Insurance companies may offer up to 10 different Medigap A Medigap is a supplemental health insurance policy that is sold by private insurance companies and works only with Original Medicare. Medigaps pay part or all of certain remaining costs after Original Medicare pays first. Depending on where you live and when you became eligible for Medicare, you have up to 10 different Medigap policies to choose from, each with a different set of standardized benefits. policies labeled A, B, C, D, F, G, K, L, M and N. Each lettered policy is standardized. This means that all policies labeled with the same letter have the same benefits, no matter which company provides them or their price. For example, Medigap policy A offered by company 1 provides exactly the same benefits as Medigap policy A offered by company 2. Companies are not required to offer all 10 standardized Medigap policies, meaning some may be unavailable in your state.
Note that Minnesota, Massachusetts, and Wisconsin have different ways of standardizing Medigap policies. If you live in one of these states, please contact your, State Health Insurance Assistance Program (SHIP) or State Department of Insurance for more information on purchasing a Medigap policy.
Medigaps help pay certain Medicare costs, including deductibles, coinsurance The coinsurance is the portion of the cost of care you are required to pay after your health insurance pays. Usually, it is a percentage of the approved amount or negotiated amount. In Original Medicare, the coinsurance is usually 20% of Medicare’s assignment. , and copays. Medigaps do not help pay for Medicare premiums. All policies must offer the following basic benefits:
- Hospital coinsurance coverage
- 365 additional days of full hospital coverage
- Full or partial coverage for the 20% coinsurance for provider See Health Care Provider. charges and other Part B services
- Full or partial coverage for the first three pints of blood you need each year
- Hospice Hospice is a program of end-of-life pain management and comfort care for those with a terminal illness. Medicare’s hospice benefit includes inpatient care and outpatient care, respite care, prescription drugs, counseling, and social services. coinsurance for drugs and respite care Respite care provides relief for caregivers of hospice patients by arranging a brief period (up to five days) of inpatient care for the patient. Medicare only covers respite care under the hospice benefit.
Beyond these basic benefits, each standardized Medigap covers a different amount of your Medicare cost-sharing Cost-sharing is the portion of medical care costs that you pay yourself, such as a copayment, coinsurance, or deductible, if you have health insurance coverage. See also: Out-of-Pocket Costs. . Depending on which Medigap policy you choose, you can get coverage for additional expenses, including:
- Hospital deductible The deductible is the amount you must pay for health care expenses before your health insurance begins to pay. Deductible amounts can change every year.
- Skilled nursing facility coinsurance
- Part B deductible (Note: People eligible for Medicare on or after January 1, 2020 cannot purchase Medigaps that pay for the Part B deductible. See below for more information.)
- Emergency care outside the U.S.
- Preventive care Preventive care is care intended to prevent illness, detect medical conditions, and keep you healthy. Medicare Part B covers many preventive services, such as routine checkups, flu shots, and tests like prostate cancer screenings and yearly mammograms. that Medicare does not cover
- Excess physician’s charges (some Medigaps will pay the limiting charge A limiting charge is the amount above the Medicare-approved amount that non-participating providers can charge. These providers accept Medicare but do not accept Medicare’s approved amount for health care services as full payment. They can charge up to 15% more than the Medicare-approved amount, which you pay in addition to the 20% coinsurance. Some states restrict the limiting charge further. For example, in New York providers can only charge 5% more instead of 15% for most services. Providers who opt out of Medicare are not subject to these limiting charges and can charge as much as they want, if they maintain their opt-out status and give the patient a private contract that meets Medicare’s rules. , which is the amount above the Medicare-approved amount See Approved Amount. that non-participating doctors can charge).
Medigap policy A is often the least expensive, but it only covers the basic benefits listed above. Policies C and F are the most comprehensive, but they generally cost more. See the Medigap Plan Benefits Chart for a fuller explanation of what each policy covers. Please note that this information is only applicable to plans sold beginning June 1, 2010.
Medigap Plans C and F
Medigap Plans C and F are only available to you if you became eligible for Medicare before January 1, 2020. This is because people eligible for Medicare on or after January 1, 2020 cannot purchase Medigaps that pay the Part B deductible.
If you became Medicare-eligible before this date, you will still be able to purchase Plan C or Plan F. If you were eligible for Medicare before this time but did not enroll, you will be able to purchase Plan C or Plan F as long as you are within your Medigap open enrollment period or have a guaranteed issue right once you enroll in Original Medicare Original Medicare, also known as Traditional Medicare, is the fee-for-service health insurance program offered through the federal government, which pays providers directly for the services you receive. Almost all doctors and hospitals in the U.S. accept Original Medicare. . If you currently have Medigap Plan C or Plan F, you can continue to renew it from insurers in your state.
Policies sold before June 1, 2010
Keep in mind that policies sold today have slightly different benefits from those offered before June 1, 2010. Also, policies E, H, I, and J are no longer sold. If you bought your Medigap before June 1, 2010, and have a discontinued policy, you can keep it as long as you like. The insurance company must continue to renew the discontinued Medigap policy each year you wish to keep it.
See the Medigap Plan Benefits Chart for plans purchased between July 31, 1992, and May 31, 2010 for more information on your Medigap policy’s coverage.