Questions to Ask About Medicare Supplemental Insurance
For anyone turning 65 or already on Medicare in the United States, and for the family member helping them, to take to an agent, an insurer or a SHIP counselor before buying or switching a Medicare supplement (Medigap) policy. The list follows the order of the decision: Medigap or Medicare Advantage, the plan letters, what a supplement leaves out, premiums, enrollment and health questions, and the agent and insurer. Where the answer depends on your state, as it does for switching later without health questions, the note says to ask how it works where you live.
Want questions from the whole vault instead? Try the random question generator.
The questions
Each question, and why to ask it
Medigap or Advantage
What does Original Medicare leave me to pay, and which of those costs would a supplement pick up?
Why ask it
Begin here, because a Medigap policy only makes sense once you have seen the gaps it fills: the Part A hospital deductible, your share of each Part B bill, and the fact that Original Medicare has no yearly limit on what you can owe. A good answer puts this year's dollar figures on each gap and shows which ones each lettered plan pays. If the person jumps straight to a product, slow them down and ask again.
What is the difference between a Medicare supplement and a Medicare Advantage plan for someone like me?
Why ask it
They are two separate routes, not two versions of one product: a supplement sits on top of Original Medicare, while an Advantage plan replaces it with a private plan that usually has a network and its own copays. Listen for the trade stated plainly, a higher monthly premium for fewer bills and a free choice of doctors on one side, a lower premium with networks and approvals on the other. An answer that only runs one way tells you what the person sells.
If I choose Medicare Advantage now and want a supplement later, will I be able to get one?
Why ask it
It costs nothing to ask this at 65 and a great deal to find out at 72. In most states an insurer can ask health questions once your first enrollment window has closed and can decline you, although there are trial rights with deadlines and a few states are more generous. Ask for the rule where you live and check it with the state insurance department before relying on it.
Do I have other coverage that makes a supplement unnecessary, or that will not work alongside one?
Why ask it
Mention retiree coverage from an employer or union, Medicaid, TRICARE or VA care before anyone quotes a price, because some of these already fill the same gaps and a retiree plan that is dropped often cannot be picked up again. A supplement also pays nothing toward a Medicare Advantage plan's copays, so nobody should be selling you both at once. A careful agent raises all of this before you do; one who never asks is quoting without the facts.
Will every doctor and hospital I use accept this policy?
Why ask it
The usual answer is that a supplement follows Medicare: where Original Medicare is accepted the policy pays its share, and there is no network to check. Confirm that your own doctors take Medicare, and ask whether the policy being quoted is a Medicare SELECT type, which can require you to use certain hospitals for non-emergency care.
Would I need a referral or prior approval for anything under a supplement?
Why ask it
A supplement adds no approval step of its own: it pays its share once Medicare has approved the claim, and Original Medicare generally lets you see a specialist without a referral. Advantage plans commonly want to approve some scans, hospital stays and treatments ahead of time. Name the care you expect to need in the next few years and have the person say which of it the Advantage plan would have to sign off first.
I spend part of the year in another state. Does the coverage work the same way there?
Why ask it
A standard supplement generally works with any provider in the country that takes Medicare, and that is the strongest case for one if you keep two homes, since an Advantage plan's network is usually built around one area. Settle which address the company uses to set your premium, and what you would have to tell them if the winter home became the main one.
What is the most I could owe in a bad year with this policy, next to Original Medicare alone and next to an Advantage plan?
Why ask it
Have the three figures written side by side, each with a year of premiums included. Original Medicare alone has no ceiling, an Advantage plan sets a yearly maximum for covered services, and a supplement's worst case depends on the letter you buy. A comparison that leaves the premiums out flatters whichever option costs more each month.
Plan letters
Which lettered plans am I allowed to buy, given when I became eligible for Medicare and where I live?
Why ask it
Supplements are standardized by letter, but not every letter is open to everyone. Plans that pay the Part B deductible are generally closed to people who became eligible in 2020 or later, and Massachusetts, Minnesota and Wisconsin use their own designs instead of the letters. You should come away with a short list, and a reason for each plan left off it.
Is Plan G from one company the same coverage as Plan G from another?
Why ask it
For the standardized benefits it should be, and that one fact shapes the whole shopping trip: once the letter is chosen you are comparing price, rate history and service, not coverage. If someone suggests their company's version of a letter pays more medical bills than a rival's, ask them to point to it in the outline of coverage.
What does Plan G pay that Plan N does not, and what would the difference have cost me last year?
Why ask it
The gap is usually a few copays for office and emergency room visits plus any excess charges, set against a lower premium for N. Count your own visits from last year and have the agent do the arithmetic in front of you. If the premium saving is smaller than the copays you would have paid, the cheaper plan is not cheaper for you.
What are Part B excess charges, and do doctors where I live bill them?
Why ask it
An excess charge is an amount above Medicare's approved rate that a doctor who does not accept assignment may add to the bill. Some states do not permit them and in many places few doctors charge them, so the honest answer is local. It decides whether paying more for a letter that covers them buys you anything.
Which deductibles, copays and coinsurance would still be mine to pay under this plan?
Why ask it
Ask for the answer as a list in dollars, starting with the Part B deductible, which plans open to newer enrollees do not pay. It should take under a minute. Long hesitation here suggests the person knows the brochure better than the policy.
Is there a high-deductible version of this plan, and who does it suit?
Why ask it
Some letters come in a high-deductible form: a much lower premium, and you pay Medicare's cost sharing yourself up to a set amount each year before the policy starts paying. It tends to suit someone in good health who has that amount in savings and would not be shaken by spending it. Ask what the deductible is this year, since it is adjusted over time.
Are the lower-premium letters, such as K, L or M, worth a look in my case?
Why ask it
These pay part of certain gaps instead of all of them, and K and L add a yearly limit on what you spend out of pocket. Fewer companies sell them, so a quote may simply not exist in your area. Worth five minutes if the premium for G or N is out of reach, and safe to skip if it is not.
What does the policy pay toward a long hospital stay or time in a skilled nursing facility?
Why ask it
These are the bills that grow by the day, so ask what happens after Medicare's fully paid days end and its daily coinsurance begins. Letters differ on skilled nursing coinsurance, and the most basic ones leave it out. Do not let a yes here stand in for long-term care: a short skilled stay after a hospital admission is one thing, and living in a nursing home is another that no letter pays for.
Could the benefits under this letter change after I have bought it?
Why ask it
The benefits of a policy you already hold generally stay as written, even if that letter is later closed to new buyers, while the Medicare deductibles it pays are reset each year. What the company can change is the price. A clear answer keeps those apart: the coverage holds, the premium does not.
What it leaves out
Does this policy cover prescription drugs, and if not, what do I need to buy with it?
Why ask it
Supplements sold today do not include drug coverage, so you should be pointed to a separate Part D plan. Follow up with what it costs to put Part D off: going without drug coverage that Medicare counts as creditable can add a penalty to the premium for as long as you have the coverage.
Who can check my prescriptions against the Part D plans in my area?
Why ask it
Bring the list with doses and how often you fill each one. An agent who sells only supplements may not run this comparison, in which case Medicare's own plan finder or a SHIP counselor will. The drug plan is worth rechecking every fall, because its drug list and price can change yearly in a way the supplement's benefits do not.
Does it cover routine dental care, eye exams, glasses or hearing aids?
Why ask it
Expect a no, because a supplement pays where Medicare pays and Medicare generally does not cover these. Some insurers attach discount programs, which are not insurance. If dental coverage is the reason an Advantage plan looks attractive, price a separate dental policy next to the supplement, with its waiting periods and yearly maximum, before deciding.
Does it pay anything toward long-term care in a nursing home, in assisted living or at home?
Why ask it
The straightforward answer is no: help with bathing, dressing and daily living is outside Medicare, so it is outside a policy built on Medicare. A vague yes is the worrying answer here. Families often assume this is covered until the first bill, so say the question out loud even if you think you know.
If Medicare refuses to pay for a service, does the supplement pay anything?
Why ask it
Generally not. A supplement pays its share of what Medicare approves, so a service Medicare rejects as not covered or not medically necessary usually falls to you in full. Knowing this stops the phrase 'full coverage' from meaning more in your head than it does in the contract.
What does the policy pay if I need emergency care outside the United States?
Why ask it
Several letters include a foreign travel emergency benefit with its own deductible, a share you pay, a lifetime limit and a cutoff a certain number of days into the trip. Collect all four numbers. If you take long trips or cruises, ask whether the agent would still buy separate travel medical insurance, and why.
Are the gym membership, discount card and other perks written into the policy, or can the company withdraw them?
Why ask it
Extras sit outside the standardized benefits, so a company can usually change or withdraw them while the policy carries on. Give them a value of zero when comparing prices unless you would pay cash for the same thing. A pitch that leads with the gym membership is leading with the weakest part.
Do I still pay the Part B premium on top of this, and what do all my premiums add up to each month?
Why ask it
Generally yes: a supplement is paid for in addition to Part B, and a Part D drug plan adds a third premium. The Part B premium is owed on the Advantage route as well, so a low-premium Advantage plan saves less than its price tag suggests. Have all three added into one monthly figure, including any income-related surcharge if you have been told you owe one.
How is this policy priced as I get older: community rated, issue-age rated or attained-age rated?
Why ask it
The method tells you how the price behaves as you age: community rating charges everyone the same whatever their age, issue-age pricing is set by your age when you buy, and attained-age pricing climbs as birthdays pass. Some states require one method, so ask which are sold where you live. A low attained-age price at 65 says little about the price at 80.
How much has this company raised the premium on this plan in each of the last five years?
Why ask it
Every pricing method allows increases as medical costs rise, so the history matters more than the label. A prepared agent has the figures or knows where the state publishes them. 'Our rates are very stable' with no numbers behind it is a reason to look the company up yourself.
What does this same policy cost a 75-year-old and an 85-year-old today?
Why ask it
Nobody can forecast your premium, but today's rate card for older ages shows the slope you are signing up for. Compare the slope between two companies as well as the starting price. The company that costs a little more at 65 is sometimes much gentler at 85.
Why is one company's price for this letter so much lower than another's when the benefits are identical?
Why ask it
The possible reasons include the pricing method, a newly launched plan with an introductory rate, a discount that expires, or stricter health screening. None of them is sinister, but each changes what the low price means over fifteen years. Ask how long the company has sold this plan in your state and what its older policyholders pay now.
Which discounts are in this quote, and do any of them shrink or end?
Why ask it
Common ones are for living with another adult, paying by bank draft, paying yearly and not using tobacco, and some companies add a new-customer discount that steps down each year. A discount that fades is a price rise you can see coming. Ask for the premium with every temporary discount removed.
Does one policy cover my spouse and me, or do we each need our own?
Why ask it
A supplement covers one person, so a couple holds two policies and is free to pick different letters or different companies. That is useful when one of you sees far more doctors than the other. If a household discount is offered, ask what happens to it when one of you dies or moves into care.
How is the premium collected, and what happens if a payment is missed?
Why ask it
The premium is usually paid to the insurer directly and not taken from a Social Security deposit, so someone has to keep the bank draft or the bills in order. For a son or daughter helping a parent this is the practical question: ask about the grace period and whether a second person can be sent late notices. A policy that lapses may only be replaceable by passing health questions.
How much notice would I get of a rate increase, and when in the year do increases arrive?
Why ask it
Some companies adjust on the policy anniversary, some on your birthday and some for a whole group of policyholders at once, and a policy can see more than one kind. States also differ on whether an increase needs a regulator's approval first. The answer tells you which month to expect the letter and what to budget around.
If the premium becomes more than I can manage in ten or fifteen years, what could I do then?
Why ask it
A truthful answer lists the options with the catch attached to each: a cheaper letter or company if you can pass health questions, whatever switching right your state gives, or an Advantage plan during the yearly enrollment period. 'You can always switch' with no mention of health questions leaves out the hard part.
Enrollment
When does my Medigap open enrollment period start, and on what date does it end?
Why ask it
Under federal rules it generally runs for six months from the month you are both 65 or older and enrolled in Part B. During it a company cannot turn you down or charge more because of your health. Ask for the two dates and write them on the calendar, because for most people this window opens once.
I am still working at 65 and covered through my job. When should I buy a supplement, if at all?
Why ask it
Because the window is tied to Part B, putting off Part B while you have coverage from current work usually moves the window with it. Whether you can safely delay depends on the employer's size and plan, so put that part to the benefits office and to Medicare. A supplement bought while the work plan is still paying first may be money spent on nothing.
If I apply after the window has closed, which health questions will I have to answer?
Why ask it
Ask to read the health section of the application before you fill anything in. Companies differ in what they ask and how far back they look, so being declined by one does not settle it with the others. Answer exactly: a wrong answer on an application can give the company grounds to cancel the policy or refuse a claim later.
Does my state give me any extra chances to buy or switch without health questions?
Why ask it
A number of states add their own rights, such as a yearly window around your birthday or the policy anniversary, and a few require companies to accept applicants all year. This depends entirely on where you live and the rules change, so check what you are told with your state insurance department or a SHIP counselor.
Which events would give me a guaranteed issue right later, and how long would I have to use it?
Why ask it
Federal rules give a right to buy certain letters without health questions after specific events, such as losing employer or retiree coverage, a plan leaving your area, or leaving an Advantage plan within its trial period. Each right has a deadline counted in days and a list of the letters it applies to. Keep any letter that shows your old coverage ending, since it is your proof.
Would there be a waiting period before the policy pays for a condition I already have?
Why ask it
Even a company that must accept you may be allowed to delay paying for a preexisting condition for a limited number of months, and recent continuous coverage usually shortens or removes that delay. You want either 'none in your case, and here is why' or a specific number of months. Bring proof of the coverage you had before.
I am under 65 and on Medicare because of a disability. Can I buy a supplement, and at what price?
Why ask it
Federal rules do not require companies to sell to people under 65, many states do, and the price for this group can be much higher where policies are offered. Ask both halves of the question. Then ask whether you get a fresh open enrollment window at 65, which is when the choice and the prices usually improve.
How early can I apply so the supplement starts on the same day as my Part B?
Why ask it
Lining the two up avoids a month of Original Medicare with nothing behind it. Many companies take applications some months ahead, so find out how early, when the first premium is drawn and what you will receive as confirmation. If your Part B date is not settled yet, say so, because the policy start date hangs on it.
If I change to a different supplement later, how should the changeover be timed?
Why ask it
The safe order is new policy approved in writing first, old policy canceled second. A new policy generally comes with a free look period of about a month in which you can change your mind, and you would pay both premiums while you use it. Check too whether the new policy brings a new waiting period for existing conditions.
If I move to another state, can I keep this policy, and will the price change?
Why ask it
A standard supplement can generally move with you, though the company may reprice it for the new area and a SELECT policy may have to be exchanged. Your rights to switch without health questions belong to the state you live in, so they change at the border too. Put this one to the insurer as well as the agent.
Agent and insurer
Do you sell supplements from one insurer or several, and whose prices are missing from what you have shown me?
Why ask it
Since a letter's benefits are the same at every company, the range of companies quoted matters more here than with most insurance. Nobody represents all of them. Check the quotes against your state's published rate comparison, if it has one, to see how much of the market you were shown.
How are you paid if I buy this, and does a Medicare Advantage plan pay you differently?
Why ask it
Agents are normally paid a commission by the insurer, and the amount can vary by company, by product type and between the first year and later years. You do not need the dollar figure. You need to hear the question answered without discomfort, and to weigh any advice to change products or companies with it in mind.
Are you licensed in my state, and do you also sell Advantage and Part D plans?
Why ask it
Your state insurance department's website will confirm a license in a couple of minutes. Someone who sells all three kinds of plan can compare the routes for you, while someone who sells one kind tends to find that it fits everybody. Remember too that Medicare itself does not sell supplements or phone people to offer them.
What is this insurer's financial strength rating, and what does its complaint record look like?
Why ask it
You may hold this policy for twenty-five years, so the company's staying power counts for more than its logo. Ratings come from independent rating agencies and complaint figures from state regulators, and a good answer names the source so you can look it up. Being unable to say where the numbers come from is the warning sign.
Can the company cancel the policy or single me out for an increase because my health gets worse?
Why ask it
Standardized supplements are generally guaranteed renewable, meaning the company has to keep the policy going while premiums are paid and the application was truthful. Increases apply to a class of policyholders, not to one person's claims. If the answer is any less firm than that, ask to be shown the renewal wording in the policy.
Does Medicare send my claims to this company automatically, or is there paperwork for me?
Why ask it
In most cases Medicare passes the claim to the supplement insurer automatically and the provider is paid without you doing anything. Confirm this company works that way and ask what statements will arrive in the mail. If you are helping a parent, ask how to be authorized to speak to the insurer on their behalf before a problem comes up.
Can I take the outline of coverage and the rate sheet home before I apply?
Why ask it
The outline of coverage is a standard document that sets out the benefits and the premium, and it is what you compare between companies. Your enrollment window is measured in months, so no decision has to be made at the table. Pressure to sign today is the clearest reason on this page to walk away.
Who can I check this recommendation with who has nothing to sell?
Why ask it
Every state has a State Health Insurance Assistance Program, known as SHIP although some states give theirs another name, with free counselors who are not paid commission. Asking an agent for the number is a fair test: a confident one hands it over. Take the counselor your quotes and anything you were told about your state's rules.
Which letter and which company would you pick for me, and what would I give up by taking your second choice?
Why ask it
The reasons should be built from things you said: the specialists you see, whether a copay at each visit would bother you, how a higher premium at 80 would sit with your income. Reasons that would fit any customer are a pitch. The second choice is where you learn what the first one costs you.
Will you check my rate against other companies each year, or do I only hear from you if I call?
Why ask it
A supplement does not have to be chosen again every fall the way a drug plan does, so some agents are not heard from after the sale. A useful answer offers a yearly look at your rate against the market and a review of the Part D plan. Find out which number to call with a billing problem, theirs or the insurer's.
How to shop for a Medicare supplement
Practical guidance for the conversation itself
Before you talk to anyone
Find your two dates
Look at the Medicare card or the enrollment letter for the dates Part A and Part B begin. The open enrollment window for a supplement is counted from Part B, so every conversation goes better when you can name the month it starts.
Write down what a quote needs
Zip code, date of birth, tobacco use, the doctors you see, your prescriptions with doses, and any other coverage: a retiree plan, Medicaid, TRICARE, VA care. That one page answers most of what an agent will ask and stops anyone quoting on a wrong assumption.
Decide who is in the conversation
If a son or daughter is helping, have them on the call from the first minute. Insurers and Medicare generally will not discuss a person's coverage with a relative without permission, so ask early how that permission is given.
Keep the Medicare number back until you apply
A price quote does not need it. Someone who asks for the number before quoting, or who phoned you without being asked, has not earned it yet.
Who to ask what
A SHIP counselor
Free, and with nothing to sell. Start here if you are unsure between a supplement and Medicare Advantage, and bring the questions under Medigap or Advantage and under Enrollment, since the answers to those depend most on your state.
An agent who quotes several companies
Best for the questions under Plan letters and Premiums: which companies sell which letters in your zip code, how each has raised its rates and how strict each is on health questions. Ask the Agent and insurer questions first, so you know whose prices you are not seeing.
The insurance company
Some things only the company can confirm: how a move would change your price, when a discount ends, how claims reach them and how a family member gets authorized. Ask for the answer in writing, or note the date and the name of the person who gave it.
Medicare itself
The Medicare helpline and website can confirm your Part B date, compare Part D plans against your prescriptions and send the official guide to choosing a Medigap policy. Use them to check anything a seller told you about the federal rules.
Comparing quotes
Fix the letter, then compare companies
A Plan G is the same set of benefits wherever you buy it, so compare G with G and N with N. Mixing letters in one comparison hides whether a lower price comes from a cheaper company or from thinner coverage.
Add up a whole year
Twelve premiums, the Part B deductible, any copays the letter leaves with you, and the Part D premium and drug costs. Do the same sum for a Medicare Advantage plan twice, once for an ordinary year and once for a year with a hospital stay, and the trade between the two routes shows up in dollars.
Look at the price at 80 as well as at 65
Put each company's rate for older ages and its increases over the last five years next to today's quote. The lowest price in the first year is the easiest thing to sell and the least useful thing to know.
Take the week
The first window lasts months. Read the outline of coverage at home, run the quotes past a counselor and sleep on it. An offer that expires tonight is about the seller's month, not about your coverage.
After you buy
Leave the old coverage in place until the new one is confirmed
Whether you are leaving an employer plan, an Advantage plan or another supplement, wait for written approval and a start date before you cancel anything. Some of those doors do not reopen.
Keep the papers together
The policy, the outline of coverage, the application you signed and any letter showing earlier coverage ending. The last one can matter years later if you need to show you had continuous coverage or a right to buy.
Review the drug plan every fall
The supplement carries on unchanged unless you act, but a Part D plan can change its price and drug list each year. When a rate notice for the supplement arrives, check your state's switching rules before assuming you can move.
Tell one other person how it is paid
Someone in the family should know the company, the policy number and which account the premium comes from. A missed payment during an illness is one of the ordinary ways a good policy is lost.