01
The hospital deductible
Charged per benefit period rather than per year, so more than one hospital stay in a twelve-month span can mean paying it more than once. Every supplement plan covers this.
Coverage · Medigap
A supplement buys you predictability.
Original Medicare pays most of a hospital or doctor bill and leaves the rest to you, with no annual ceiling. A Medigap policy pays that remainder. You keep any doctor in the country who takes Medicare, and you generally stop receiving bills.
The thing to understand first
Supplements are standardised by law. A Plan G from one insurer covers exactly what a Plan G from another covers.
What differs is the price and the company's rate history. Nothing else.
Read this part twice
There is one window when they cannot say no.
When you first enroll in Part B at 65 or later, a six-month period opens in which any supplement insurer must accept you. Your health does not matter. Your medications do not matter. A condition you already have is covered.
After that window closes, in most states an insurer may ask health questions and may decline you. That is not a penalty and it is not a punishment — it is simply how the product is regulated. But it means the decision you make at 65 is not fully reversible at 70.
This is the reason we would rather meet you three months before your birthday than three weeks after it, and the reason we say plainly that the free dinner seminars in October are aimed at a different question than the one that matters most to you.
Book before your window opensWhat a supplement pays
The gaps it fills, in order of what they cost you.
These are the pieces Original Medicare leaves behind. A supplement covers some or all of them depending on which letter plan you hold.
02
The twenty per cent
Part B generally pays eighty per cent of approved charges and leaves the rest to you — with no annual limit. On an ordinary year that is modest. On a year involving chemotherapy or dialysis it is not.
03
Long hospital stays
Daily charges begin after a set number of days and rise sharply. Supplements extend hospital coverage well beyond where Original Medicare stops.
04
Skilled nursing coinsurance
After a qualifying hospital stay, a daily charge applies from a certain day onward. Most supplement plans cover it; a couple do not, which is worth checking.
05
Excess charges
A minority of doctors may bill above the Medicare-approved amount. Some plans cover that difference and some do not. Ohio, Kentucky and Indiana all permit it, so it is a live question here.
06
Emergency care abroad
Original Medicare covers almost nothing outside the country. Several supplement plans include foreign travel emergency coverage up to a lifetime limit.
The letters
Three are worth your attention. The rest are legacy.
There are ten standardised plans. In practice most people newly eligible today are choosing between two or three, and the others exist mainly because someone bought one years ago.
| Plan | What it does | Who it suits |
|---|---|---|
| GMost common today | Covers everything above except the annual Part B deductible, which you pay once a year. Includes excess charges and foreign travel emergency. | Anyone who wants bills to stop arriving. The default recommendation for most people newly eligible. |
| NLower premium | Like G, but you pay small copays at some office and emergency visits, and it does not cover excess charges. | People comfortable with modest copays in exchange for a lower monthly premium, whose doctors accept assignment. |
| HD‑GHigh deductible | Same coverage as G, but only after you have paid an annual deductible yourself. Much lower premium in exchange. | People who want the protection against a catastrophic year but can absorb ordinary costs, and who will actually set the money aside. |
| FClosed to new | Covered the Part B deductible too. Unavailable to anyone who became eligible for Medicare on or after 1 January 2020. | Existing holders only — and worth reviewing, since a closed plan's pool ages and rates can rise faster than an open one's. |
Choosing an insurer
If the coverage is identical, what are you choosing between?
Price today, and how the price is likely to behave over twenty years. The second matters more and almost nobody asks about it.
How the company rates
Some price by your age at purchase and raise rates only for the whole pool. Others raise your premium as you age, on top of general increases. The cheapest policy at 65 is frequently not the cheapest at 78.
Rate increase history
A company's track record of increases is public information and is a better guide than this year's price. We will show you the history rather than only the quote.
Household and payment discounts
Many insurers reduce the premium where two people in a household both hold policies, or where you pay annually by bank draft. These are not always offered unprompted.
Questions
Asked most about supplements.
Five of about thirty. The rest are grouped by subject.
Does a supplement cover my prescriptions?
No. Supplements sold today do not include drug coverage — you buy a separate Part D plan alongside.
Going without one when you have no other creditable coverage generally means a permanent late-enrollment penalty added to your premium for as long as you have Part D.
Can I switch supplements later if the price rises?
You may apply at any time, but outside your open enrollment window the new insurer may ask health questions and may decline. In good health it is often straightforward; after a diagnosis it may not be.
A handful of states have rules allowing certain switches without underwriting — Ohio, Kentucky and Indiana do not have a general annual right of that kind, so plan accordingly.
Do I need referrals, or approval before treatment?
Generally no. With Original Medicare and a supplement you may see any provider in the country who accepts Medicare, without a referral, and prior authorisation is used far less than under Advantage plans.
For people managing a complex condition across several specialists, this is usually the deciding factor.
Is a cheaper company a worse company?
Not on coverage — the benefits are identical by law, and claims are largely paid automatically through Medicare's own crossover system.
Where companies differ is financial strength, service, and how aggressively they raise rates. A low introductory price from a carrier with a poor increase history is the trap to watch for.
Which road should I take — Advantage or this?
We will not answer that in the abstract, and anyone who does without asking about your doctors, your medications, your travel and your budget is selling rather than advising.
What we can say is that the choice is easier to make at 65 than to unmake at 72.
Ask us for the rate history, not just the rate.
We will show you what each company has done to its premiums over the past several years alongside what it is quoting you today.