Medicare Insurance Supplemental Plans

Medigap policies fill in the coverage gaps

Original Medicare (5Parts A and B) pays for many of your health care services and supplies, but it doesn’t pay for everything. That’s why you may want to consider getting a Medicare Supplement Insurance policy, also called Medigap. A Medigap policy is health insurance sold by private insurance companies. They help pay some of the costs that Original Medicare doesn’t cover, such as copayments, coinsurance, and yearly deductibles. Some Medigap policies also help pay for services that Original Medicare doesn’t cover at all. Basically, a Medigap policy fills the “gaps” in Original Medicare coverage.

How do Medigap policies work with Medicare?

Medigap policies supplement your Original Medicare benefits, which is why these policies are also called Medicare Supplement plans. If you have Original Medicare and a Medigap policy, Medicare will pay first and your Medigap policy will fill in the gaps. For example, suppose you have a $5,000 ambulance bill and have not yet met the yearly Part B deductible (5$140 in 2012). Medicare Part B will pay 80 percent of your bill, minus the deductible amount. Your Medigap policy will then pay the remaining 20 percent plus the deductible amount.

Medigap policies protect you from big medical bills

Your cost with a Medigap policy* Your cost without a Medigap policy*
Ambulance charge: $5,000 Ambulance charge: $5,000
Part B yearly deductible: $140 Part B yearly deductible: $140
Medicare Part B pays: $3,860 Medicare Part B pays: $3,860
Medigap policy pays: $1,140
You pay: $0 You pay: $1,140

*Costs shown are examples only and do not represent exact calculations.

Plans that don’t supplement Medicare coverage (5aren’t Medigap policies)

  • Medicare Advantage plans (5like an HMO or PPO)
  • Medicare Prescription Drug plans(5Part D)
  • Medicaid
  • Employer’s or union’s plans
  • TRICARE
  • Veterans’ benefits
  • Long-term care insurance policies

What benefits do Medigap policies cover?

Currently, there are 10 standardized Medigap plans and one high deductible plan, each represented by a letter (5A, B, C, D, F, G, K, L, M, N, and high deductible F) sold in most states. Benefits and coverage rates vary with each policy, but details of each plan remain the same despite the plan provider or location. For example, Plan A details are the same in New Jersey as they are in Oregon.

In general, Medigap policies cover the following benefits:

  • Medicare Part A coinsurance and hospital costs (5up to an additional 365 days after Medicare benefits are used)
  • Medicare Part B coinsurance or copayment*
  • Blood (5first 3 pints)*
  • Part A hospice care coinsurance or copayment*

*coverage may be partial for some plans

Some types of Medigap policies also cover:

  • Skilled nursing facility care coinsurance
  • Medicare Part A deductible
  • Medicare Part B deductible
  • Medicare Part B excess charges
  • Foreign travel emergency

What benefits are not covered by Medigap policies?

Medigap policies will not cover the following health services and supplies:

  • Long-term care (5care in a nursing home)
  • Vision or dental care
  • Hearing aids
  • Eyeglasses
  • Private-duty nursing

Additional facts about Medigap policies

You must have Medicare Part A and Part B to get a Medigap policy.
Every Medigap policy must be clearly identified as “Medicare Supplement Insurance.”
A Medigap policy can only cover one person, so if you are married, both you and your spouse must buy separate policies.

Not all types of Medigap policies may be available in your state.

Medicare has neither reviewed nor endorsed this information.