Wyoming · Life, Accident & Health Sample Interactive Mind Map
Medicare Supplement (Medigap)
A visual breakdown of Medicare Supplement (Medigap) — one of the concepts you can count on seeing on the exam.
The TESTivity Interactive Mind Mapping Graphic we picked for the Wyoming Life & Health sample is Medicare Supplement (Medigap) — and this is a concept you can count on seeing on your pre-licensing exam. Get the structure straight once and those questions turn into free points.
So explore it. Click through, see how the pieces relate, and let the layout do some of the remembering for you.
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Medicare has gaps — Medigap is how people fill them.
Medicare's deductibles, coinsurance, and copays can add up to thousands out of pocket. Medigap (Medicare Supplement Insurance) is a private insurance product designed to cover those costs. Understanding what it is — and what it isn't — is essential exam knowledge.
Medicare's deductibles, coinsurance, and copays can add up to thousands out of pocket. Medigap (Medicare Supplement Insurance) is a private insurance product designed to cover those costs. Understanding what it is — and what it isn't — is essential exam knowledge.
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Filling the Gap
Medicare covers a lot — but not everything. Beneficiaries are still responsible for Part A and B deductibles, coinsurance, copays, and costs beyond certain coverage limits.
Medigap policies — sold by private insurers — are designed to pick up some or all of these leftover costs. Think of Medigap as the piece that snaps onto Medicare to eliminate or reduce out-of-pocket exposure.
To buy a Medigap policy, you must be enrolled in Medicare Parts A and B. Medigap is a supplement to traditional Medicare — it cannot be paired with Medicare Advantage (Part C).
Medigap policies — sold by private insurers — are designed to pick up some or all of these leftover costs. Think of Medigap as the piece that snaps onto Medicare to eliminate or reduce out-of-pocket exposure.
To buy a Medigap policy, you must be enrolled in Medicare Parts A and B. Medigap is a supplement to traditional Medicare — it cannot be paired with Medicare Advantage (Part C).
Exam angle
Medigap works alongside original Medicare only — it cannot be used with Medicare Advantage. Must have both Part A and Part B enrolled first.
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Private Companies — Not the Government
Medigap policies are sold and serviced exclusively by private insurance companies — not by Medicare or any government agency.
This is a critical exam and compliance point: No agent selling Medicare Supplement policies may claim to represent Medicare or any government agency. Doing so is a violation of federal and state law.
While the federal government standardizes Medigap plan designs (so Plan G is identical no matter which insurer sells it), the government does not sell, administer, or service these policies.
This is a critical exam and compliance point: No agent selling Medicare Supplement policies may claim to represent Medicare or any government agency. Doing so is a violation of federal and state law.
While the federal government standardizes Medigap plan designs (so Plan G is identical no matter which insurer sells it), the government does not sell, administer, or service these policies.
Exam angle
An agent CANNOT say "I represent Medicare" when selling Medigap. Private companies sell them. Government standardizes the plan designs but does not sell the policies.
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One Person Per Policy
Each Medigap policy covers one individual only — there are no family or couples Medigap policies. If a husband and wife both want Medigap coverage, each must buy their own separate policy.
Medigap policies are also guaranteed renewable for life as long as the premium is paid — the insurer cannot cancel the policy based on health status changes after issue.
A person cannot hold two Medigap policies simultaneously. If a new policy is purchased, the old one should be cancelled.
Medigap policies are also guaranteed renewable for life as long as the premium is paid — the insurer cannot cancel the policy based on health status changes after issue.
A person cannot hold two Medigap policies simultaneously. If a new policy is purchased, the old one should be cancelled.
Exam angle
No family coverage — one policy, one person. Cannot hold two Medigap policies at the same time. Guaranteed renewable for life as long as premiums are paid.
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Standardized Plan Designs
The federal government standardizes Medigap plans into 10 lettered plans: A, B, C, D, F, G, K, L, M, and N.
The critical implication: Plan G from Company X is identical in benefits to Plan G from Company Y. Standardization protects consumers — you're comparing prices for the same product. The only difference between insurers for the same plan letter is the premium charged.
Note: Plans C and F are no longer available to individuals who first became eligible for Medicare on or after January 1, 2020 (due to MACRA legislation).
The critical implication: Plan G from Company X is identical in benefits to Plan G from Company Y. Standardization protects consumers — you're comparing prices for the same product. The only difference between insurers for the same plan letter is the premium charged.
Note: Plans C and F are no longer available to individuals who first became eligible for Medicare on or after January 1, 2020 (due to MACRA legislation).
Exam angle
10 standardized plans (A, B, C, D, F, G, K, L, M, N). Same plan letter = same benefits regardless of insurer. Plans C and F closed to new Medicare eligibles after 1/1/2020.
⚠️ Important 2020 Change — Plans C and F Are Closed to New Enrollees
As of January 1, 2020, Plans C and F may no longer be sold to anyone who first became eligible for Medicare on or after that date. The reason: both plans covered the Medicare Part B deductible, which Congress eliminated as a "first dollar coverage" option under MACRA. People who were already Medicare-eligible before 1/1/2020 may still have or purchase these plans. Plan G is now the most comprehensive plan available to new Medicare beneficiaries.
As of January 1, 2020, Plans C and F may no longer be sold to anyone who first became eligible for Medicare on or after that date. The reason: both plans covered the Medicare Part B deductible, which Congress eliminated as a "first dollar coverage" option under MACRA. People who were already Medicare-eligible before 1/1/2020 may still have or purchase these plans. Plan G is now the most comprehensive plan available to new Medicare beneficiaries.
Medicare Part A Coinsurance — hospital costs up to 365 additional days after Medicare benefits are exhausted.
Medicare Part B Coinsurance or Copayment — the 20% not covered by Medicare for most outpatient services. (Plans K and L cover 50% and 75% respectively.)
First 3 Pints of Blood — Medicare doesn't cover the first 3 pints of blood needed each year. All Medigap plans cover this. (Plans K and L cover 50% and 75%.)
A
The Baseline
Covers the 3 core benefits only — Part A coinsurance, Part B coinsurance, and blood. Nothing more.
The minimum Medigap plan available. Lowest premium of any plan.
The minimum Medigap plan available. Lowest premium of any plan.
Exam angle
Plan A = core only. All other plans build on top of Plan A's benefits.
G
New Gold Standard
⭐ Most comprehensive for new enrollees
Covers everything Plan F covers except the Medicare Part B deductible. Includes: Part A deductible, Part A & B coinsurance, skilled nursing coinsurance, foreign travel emergency (80%), and excess Part B charges.
Since Plans C and F are closed to new Medicare eligibles, Plan G is now the most comprehensive plan available to anyone first eligible for Medicare on or after January 1, 2020.
Since Plans C and F are closed to new Medicare eligibles, Plan G is now the most comprehensive plan available to anyone first eligible for Medicare on or after January 1, 2020.
Exam angle
Plan G = Plan F minus the Part B deductible. The new gold standard for new Medicare beneficiaries. Covers foreign travel emergency.
F
Closed to New Eligibles
⛔ Not available to new enrollees post-2020
Was the most comprehensive plan — covered all Medicare gaps including the Part B deductible. "First dollar coverage" — zero out of pocket for Medicare-covered services.
Still available to those who were Medicare-eligible before January 1, 2020. A high-deductible version of Plan F also exists.
Still available to those who were Medicare-eligible before January 1, 2020. A high-deductible version of Plan F also exists.
Exam angle
Plan F = historically the most comprehensive. Closed to anyone first eligible for Medicare on or after 1/1/2020. Existing enrollees may keep it.
N
Cost-Sharing Option
Covers Part A deductible, Part A & B coinsurance, skilled nursing, and foreign travel. Does not cover the Part B deductible or Part B excess charges.
Unique feature: requires copays up to $20 for some office visits and up to $50 for ER visits that don't result in inpatient admission. Lower premium in exchange for these copays.
Unique feature: requires copays up to $20 for some office visits and up to $50 for ER visits that don't result in inpatient admission. Lower premium in exchange for these copays.
Exam angle
Plan N = lower premium with $20 office / $50 ER copays. Does NOT cover Part B excess charges. Popular with healthier beneficiaries who want lower premiums.
K&L
Out-of-Pocket Limit Plans
Plan K covers 50% of most benefits (not 100%) and has an annual out-of-pocket maximum. Once the limit is reached, Medicare and Plan K cover 100% for the rest of the year.
Plan L covers 75% of most benefits with a lower annual out-of-pocket limit than Plan K.
These are the only two Medigap plans with annual out-of-pocket limits.
Plan L covers 75% of most benefits with a lower annual out-of-pocket limit than Plan K.
These are the only two Medigap plans with annual out-of-pocket limits.
Exam angle
K and L are the only plans with out-of-pocket maximums. K = 50% coinsurance. L = 75% coinsurance. Once the limit is hit → 100% coverage.
C
Closed to New Eligibles
⛔ Not available to new enrollees post-2020
Similar to Plan G — covers Part A deductible, coinsurance, skilled nursing coinsurance, and foreign travel emergency, plus the Part B deductible.
Closed to new Medicare eligibles along with Plan F as of January 1, 2020. Those first eligible before that date may still have or purchase Plan C.
Closed to new Medicare eligibles along with Plan F as of January 1, 2020. Those first eligible before that date may still have or purchase Plan C.
Exam angle
Plan C and Plan F are both closed to new eligibles — same reason: both covered the Part B deductible, which Congress eliminated for new enrollees.
A — Core benefits only ·
B — Core + Part A deductible ·
C — Core + Part A ded + Part B ded + SNF + foreign travel (closed to new eligibles) ·
D — Core + Part A ded + SNF + foreign travel ·
F — Most comprehensive; covers everything incl. Part B ded + excess charges (closed to new eligibles) ·
G — Like F minus Part B deductible; covers Part B excess charges (gold standard for new enrollees) ·
K — 50% cost-share + out-of-pocket maximum ·
L — 75% cost-share + lower out-of-pocket maximum ·
M — Core + 50% Part A ded + SNF + foreign travel ·
N — Core + Part A ded + SNF + foreign travel + $20/$50 copays; no Part B excess charges
Medigap comes with strong consumer protections — and the exam tests every one of them.
Open enrollment timing, guaranteed issue rights, the free look period, and the outline of coverage rules are all high-frequency test topics. Know the specific time frames cold.
Open enrollment timing, guaranteed issue rights, the free look period, and the outline of coverage rules are all high-frequency test topics. Know the specific time frames cold.
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Open Enrollment Period
The Medigap Open Enrollment Period is a 6-month window that begins on the first day of the month in which a person is both age 65 or older AND enrolled in Medicare Part B.
During this period, insurers must sell any Medigap plan at standard rates — no medical underwriting, no denials, no higher premiums due to health status.
This window is use-it-or-lose-it. Once it expires, applying for Medigap outside this period is subject to full underwriting — and the insurer can deny coverage or charge higher premiums based on health.
During this period, insurers must sell any Medigap plan at standard rates — no medical underwriting, no denials, no higher premiums due to health status.
This window is use-it-or-lose-it. Once it expires, applying for Medigap outside this period is subject to full underwriting — and the insurer can deny coverage or charge higher premiums based on health.
Exam angle
6 months starting when both conditions are met: age 65+ and enrolled in Part B. Guaranteed issue during this window only. Missing it can mean being uninsurable for Medigap.
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Guaranteed Issue Rights
Outside of open enrollment, certain triggering events give individuals guaranteed issue rights — the right to buy a Medigap policy without underwriting. These include:
· Losing employer-sponsored coverage
· Losing coverage through a Medicare Advantage plan (plan leaves the area, disenrollment)
· Moving out of a plan's service area
· The insurer becomes insolvent
When guaranteed issue rights apply, the insurer cannot deny coverage, charge more, or add a waiting period due to pre-existing conditions.
· Losing employer-sponsored coverage
· Losing coverage through a Medicare Advantage plan (plan leaves the area, disenrollment)
· Moving out of a plan's service area
· The insurer becomes insolvent
When guaranteed issue rights apply, the insurer cannot deny coverage, charge more, or add a waiting period due to pre-existing conditions.
Exam angle
Guaranteed issue ≠ only during open enrollment. Certain triggering events restore it. Key examples: losing employer coverage, Advantage plan leaving the area.
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Outline of Coverage
Insurers must provide an Outline of Coverage to every Medigap applicant. This document clearly explains what the policy covers, excludes, and costs.
Delivery requirement: the Outline of Coverage must be delivered no later than at the time the policy is delivered.
Format requirement: the Outline of Coverage must be printed in at least 12-point (1/6-inch) type.
Purpose: ensures the consumer knows exactly what they're buying before they are bound to the policy.
Delivery requirement: the Outline of Coverage must be delivered no later than at the time the policy is delivered.
Format requirement: the Outline of Coverage must be printed in at least 12-point (1/6-inch) type.
Purpose: ensures the consumer knows exactly what they're buying before they are bound to the policy.
Exam angle
Delivered no later than policy delivery (not before — at the time of delivery). Must be in 12-point type minimum. Both details are tested.
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Free Look Period
All Medigap policies must include a minimum 30-day free look period starting from the date the policy is delivered to the policyholder.
During this period, the buyer can review the policy and return it for a full refund of any premiums paid — no questions asked, no penalty.
This protection applies regardless of health status and is in addition to any state-mandated free look provisions.
During this period, the buyer can review the policy and return it for a full refund of any premiums paid — no questions asked, no penalty.
This protection applies regardless of health status and is in addition to any state-mandated free look provisions.
Exam angle
30-day minimum free look for all Medigap policies. Full premium refund if returned within 30 days. Starts from the date of policy delivery.
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Guaranteed Renewable
All Medigap policies are guaranteed renewable for life as long as premiums are paid on time. The insurer cannot cancel a Medigap policy due to the insured's age, health deterioration, or number of claims filed.
The insurer CAN increase premiums, but cannot single out an individual for a rate increase — any premium changes must apply to an entire class of policyholders.
This provides long-term security for beneficiaries who purchase Medigap coverage.
The insurer CAN increase premiums, but cannot single out an individual for a rate increase — any premium changes must apply to an entire class of policyholders.
This provides long-term security for beneficiaries who purchase Medigap coverage.
Exam angle
Cannot be cancelled due to health or age. Cannot have individual premium increases — only class-wide rate adjustments. Guaranteed renewable for life.
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Rules Around Medicaid & Duplicates
An agent cannot sell a Medigap policy to someone who has Medicaid without that person's written informed consent — Medicaid already covers most of what Medigap would pay, making the purchase potentially wasteful.
A person cannot hold two Medigap policies simultaneously. If a new policy is issued to replace an existing one, the old one must be cancelled.
Medigap cannot be sold to someone enrolled in Medicare Advantage (Part C) — these are incompatible coverage types.
A person cannot hold two Medigap policies simultaneously. If a new policy is issued to replace an existing one, the old one must be cancelled.
Medigap cannot be sold to someone enrolled in Medicare Advantage (Part C) — these are incompatible coverage types.
Exam angle
Selling Medigap to a Medicaid recipient requires written consent. Cannot hold 2 Medigap policies. Cannot sell Medigap to a Medicare Advantage enrollee.
Knowing what Medigap does NOT cover is just as important as knowing what it does.
These exclusions are high-frequency exam content — and common points of consumer confusion. A beneficiary who buys Medigap expecting dental or Rx coverage will be unpleasantly surprised. The exam tests whether you know the difference.
These exclusions are high-frequency exam content — and common points of consumer confusion. A beneficiary who buys Medigap expecting dental or Rx coverage will be unpleasantly surprised. The exam tests whether you know the difference.
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Long-Term Care
Medigap does not cover custodial care — help with bathing, dressing, eating. That's Medicaid or a separate LTC policy.
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Prescription Drugs
Medigap policies do not cover Rx drugs. Beneficiaries must enroll in Medicare Part D for prescription coverage.
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Dental Care
Routine dental — cleanings, fillings, extractions, dentures — is not covered by Medigap or original Medicare.
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Vision Care
Routine eye exams and corrective eyeglasses are not covered. Some Medicare Advantage plans include vision; Medigap does not.
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Hearing Aids
Hearing exams and hearing aids are excluded from both original Medicare and Medigap coverage.
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Private-Duty Nursing
A dedicated private nurse for one-on-one care is not covered under any Medigap plan.
✅ Medigap DOES Cover
❌ Medigap Does NOT Cover
Cost-Sharing Gaps
Medicare Part A and Part B deductibles, coinsurance, and copays — the gaps left behind by original Medicare (varies by plan letter).
Non-Medicare Services
Anything Medicare itself doesn't cover — dental, vision, hearing, Rx drugs. Medigap only fills Medicare's gaps, not unrelated services.
Skilled Nursing Coinsurance
Most plans cover the daily coinsurance for extended skilled nursing facility stays beyond what Medicare pays (Plans C, D, F, G, M, N and others).
Long-Term / Custodial Care
Daily care in a nursing home when the person needs help with activities of daily living. Medicaid or stand-alone LTC insurance covers this.
Foreign Travel Emergency
Most plans (C, D, F, G, M, N) cover 80% of foreign travel emergency care after a deductible, up to a lifetime maximum — a benefit Medicare itself doesn't provide.
Prescription Drugs
Medigap has never covered prescriptions for new enrollees. Medicare Part D is the required add-on for drug coverage. (A few grandfathered pre-2006 plans may still have Rx, but these cannot be sold today.)
Exam Tip
On the exam, if a benefit is a Medicare-covered service and the question is whether Medigap covers the cost-sharing, usually yes (depending on plan letter).
Exam Tip
If a benefit is something Medicare never covers — dental, Rx, vision, custodial care — Medigap does not cover it either. Medigap supplements Medicare; it doesn't replace it.
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Top Exam Tips — Medigap / Medicare Supplement
1. Medigap is sold by private companies — never by the government. An agent CANNOT claim to represent Medicare or a government agency.
2. Plans C and F are closed to anyone first eligible for Medicare on or after January 1, 2020. Plan G is now the most comprehensive plan for new enrollees.
3. ALL plans include 3 core benefits: Part A coinsurance, Part B coinsurance, and blood (first 3 pints).
4. Open Enrollment = 6 months starting when the person is both 65+ AND enrolled in Part B. Guaranteed issue during this window.
5. Free look = 30-day minimum. Outline of Coverage delivered no later than policy delivery in 12-point type minimum.
6. Plans K and L are the only plans with annual out-of-pocket maximums. Plan N has $20/$50 copays.
7. Medigap does NOT cover: Rx drugs (need Part D), dental, vision, hearing, long-term care, or private-duty nursing.
2. Plans C and F are closed to anyone first eligible for Medicare on or after January 1, 2020. Plan G is now the most comprehensive plan for new enrollees.
3. ALL plans include 3 core benefits: Part A coinsurance, Part B coinsurance, and blood (first 3 pints).
4. Open Enrollment = 6 months starting when the person is both 65+ AND enrolled in Part B. Guaranteed issue during this window.
5. Free look = 30-day minimum. Outline of Coverage delivered no later than policy delivery in 12-point type minimum.
6. Plans K and L are the only plans with annual out-of-pocket maximums. Plan N has $20/$50 copays.
7. Medigap does NOT cover: Rx drugs (need Part D), dental, vision, hearing, long-term care, or private-duty nursing.
Exam vocabulary
Key Terms to Know
Medigap / Medicare Supplement
Private insurance that covers Medicare's deductibles, coinsurance, and copays. Sold by private companies, not the government.
Standardized Plans
10 lettered plans (A, B, C, D, F, G, K, L, M, N). Same plan letter = identical benefits regardless of which insurer sells it.
Plan G
Currently the most comprehensive Medigap plan available to new Medicare enrollees. Covers everything Plan F covers except the Part B deductible.
Plan F (and C)
No longer available to individuals who first became Medicare-eligible on or after January 1, 2020. Both covered the Part B deductible.
Plan N
Comprehensive coverage with cost-sharing: copays up to $20 for office visits and $50 for ER visits that don't result in admission. Does not cover Part B excess charges.
Plans K & L
The only Medigap plans with annual out-of-pocket maximums. K = 50% cost-share; L = 75% cost-share. Once the limit is met, all costs covered.
Core Benefits
Three benefits included in all Medigap plans: Part A coinsurance, Part B coinsurance (partial in K/L), and first 3 pints of blood.
Medigap Open Enrollment
6-month guaranteed issue window starting the first day of the month the beneficiary is both 65+ and enrolled in Part B. Cannot be denied or charged more based on health.
Guaranteed Issue Rights
Rights to purchase Medigap outside open enrollment without underwriting, triggered by specific events such as losing employer coverage or a Medicare Advantage plan leaving the area.
Outline of Coverage
Disclosure document delivered no later than policy delivery. Must be printed in at least 12-point type. Describes benefits, exclusions, and costs.
Free Look Period
Minimum 30-day period after policy delivery during which the buyer can return the policy for a full premium refund.
Part B Excess Charges
Amount above Medicare's approved fee charged by non-participating providers. Covered by Plans F and G only — Plan N does not cover this.
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