Medicare Supplement Plans

Medigap

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Medicare Supplement Plans - Medigap

Original Medicare pays for many, but not all, healthcare services and supplies. Medicare Supplement Insurance policies, sold by private insurance companies, can help pay your share of some of the healthcare cost that Original Medicare doesn’t cover, like co-payments, coinsurance, and deductibles.

Benefits of Medicare Supplement Plan

Medicare Supplement Insurance policies are also called Medigap policies. If you have original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare approved amount for covered healthcare cost. Then, your Medigap policy pays its share. You pay premiums for a Medigap policy

Medigap plans may include any or all of the following:

medical care

Medical care coverage when you travel outside of the United States

reduce costs

Reduce your out-of-pocket costs, such as co-payments, coinsurance and deductibles

complete coverage

More complete coverage

A Medigap policy is different from a Medicare Advantage Plan (like an HMO or PPO). Medicare Advantage Plans are ways to get your Medicare benefits. It’s generally illegal for an insurance company to sell a Medigap policy to anyone who is still enrolled in a Medicare Advantage plan.

If you have Medigap and switch to enroll in in a Medicare Advantage Plan for the first time, you have the right to change your mind and you’ll have special rights under federal law to buy a Medigap policy if you return to Original Medicare 12 months aer you enrolled in the Medicare Advantage Plan.

Medicare Supplemental Plans - Medigap FAQs

A Medicare Supplement Insurance (Medigap) policy can help pay for some of the health care costs not covered by original Medicare. A Medigap policy covers only one person. Spouses must buy separate policies.

Generally, Medigap policies don’t cover long-term care (like non-skilled care you get in a nursing home), vision or dental care, hearing aids, eyeglasses, or private‑duty nursing.

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.

Medigap Benefits Chart Plan A Plan B Plan C Plan D Plan F Plan G Plan K Plan L Plan M Plan N
Medicare Part A coinsurance and hopital costs (up to an additional 365 days after Medicare benefits are used up) 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% 100% 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%
Out of Pocket Limit** Out of Pocket Limit**
$5,120 $2,560


* Plans F and G also oer a high-deductible plan in some states. With this option, you must pay for Medicare-covered costs (coinsurance, copayments, and deductibles) up to the deductible amount of $2,340 in 2020 before your policy pays anything. (Plans C and F won’t be available to people who are newly eligible for Medicare on or after January 1, 2020.) **For Plans K and L, after you meet your out-of-pocket yearly limit and your yearly Part B deductible ($198 in 2020), 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. 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.
You’re eligible for a Medigap policy if you have Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance).
Every Medigap policy must follow federal and state laws designed to protect you, and the policy must be clearly identified as “Medicare Supplement Insurance.” Insurance Companies can sell you only a “standardized” Medigap policy, identified in most states by letters A-N. In Massachusetts, Minnesota, and Wisconsin. Medigap policies are standardized in a different way. For more information, contact an agent for assistance.

All standardized policies offer the same basic benefits, no matter which insurance company sells it, but some offer additional benefits so you can choose which one meets your needs. Plans E, H, I, and J are no longer available to buy, but, if you already have one of those policies, you can generally keep it. Contact your insurance company for more information. In some states, you may be able to buy another type of Medigap policy called Medicare SELECT.

Medicare SELECT plans are standardized Medigap policies that require you to use specific hospitals and, in some cases, specific doctors or other health care providers to get full supplemental coverage (except in an emergency). If you have Medigap and switch to a Medicare SELECT policy, you have the right under federal law to change your mind within 12 months and switch to a standard Medigap policy.

Starting January 1, 2020, Medigap plans sold to people new to Medicare weren’t allowed to cover the Part B deductible. Because of this, Plans C and F are no longer available to people new to Medicare on or after January 1, 2020 (those who turned 65 on or after January 1, 2020, and those who get Medicare Part A (Hospital Insurance) on or after January 1, 2020.) If you had one of these plans (or the high deductible version of Plan F) before January 1, 2020, you can keep it. If you were eligible for Medicare before January 1, 2020 but not yet enrolled, you may be able to buy Plan C or Plan F.

Standardized Medigap policies aren’t required to cover long-term care (like care in a nursing home), vision or dental care, hearing aids, eyeglasses, and private-duty nursing
    • You must have Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance).
 
    • If you have a Medicare Advantage Plan (like an HMO or PPO) but are planning to return to Original Medicare, you can apply for a Medigap policy before your coverage ends. The Medigap insurer can sell it to you as long as you’re leaving the Plan. Ask that the new Medigap policy start when your Medicare Advantage Plan enrollment ends, so you’ll have continuous coverage.
 
    • You pay the private insurance company a premium for your Medigap policy in addition to the monthly Part B premium you pay to Medicare
 
    • A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you each will have to buy separate Medigap policies.
 
    • When you have your Medigap Open Enrollment Period, you can buy a Medigap policy from any insurance company that’s licensed in your state.
 
    • Any standardized Medigap policy is guaranteed renewable even if you have health problems. This means the insurance company can’t cancel your Medigap policy as long as you stay enrolled and pay the premium.
 
    • Different insurance companies may charge different premiums for the same exact policy. As you shop for a policy, be sure you’re comparing the same policy (for example, compare Plan A from one company with Plan A from another company).
 
    • Some states may have laws that may give you additional protections.
 
    • Although some Medigap policies sold in the past covered prescription drugs, Medigap policies sold after January 1, 2006, aren’t allowed to include prescription drug coverage. If you want prescription drug coverage, you can join a Medicare Prescription Drug Plan (Part D) offered by private companies approved by Medicare.
 

Got More Questions About Medigap?

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