What Does Medigap Insurance Cover?

Some expenses that Medigap insurance may cover include Medicare deductibles, copayments and coinsurance. In most states, there are 10 standardized Medigap plans to choose from, each providing a different variation of basic benefits to help cover certain Medicare out-of-pocket costs.

What Medigap Insurance May Cover

The nine benefit areas that Medigap insurance may cover include: coinsurance, copayments, deductibles, and excess charges. 

• Medicare Part A coinsurance and hospital costs
  Potential savings in 2025 = Up to $419 per day for days 61-90 of a hospital stay and up to $838 per day thereafter.
  
  
• Medicare Part B coinsurance or copayment
  Potential savings in 2025 = Up to 20 percent of the cost of services and products. 
  
  
• First three pints of blood
  Potential savings in 2025 = Up to $150 per pint.
  
  
• Medicare Part A hospice care coinsurance or copayments
  Potential savings in 2025 = Up to $5 for each prescription drug and 5 percent of the Medicare-approved amount for inpatient respite care.
  
  
• Medicare Part A deductible
  Potential savings in 2025 = Up to $1,676 per benefit period.
  
  
• Medicare Part B deductible
  Potential savings in 2025 = Up to $240 per year.
  
  
• Medicare Part B excess charges
  Potential savings in 2025 = Up to 15 percent of the Medicare approved amount.
  
  
• Skilled nursing facility care coinsurance
  Potential savings in 2025 = Up to $209.50 per day for days 21-100 of a stay.
  
  
• Emergency care outside of the U.S.

The first four benefits listed above are covered (at least in part) by all 10 Medigap plans. The other benefits may or may not be included, depending on which Medigap plan option you choose. 

Before purchasing a Medigap plan, make sure you understand which benefits are included. The following chart shows the basic benefits of all 10 standardized plans.

NOTE: In Massachusetts, Minnesota and Wisconsin, Medigap insurance plans are standardized differently.

Signing Up For Medigap Insurance

To be eligible for a Medigap policy, you must be at least 65 years old and enrolled in Medicare Part B. The best time to enroll in a Medigap policy is during your six-month Medigap open enrollment period.

• Failing to enroll in a Medigap plan during this time may result in higher monthly premiums or refusal of coverage.
  
  
• If you enroll in a Medigap insurance policy during your open enrollment period, insurance companies cannot use medical underwriting to determine the cost of your plan, regardless of your current health or health history.
  
  
• You cannot be enrolled in Medicare Advantage (Medicare Part C) and a Medigap plan. If you enroll in a Medigap plan while you are enrolled in Medicare Part C, you will lose your Medicare Part C coverage and be automatically enrolled in Original Medicare.

Have questions about what Medigap covers? Ready to start comparing quotes in your area? Connect with a licensed insurance agent to speak with someone who can help. Based in the United States, our agents are trained to help you find the right plan for your needs. 

Call 1-800-995-4219 today to speak with a licensed agent and learn more about your Medigap insurance options.