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A Medigap policy is supplemental medical insurance that covers some of the gaps in Original Medicare (Parts A and B). There are currently 10 standardized Medigap plans and one high deductible plan available. Each plan is represented by a letter: A, B, C, D, F, G, K, L, M, N, and a high-deductible version of Plan F.
Quick facts about Medigap policies
- All insurance companies that sell Medigap policies must offer Plan A. If a company offers any other Medigap plan, it must also offer either Plan C or Plan F.
- Each standardized Medigap plan option must provide the same basic benefits. For example, a Plan A policy sold by a company in Texas will have the same basic benefits as a Plan A policy from a company in New York.
- Plans D and G that went into effect on or after June 1, 2010, will have different benefits than Plans D and G purchased before June 1, 2010.
- Plans E, H, I, and J are no longer available. However, if you already have one of these plans, you can keep using it.
- Not all Medigap policies may be available in your state. (For example, Massachusetts, Minnesota and Wisconsin have different standardized plans.)
- In some states, you can purchase a type of Medigap policy called Medicare SELECT. Medicare SELECT is any standardized Medigap plan that requires you to use network providers.
Core benefits covered by Medigap policies
All Medicare Supplement plans must offer a basic set of coverage, which includes Medicare Parts A and B coinsurance or copayment amounts, blood, and additional hospital benefits not covered by Original Medicare. Plan A is the most basic Medigap policy because it covers only these core benefits. All other Medigap plans provide coverage for the core benefits plus one or more additional benefit.
Part A costs covered by Medigap plans
- Coinsurance for hospital stays: All Medigap plans cover the coinsurance on hospital costs, up to an additional 365 days after your Original Medicare hospital benefits have run out.
- Copayment or coinsurance for hospice care: Medigap plans cover 50 to 100 percent of your copayments and coinsurance for Part A hospice care expenses, depending on the plan option you choose.
- Medicare Part A deductible: Although Plan A does not cover the deductible, the remaining plans cover 50 to 100 percent of this cost.
Part B costs covered by Medigap plans
- Copayment or coinsurance: Medigap plans cover 50 to 100 percent of your Part B copayment and coinsurance amounts, based on plan option.
- Medicare Part B deductible: Only two plans cover the deductible: C and F. This is one reason why Plan C and Plan F are two of the most popular plans.
- Part B excess charges: Medicare Part B excess charges occur when a health care provider declines to accept Medicare's "assignment" for a particular procedure or visit. Excess charges are covered by two Medigap plans: F and G.
Although most hospitals get blood at no cost from subsidized blood banks, you will be charged if a hospital must purchase additional blood for you. Medigap plans cover up to 100 percent of the cost for the first three pints of blood; Original Medicare will start paying after the third pint.
Skilled nursing facilities
Skilled nursing facilities are health care facilities that offer short- and long-term care for those with serious medical needs who cannot be treated at home. Although the coinsurance for this type of care is not covered by Plans A or B, the other plans cover 50 to 100 percent of these costs.
Because Medicare generally provides coverage only in the United States and its territories, a number of Medigap plans cover foreign travel emergencies (up to plan limits). If you travel on a regular basis, you may want to consider one of these plans: Plans C, D, F, G, M, and N.
Medigap policies do not cover:
- Long-term care (care in a nursing home)
- Vision or dental care
- Hearing aids
- Private-duty nursing
For additional Medigap coverage details
To help determine which of the 11 Medigap plans best meet your coverage needs, click here for a more detailed overview of the benefits offered by each plan option.