What is Not Covered by Medicare Supplement Plans?

Last Updated : 09/16/20184 min read

Are you thinking about buying a Medicare Supplement plan, but you’re concerned about what these plans do and don’t cover? Read on to learn about the benefits Medicare Supplement plans may include, and what they don’t typically cover.

What do Medicare Supplement plans cover?

Medicare Supplement (Medigap) insurance is designed to help pay for some of the out-of-pocket costs of Original Medicare, Part A and Part B, such as copayments, coinsurance, and deductibles.

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In all but three states, there are up to 10 standardized Medicare Supplement plans available (Massachusetts, Minnesota and Wisconsin have their own standardized plans). Their lettered names (such as Medicare Supplement Plan M) help distinguish one plan from another; each standardized plan may cover a different portion of certain Medicare expenses.

For example, Medicare Supplement Plan A and Plan D both usually cover Medicare Part B copayments or coinsurance amounts, but Plan A does not cover the Medicare Part A deductible (Plan D generally does). Please note that Medicare Supplement Plan A and Plan D are not the same as Medicare Part A and Part D.

It’s important to understand which Medicare out-of-pocket costs each Medicare Supplement plan may pay for, and which costs a plan doesn’t cover or covers only a portion of. Here’s a detailed list of the benefits of each standardized Medicare Supplement plan.

What kinds of benefits are usually not covered by Medicare Supplement plans?

Medicare Supplement plans are sold by private insurance companies, and while a lettered plan’s standard benefits are the same no matter where you buy it, premiums may vary among plans.

As mentioned, Medicare Supplement plans mainly involve Medicare Part A and Part B out-of-pocket costs, like deductibles and copayments. The standard benefits in most Medicare Supplement plans sold today do not cover items and services such as those in the list below (this is not a complete list). However, please note that some Medicare Supplement plans may offer additional benefits, which might include some from this list.

  • Prescription drug coverage
  • Routine vision services
  • Routine dental services
  • Private-duty nursing services
  • Hearing aids
  • Eyeglasses
  • Long-term care (in most cases; for example, custodial care in nursing homes)

How can I get a Medicare health plan for services that Medicare Supplement plans don’t cover?

In general, Original Medicare (Part A and Part B) doesn’t cover the services listed above. But you might have another option. Some Medicare Advantage plans include certain additional benefits, such as prescription drug coverage and routine dental care.

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With Medicare Advantage plans, you get your Part A and Part B benefits through the plan instead of directly through Medicare. Hospice benefits are still provided directly from Part A. Additional benefits, if any, vary among plans, so if you’re looking for a Medicare Advantage plan, you may want to take a look at the plan details before you sign up. Feel free to click Find Plans on this page to get started.

Medicare Advantage plans are available from private, Medicare-approved insurance companies. When you’re enrolled in a Medicare Advantage plan, you continue paying your Part B premium, along with any premium the plan might charge.

Please note that Medicare Advantage plans and Medicare Supplement plans don’t work together. So, if you’re thinking that you might want a benefit that a Medicare Supplement plan doesn’t cover, such as membership in a fitness program – signing up for Medicare Advantage may be possible, but your Medicare Supplement plan wouldn’t cover any of the Medicare Advantage plan’s out-of-pocket costs.

If you want more information about Medicare plan options that may work for you, I’m here to help. You can start by using the links below, next to my photo, to set up a phone appointment or have me email you some personalized recommendations. Or, if you’d like to see some options now, use the Find Plans or Compare Plans buttons to begin comparing plans in your zip code.

Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program.

The product and service descriptions, if any, provided on these eHealth Insurance Web pages are not intended to constitute offers to sell or solicitations in connection with any product or service. All products are not available in all areas and are subject to applicable laws, rules, and regulations.

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