All About Medicare Supplement Insurance (Medigap) Coverage
Key Takeaways
- You can purchase Medicare Supplement Insurance (Medigap)Medicare Supplement Insurance (Medigap) is designed to provide coverage that Original Medicare (Parts A and B) does not. Medigap policies are purchased in addition to Original Medicare and have their own monthly premiums you’ll need to pay. in addition to Original Medicare (Parts A and B)Original Medicare is a fee-for-service health insurance program available to 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 copaymentsA copayment 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 copayment of $20 for office visits, you’ll pay $20 to your doctor whenever you have an appointment. and coinsurance from certain medical treatments or lengthy hospital stays.
- Medigap plans sold with Medicare policies do not cover the Part B deductible.
You may have noticed some gaps between your needs and what’s covered by Original Medicare. These gaps can include expensive coinsurance and copayment charges that you pay out of pocket when receiving services. Medicare Supplement Insurance (Medigap) is a set of health insurance 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.
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What’s Covered?
Not everyone will — or should — choose the most comprehensive option. It’s important to know what is, and isn’t, included in each plan option.
In most states, 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 (Plans are standardized differently in Massachusetts, Minnesota, and Wisconsin).
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, as not all states offer all ten supplemental plans. Here’s a breakdown of what each Medigap plan covers.
All Medigap policies cover at least a portion of the following services:
- Medicare Part A coinsurance and hospital costs
- Medicare Part B coinsurance and copayments
- 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. coinsurance and copayments
Is there anything Medigap doesn’t cover?
While Medigap plans may offer a range coverage levels, they usually don’t cover any of the following:
- 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
If you’re interested in benefits like these, look into what Medicare Advantage plans are available in your area to substitute for your Original Medicare coverage. Medicare Advantage, or Medicare Part C, plans are sold by private insurers and may offer additional benefits.
Still have questions? GoHealth has the answers you need.
Important Notes About Medigap Coverage
As of January 1, 2020, Medigap plans sold with Medicare policies can not cover the Part B deductible. Plans C and F are not available to new enrollees joining Medicare on or after that date. Enrollees eligible for Medicare before January 1, 2020, but who have not yet enrolled, 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 copayments and coinsurance.
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.
Does Medigap cover prescription drugs?
No. However, prescription drugs can be covered by a Medicare Prescription Drug Plan (Part D). Medicare Part D is sold separately from Parts A and B. Medicare Advantage plans often include Part D coverage.
Sources
- Find a Medigap policy that works for you. Medicare.gov.
- How to compare Medigap policies. Medicare.gov.
- What’s Medicare Supplement Insurance (Medigap)? Medicare.gov.
This website is operated by GoHealth, LLC., a licensed health insurance company. The website and its contents are for informational and educational purposes; helping people understand Medicare in a simple way. The purpose of this website is the solicitation of insurance. Contact will be made by a licensed insurance agent/producer or insurance company. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. Our mission is to help every American get better health insurance and save money.
Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.