What are Medigap Plans?
A Medigap plan may be able to help with your Medicare Part A and Part B out-of-pocket costs. If you have health problems, or expect to have them in the future, you may be especially interested in Medigap plans.
Medigap Plans: How Do They Work?
Medigap (Medicare Supplement) insurance is supplemental coverage you can buy to help pay the “gaps” in Medicare coverage.
Original Medicare, Part A and Part B, comes with out-of-pocket costs. For example:
- You have to pay a 20% coinsurance amount for doctor visits, in many cases.
- If you’re an inpatient in a hospital, you typically pay a Part A deductible amount. After you pay the deductible, you usually pay coinsurance every day for hospital stays longer than 60 days.
These are just two examples of the expenses you could be faced with.
In short, your Medicare expenses could really pile up – especially if you have an illness. That’s where Medigap plans come in. In most states, Medigap plans are standardized with lettered names, like Medicare Supplement Plan G.
Each standardized plan has the same basic benefits. For instance, Medicare Supplement Plan G has the same basic benefits whether you buy it in Louisville, Kentucky, or Lewiston, Maine – regardless what insurance company you buy it from.
At the same time, Medicare Supplement Plan G will be different from any other Medicare Supplement plan. Plan G and Plan A, for instance, have different sets of basic benefits.
Medigap Plans: What Do They Cover?
Even though the 10 different Medigap plans have different sets of basic benefits, there are some basic benefits all of them may cover.
- Hospital costs and coinsurance under Medicare Part A for another year (365 days) after Part A coverage is used up.
- First three pints of blood (covered at 50%, 75%, or 100%, depending on the plan)
- Coinsurance or copayments under Medicare Part B for doctor visits, lab tests, and other covered services (covered at 50%, 75% or 100%, depending on the plan)*
- Hospice care (covered at 50%, 75%, or 100%, depending on the plan)
Medigap plans may also cover the following benefits. Not every Medigap plan covers these benefits, and some may cover 50% or 75% rather than 100%.
- Skilled nursing facility care coinsurance
- Part B excess charges. If a doctor is legally allowed to charge more than the approved Medicare amount, some Medigap plans may pay the difference (called an excess charge).
- Medicare Part A deductible
- Medicare Part B deductible**
- Emergency medical care during travel (at 80%, up to plan limits)
Medigap Plans K and L have out-of-pocket limits. If you spend up to this annual limit, the plan may pay 100% of your Medicare-approved costs for the rest of the year.
What else should I know about Medigap plans?
- Medigap plans are guaranteed renewable in most cases. Once you have a plan, the insurance company can’t drop you unless you don’t pay your premium, you were dishonest on your application, or the company goes bankrupt.
- A good time to buy a Medigap plan may be during your Medigap Open Enrollment Period. This 6-month period starts the month you’re both 65 or older, and enrolled in Medicare Part B. After this period is over, you generally no longer have guaranteed-issue rights to buy a plan, and your application could be rejected. You could have to pay a higher premium.
- Most Medigap plans let you see any doctor who accepts Medicare assignment. You’re not typically limited to doctors in a plan So, you can get care anywhere in the country.
- You need to be enrolled in both Medicare Part A and Part B to qualify for a Medigap plan.
- Massachusetts, Minnesota, and Wisconsin each have their own Medigap plans.
Ready to start comparing Medigap plans where you live? You can click the Browse Plans button on this page to display a list of plans right away. You can also contact eHealth to reach a licensed insurance agent.
* Medigap Plan N may pay 100% of the Part B coinsurance amount. However, you may still have to pay a copayment:
- Up to $20 for certain office visits
- Up to $50 for each emergency room visit if you’re not then admitted to a hospital as an inpatient.
** After January 1, 2020, Medigap Plans C and F may no longer be available to new Medicare enrollees. These are the only Medigap plans that may cover the Medicare Part B deductible in most states. Read more about whether Medicare Supplement Plans F and C are going away.
The product and service descriptions, if any, provided on these eHealth web pages are not intended to constitute offers to sell or solicitations in connection with any product or service. All products are not available in all areas and are subject to applicable laws, rules, and regulations.