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Changing Medicare Supplement Plans: What to Know Before You Switch

Medicare Supplement (Medigap) plans are a great choice for covering the portion of out-of-pocket costs that Original Medicare doesn’t. However, as health needs and financial situations change, beneficiaries might consider changing Medicare supplement plans. Whether it’s to reduce premiums or adjust coverage, making a change requires some thought and planning.

Here’s what to keep in mind when considering a change to Medicare Supplement coverage.

Why People Change Medigap Plans

There are several reasons why someone might decide to change their Medigap plan:

• Overpaying for coverage: The current plan might offer more coverage than needed, meaning the policyholder may not use as much coverage as much as expected.
• Needing additional benefits: Health needs can change, and a different plan may provide better or more suitable coverage.
• Shopping for a better rate: Even if the benefits remain the same, switching to a different insurance carrier offering the same plan at a lower premium makes sense.
• Company dissatisfaction: Some beneficiaries want to change to a new insurer due to customer service or other experiences.

When You Can Switch

Changing Medigap plans isn’t quite as simple as enrolling in Medicare for the first time. There are only a few scenarios when someone can switch plans without facing potential roadblocks:

• During their six-month Medigap Open Enrollment Period: This period starts the month they turn 65 and are enrolled in Medicare Part B. During this time, they can buy any Medigap plan offered in their state or switch plans. Insurance companies cannot deny coverage based on health.
• 30 day free look period: After purchasing a new Medigap policy, you have 30 days to decide if you want to keep it. This allows beneficiaries to compare other plans with their your current plan. 
• With guaranteed issue rights: These are special protections that allow someone to buy certain Medigap plans without medical underwriting. Common situations that trigger guaranteed issue rights include losing employer coverage or moving out of a plan’s service area. However, there are currently 4 states that offer guaranteed issue rights regardless of the circumstance.

Please note: A new Medigap policy doesn’t automatically cancel the old one the way Medicare Advantage and PDP plans do. It is best not to cancel your old Medigap policy until you are sure you want to keep the new one.

Watch a YouTube video on Medicare Supplement underwriting.

Outside of the situations listed above, beneficiaries may need to go through medical underwriting to enroll in a new Medigap plan.

Understanding Medical Underwriting

Medical underwriting is a review process insurers use to assess an applicant’s health history and current conditions. Based on this review, a company can:

• Approve or deny the application.
• Charge a higher premium.
• Apply a waiting period for coverage of pre-existing conditions.

If a person applies for a Medigap plan outside their Open Enrollment Period and without guaranteed issue rights, their application could be declined based on health.

One common underwriting consideration is tobacco use. Smokers often face higher premiums, even if they are otherwise in good health.

No Waiting Period to Switch

There’s a common misconception that people have to keep their Medigap plan for a set amount of time before switching. The truth is, once someone has a Medigap policy, they can apply for a new one at any time. As long as they’re willing to go through underwriting if required.

Switching Medicare Supplement plans isn’t something to rush into, but with the right timing and a good understanding of the process, it can be a good idea for your health and finances. Whether it’s finding more appropriate coverage or simply lowering monthly costs, reviewing options regularly ensures your Medicare Supplement plan continues to meet your needs. It is best to speak with a licensed Medicare agent who can guide you through the options and find the best fit for your needs.A

If you are an agent who is ready to join the team at Crowe; click here for online contract.

Agents helping clients navigate this process; be sure they understand the importance of timing and potential underwriting challenges. They must understand how their health status could impact their options.

Stay up-to-date on agent events and information; click here.

What Medicare Plan N Covers: Is It the Right Supplement for You

When it comes to supplementing Original Medicare (Part A and Part B), Medigap Plan N is one of the more popular options. It offers strong coverage at a lower premium than some other Medigap plans. This makes it an attractive choice for many Medicare beneficiaries. We will go over what Medicare Plan N covers, and why someone might choose it over other options.

What Medicare Plan N Covers

Medigap Plan N is a standardized Medicare Supplement Insurance plan, which means the benefits are the same no matter which insurance company offers it. Here’s what Plan N covers:

1. Medicare Part A Coinsurance and Hospital Costs – Covers up to an additional 365 days after Medicare benefits are used up.
2. Medicare Part B Coinsurance or Copays – Covers most of the 20% coinsurance beneficiaries would otherwise pay. This excludes copays; up to $20 for doctor visits and up to $50 for ER visits that don’t result in admission.
3. Blood (First 3 Pints) – Covers the cost of the first three pints of blood needed for a medical procedure.
4. Part A Hospice Care Coinsurance or Copays
5. Skilled Nursing Facility Care Coinsurance
6. Medicare Part A Deductible – Plan N covers this cost, which can save you over $1,600 per admission in 2025.
7. Emergency Medical Care During Foreign Travel – Covers 80% (up to plan limits) for medically necessary care during international travel.
   

What Plan N Does Not Cover

There are a few out-of-pocket costs you may still be responsible for:

1. Medicare Part B Deductible – You’ll need to pay this annually ($240 in 2025).
2. Part B Excess Charges – If your doctor does not accept Medicare assignment and charges more than Medicare-approved amounts, Plan N does not cover those excess charges.
3. Copayments – As mentioned earlier, you’ll pay small copays for some office and emergency room visits.
   

Why Choose Medicare Plan N

Here are some reasons why Plan N might be the right choice for you:

Lower Monthly Premiums

Plan N generally has lower premiums than Plan G or Plan F. This makes it a budget-friendly option for those who want solid coverage without a high monthly cost.

Predictable Costs

Aside from the Part B deductible and occasional copays, your out-of-pocket costs are minimal. This makes it easier to plan financially, especially for healthy individuals who don’t visit the doctor often.

Access to Nationwide Coverage

Like all Medigap plans, Plan N allows you to see any provider in the U.S. who accepts Medicare; no networks or referrals needed.

Foreign Travel Coverage

If you travel abroad, the emergency coverage provided under Plan N gives you added peace of mind.

Ideal for Healthy Retirees

If you’re in good health and don’t mind paying occasional small copays, Plan N can offer significant savings while still covering major expenses.

Watch a quick video on Medicare enrollment periods

Is Plan N Right for You

Plan N is best for those looking to balance good coverage with lower monthly premiums. It’s especially attractive if you don’t anticipate frequent medical visits and prefer to avoid the higher costs of Plan G or Plan F.

Agents; if you are ready to join the team at Crowe, click here for contract.

Click here to stay updated on the latest agent events and information.

As always, it’s important to review personal health needs, provider preferences, and budget with a licensed Medicare agent to determine if Plan N is your best fit.

Get a Head Start on AEP: Prep Now for a Successful Enrollment Season

The Annual Enrollment Period (AEP) is one of the busiest and most profitable times of the year for Medicare agents. Between October 15th and December 7th, the demand for knowledgeable, trusted advisors skyrockets. But here’s the truth: agents who wait until the fall to prepare are already behind. It is best to get a head start on AEP before everything piles up.

The most successful Medicare agents treat the months leading up to AEP as preparation time. By getting a head start now, you’ll not only reduce stress but also position yourself to grow your book of business and serve clients more effectively when the rush begins.

Here are some steps you can take right now to set yourself up for your best AEP yet:

Complete Certifications and Training

Staying current with your certifications is critical. Most carriers require agents to complete either AHIP or NABIP certification and plan-specific training before they can begin selling Medicare Advantage or PDP plans during AEP.

• AHIP and NABIP typically launch in June, so mark your calendar.
• Many carriers offer a discount if you complete AHIP through their portal; take advantage of that!
• Start your carrier certifications as soon as possible so they do not pile up (they can be time consuming). This helps you minimize stress as it gets closer to the October deadline.

By getting these done early, you’ll be compliant, confident, and ready to hit the ground running.

Stay Updated on Industry Changes & Training Opportunities

The Medicare landscape is constantly evolving; plan changes, regulatory updates, compliance rules, and new technology are all part of the mix. That’s why staying informed isn’t just helpful; it’s essential.

Take time now to:

• Subscribe to carrier newsletters and CMS updates.
• Attend webinars, workshops, or local training events.
• Engage in forums or networking groups with other Medicare agents.

The more informed you are, the more value you bring to your clients—and the more confident you’ll feel going into AEP.

Click here to view the latest agent events and information.

Prepare and Update Your Marketing Materials

Your marketing materials are your first impression; make sure they’re working for you, not against you.

Before AEP begins, audit and refresh all your materials:

• Brochures
• Flyers
• Business cards
• Educational handouts
• Giveaways or branded items (under $15 for compliance!)

Make sure everything reflects your current branding, includes up-to-date contact information, and is tailored to your audience.

If you’re planning to promote yourself through social media, email, or your website, remember:

• Include all required disclaimers (especially for Medicare Advantage or PDP).
• Double-check whether your materials require HPMS filing and approval.
• For peace of mind, consider working with your compliance department to review and file your materials properly.

Watch a YouTube Video of the CMS proposed changes for CY2026

When in doubt; ask. Staying compliant now saves headaches later.

Test Lead Sources Before the Rush

Not all leads are created equal; the best time to figure out what works is before the pressure of AEP hits.

Now is the perfect time to test and evaluate:

• Digital leads (Google ads, Facebook campaigns)
• Direct mail campaigns
• Community referrals
• Educational events
• Grassroots marketing (partnering with local businesses or pharmacies)

Track metrics like cost per lead, contact rate, appointment set rate, and ultimately, conversion to sale.

Give yourself time to test, and refine your lead strategy so when AEP begins, you’re not guessing, you’re scaling.

Make a Marketing Plan

Don’t wait until October to promote yourself; start building awareness now. Consider:

• Planning grassroots marketing like community events or educational seminars.
• Designing print materials (postcards, flyers, business cards).
• Lining up email campaigns or social media content to build visibility.

Make sure your Permission to Contact (PTC) processes are compliant and ready to go.

Update Tools and Technology

Evaluate whether your current tools are working efficiently:

• Is your CRM user-friendly and up to date?
• Are your quoting tools and enrollment platforms ready?
• Do you need to upgrade your laptop, printer, or internet connection?

Watch a YouTube video on Connecture & Sunfire quoting and enrollment tools

A little tech prep now can save you major headaches later.

Check that your systems are:

• Updated and running smoothly
• Synced across devices
• Easy for both you and your clients to use

Key tools to have ready:

• Online quoting tools – for fast and accurate plan comparisons
• E-app platforms – for secure and paperless enrollment
• Video conferencing tools – for remote appointments
• Electronic scope of appointment (SOA) tools – for compliance

Also, make sure your email, calendar, and CRM are integrated so nothing slips through the cracks.

Learn about Pinnacle’s BOSS agent portal & CRM for agents

By mastering your tech tools before AEP, you’ll boost efficiency, reduce errors, and deliver a smoother experience to every client; earning trust and more referrals.

If you are ready to join the team at Crowe,; click here for online contracting

Take Care of Yourself

Don’t forget: you’re your biggest asset. AEP is a marathon, not a sprint. Use this pre-season time to get into a good routine; physically, mentally, and professionally so you can show up at your best every day during the rush.

Prior Authorization For Original Medicare

Starting January 1, 2026, those on Original Medicare who reside in New Jersey, Ohio, Oklahoma, Texas, Arizona, or Washington, will be required to get a prior authorization for Original Medicare before you receive some covered services. This will cause a major shift in how some beneficiaries use their Medicare benefits.

Medicare is launching a pilot program called the WISeR Model; short for Wasteful and Inappropriate Services Reduction and with it comes something traditionally associated with Medicare Advantage plans: prior authorization.

What Is Prior Authorization

Think of prior authorization as an ok from Medicare. Before your doctor can move forward with certain procedures such as; back surgery, an epidural, or a knee replacement, they have to get Medicare’s approval first. If Medicare doesn’t approve the service, the beneficiary will be on the hook for the entire cost.

This step is designed to prevent beneficiaries undergoing unnecessary or risky treatments, but it also means more paperwork, potential delays, and a new layer of bureaucracy for Original Medicare beneficiaries.

Why Is Medicare Doing This

According to CMS, the WISeR model has three main goals:

• Cutting down on fraud and wasteful spending
• Protecting patients from unnecessary or potentially harmful care
• Using technology and expert review teams to promote high-quality, cost-effective treatment

Medicare emphasizes that the goal is not to deny care, but to ensure the care being provided is truly necessary.

Which Services Will Require Prior Authorization

The WISeR pilot affects 17 outpatient services Medicare has identified as potentially overused or subject to misuse. These include:

• Back and neck surgeries
• Knee and joint surgeries
• Epidural injections and other pain treatments
• Skin grafts
• Nerve stimulators

What You Need to Know if You Have a Medigap Plan

Even if you have a Medicare Supplement plan (Medigap) like Plan G or Plan N, this change still affects you:

Watch a quick video on High Deductible Plan G

• Medicare Must Approve First: Medigap only helps pay your portion after Medicare approves the service. If Medicare denies it, Medigap won’t cover anything.
• Longer Wait Times: Prior authorization can delay access to care while your provider waits for Medicare’s decision.
• Less Flexibility: Traditional Medicare has long been valued for its ease of access to services—this new layer limits that freedom for certain procedures.
• No Formal Appeals: Under the WISeR pilot, there’s no standard appeal process. If denied, your doctor can submit more info, but there’s no official right to appeal like there is in broader Medicare.

How Does This Compare to Medicare Advantage

If this sounds familiar, it’s because Medicare Advantage plans have used prior authorization for years. However, there are key differences:

• Traditional Medicare is administered by the federal government, while Medicare Advantage is offered by private insurers.
• The WISeR model only requires PA for 17 specific outpatient services, while Medicare Advantage may require approval for hundreds of services and medications.

What’s Next

Right now, this is a pilot program affecting just six states. But if it’s successful, Medicare could expand it nationwide or add more services to the list.

Even if you don’t live in one of the six pilot states, it’s wise to stay informed—these changes could affect you in the future.

What Medicare Beneficiaries Should Do

1. Talk to Your Doctor
   Ask if any upcoming procedures might require prior authorization.
2. Plan Ahead
   Build in extra time for possible delays when scheduling certain treatments.
3. Stay Informed
   Keep up with updates from CMS and talk to your Medicare agent, especially if you plan to travel or move to another state.

The WISeR model represents a big change for Traditional Medicare, especially for those who’ve enjoyed its simplicity and flexibility. While the goal is to protect patients and reduce waste, many worry it could delay care or add confusion.

Agents who are ready to join the team at Crowe; click here for online contracting

Stay up-to-date on agent events and information

For now, being proactive is your best defense. Know which services are affected, communicate clearly with your doctor, and keep up with Medicare updates. This pilot could be the first step in a broader transformation of how Original Medicare works.

When it comes to navigating the maze of Medicare, choosing the right supplemental coverage can make a significant difference in both healthcare coverage and out-of-pocket costs. One option that remains popular is Medigap Plan N. We will outline the benefits of Medigap Plan N and highlight it’s balance of coverage and affordability. This post includes both the benefits and downsides of Medigap Plan N.

Medigap Plan N

Medigap (Medicare Supplement Insurance) helps pay for healthcare costs that Original Medicare (Part A and Part B) doesn’t cover, such as copays, coinsurance, and deductibles. Plan N is one of 10 standardized Medigap plans available in most states. It offers a good blend of coverage and cost savings, making it appealing to Medicare enrollees who want solid protection without having to pay the highest premiums.

Benefits of Medigap Plan N

Lower Monthly Premiums

In general, Plan N has lower premiums than more comprehensive plans like Plan F or Plan G. This makes it a good option for individuals who are relatively healthy and want to save on fixed monthly costs.

Plan N Covers Cost Gaps

• 100% of Part A coinsurance and hospital costs
• 100% of Part B coinsurance (with a few exceptions)
• Skilled nursing facility care coinsurance
• Part A deductible
• Emergency care during foreign travel (up to plan limits)

Nationwide Access

Like all Medigap plans, any provider that participates with Medicare will accept Plan N. Enrollees do not have to worry about provider networks or referrals. Enrollees can see any doctor or specialist who accepts Medicare.

Predictable Inpatient Costs

Because inpatient services are well covered by Plan N, beneficiaries can feel confident with their choice, if they are hospitalized or require skilled nursing care. Their costs should generally be predictable.

Downsides of Medigap Plan N

Copays for Doctor and ER Visits

While most Part B coinsurance is covered by Plan N, beneficiaries must still make some copays:

• Up to $20 for office visits
• Up to $50 for emergency room visits (waived if the patient is admitted)

These copays can add up for anyone who frequently requires the care of a doctor.

Doesn’t Cover Part B Deductible

Like all Medigap plans issued to new enrollees after January 1, 2020, Plan N does not cover the Medicare Part B deductible, which is $257 in 2025.

Excess Charges Not Covered

Plan N does not cover Part B excess charges. These are extra charges from providers who don’t accept Medicare assignment. These providers are allowed to bill up to 15% over the Medicare-approved amount. While this isn’t common, it can be a concern for those who live in or travel to areas where non-participating providers are prevalent.

Not Ideal for High Users of Care

Beneficiaries who require frequent doctor visits, lab work, or outpatient treatments may cause the recurring copays and potential for excess charges to outweigh the savings of the lower premiums. When that is the case, Plan G could be a better value despite higher monthly premiums.

Plan N can be an excellent choice for

• People in relatively good health
• Those who prefer lower monthly premiums
• Individuals who rarely see non-participating Medicare providers
• Enrollees who are comfortable paying small copays in exchange for premium savings

Plan N may not be ideal for

• People who visit the doctor frequently
• Those who live in areas where excess charges are more common
• Individuals who want the most comprehensive coverage available

Watch a video on Physicians Mutual Innovative Plan G

Medigap Plan N is a well-balanced choice for Medicare beneficiaries who want solid protection without paying top-dollar premiums. Its design provides comprehensive healthcare at an affordable rate. As always, choosing the right Medigap plan depends on health needs, budget, and lifestyle. Comparing Plan N with other options like Plan G can help beneficiaries make the most informed decision. A licensed Medicare agent can help compare plans and weigh all the options.

For many people trying to navigate Medicare, understanding how and when out-of-pocket costs apply can be overwhelming. The terminology “first dollar Medicare services” may cause confusion for some individuals. We will explain what it actually means and how they work in the context of Medicare services.

First Dollar Coverage

First dollar coverage refers to insurance benefits that begin immediately. The enrollee is not required to, pay a deductible, copay, or coinsurance before the carrier provides coverage for a medical service. This coverage literally begins from the “first dollar” of a medical bill providing the highest level of financial protection.

With Original Medicare (Parts A and B), this kind of coverage is not included by default, although it may be accessed through either supplemental plans or Medicare Advantage plans in some circumstances.

Original Medicare: No First Dollar Coverage

Medicare is divided into Part A (hospital insurance) and Part B (medical/outpatient insurance).

Original Medicare enrollees are responsible for the following out-of-pocket costs:

• Deductibles: Part A ($1,632 per benefit period in 2025); Part B ($240 annual)
• Coinsurance: 20% for most Part B services after the deductible
• Copays: Varies depending on the service or provider

Please note; although Medicare covers a significant portion of approved healthcare costs, it does not offer first dollar coverage when used on its own. Beneficiaries are responsible for cost-sharing amounts unless they purchase supplemental coverage.

First Dollar Coverage for Medicare Services

In general, there are two ways Medicare beneficiaries receive first dollar coverage:

1. Medicare Supplement (Medigap) Plans

The Medigap plans listed below cover most or all out-of-pocket costs after Original Medicare pays its share.

• Plan F: Offers true first dollar coverage. This plan covers both Part A and Part B deductibles as well as all coinsurance and copays for approved medical expenses as well as excess charges.
• Plan C: Similar to Plan F but doesn’t cover excess charges. Important: Plans F and C are not available to individuals who were eligible for Medicare after January 1, 2020.
• Plan G: Covers all approved Medicare expenses; except the Part B deductible, making this plan very close to first dollar coverage.

Beneficiaries enrolled in a Plan F shouldn’t have to pay anything out-of-pocket for Medicare covered services.

2. Some Medicare Advantage (Part C) Plans

Medicare Advantage plans are an alternative to Original Medicare. Some Medicare Advantage plans offer enrollees:

• $0 monthly premiums
• $0 copays for primary care, lab work, preventive services, or telehealth
• Reduced out-of-pocket costs through annual limits

Although technically they are not considered “first dollar” coverage, some plan benefits can effectively eliminate upfront costs for specific services, depending the plan design.

Keep in mind: Medicare Advantage plans may include networks, referrals, and prior authorization requirements.

Watch a quick YouTube video on Medicare enrollment periods

Examples of First Dollar Medicare Service

• Example 1: A Medigap Plan F enrollee visits the emergency room. The bill is fully covered; no deductible, no copay, no coinsurance. This is real first dollar coverage.
• Example 2: A Medicare Advantage plan enrollee has a $0 copay for a primary care visit. Although the plan may have a deductible for other services, this specific visit is a first dollar service.
• Example 3: A individual with Original Medicare and no supplemental coverage uses the services of a specialist. This individual must meet the Part B deductible and then pay 20% for all approved charges. In other words, this is not first dollar coverage.

Why First Dollar Coverage Matters

• Predictable healthcare costs
• Easier budgeting for individuals on fixed incomes
• Reduces the risk of surprise bills
• Encourages timely medical visits and screenings

Possible Downside

• Higher monthly premiums (especially with Medicare Supplement Plans)
• Less flexibility (if beneficiaries opt for a Medicare Advantage Plan) they must use specific provider networks.
• Limited plan availability for more recent enrollees (Medicare Supplement Plan F and Plan C enrollment restrictions).

First dollar Medicare services are about financial peace of mind. While Original Medicare doesn’t provide this level of coverage on its own, many beneficiaries learn that Medicare Supplements or Medicare Advantage plans reduce or eliminate the high price of medical care.

Beneficiaries who like predictable expenses and minimal out-of-pocket costs, may opt for a plan that offers first dollar coverage. As a licensed Medicare agent, it is important to understand your clients healthcare needs and budget to offer plan choices that provided the best benefit options.

Navigating the world of Medicare can be overwhelming, especially when it comes to choosing the right supplemental coverage. That’s why it is important to understand what Medigap standardized benefits are and how they work.

Medigap is a type of private insurance that helps beneficiaries cover the “gaps” in Original Medicare (Parts A and B). Medigap plans cover things like; deductibles, coinsurance, and copays. What many people don’t realize is that Medigap policies are standardized, meaning the benefits for each plan type are the same, no matter which insurer you choose.

What “Standardized” Means

Starting in 1992, federal law requires all Medigap policies to adhere to standardized benefit structures, designated by letters: Plans A through N. The only real difference in plans is the premium each carrier charges for the plan. Although insurance companies charge different premiums, the benefits for each plan letter must be identical no matter who the provider is. In other words, every Plan N has to provide the exact same coverage for medical expenses no matter what company offers it.

Standardization makes it easy for beneficiaries to compare plans without worrying about differences in coverage. They can simply compare cost and company ratings to find the best options.

Examples of Medigap Plan options

• Plan A: This is the most basic plan option. It provides coverage for Medicare Part A coinsurance and hospital costs, Part B coinsurance, and the first three pints of blood.
• Plan G: The most comprehensive plan available to those who turned 65 after 1-1-2020. It covers all Medicare approved expsnes with the exception of the Part B deductible.
• Plan N: Offers lower premiums than Plan G and covers a portion of the copays for doctor visits and hospital visits. The enrollee will still have a small copay for Medical services. This plan does not cover the Part B deductible or excess charges.

Some States Have Different Medigsp Standards

Although most states follow the federal standardization model, Massachusetts, Minnesota, and Wisconsin have their own versions of standardized Medigap plans. These states use their own benefit structures however, they still follow the principle of offering consistent benefits across insurers within their states.

Please Note

• Plan C and Plan F are no longer available to beneficiaries who became eligible for Medicare on or after January 1, 2020. These plans provided coverage for the Medicare Part B deductible, which new legislation phased out to cut back on the overuse of services.
• Beneficiaries must have both Medicare Part A and Part B to enroll in a Medigap plan. There is a premium for Medigap plans in addition ot the Part B premium.
• Medigap works with Original Medicare, beneficiaires cannot use a Medigpa plan with a Medicare Advantage (Part C) plan.

Why Standardization is Important

Standardization simplifies decision-making for Medicare beneficiaries. It eleiminates the need to decipher insurnace benefits accross multiple insurance companies; instead, the focus is on price, company reputation, and rate increase history.

Watch a quick YouTube video on Medicare Supplement Underwriting

This helps foster competition between companies based on cost and service quality instead of confusing plan designs.

Choosing a Medigap plan doesn’t have to be a guessing game. With standardized benefits, benficiaries can make apples-to-apples comparisons between insurers and choose the coverage that meets both healthcare and financial needs.

Agents, are you ready to join the team at Crowe; click here

As Medicare beneficiaries consider supplemental coverage to fill the gaps left by Original Medicare (Parts A and B), many turn to Medigap plans. Among them, The HDG (High Deductible Plan G) stands out for the comprehensive benefits it provides at a lower monthly premium, but with a catch: a high annual deductible. If your client is considering a HDG Plan, understanding the pros and cons of HDG Plans will help them make an informed decision.

What Is HDG

HDG or High Deductible Plan G provides the same benefits as standard Medigap Plan G; one of the most comprehensive Medigap options, but only after the beneficiary meets an annual deductible. Each year, CMS decided what that deductible amount will be; in 2025, the deductible is $2,800.

Once the beneficiary pays the deductible for the year, the plan pays 100% of covered Medicare expenses, just like a standard Plan G.

Pros of HDG

1. Low Monthly Premiums

The biggest selling point of the HDG plans is their affordability upfront. The premiums for HDG Plans is typically much lower than standard Plan G, in some cases, less than 1/3 of the price, making this a great option for healthy enrollees or individuals living on a fixed income who want to be prepared for unexpected health issues.

2. Full Coverage

Once the beneficiary meets the annual deductible, HDG covers:

• Part A coinsurance and hospital costs
• Part B coinsurance/copays
• Blood (first 3 pints)
• Skilled nursing facility coinsurance
• Part A hospice care coinsurance/copays
• Medicare Part A deductible
• Part B excess charges
• Foreign travel emergency care (up to plan limits)

3. Good Option for Health Individuals

Those who rarely seek medical care may not reach the annual deductible; in other words, out-of-pocket spending could stay well below the cost of a standard Plan G’s premium.

4. Standard Benefits

Just like all other Medicare Supplement plans; HDG is standardized. Therefore, after the deductible is met, the benefits are the same regardless of insurer. The only thing to compare are the premiums and service quality, not the coverage.

Cons of HDG

1. High Upfront Costs

Individuals who require frequent care (doctor visits, outpatient services, hospital stays) pay out-of-pocket until they reach the $2,800 (in 2025) deductible. For some, this could all happen early in the year, and the savings from lower premiums may not offset that.

2. Not Ideal for Some Budgets

For individuals on a tight or fixed income, facing unexpected out-of-pocket expenses could be difficult to manage before the deductible is met, even if the plan is technically cost-effective over time.

3. Premiums Aren’t Fixed

Although the premiums are much lower than standard Plan G, HDG premiums (like all Medigap plans) can still increase annually, leading to less savings over time. It may be a good idea to check the rate history of the insurer before choosing a plan.

4. Deductible Increases

Each year, CMS sets the annual deductible and it usually has a slight increase each year. This unpredictability can cause some issues with long-term budgeting when compared to standard plans.

Who May Be a Good Fit For HDG

• Healthy individuals with few healthcare needs
• Younger Medicare beneficiaries (e.g., age 65-70) not expecting major procedures
• Those comfortable with financial risk with the means to pay the deductible if necessary
• Budget-conscious individuals looking for low monthly expenses

Medicare HDG provides similar peace of mind to regular Plan G. It is just delayed until after the deductible is met. It’s a good option for those who can afford some out-of-pocket risk in exchange for lower premiums. As with all coverage options, it’s not a one-size-fits-all solution.

A licensed Medicare agent can help run the numbers and explore quotes tailored to an individual’s specific needs.

As an agent, helping clients navigate Medicare Supplement (Medigap) insurance can be both rewarding and challenging. One key aspect agents must understand and be able to explain to clients is what is Medicare supplement underwriting. Although Medigap plans offer standardized benefits, getting approved for coverage; especially outside of guaranteed issue periods, often depends on the underwriting process. Here’s what you need to know to guide your clients effectively.

Medicare Supplement Underwriting

Underwriting for Medicare Supplement plans refers to the process insurers use to evaluate an applicant’s health history before they issue a policy. This process determines whether an applicant qualifies for coverage and, in some cases, what premium they’ll pay. It typically includes a health questionnaire and a review of the applicant’s prescrption medications and medical history.

When Underwriting Is Required

Underwriting is generally required when a client applies for a Medigap plan outside of their open enrollment period or a guaranteed issue period. Here’s a breakdown:

Medigap Open Enrollment Period (OEP): This is a six-month window that starts the first month a client is 65 or older and enrolled in Medicare Part B. During this time, carriers must accept the applicant regardless of health status; CMS does not permit underwriting.

Guaranteed Issue Rights: These occur in specific situations (such as losing employer coverage or moving out of a Medicare Advantage plan’s service area). During this time, the client can enroll in certain Medigap plans without having to go through medical underwriting.

Learn more about Guaranteed Issue Rights

Unfortunately, outside of these periods, applicants are typically subject to underwriting and can be denied coverage based on pre-existing conditions.

Common Health Conditions That Affect Underwriting

While each carrier has it’s own underwriting criteria, common disqualifying conditions include:

• Congestive heart failure
• Insulin-dependent diabetes with complications
• Chronic obstructive pulmonary disease (COPD)
• Cancer within the past two years
• Alzheimer’s or dementia
• End-stage renal disease (ESRD)

In addition; some carriers may impose a waiting period for pre-existing conditions or adjust premiums based on health history.

Watch a quick YouTube video on Medicare Supplement underwriting

Navigating Medicare Supplement Underwriting

• Timing is everything: Try and encourage clients to apply during their OEP or another guaranteed issue window to avoid underwriting altogether.
• Pre-Qualify Applicants: Ask clients key health questions before submitting applications to avoid the disappointment of unnecessary declines.
• Know the Carriers: Different insurers have different underwriting guidelines. It is a good idea to familiarize yourself with each carrier you represent’s underwriting grids and health questions.
• Explore Alternatives: In the event the plan declines a client, they can opt for a plan that does not require underwriting, such as Medicare Advantage or other coverage options.

Understanding Medicare Supplement underwriting is essential to provide viable options to your clients. By staying informed about carrier guidelines and knowing how to time applications correctly, you can help clients get the coverage they need with fewer issues.

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Because there are so many regulations for Medicare sales, agents need to constantly be learning. That is why we will discuss Medigap Guaranteed Issue Rights in this post. This is a subject that is crucial to understand but often misunderstood.

Medigap Guaranteed Issue Rights

Guaranteed Issue (GI) Rights are protections under federal law that provide beneficiaries the right to purchase certain Medigap (Medicare Supplement) policies without having to go through medical underwriting. That means insurance companies can’t:

• Deny the beneficiary enrollment in a policy
• Charge enrollees more based on health
• Impose waiting periods for pre-existing conditions (in most cases)

These rights kick in during specific situations, often tied to changes in your health coverage or life circumstances.

When Guaranteed Issue Rights Apply

Here are some common scenarios that trigger GI rights:

Turning 65

Anyone who turns 65 has a 6 month period where they can enroll in a Medigap plan without having to go through underwriting.

Loss of Employer or Union Coverage

Individuals that have health coverage through an employer or union (including COBRA) that ends have 63 days from the end of that coverage to buy a Medigap policy using GI rights.

Medicare Advantage Plan Leaves a service Area

If a Medicare Advantage (MA) plan no longer provides service the enrollee’s area, is terminated, or they move out of the plan’s service area, they can return to Original Medicare and buy a Medigap policy under GI protections.

Beneficiary Tries a Medicare Advantage Plan for the First Time

Those who joined an MA plan when they were first eligible for Medicare at 65 and switch back to Original Medicare within the first 12 months can buy any Medigap policy offered in their state.

Medigap Insurance Company Goes Bankrupt or Misleads You

If the Medigap insurer goes out of business or the beneficiary is misled into buying a policy, they have GI rights to purchase another policy.

Trial Rights

In some cases, beneficiaries have “trial rights” that allow them to try out an MA plan and return to a Medigap plan under GI protections. This typically applies if they dropped a Medigap policy for an MA plan and want to switch back within 12 months.

Rules and Timelines

• Typically individuals have a 63-day window from the date previous coverage ends to use their GI rights.
• The plans that are guaranteed issue depend on eligibility and location. The standard Medigap plans are Plans A, B, C, F, K, or L.
• The federal government mandates guaranteed issue rights, although some states offer broader protections. It is important to check the rules for each state.

Watch a YouTube video on Medicare Supplement Underwriting GI & non-GI states

Why Guaranteed Issue Rights Matter

Without GI rights, applying for Medigap outside the initial enrollment period often means going through medical underwriting. Those who have pre-existing conditions could be denied coverage or charged more.

GI rights are a safeguard. They ensure that when life throws a curveball like; losing coverage, moving, or simply changing your mind, beneficiaries can access supplemental coverage without penalty.

Birthday Rule

There are 6 states that allow beneficiaries to change Medigap plans without underwriting during a specific period before/after their birthday each year on a GI basis. The states that have this rule are: CA, ID, IL,KY, LA, MD, NV, OK & OR. Each of these states has it’s own specific rules for this.

Important:

Some states allow beneficiaries to change Medigap plans any time or at specific times without undergoing medical underwriting. These states are: CT, NY, MA & ME.

In CT & NY enrollees change Medigap plans anytime of the year without underwriting. Massachusetts offers an annual open enrollment where beneficiaries do not have to go through underwriting. In Maine there is an open enrollment in June where Medicare Supplement enrollees can switch to a similar or lower benefit plan without underwriting.

Anyone applying under GI rights; insurance companies may request documentation (like letters from the former insurer). Keeping all notices and paperwork handy makes the application process smoother.

Medigap Guaranteed Issue Rights are an important part of the Medicare landscape, especially for those navigating transitions. Understanding when and how they apply allows you to help clients make informed choices and avoid gaps in healthcare coverage.