Medicare Supplement

Medigap versus other Medicare mail landing in Burlington

BURLINGTON, Vt. — If you're new to Medicare, or helping a parent sort through the mail piling up on the kitchen table, you've probably run into a confusing question: what exactly is Medigap, and how is it different from everything else with the word "Medicare" on it?

Medigap — the nickname for Medicare Supplement insurance — is one of the older, steadier corners of the Medicare world. It doesn't replace Original Medicare. It sits alongside it and helps pay some of the out-of-pocket costs Original Medicare leaves behind. Here's a plain-language walk-through for readers here in Chittenden County.

What Medigap actually is

Original Medicare (Part A and Part B) pays for a large share of hospital and doctor bills, but not all of it. There are deductibles, coinsurance, and — importantly — no yearly cap on what you could owe out of pocket.

A Medigap policy is private insurance you can buy to help fill those gaps. You pay a monthly premium to the insurance company, and in return, the policy pays some or all of the cost-sharing that Original Medicare leaves you with, depending on which lettered plan you pick.

A few key points from Medicare.gov:

• Medigap only works with Original Medicare. It does not work with a Medicare Advantage plan.
• Medigap policies generally do not include prescription drug coverage. For drugs, you'd add a separate Part D plan.
• You pay a premium for the Medigap policy in addition to your Part B premium.

How the standardized letters work

Here's the part that trips people up. In most states, Medigap policies are standardized by the federal government. That means a Plan G from one company covers the same core benefits as a Plan G from another company. The letters — A, B, C, D, F, G, K, L, M, and N — each represent a specific package of benefits set by Medicare.

Why does that matter? Because once you know which letter you want, you're really comparing insurance companies on price, customer service, and stability — not on the benefits themselves, which are fixed.

A few things to know about the letters:

• Plans C and F are only available to people who became eligible for Medicare before Jan. 1, 2020. If you turned 65 after that, those two aren't on the menu.
• Plans K and L have their own yearly out-of-pocket limits and pay a smaller share of some costs.
• Plan N has some copays for office and emergency room visits.
• Three states — Massachusetts, Minnesota, and Wisconsin — standardize their Medigap plans differently. Vermont uses the standard federal letter system.

What Medigap does not cover

Even the most generous Medigap plan is not a catch-all. Medigap generally does not cover:

• Prescription drugs (that's Part D)
• Routine dental, vision, or hearing care
• Long-term custodial care in a nursing home
• Private-duty nursing
• Eyeglasses or hearing aids

If those benefits matter to you, you'd need to look at other coverage, or budget for them separately.

The Burlington picture

Burlington sits in Chittenden County, and like the rest of Vermont, it uses the standard federal Medigap lettering. That's good news for comparison shopping — the benefits inside each letter are the same no matter which company sells it.

One important local wrinkle: Medigap is regulated at the state level, and states set their own rules about when you can buy a policy and whether companies can turn you down based on health. Vermont's rules are not the same as, say, Florida's or Texas's. Before you shop, it's worth checking with Vermont's State Health Insurance Assistance Program (SHIP), which offers free, unbiased counseling to Medicare beneficiaries.

The best time to buy

Timing matters more with Medigap than almost any other Medicare decision. There's a one-time, six-month Medigap Open Enrollment Period that starts the month you're 65 or older and enrolled in Part B. During that window, insurance companies can't deny you a policy or charge you more because of health conditions.

Outside that window, in many states, insurers can use medical underwriting — meaning your health history can affect whether you get coverage and what you pay. Vermont has some additional consumer protections, but the six-month window is still the cleanest, simplest time to enroll.

This is different from the fall Annual Enrollment Period (Oct. 15 – Dec. 7), which is for Medicare Advantage and Part D — not Medigap.

Medigap vs. Medicare Advantage — a quick note

You cannot have both. Medicare Advantage (Part C) is an alternative to Original Medicare, run through a private plan with its own network and rules. Medigap only works with Original Medicare. Choosing between the two is a personal decision based on your doctors, your budget, your health, and how you feel about networks. Neither is universally "better" — they're just different.