Aetna Medigap — Comparing Senior Supplemental Coverage

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Aetna Medigap — Comparing Senior Supplemental Coverage

Roughly 12.5 million Americans, or around 42% of those with traditional Medicare, combine a Medigap policy with their Original Medicare. These private plans help cover out-of-pocket expenses for beneficiaries, offering an important function in providing financial predictability and simplifying the often confusing world of medical billing.

Aetna, a subsidiary of CVS Health, offers standardized Medigap policies in several states. However, there are differences in costs depending on the area, the specific policies available, and any discounts that may apply.

This guide provides a straightforward comparison of Aetna’s Medigap plans, focusing on coverage, costs, and real-world effectiveness.

How Aetna Medigap Works

What Medigap Covers

Medigap supplements provide coverage for out-of-pocket expenses associated with Original Medicare, such as the Part A and B deductible amounts, co-payments, and coinsurance amounts. The standardized benefits offered by these plans also cover many services, including travel emergencies outside the United States, but do not include Part D or dental and vision benefits.

Notably, analysis performed by KFF found that beneficiaries with Medigap were significantly less likely to report cost-related problems than those with Medicare and no supplemental coverage.

Where Aetna Sells and How to Verify

Aetna sells Medigap plans in several states; however, availability varies by location. The benefits remain standardized, but premiums and discounts differ by state. To see your available options, use Aetna’s state plan finder or review the Evidence of Coverage (EOC) documents.

Key Takeaway

Aetna Medigap covers Medicare’s cost-sharing gaps. However, plan availability, pricing, and discounts can vary by state, thus making it necessary to check your location carefully.

Plan G versus Plan N (and High-Deductible G)

Plan G Coverage Highlights

Plan G provides nearly complete coverage for Original Medicare gaps. It covers Part A/B coinsurance, costs associated with hospital stays and skilled nursing, hospice care, and foreign emergency care, with the only exception being the Part B deductible.

It also covers Part B excess when providers don’t accept assignments. Plan G has, due to its overall protection, has become the most popular Medigap plan. Since 2020, over 39% of new Medicare enrollees have selected it.

Plan N Trade-Offs

Plan N has lower monthly premiums with copays, with a few exceptions. It generally offers $20 for office visits and $50 for ER visits (not if admitted), and it does not cover Part B excess charges. It offers savings for healthier beneficiaries with fewer doctor visits, but provides less predictability in out-of-pocket costs.

High-Deductible G

High-Deductible Plan G offers the same coverage as Plan G after a $2,870 deductible, but with lower premiums. Availability varies by state.

Quick Comparison — Plan G vs. Plan N vs. High-Deductible G

Key Takeaway

Plan G is the best overall coverage and predictability, whereas Plan N is good if you want to pay premiums and occasionally copays. HD-G gives you lower monthly premiums, but at a higher deductible when you need to use it.

What Drives Aetna Medigap Pricing

Rating Methods

Your Medigap premiums are highly dependent on the pricing method, such as attained-age, issue-age, or community rating. Attained-age pricing starts with a lower cost but can go up as you get older.

Issue-age pricing locks in your rate to the age you enroll, and your premium will not go up due to your increased age, only inflation. Community-rated pricing maintains the same premium amount for all enrollees, regardless of age. There is a lot of variability across states: nine require community rating, and others have all methods allowed.

Discounts and Underwriting

While Aetna may provide discounts for households, non-smokers, or those who choose electronic payment, once you move past the Open Enrollment or guaranteed issue period, you may have medical underwriting, which may affect price and eligibility.

Research published by KFF mentions that switching plans outside of guaranteed-issue windows can be risky for beneficiaries with medical conditions, since underwriting may raise costs or deny coverage.

Key Takeaway

Your long-term Medigap cost is shaped more by pricing method, discounts, and underwriting rules than just the current premium.

Enrollment Windows and Switch Rules

Medigap Open Enrollment and Guaranteed Issue Rights

When you become 65 and sign up for Medicare Part B, you receive a six-month Medigap Open Enrollment period. During this time, insurers must provide you a policy regardless of your health and may not charge higher premiums or deny coverage for pre-existing conditions.

After that, guaranteed issue rights allow you to enroll without medical underwriting in certain situations, such as when you lose your employer coverage or your Medicare Advantage plan is no longer available in your area.

State “Birthday Rules”

A number of states have a Medigap birthday rule for current Medigap beneficiaries, allowing them to switch plans around their birthday without underwriting.

As of 2025, eight states have laws that establish birthday rules, including California (60 days), Idaho (63 days), and Maryland (30 days). Virginia also joined in 2025. Birthday rules create flexibility, but the rules are different for each state, so be mindful of your local rules.

Part B Excess Charges and Why They Matter for Plan N

What excess charges are

When a healthcare provider doesn’t accept Medicare assignment, they can bill you up to 15% above Medicare’s approved amount. This is fully covered by Plan G, but not Plan N.

States that restrict/ban excess charges

Eight states,i.e., Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont, prohibit Part B excess charges. If you live in one of them, the financial risk of Plan N is much less.

Key Takeaway

Plan N may save on premiums, but excess charges apply unless your doctors accept Medicare or live in certain states.

Total Cost Picture — Medigap + Part D versus Medicare Advantage

●        Premium Stability — Medigap has higher, but more stable, premiums that cover almost everything, whereas Medicare Advantage premiums may start lower and increase without explanation.

●        Provider Choice — Medigap allows providers across the country without a referral, while Medicare Advantage limits options to in-network and requires prior authorization.

●        Drug Benefit — Medigap requires a Part D to be purchased separately to provide a prescription benefit, but there is now a $2000 limit on out-of-pocket for drugs starting in 2025.

●        Network Tradeoffs — Medicare Advantage often only provides coverage for regional networks, whereas Medigap is portable from state to state and can be accepted by multiple physicians.

●        Out-of-Pocket Cost — Medicare Advantage plans may have a copay and coinsurance with more potential variability, whereas Medigap covers out-of-pocket costs, and the premiums can be common to control.

Key Takeaway

Pick Medigap + Part D for stability and flexibility, or Medicare Advantage for lower upfront premiums but restrictions.

Choosing the Best-Fit Aetna Medigap Plan

When contrasting Aetna’s Plan G, N, or HD-G, be sure to confirm your doctors’ billing methods, state’s regulations and pricing procedure, discounts available, and how Part D plans fit together. Medicare Sharks makes it easy and stress-free to get organized for these Medicare comparisons.