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Understanding Medigap Insurance

Medigap insurance (also known as Medicare Supplement Insurance) can help cover some of the out-of-pocket costs that Original Medicare leaves behind. 

Medigap insurance plans are sold by private insurers and work alongside your Original Medicare coverage. In fact, you must be enrolled in Original Medicare (Medicare Part A and Part B) to be eligible for Medigap insurance.

Medigap Coverage

Some of the out-of-pocket health care costs that Medigap insurance can help cover may include:

  • Coinsurance
    Medigap can help cover your Medicare Part A coinsurance for inpatient hospital stays that last longer than 60 days. All Medigap insurance plans also cover Medicare Part B coinsurance to a varying degree, which is typically a 20 percent charge for all Medicare-approved costs of services after your Medicare Part B deductible has been met.

  • Excess charges
    Some health care providers may charge more for services than Medicare will pay, leaving the “excess charges” to the beneficiary. Medigap plans can help cover Medicare Part B excess charges.

  • Deductibles
    Some Medigap insurance plans will pay your Medicare Part A deductible, which is $1,364 per benefit period in 2019. Some plans also cover the Medicare Part B deductible, which is $185 per year in 2019.

  • Hospice care costs
    Medigap insurance plans can help cover the coinsurance costs related to Part A hospice care.

  • Coinsurance for skilled nursing facility care
    Nursing care can be expensive, but some Medigap policies can help cover the out-of-pocket costs associated with these medical services.

Use the chart below to compare the basic benefits of each type of Medigap insurance plan.

Medicare Supplement Benefits A B C D F1 G K2 L3 M N4
Part A co-insurance and hospital costs
Part B co-insurance or co-payment 50% 75%
First 3 pints of blood 50% 75%
Part A hospice care co-insurance or co-payment 50% 75%
Co-insurance for skilled nursing facility     50% 75%
Medicare Part A deductible   50% 75% 50%
MedicarePart B deductible                
Medicare Part B excess charges                
Foreign travel emergency     80% 80% 80% 80%     80% 80%
1. Plan F offers a high-deductible plan. This plan requires you to pay a $2,300 deductible in 2019 before it covers anything.
2. Plan K has an out-of-pocket yearly limit of $5,560 in 2019. After you pay the out-of-pocket yearly limit and yearly Part B deductible, it pays 100% of covered services for the rest of the calendar year.
3. Plan L has an out-of-pocket yearly limit of $2,780 in 2019. After you pay the out-of-pocket yearly limit and yearly Part B deductible, it pays 100% of covered services
for the rest of the calendar year.
4. Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don’t result in an inpatient admission.

Buying a Medigap Insurance Plan

Thinking about purchasing a Medigap insurance policy? Here’s a list of additional details to consider:

  • Medigap insurance plans require a monthly premium that is in addition to your Medicare Part B premium.
  • Spouses need to purchase separate Medicare Supplement Insurance plans.
  • The federal government standardizes the basic benefits of Medigap insurance plans. For example, a Medigap Plan A policy will include the same basic benefits from one insurer to the other, no matter where it is sold.
  • Even if a health issue arises, you’ll be able to renew your Medigap insurance policy as long as you continue to pay your monthly premiums on time.
  • You cannot have a Medicare Advantage plan and a Medicare Supplement Insurance plan at the same time.
  • You need Medicare Part A and Part B in order to buy a Medigap plan.

The earliest — and best — time to purchase a Medigap insurance plan is during your Medigap open enrollment period. Your Medigap open enrollment period starts as soon as you are at least age 65 and are enrolled in Medicare Part B. Your open enrollment period only lasts for six months.

Speak with a licensed agent at --ms-tfn-- , or read through our Medigap Comparison Guide to learn more.

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