Medicare Select is a type of Medigap coverage with network restrictions

Medicare Select is a Medigap policy sold by private insurers that covers the same benefits as standard Medigap plans, but requires you to use doctors and hospitals in the plan's network to receive full coverage. If you go out of network (except in emergencies), you pay more out of pocket. This is the main difference between Medicare Select and other Medigap plans, which let you see any doctor who accepts Medicare anywhere in the country.

Medicare Select plans are standardized by the federal government, meaning each plan letter (like Plan G or Plan N) covers identical benefits no matter which insurance company sells it. The only variation is price and which providers are in the network. Because you are restricted to in-network care, premiums are typically lower than standard Medigap plans with the same letter designation.

Not all states allow Medicare Select plans to be sold. Currently, about 30 states offer them. If you live in a state where they are available and you are comfortable using a specific network, a Medicare Select plan can reduce your monthly costs compared to unrestricted Medigap coverage.

Key Takeaways

  • Medicare Select plans cover the same benefits as standard Medigap plans with the same letter, but charge lower premiums because they limit you to in-network providers.
  • Using an out-of-network doctor or hospital means you pay the full bill yourself, except in true emergencies, which are always covered at in-network rates.
  • Medicare Select plans are only sold in about 30 states, and availability varies by insurer and plan letter within each state.
  • The standardized benefits for each plan letter are set by Medicare, so Plan G from one insurer covers the same things as Plan G from another — only the network and price differ.
  • You can switch from Medicare Select to a standard Medigap plan, but timing and your health history may affect your ability to do so without underwriting.

How the network restriction actually works in practice

When you enroll in a Medicare Select plan, you receive a list of in-network doctors, hospitals, and other providers. You are expected to use these providers for all non-emergency care. Medicare still pays its share of the bill first, and then your Medigap plan pays its share — but only if the provider is in the network.

If you see an out-of-network provider, Medicare still pays its portion, but the Medigap plan does not pay anything. You are responsible for the remaining balance. This can be a significant amount, depending on the provider's charges and what Medicare allows. For example, if a specialist charges $500 and Medicare allows $300, Medicare pays its share, but you pay the full $200 difference plus any coinsurance.

Emergency care is the exception. If you need emergency treatment — such as care for a heart attack, severe injury, or sudden illness — you can go to any hospital, and the plan covers it as if it were in-network. The plan also covers emergency care you receive while traveling outside your state, as long as it is truly emergent.

Some Medicare Select plans also cover urgent care at out-of-network facilities if you are traveling and cannot reach an in-network provider. Check your plan documents to see what counts as urgent versus routine care in your specific plan.

Which plan letters are available as Medicare Select

Not every Medigap plan letter is offered as Medicare Select. The most commonly available Medicare Select plans are Plan G, Plan N, and Plan F (in states that still allow it). Some insurers also offer Medicare Select versions of Plan C, Plan D, Plan K, or Plan L, but availability is limited and varies by state and carrier.

Plan G and Plan N are the most popular Medicare Select options because they offer broad coverage at a lower cost than their standard Medigap counterparts. Plan F, which was the most comprehensive Medigap plan, is no longer sold to people who became may be able to access for Medicare after January 1, 2020, but existing Plan F holders can keep their coverage.

Before you choose a Medicare Select plan, confirm that the specific plan letter you want is available in your state and from the insurers you are considering. You can check this by contacting insurers directly or using your state's health insurance counselor, who can tell you what is sold in your area.

Comparing Medicare Select to standard Medigap plans

The main trade-off is cost versus flexibility. Standard Medigap plans cost more per month but let you see any Medicare-accepting doctor or hospital without penalty. Medicare Select plans cost less but lock you into a network. The savings vary by plan letter, insurer, and state — sometimes $20 to $50 per month, sometimes more.

If you travel frequently, live in a rural area with few in-network providers, or see specialists outside your local area, a standard Medigap plan may be worth the higher premium. If you have established doctors in your area and rarely travel, or if you are price-sensitive, Medicare Select can save you money.

Both types of Medigap plans work alongside Medicare Part A and Part B. Neither is the same as a Medicare Advantage plan, which is a different type of coverage with its own network rules and different cost structures. Medigap (whether Select or standard) is supplemental coverage that fills gaps in Original Medicare.

What happens if you move or your doctor leaves the network

If you move to a different state or area, your Medicare Select plan may not have providers in your new location. Some plans operate in multiple states, but many are regional. You should check whether your plan is available where you are moving before you relocate, or be prepared to switch plans.

If your doctor leaves the network while you are enrolled, you have the right to continue seeing that doctor for a limited time (usually 30 to 90 days, depending on your plan and state rules) while you find a new in-network provider. Check your plan documents or call the plan to confirm the transition period and any costs you may owe during that time.

If you need to switch to a different Medigap plan because your network no longer works for you, you may be able to do so without medical underwriting if you switch within a certain window. Rules vary by state. Your state health insurance counselor can tell you what protections explore where you live.

Enrollment and switching rules for Medicare Select

You can enroll in a Medicare Select plan during your initial Medicare enrollment period (the six-month window that starts the month you turn 65 and enroll in Medicare Part B). You can also switch to Medicare Select during the annual open enrollment period for Medigap, which runs from October 15 to December 7 each year, and the change takes effect January 1.

If you already have a standard Medigap plan and want to switch to Medicare Select, you can do so during open enrollment without underwriting. However, if you switch from Medicare Select to a standard Medigap plan, some states require medical underwriting, which means the insurer can deny you, charge you more, or exclude pre-existing conditions. Check your state's rules before you switch.

Some states have "may provide issue" protections that let you switch from Medicare Select to standard Medigap without underwriting in certain situations — for example, if your plan is no longer sold in your area, or if you move out of the service area. Your state health insurance counselor can tell you what protections you have.

Checking the network before you enroll

Before you sign up for a Medicare Select plan, ask the insurer for a current provider directory and check whether your current doctors are in the network. Do not rely on a list from six months ago — networks change, and providers leave or join regularly. Call your doctor's office directly to confirm they are in the plan's network and accepting new patients.

Also check whether the hospitals you would likely use are in the network. If you have a preferred hospital or a specialist you see regularly, confirm they are included. Some plans have strong networks in urban areas but weak coverage in rural areas, or vice versa.

If your doctors are not in the network, ask the insurer whether they plan to add them, or whether you can see them out of network at in-network rates. Some plans have exceptions for established patients, but this is rare and must be arranged in advance. In most cases, if your doctor is not in the network, you will pay out of pocket.

Frequently Asked Questions

Can I use Medicare Select if I have a chronic condition?

Yes. Medicare Select plans cannot deny you coverage or charge you more based on your health history if you enroll during your initial Medicare enrollment period or during the annual Medigap open enrollment period. However, if you switch from another type of coverage to Medicare Select outside these windows, the insurer may require medical underwriting.

What happens if I need emergency surgery while traveling out of state?

Emergency care is covered at in-network rates even if you are out of state and use an out-of-network hospital. You do not need to call ahead or get permission. After the emergency is stabilized, if you need ongoing care, you may need to return to your home state or an in-network facility to maintain full coverage.

Are prescription drugs covered by Medicare Select?

No. Medicare Select is a Medigap plan and does not include prescription drug coverage. You need to enroll in a separate Medicare Part D plan (a prescription drug plan) if you want coverage for medications. You can enroll in Part D when you first become may be able to access for Medicare or during the annual open enrollment period.

Can I switch from Medicare Select to a standard Medigap plan if I do not like the network?

Yes, during the annual Medigap open enrollment period (October 15 to December 7) you can switch to a standard plan without underwriting. Outside this window, some states allow you to switch without underwriting if your plan is no longer sold or you move out of the service area. Contact your state health insurance counselor to learn what applies to you.

Is Medicare Select the same as Medicare Advantage?

No. Medicare Select is a type of Medigap (supplemental) plan that works with Original Medicare. Medicare Advantage is a separate type of coverage that replaces Original Medicare entirely. They have different networks, costs, and rules. Do not confuse the two.