Medigap Plan Benefits Chart: Plans purchased between July 31, 1992 and May 31, 2010
Prior to June 1, 2010 all Medigap plans must include the following basic benefits:
- Hospital coinsurance coverage
- 365 additional days of full hospital coverage
- Full or partial coverage for the 20 percent coinsurance for doctor charges and other Part B services
- Full or partial coverage for the first 3 pints of blood you need each year
All Medigap plans sold starting June 1, 2010 (including new plans M and N) must offer these basic benefits and also pay all or part of the hospice coinsurance for drugs and respite care.
Depending on which Medigap plan you choose, you can get coverage for additional expenses Medicare doesn't cover, including:
- Hospital deductible
- Skilled nursing facility coinsurance*
- Part B deductible
- Emergency care outside the U.S.
- At-home recovery**
- Preventive care that Medicare does not cover**
- Excess doctor charges. “Excess charges” refer to the amount above the Medicare-approved amount “non-participating doctors” can charge. To learn more about what doctors can charge, click on the MI Extra below.
New plans M and N will offer some of these additional benefits. Plan M will cover the basic benefits and also cover half of the Part A deductible, skilled nursing facility coinsurance, and some of the cost of foreign travel emergencies. Plan N will also cover the basic benefits except for $20 copayments for office visits and $50 copayments for emergency room visits. Plan N will also offer foreign travel emergency coverage and cover the full Part A deductible as well as skilled nursing facility coinsurance.
*Note: Medigap plans K and L will only pay for a portion of the cost that Medicare does not cover until you reach a yearly out-of-pocket limit. In some areas, Medigap plans F and J are offered as high-deductible plans, which will only cover you after you have met an annual deductible. From June 1, 2010 and on, J and high deductible J will no longer be offered. If you currently have plan J or high deductible J you can keep it as long as you like, and your benefits will usually not change.
**Note: Plans purchased between July 31, 1992 and May 31, 2010 may include the at-home recovery benefit and preventive care that Medicare does not cover. Plans purchased on or after June 1, 2010 will no longer include the at-home recovery benefit and the preventive care benefit.
To find out more about Medigap plans K and L, click on the link in the GO TO box.
To find out more about high-deductible Medigap plans, click on the link in the GO TO box.
Before 2006, Medigap plans H, I and J were sold with drug coverage. These plans are no longer sold with drug coverage. If you bought a Medigap plan H, I or J with drug coverage before 2006, you can keep the drug coverage benefit. However, it is not considered as good as the Medicare drug benefit (“creditable”). You may pay a penalty if you do not enroll in a Medicare private drug plan when you are first eligible. If you do enroll in the Medicare drug benefit, your plan must automatically remove the drug coverage from your benefits and adjust your premium. Plans H, I and J will no longer be offered beginning June 1, 2010. If you purchased one of these plans you can usually keep it for as long as you would like, and your benefits will not change.
For more information, click on "Can I buy a Medigap plan with drug coverage?" in the GO TO box.
Under national law, you only have the right to buy a Medigap policy at certain times. All states must give people with Medicare, at minimum, the purchase protections offered under federal law. A few states, like New York and Connecticut, give you much broader protections. Your rights are different depending on whether you are at least 65 years old or under 65. It is important to know when you have the right to buy a Medigap policy. If you miss your window of opportunity, your costs may go up or insurers may refuse to sell you any Medigap at all.
For exact rules and protections in your state, contact your State Health Insurance Assistance Program (SHIP) or Department of Insurance.
To learn when you have the right to buy a Medigap policy under federal rules, click on the link in the GO TO box.
Note: If you bought a supplemental insurance policy before 1992, it may be different than the standardized plans assigned letters, described above. Some of these plans have drug coverage, some of it creditable. If you have one of these plans, you may be able to renew it (but plans are not required to grant a renewal). You will have the right to buy a new standardized Medigap within 63 days of losing your old supplemental insurance plan.
To learn more about Medigap policies in your state, call your State Department of Insurance or your State Health Insurance Assistance Program (SHIP).
Click on the links in the LINKS box to find contact information for your State Department of Insurance or SHIP.
