The Gap in Medigap
This policy insight examines the low rate of Medigap coverage among people under age 65 with disabilities on Medicare and the federal law that governs consumer rights and protections related to Medigap open enrollment.
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This policy insight examines the low rate of Medigap coverage among people under age 65 with disabilities on Medicare and the federal law that governs consumer rights and protections related to Medigap open enrollment.
This brief considers how default enrollment into Medicare Advantage might work, potential challenges with this approach, and implications for beneficiaries, insurers, providers, agents and brokers, and the federal budget.
Medicare supplemental insurance, also known as "Medigap," is an important source of supplemental coverage for nearly one in four people on Medicare. Traditional Medicare has cost-sharing requirements and significant gaps in coverage; Medigap helps make health care costs more predictable and stable for beneficiaries by covering some or all Medicare costs, including deductibles and cost-sharing.
This issue brief analyzes federal and state guaranteed issue rules and how they impact beneficiaries’ access to Medigap, including the implications for Medicare beneficiaries with pre-existing conditions and those under age 65 with long-term disabilities. This brief also explores a recently finalized rule: Nondiscrimination in Health Programs and Activities regarding Section 1557 of the Affordable Care Act that may have implications for the Medigap market.
Sources of Supplemental Coverage Among Medicare Beneficiaries, 2009 Download Source Kaiser Family Foundation analysis of the Centers for Medicare & Medicaid Services Medicare Current Beneficiary Survey, 2009 Cost and Use file.
To capture the state of television marketing activities and consider the implications for people with Medicare, KFF analyzed ad data compiled by the Wesleyan Media Project, that were obtained from Vivvix (formerly Kantar) CMAG, a data analytics and consulting firm, and were coded by the Wesleyan Media Project in collaboration with KFF. The data set included all English-language TV ads that aired across national and local markets on broadcast television or national cable, from October 1st, 2022, through December 7th, 2022, the period that includes the Medicare open enrollment period for coverage in 2023.
This brief presents facts about Medigap, including the characteristics of Medicare beneficiaries with a Medigap policy, variation in Medigap enrollment by state, and Medigap premiums.
Virtually all (98.9%) of the 2.6 million Medicare beneficiaries enrolled in a Medicare Advantage plan that terminated coverage at the end of 2025 have at least one MA-PD available in 2026, including more than two-thirds (68.7%) who have the option of enrolling in a plan sponsored by the same insurer.
On March 26, 2015, the House of Representatives passed H.R. 2, the Medicare Access and CHIP Reauthorization Act of 2015, which would replace the Sustainable Growth Rate (SGR) formula, among other changes; the bill is currently pending in the U.S. Senate. H.R. 2 includes a provision that would prohibit Medicare supplemental insurance (Medigap) policies from covering the Part B deductible for people who become eligible for Medicare on or after January 1, 2020. This data note looks at the number and share of “new” Medicare beneficiaries who would be affected by the Medigap provision in H.R. 2, if it had been implemented in 2010, using the most current data sources available, and examines trends in Medigap enrollment among new beneficiaries since 2000.
The House-passed legislation to repeal the Medicare Sustainable Growth Rate (SGR) includes a provision that would prohibit Medicare supplemental insurance (Medigap) policies from covering the Part B deductible for people who become eligible for Medicare beginning in 2020.
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