All About Medicare Supplement Insurance (Medigap) Coverage
How Medigap covers unwanted gaps in your health insurance coverage
Key Takeaways
Medicare Supplement Insurance (Medigap)Medicare Supplement Insurance (Medigap) are policies designed to provide coverage that Original Medicare (Parts A and B) do not. Medigap policies are purchased in addition to Original Medicare and have their own monthly premiums you'll need to pay. is extra insurance that can be added to Original Medicare (Parts A and B)Original Medicare (Parts A and B) is fee-for-service health insurance available to all Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance)..
Medigap guards Original Medicare enrollees against costly co-paymentsA co-payment is the fixed amount you pay directly to your provider for medical services or prescription drugs covered in your plan. For example: If your plan includes a co-payment of $20 for office visits, you'll pay $20 to your doctor whenever you have an appointment., deductiblesA deductible is the amount you pay out of pocket before your insurance company covers its portion of your medical bills. For example: If your deductible is $1,000, your insurance company will not cover any costs until you pay the first $1,000 yourself. and co-insuranceCo-insurance is the percentage of your medical costs that you pay after you meet your deductible. The remaining amount is paid by your insurance company. For example: If you have a $1,000 medical bill and your co-insurance is 20%, you'll pay $200. Your insurance company will cover the final $800. from certain medical treatments or lengthy hospital stays.
Medigap plans sold with Medicare policies do not cover the Part B deductible.
Whether you’re new to Medicare, or you’ve been a customer and are looking for more coverage, you may have noticed some gaps between your needs and what’s covered by Original Medicare. These gaps include co-insurance and co-payment charges that can be expensive for most people. Medicare Supplement Insurance (Medigap) is a set of health insuranceHealth insurance is a form of insurance that covers a portion of your medical expenses. In exchange, you pay a monthly premium and other costs. policies, sold by private insurance carriers, that cover these needs.
Medigap coverage typically offers:
- Different coverage levels with standard benefits for each plan.
- A range of services and plans, each assigned with a letter from “A” to “N.”
Medicare Supplement Insurance (Medigap) is only available to those enrolled in Original Medicare; it’s illegal for someone to sell you Medigap coverage if you’re enrolled in Medicare Advantage. Some plans have different benefits than others, but basic coverage is the same across most states and insurance companies. Each Medigap plan is required to follow federal and state laws to protect you and your policy.
What’s Covered?
Not everyone will–or should–choose the most comprehensive option. When the time comes to make your choice, it’s important to know what is, and isn’t, included in each plan option.
Medigap plans are identified alphabetically from “A” to “N”, (though plans “E”, “H”, “I” and “J” are no longer sold). Plan A provides the most basic coverage, while Plan F is the most comprehensive.
Each plan has different levels of coverage, but federal law requires all Medigap plans to offer equal basic healthcare services. The decision to provide additional benefits is made on a state-by-state basis. It’s important to know which plans your state offers [1] , as not all states offer all ten supplemental plans. Here’s a breakdown of what each Medigap plan covers [2] .
All Medigap policies cover at least a portion of the following services:
- Medicare Part A co-insurance and hospital costs
- Medicare Part B co-insurance and co-payments
- The first three pints of blood
- Part A hospice careHospice care is for people who are terminally ill. The care includes pain management, counseling, respite care as well as inpatient and outpatient care. Hospice care is covered by Medicare Part A. co-insurance and co-payments
Is there anything Medigap doesn’t cover?
While Medigap has several plans and coverage levels, you can’t buy a policy that covers the following: [3]
- Long-term careLong-term care coverage is insurance that helps pay for medical services and care you receive due to a chronic illness or disability. Long-term care often refers to "custodial care," or personal care needs.
- Vision
- Eyeglasses
- Dental
- Hearing aids
- At-home or private-duty nursing care
Customers that need these services can opt for Medicare Advantage instead of Original Medicare. Medicare Advantage, or Medicare Part C, is also sold by private insurers and offers more comprehensive coverage.
Important Notes About Medigap Coverage
As of January 1, 2020, Medigap plans sold with Medicare policies do not cover the Part B deductible. Plans C and F are not available to new enrollees joining Medicare on or after January 1, 2020. Enrollees eligible for Medicare before January 1, 2020, but not yet enrolled, you may be able to buy one of these plans.
Customers that are new to Medicare and want a comprehensive plan similar to Plans C and F may want to consider Medicare Plan G coverage because it pays for most co-payments and co-insurance.
FAQs
Does Medigap cover my spouse?
Medigap policies only cover the actual policyholder, not spouses. If you and your spouse both need Medigap coverage, you will need to sign up separately and purchase individual policies. This can be helpful because many married couples often don’t need the same levels of care. With Medigap, you can customize each of your plans to get the value and coverage you need.
Does Medigap cover prescription drugs?
No– however, prescription drugs can be covered by the Medicare Prescription Drug Plan (Part D), which is not a Medigap plan. Medicare Part D is often sold separately from Parts A and B or is bundled with the two into a Medicare Advantage policy.