What is Medigap (Medicare Supplement) Insurance?
Medigap insurance is a Medicare Supplemental Insurance policy for individuals with original Medicare. Medigap insurance helps to cover some or all of the costs or gaps that are not covered by original Medicare, including deductibles, copayments and coinsurance.
Each standardized Medigap policy must offer the same basic benefits. Cost & rate increase history is usually the only difference between Medigap policies with the same letter sold by different insurance companies. In Massachusetts, Minnesota, and Wisconsin, Medigap policies are standardized in a different way.
Medigap Plans Effective on or after June 1, 2010
How to read this chart: If a check box appears in a column of this chart, the Medigap policy covers 100% of the described benefit. If a column lists a percentage, the policy covers that percentage of the described benefit. If a column is blank, the policy doesn’t cover that benefit. Note: The Medigap policy covers coinsurance only after you have paid the deductible (unless the Medigap policy also covers the deductible).
*Click on a plan type below in the chart to see outline of coverage for that plan*
|Medicare Part A Coinsurance hospital costs up to an additional 365 days after Medicare benefits are used up||X||X||X||X||X||X||X||X||X||X|
|Medicare Part B Coinsurance or Copayment||X||X||X||X||X||X||50%||75%||X||X***|
|Blood (First 3 Pints)||X||X||X||X||X||X||50%||75%||X||X|
|Part A Hospice Care Coinsurance or Copayment||X||X||X||X||X||X||50%||75%||X||X|
|Skilled Nursing Facility Care Coinsurance||X||X||X||X||50%||75%||X||X|
|Medicare Part A Deductible||X||X||X||X||X||50%||75%||50%||X|
|Medicare Part B Deductible||X||X|
|Medicare Part B Excess Charges||X||X|
|Foreign Travel Emergency (Up to Plan Limits)||X||X||X||X||X||X|
|Medicare Preventive Care Part B Coinsurance||X||X||X||X||X||X||X||X||X||X|
*Plan F also offers a high-deductible plan. If you choose this option, this means you must pay for Medicare-covered costs up to the deductible amount of $2,110 (2013) before your Medigap plan pays anything.
** Plans K ($4,660) & L ($2,330) have a out of pocket limit. After you meet your out of pocket limit and your Part B deductible ($147) yearly, the Medigap plan pays 100% of covered services for the rest of the calendar year.
***Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don’t result in an inpatient admission.
Basic Benefits of Medigap
There are a few benefits that all Medigap policies cover. Firstly, all Medigap policies cover Medicare Part A Coinsurance hospital costs & Part B preventative care coinsurance. After your original Medicare benefits are exhausted, Medigap pays for an entire extra year. This covers 100 percent of the costs and Medicare Part A coinsurance. Secondly, all Medigap policies cove Medicare Part B preventative care coinsurance. Medigap policies also cover Part B coinsurance and copayment for medical costs. All of the plans pay this at 100% besides plans K, L & N. Plan K pays 50%, Plan L pays 75% and Plan N pays 100% but has a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visit that doesn’t result in an inpatient admission. All Medigap policies also cover the first 3 pints of blood. Again, most of the plans pay this at 100%, Plans K & L cover 50% and 75%. Medigap policies also cover Part A hospice care coinsurance and copayment. All of the plans pay this at 100% besides plans K & L. Plan K pays 50% and Plan L pays 75%.
Different Medigap Policies
In total, there are ten Medigap policies: A, B, C, D, F, G, K, L, M and N. Plan A is the most basic and only covers the aforementioned basic benefits. All the other plans cover at least one or more cost than the basic benefits.
Plan A – Only covers the basic benefits
Plan B – Covers all the basic coverage that is included in the Plan A and the deductible for Part A
Plan C – Covers everything except for the excess charges of Part B
Plan D – Covers everything except for the deductible or the excess charges for Part B
Plan F – Covers everything that Part A and Part B do not cover
Plan G – Covers everything that Part A and Part B do not cover, except for the deductible for Part B
Plan K – Does not cover deductible or excess charges for Part B, and it does not cover the emergency foreign travel. All coverage is at 50 percent, except the hospital coverage. Hospital coverage is still 100 percent
Plan L – Same as Plan K; however, coverage is 75 percent
Plan M – Same as Plan D; however, coverage for Part A deductible is 50%
Plan N – Does not cover the deductible or the excess charges for Part B. In addition, there may be a copayment for some doctor and ER visits.
Qualifications for Medigap
Medigap policies are sold by individual insurance carries, but there are some rules that may limit your eligibility to qualify for a Medigap policy.
- Must have Medicare Part A and Part B
- Must be 65 years or older in some states, even if you have Medicare due to a qualifying disability
- Cannot be enrolled in Medicare Advantage or Medicaid
Remember that Medigap policies are only for one person. If you are married, your spouse is not covered under your Medigap policy. They would need their own plan to be covered.
Medigap is a great benefit to give your Medicare a boost. There are many different plans from which to choose, so you can find the right one for you. Many cover the costs at 100 percent. Know the plans and make sure to pick the right one for you.
Our agency helps you understand the different types of Medigap plans & options available to you in your specific state. We will compare and explain each plan along with giving you quote details on the carries in your area. If you would like to speak with a specialist about your options or to get a better understanding of Medicare and Medigap insurance please give us a call at (855) 321-3210. If you are just looking for a quote comparison please fill out the form on this page and one will be available to you.