Coverage

What Does Medigap Insurance Cover?

Christian Worstell

by Christian Worstell | Published February 18, 2021 | Reviewed by John Krahnert

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.

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Medigap's 9 Benefit Areas

The nine benefit areas that Medigap insurance may cover include:

  • Medicare Part A coinsurance and hospital costs
    Potential savings in 2021 = Up to $371 per day for days 61-90 of a hospital stay and up to $742 per day thereafter.

  • Medicare Part B coinsurance or copayment
    Potential savings in 2021 = Up to 20 percent of the cost of services and products. 

  • First three pints of blood
    Potential savings in 2021 = Up to $150 per pint.

  • Medicare Part A hospice care coinsurance or copayments
    Potential savings in 2021 = 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 2021 = Up to $1,484 per benefit period.

  • Medicare Part B deductible
    Potential savings in 2021 = Up to $203 per year.

  • Medicare Part B excess charges
    Potential savings in 2021 = Up to 15 percent of the Medicare approved amount.

  • Skilled nursing facility care coinsurance
    Potential savings in 2021 = Up to $185.50 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.

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Medicare Supplement Benefits

Part A coinsurance and hospital coverage

Part B coinsurance or copayment

Part A hospice care coinsurance or copayment

First 3 pints of blood

Skilled nursing facility coinsurance

Part A deductible

Part B deductible

Part B excess charges

Foreign travel emergency

A B C* D F1* G1 K2 L3 M N4
50% 75%
50% 75%
50% 75%
50% 75%
50% 75% 50%
80% 80% 80% 80% 80% 80%

* Plan F and Plan C are not available to Medicare beneficiaries who became eligible for Medicare on or after January 1, 2020. If you became eligible for Medicare before 2020, you may still be able to enroll in Plan F or Plan C as long as they are available in your area.

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1 Plans F and G offer high-deductible plans that each have an annual deductible of $2,370 in 2021. Once the annual deductible is met, the plan pays 100% of covered services for the rest of the year. The high-deductible Plan F is not available to new beneficiaries who became eligible for Medicare on or after January 1, 2020.

2 Plan K has an out-of-pocket yearly limit of $6,220 in 2021. 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 $3,110 in 2021. 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 $50 copayment for emergency room visits that don’t result in an inpatient admission.

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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.

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