September 1, 2022

What’s Medicare Supplement Insurance (Medigap)?

Medicare Supplement Insurance referred to as Medigap, helps cover some of the costs Original Medicare doesn’t cover. Medigap may help beneficiaries cover deductibles, copayments, coinsurance, and benefits not covered by Medicare like medical care received outside the United States. Private insurance companies sell Medigap plans to help fill these gaps.

Do I Need Medigap Insurance?

If you’ve been wondering if you need Medigap insurance, it helps to understand how these policies work. To qualify for a Medigap plan, you must have Medicare Part A and Part B. Most states offer the same types of Medigap plans, identified by letters A through N.

The federal government standardizes Medicare Supplement Insurance, meaning each Medigap plan consists of the same benefits no matter the carrier. However, prices among carriers greatly vary. When you purchase a Medigap policy, you pay the private insurance company a monthly premium on top of the monthly Part B premium you pay to Medicare.

When you have Original Medicare and purchase a Medigap policy, Medicare pays its share of approved healthcare costs.

Your Medigap insurance company then pays its share, but it doesn’t cover everything. Medigap usually won’t cover:
• Vision care and eyeglasses
• Dental services
• Hearing aids
• Long-term care
• Private-duty nursing

Some Medigap policies used to cover prescriptions, but policies sold after January 1, 2006, weren’t allowed to include prescription coverage. Beneficiaries who want prescriptions covered must join a Medicare Prescription Drug Plan, called Medicare Part D. Many private insurance companies also sell Medicare drug plans but may require a separate premium payment.

Different Types of Medicare

All Medigap plans cover Part A coinsurance and hospital costs up to 365 days after you exhaust your Medicare benefits. Some individual plans also cover all or a percentage of specific benefits, while others won't cover certain benefits at all.

  • Plan A: Covers 100% of Part A hospice care coinsurance/copayment, Part B coinsurance/copayment and the first three units of blood if the healthcare provider must buy blood for you.
  • Plan B: Covers 100% of Part A deductible, Part A hospice care coinsurance/copayment, Part B coinsurance/copayment and the first three units of blood if the healthcare provider must buy blood for you.
  • Plan C: Covers 100% of Part A deductible, Part A hospice care coinsurance/copayment, skilled nursing facility care coinsurance, Part B coinsurance/copayment, Part B deductible and the first three units of blood if the healthcare provider must buy blood for you; and 80% of emergency medical care during foreign travel. Not available if you became newly eligible for Medicare on or after January 1, 2020.
  • Plan D: Covers 100% of Part A deductible, Part A hospice care coinsurance/copayment, skilled nursing facility care coinsurance, Part B coinsurance/copayment and the first three units of blood if the healthcare provider must buy blood for you; and 80% of emergency medical care during foreign travel.
  • Plan F: Covers 100% of Part A deductible, Part A hospice care coinsurance/copayment, skilled nursing facility care coinsurance, Part B coinsurance/copayment, Part B deductible, Part B excess charge and the first three units of blood if the healthcare provider must buy blood for you; and 80% of emergency medical care during foreign travel. Not available if you became newly eligible for Medicare on or after January 1, 2020.
  • Plan G: Covers 100% of Part A deductible, Part A hospice care coinsurance/copayment, skilled nursing facility care coinsurance, Part B coinsurance/copayment, Part B excess charge and the first three units of blood if the healthcare provider must buy blood for you; and 80% of emergency medical care during foreign travel.
  • Plan K: Covers 50% of Part A deductible, Part A hospice care coinsurance/copayment, skilled nursing facility care coinsurance, Part B coinsurance/copayment and the first three units of blood if the healthcare provider must buy blood for you, with an out-of-pocket limit of $6,620 in 2022.
  • Plan L: Covers 75% of Part A deductible, Part A hospice care coinsurance/copayment, skilled nursing facility care coinsurance, Part B coinsurance/copayment and the first three units of blood if the healthcare provider must buy blood for you, with an out-of-pocket limit of $3,310 in 2022.
  • Plan M: Covers 100% of Part A hospice care coinsurance/copayment, skilled nursing facility care coinsurance, Part B coinsurance/copayment and the first three units of blood if the healthcare provider must buy blood for you; 50% of Part A deductible; and 80% of emergency medical care during foreign travel.
  • Plan N: Covers 100% of Part A deductible, Part A hospice care coinsurance/copayment, skilled nursing facility care coinsurance and the first three units of blood if the healthcare provider must buy blood for you; 80% of emergency medical care during foreign travel; and 100% of Part B coinsurance/copayment minus a copayment of up to $20 for some office visits and up to $50 for emergency room visits without hospital admission.

Plans E, H, I and J are no longer available to buy, but consumers who already have one of these policies can usually keep them.

Medigap Isn't Medicare Advantage

Medicare Supplement Insurance isn't the same as Medicare Advantage Plans, though private insurance companies also offer these policies. Medicare Advantage, sometimes called Medicare Part C, covers your Medicare Part A and Part B coverage and prescription drug coverage, also called Medicare Part D. Medigap policies to supplement Original Medicare benefits and you can't use them with a Medicare Advantage Plan.

Buying a Medigap Policy

The ideal time to buy a Medigap policy is during your six-month Medigap Open Enrollment Period when you usually get better prices and more policy options. You can purchase any Medigap policy available in your state during the open enrollment, even if you have existing health conditions. After open enrollment, private insurance companies may not sell you a Medigap policy if you don't meet medical underwriting requirements.

Benefits of Working with a Medicare Agent

There's no requirement to work with a Medicare agent, but an agent can help you navigate the complex rules, benefits, plans, and exceptions that makeup Medicare. An agent provides you with options from multiple companies, saving you time and ensuring you get the right fit. If you're buying Medigap after your open enrollment period, a Medicare agent can also help determine whether you'll meet the underwriting requirements of your desired plan. You can find a Medicare agent near you on HeathCare.gov or through your state insurance department.

Source: Medicare.gov

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