Medigap/Medicare Supplement Plans
A Medigap/Medicare Supplement policy is an insurance policy that helps supplement Original Medicare and is sold by private companies. A Medigiap policy can help pay some of the remaining health care costs that Original Medicare doesn’t pay for covered services and supplies, like copayments, coinsurance, and deductibles. Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. These are “gaps” in Medicare coverage.
If you have Original Medicare and a Medigap policy, Medicare will pay its share of the Medicare‑approved amounts for covered health care costs. Then your Medigap policy pays its share. A Medigap policy is different from a Medicare Advantage Plan (like an HMO or PPO) because those plans are ways to get Medicare benefits, while a Medigap policy only supplements the costs of your Original Medicare benefits.
All Medigap policies must follow federal and state laws designed to protect you, and policies must be clearly identified as “Medicare Supplement Insurance.” Each standardized Medigap policy must offer the same basic benefits, no matter which insurance company sells it. Eleven plans are available and identified by letters A-N. Although the plans are standardized, the premiums are not so it is important to work with a broker to find the lowest price plan for you.
Medicare Supplement plans are guarantee issue when you are aging into Medicare, or within 6 months of starting Part B. Guarantee issue means that any policy you choose must accept you no matter what your health is, and they cannot ask you any medical questions. After 6 months, if you have not chosen a policy you will be asked medical questions concerning your health, and they could deny you coverage.
Many people think that their pre-existing health conditions are not a concern with Medicare as it is with the Affordable Care Act or “ObamaCare”. Unfortunately, when it comes to Medicare, at certain times you may be required to answer health questions. Here are just some of the examples of when you may or may not have what insurance calls ‘Guarantee Issue’, which means no health questions are asked.
Standardized Plans A - N
This chart shows basic information about the different benefits that Medigap policies cover. If a percentage appears, the Medigap plan covers that percentage of the benefit, and you must pay the rest. If a box is blank, the plan doesn’t cover that benefit. NOTE: Effective January 1, 2020, Plans C and F will no longer be available to people starting Medicare that were born in 1955 or later. Those born before 1955 are eligible to purchase Plan C or F.
|Medicare Supplement Insurance (Medigap) Plans|
|Medicare Part A coinurance and hospital costs (up to an additional 365 days after Medicare benefits are used)||100%||100%||100%||100%||100%||100%||100%||100%||100%||100%|
|Medicare Part B coinsurance or copayment||100%||100%||100%||100%||100%||100%||50%||75%||100%||100%
|Blood (first 3 pints)||100%||100%||100%||100%||100%||100%||50%||75%||100%||100%|
|Part A hospice care coinsurance or copayment||100%||100%||100%||100%||100%||100%||50%||75%||100%||100%|
|Skilled nursing facility care coinsurance||100%||100%||100%||100%||50%||75%||100%||100%|
|Part A deductible||100%||100%||100%||100%||100%||50%||75%||50%||100%|
|Part B deductible||100%||100%|
|Part B excess charges||100%||100%|
|Foreign travel emergency (up to plan limits)||80%||80%||80%||80%||80%||80%|
* Plans F and G also offer a high-deductible plan in some states. If you get the high-deductible option, you must pay for Medicare-covered costs (coinsurance, copayments and deductibles) up to the deductible amount of $2,700 in 2023 before your policy pays anything, and you must also pay a separate deductible ($250 per year) for foreign travel emergency services.
** Plans K and L show how much they’ll pay for approved services before you meet your out-of-pocket yearly limit and your Part B deductible ($226 in 2023). After you meet these amounts, the plan will pay 100% of your costs for approved 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.