What Medicare Supplement Insurance (Medigap) Policies Cover
This article was updated on: 07/29/2015
A Medigap policy is supplemental medical insurance that covers some of the costs of Original Medicare, Part A and Part B. There are currently 10 standardized Medigap plans and one high-deductible plan available in most states. Each plan is named with a letter: Plan 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 Medigap plan besides Plan A, 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 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 can be any standardized Medigap plan. Unlike other Medigap plans, a Medicare SELECT plan may require you to use certain network providers and hospitals.
Benefits covered by Medigap policies
All Medicare Supplement plans cover coinsurance on hospital costs, up to an additional 365 days after your Medicare Part A hospital benefits have run out.
All Medigap policies also cover at least part of these costs:
- Medicare Part A hospice coinsurance or copayment
- Medicare Part B coinsurance or copayment
- The first three pints of blood received as a hospital inpatients
Plan A is the most basic Medigap policy because it covers only these benefits.
Medicare Part A costs covered by Medigap plans
- Coinsurance for hospital stays, as noted above.
- Coinsurance for skilled nursing facility (SNF) stay.
- Copayment or coinsurance for hospice care—Medigap plans cover 50 to 100% of your copayments and coinsurance for Part A hospice care expenses, depending on the plan option you choose.
- Medicare Part A deductible—although Medigap Plan A doesn’t cover this deductible, the remaining plans cover 50 to 100% of this cost.
Medicare Part B costs covered by Medigap plans
- Copayment or coinsurance—Medigap plans cover 50 to 100% of your Medicare Part B copayment and coinsurance amounts, based on the chosen plan.
- Medicare Part B deductible—only two plans cover the deductible: Plan C and Plan F. This is one reason why these are two of the most popular plans.
- Medicare Part B excess charges—Medicare Part B excess charges occur when a health care provider declines to accept Medicare assignment (a payment agreement with Medicare) for a particular procedure or visit. Excess charges are covered by two Medigap plans: Plan F and Plan G.
Although hospitals often get blood at no cost from subsidized blood banks, you will likely be charged if a hospital must purchase additional blood for you. Medigap plans cover 50 to 100% of the cost for the first three pints of blood; Original Medicare will start paying after the third pint.
Skilled nursing facilities
Medicare covers certain limited care at skilled nursing facilities. Most Medigap plans cover 50 to 100% of the coinsurance for this type of care, but Medigap Plan A and Plan B don’t include this benefit.
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: Plan C, D, F, G, M, or N.
What Medigap policies don’t cover
- Long-term care (care in a nursing home)
- Routine vision or dental care
- Hearing aids
- Private-duty nursing
For more Medigap coverage details
To help determine which Medigap plan best meets your coverage needs, click here for a more detailed overview of the benefits offered by each plan option.
Medicare Supplement insurance can come in handy for beneficiaries with Original Medicare, especially those with frequent doctor visits or those who like to travel. Are you interested in hearing more about Medigap, and finding out which plans serve your area? I can help with that.
- To look at my profile, please click on the “View profile” link below.
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- How about delving into some Medicare plan choices on your own? If you’d like to go that route, just click on the Compare Plans buttons on this page.
- My colleagues and I are always glad to help a Medicare beneficiary discover plan options. Call Medicare.com’s licensed insurance agents at 1-844-847-2659, TTY users 711; Monday through Friday, 8AM to 8PM ET.
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