Medicare Coverage: Medigap Supplemental Insurance

Medigap Supplemental Insurance

WebMD Medical Reference

Medigap is extra health insurance you can buy from a private company. A Medigap policy helps pay for health care costs not covered by the Original Medicare plan. Medigap plans can reduce out-of-pocket costs for many people.

What Medigap Plans Cover

There are 12 kinds of Medigap plans. Each is given a letter from A to L.

Every Medigap plan from A-J includes "core" benefits. These benefits help pay for:

  • The Medicare Part A co-payment for days 61-150 of a hospital stay.
  • Up to 365 days in the hospital after all your Medicare hospital benefits have been used.
  • Co-payments for Medicare Part B services after the $124 deductible.
  • The first three pints of blood if you need a transfusion.

Medigap plan (plan A) covers only these things. Plans B-J cover more, including:

  • Prescription drugs.
  • Preventive services (such as routine checkups).
  • Part B excess charges (the difference between what a doctor bills you and Medicare's approved amount).
  • At-home recovery.
  • Co-payment for skilled nursing care.
  • Emergency care outside the United States.
  • Medicare deductibles.

This chart shows what Medigap plans A-J cover:

Coverage A B C D E F G H I J
Core Benefits X X X X X X X X X X
Part A deductible   X X X X X X X X X
Part B deductible     X     X       X
Skilled nursing care co-payment     X X X X X X X X
Foreign travel emergency care     X X X X X X X X
Part B excess charges (100%)           X     X X
Part B excess charges (80%)             X      
At-home recovery       X     X   X X
Preventive services         X         X
Prescription drugs (up to $1,250)               X X  
Prescription drugs (up to $3,000.00)                   X

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Note: Standard Medigap benefits are different for people in Massachusetts, Minnesota, and Wisconsin.

Medigap plans K and L were introduced in 2005. They are cheaper than plans A-J but have fewer benefits and require higher out-of-pockets costs. Both include:

  • Payment of $228 per day for days 61-90 of a hospital stay.
  • Payment of $456 per day for days 91-150 of a hospital stay.
  • Up to 365 days in the hospital after all your Medicare hospital benefits have been used.

Plan K pays:

  • 50% of co-payments for Medicare Part B services after the $110 deductible
  • 100% of coinsurance for preventative services.
  • 50% of the first three pints of blood if you need a transfusion.
  • 50% of hospice cost-sharing for all Medicare Part A covered expenses and respite care.
  • $4,000 out-of-pocket annual limit; after you reach the limit, the plan pays for all of your Part A and Part B co-payments for the rest of the year
  • Skilled nursing facility coinsurance (50%)
  • Medicare Part A Deductible (50%).

Plan L pays:

  • 75% of co-payments for Medicare Part B services after the $110 deductible
  • 100% of coinsurance for preventative services.
  • 75% of the first three pints of blood if you need a transfusion.
  • 75% of hospice cost-sharing for all Medicare Part A covered expenses and respite care.
  • $2,000 out-of-pocket annual limit; after you reach the limit, the plan pays for all of your Part A and Part B co-payments for the rest of the year
  • Skilled nursing facility coinsurance (75%)
  • Medicare Part A Deductible (75%)

Note: Standard Medigap benefits are different for people in Massachusetts, Minnesota, and Wisconsin.

What You Pay

You pay a monthly fee to the insurance company in addition to your Medicare Part B premium. The cost of Medigap plans varies greatly, depending on:

  • How much the plan covers
  • The company selling the plan
  • Where you live
  • Your age
  • Your sex
  • Your marital status
  • Whether you smoke

Some companies also set fees based on "medical underwriting." This means you have to answer questions about your health on the application. You may be charged more for having a pre-existing health problem.

Plans F and J also have a "high deductible" option. You pay a smaller monthly fee, but if you get sick you pay more before the plan begins to cover your costs.

To compare Medigap plans in your area, use the Medicare Personal Plan Finder on the Medicare website.

When to Buy Medigap

The best time to buy a Medigap plan is during your Medigap open enrollment period. This period lasts for six months, and begins on the first day of the month in which you are both:

  • 65 or older and
  • enrolled in Medicare Part B

During this time, an insurance company cannot:

  • Deny you coverage
  • Make you wait for coverage to begin
  • Charge you more because of a pre-existing health problem

It's important to sign up during this six month period. If you try to buy a Medigap policy after your six-month enrollment period has ended, there is no guarantee that you will be given coverage.

Note: You should not buy a Medigap plan if you have or intend to buy a Medicare Advantage plan (previously called Medicare + Choice.)

Medigap and the 2006 Drug Benefit

Starting in 2006, the new Medicare prescription drug plans become available. Medigap plans H, I, and J -- which have a drug benefit -- may still be available, but without the drug benefit. When the new Medicare drug benefit goes into effect in 2006, you may:

  • Keep your Medigap drug coverage and forgo the prescription drug benefit
  • Enroll in the prescription drug plan and keep your current Medigap plan, but without its drug benefit.
  • Cancel your Medigap plan and buy the new prescription drug policy through Medicare

Reviewed by Cynthia Haines, MD, August 2005.

SOURCES: Centers for Medicare and Medicaid Services. Medicare.gov web site. National Council on the Aging web site.

© 2005 WebMD Inc. All rights reserved.


For additional Medicare information, please read the following articles:


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Reviewed on 12/9/2005

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