: cover what Original Medicare leaves behind

What is a Medicare Supplement (Medigap)?

Medicare Supplement insurance - also called Medigap - is sold by private companies and helps pay some of the health care costs that Original Medicare doesn't cover, like copayments, coinsurance, and deductibles. Some policies also cover services Original Medicare won't, such as medical care when you travel outside the U.S.

Here's how it works: if you have Original Medicare and buy a Medigap policy, Medicare pays its share of the Medicare-approved amount for covered costs first, and then your Medigap policy pays its share. A Medigap policy is different from a Medicare Advantage Plan - Advantage plans are a way to get your Medicare benefits, while Medigap only supplements your Original Medicare benefits.

8 things to know about Medigap policies

1. You must have Medicare Part A and Part B.
2. If you have a Medicare Advantage Plan, you can apply for a Medigap policy - but make sure you can leave the Advantage Plan before your Medigap coverage begins.
3. You pay the private insurer a monthly premium for Medigap in addition to your monthly Part B premium.
4. A Medigap policy only covers one person. If you and your spouse both want coverage, you'll each need your own policy.
5. You can buy a Medigap policy from any insurance company licensed to sell one in your state.
6. Any standardized Medigap policy is guaranteed renewable even if you have health problems - the insurer can't cancel it as long as you pay the premium.
7. Medigap policies sold after January 1, 2006 can't include prescription drug coverage. For drugs, you'd join a separate Part D plan.
8. It's illegal for anyone to sell you a Medigap policy if you have a Medicare Medical Savings Account (MSA) Plan.

What Medigap doesn't cover

Medigap policies generally don't cover long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing. For those needs, Priscilla can pair your Medigap policy with the right supplemental or ancillary coverage.

Plans that aren't Medigap

These are not Medigap policies: Medicare Advantage Plans, Medicare Prescription Drug Plans, Medicaid, employer or union plans (including FEHBP), TRICARE, veterans' benefits, long-term care insurance, and Indian Health Service / Tribal / Urban Indian Health plans.

Thinking of dropping a Medigap policy?

Timing matters. If you drop your entire Medigap policy and your drug coverage wasn't creditable - or you go more than 63 days before new coverage begins - you may face a late-enrollment penalty when you join a Part D plan. Talk to Priscilla before making any change so you avoid costly gaps.

Virginia's Medigap birthday rule (and why NC differs)

Since July 2025, Virginia gives existing Medigap policyholders an annual birthday rule: a window of at least 60 days starting on your birthday to switch to any insurer's Medigap policy with the same benefits - no medical underwriting. If you hold a Medigap plan in Virginia and your rate has crept up, Priscilla can shop your exact plan across carriers every year. North Carolina has no birthday rule, so NC clients keep guaranteed acceptance only in their original 6-month open enrollment window and limited guaranteed-issue situations - one more reason the initial plan choice deserves care.