What Medigap pays for
Medigap is private insurance that works alongside Original Medicare. Medicare pays its share first, and then your Medigap plan pays some or all of the rest.
Depending on the plan, Medigap can pay your Part A hospital deductible, your Part B 20% coinsurance, skilled nursing coinsurance, and extra hospital days. Some plans also help with emergency care while traveling abroad.
Medigap does not cover long-term custodial care, dental, vision, hearing aids or prescription drugs. You need a separate Part D plan for medicines.
Standardized plans: same benefits, different insurers
Medigap plans are labeled with letters. A Plan G from one company covers the same benefits as a Plan G from another. What changes is the price and the company behind it.
In New Jersey, the plan menu includes Plans A, B, D, G, K, L, M and N. Plans C and F are open only to people whose Medicare Part A started before January 1, 2020.
Medigap premiums vary by insurer, policy and eligibility. Compare the same lettered policy and confirm current prices, underwriting rules and any costs the policy does not pay.
Two plans people ask about most: Plan G and Plan N
Plan G and Plan N cover much of the same ground. The difference is how you share costs during the year.
| Plan G | Plan N | |
|---|---|---|
| Part A hospital deductible | Covered | Covered |
| Part B 20% coinsurance | Covered | Covered, except copays |
| Doctor office visit | No copay after the Part B deductible | Verify current amount and eligibility |
| Emergency room visit | No copay after the Part B deductible | Verify current amount and eligibility |
| Part B yearly deductible | Verify current amount and eligibility | Verify current amount and eligibility |
| Part B excess charges | Covered | Not covered |
Plan G leaves you with one yearly cost, the Part B deductible. Plan N charges small copays at some visits and may charge more if a provider bills above Medicare's approved amount. Neither plan is right for everyone.
How Medigap and Medicare Advantage differ
Medigap goes with Original Medicare. Medicare Advantage replaces it. You cannot have both.
With Medigap you can see any doctor or hospital in the country that accepts Medicare, with no network and no referrals. You usually pay a higher monthly premium than you would for many Advantage plans. In return, your costs at the doctor tend to be steadier.
Timing: the Medigap window is the one that matters most
Medigap has a one-time six-month Medigap Open Enrollment Period. It begins the first month you are 65 or older and enrolled in Part B. During that time, an insurer cannot turn you down or charge more because of your health.
After that window closes, insurers in most cases can ask health questions and may decline you or charge more. A few situations give you a special right to buy, such as leaving a Medicare Advantage plan in some cases or losing certain employer coverage. Medicare.gov explains when you can buy Medigap.
If you are about to turn 65, read Turning 65 in Brick, NJ so you do not miss this window.
New Jersey rules for people under 65
Some people get Medicare before 65 because of a disability. New Jersey has special rules for them.
- If you are under 50, a contracted insurer must issue you coverage when you apply within 12 months after you enroll in Part B.
- If you are 50 through 64, insurers selling Medigap in New Jersey must offer you a plan. You apply within 12 months after you enroll in Part B.
- If your Medicare began on or after January 1, 2020, Plan D is the plan offered under these rules.
The state explains the details on its Medicare Supplement Under 50 program page. Our page on Medicare under 65 with a disability covers the rest.
Medigap plans in Brick, NJ: what to compare
Because benefits match across insurers for each letter, shopping comes down to a few things.
- Premium and how it can change. Ask whether the premium goes up as you age and how often rates change.
- The insurer's service record. Ask how claims are handled.
- Extras. Some insurers add discounts for things like fitness programs or paying by bank draft.
- Household discounts. Some insurers lower the price when two people in a home both enroll.
New Jersey SHIP posts monthly premium charts by plan and insurer on its SHIP page, so you can check prices on your own. A insurance professional can also help you compare.
Things to know in Brick and Ocean County
Many people in Brick choose Medigap because they use doctors and hospitals in more than one county. Others spend winter months in Florida and want to see doctors there with the same coverage. Medigap works anywhere in the country that accepts Medicare.
Premiums can differ from one county to another and between insurers. Ask for a quote for your specific situation.
Keep reading
This page is part of the Coverage & Costs library, inside our Medicare insurance guide for Brick, NJ. Related pages:
Unfamiliar word? Check the Medicare glossary.
Talk through Medigap options with an insurance professional
Medigap rules depend on your timing and your health history. An insurance professional can explain your options and the windows that apply to you.
Frequently Asked Questions
Does Medigap cover prescription drugs?
No. Medigap does not cover prescription drugs. You can join a stand-alone Part D plan alongside Original Medicare and Medigap.
Can I buy Medigap if I have a Medicare Advantage plan?
You cannot use the two together. If you drop your Advantage plan, you may be able to buy Medigap. The insurer may ask health questions unless you have a special right to buy.
What happens if I miss my Medigap Open Enrollment Period?
After it ends, insurers can often ask health questions and may decline coverage or charge more. A special right to buy may apply in certain cases.
Is Plan F still available in New Jersey?
Only if your Medicare Part A started before January 1, 2020. People who began Medicare after that date can choose from other plans, such as Plan G.
Do Medigap prices change?
Yes, premiums can rise over time. Ask each insurer how it sets rates and how often they change.