A Medigap plan is supplemental coverage designed to pay for out-of-pocket Original Medicare costs, such as deductibles and coinsurances.

• What is Medigap?

Medicare supplement insurance policies, often called Medigaps, are health insurance policies that offer standardized benefits to work with Original Medicare (not with Medicare Advantage plans). If you have a Medigap, it pays part or all of certain cost-sharing gaps that remain after Original Medicare pays first. Medigaps help cover outstanding deductibles, coinsurance charges, and copayments, to varying degrees. Some Medigaps also cover health care costs that Medicare does not cover at all.

Depending on where you live, you have up to 10 different Medigap policies to choose from: A, B, C, D, F, G, K, L, M, and N (policies in Wisconsin, Massachusetts, and Minnesota have different names). Each policy offers a different set of standardized benefits that ranges from basic to more comprehensive. Standardization means that policies with the same letter name offer the same benefits. However, premiums can vary from company to company.

Some costs are covered by ALL Medigaps. These include:

• Part A hospital coinsurance: The daily coinsurance change for days 61 through 90 you spend as a hospital inpatient during each benefit period. All Medigap policies also cover the full cost of 365 additional inpatient hospital days during your lifetime.
• The Part B coinsurance: All Medigaps cover at least some part of the 20% coinsurance for Medicare-covered outpatient medical services and items, like x-rays, durable medical equipment, and doctors’ visits.
• The first three pints of blood, if you are hospitalized and the hospital needs blood for a medical procedure or blood transfusion.
• Part A hospice care coinsurance or copay: All Medigaps cover the full cost of hospice coinsurance charges and copays for hospice-related drugs and respite care, as long as the Medigap was purchased on or after June 1, 2020.

SOME Medigaps cover all or part of the following costs:

• Part A skilled nursing facility (SNF) coinsurance: Some Medigaps pay for your SNF coinsurance for all of your covered days in a benefit period.
• Part A deductible: Some Medigaps pay for your Part A inpatient hospital deductible, which is the amount you owe out of pocket at the beginning of a benefit period.
• Part B deductible: The Part B deductible is the amount you owe out of pocket before Part B begins to cover the cost of your outpatient care.
• Part B excess charges: Excess charges may only be charged by non-participating providers. These providers can charge up to 15% more than the Medicare-approved cost for services. If you have a Medigap that covers excess charges, your Medigap will reimburse you if you see a non-participating provider who bills for excess charges.
• Foreign travel: With very few exceptions, Medicare does not cover services you receive in a foreign country, but some Medigaps cover emergency health care when you are abroad. These Medigaps cover 80% of the cost of emergency health care abroad during the first two months of your trip, up to a lifetime limit of $50,000, after you meet a deductible.

Learn more and see the Medigap benefits comparison table

- More at Mass. Bulletin for People with Medicare comparison of Massachusetts’ Medicare supplement plans and listings of Massachusetts Providers.

 

• Who can buy a Medigap plan? -MGH Community News, September 2013

• Choosing a Medigap Policy
  • Choosing A Medigap Policy: A Guide To Health Insurance For People With Medicare
    Developed jointly by the Centers for Medicare & Medicaid Services (CMS) and the National Association of Insurance Commissioners
  • How to Choose a Medigap Policy
    Summary of article from ElderLaw News from ElderLawAnswers, March 2009

• Pre-existing Conditions- "No policy for medicare supplement insurance... may contain any waiting period or pre-existing condition limitation or exclusion." (MGL Chapter 176K: Section 3 )

• Massachusetts Division Of Insurance
  - Mass. Bulletin for People with Medicare Comparison of Medicare Supplement plans and listings of Massachusetts Providers.

• Case Flash:  Right to Purchase Medigap If/When Retiree Coverage Ends - MGH Community News, September 2008

• Medigap and Medicare D
  Medigap Plan H (along with Plans I and J) with drug coverage has not been sold since January 1, 2006, when the Medicare drug benefit (Part D) began. However, people who bought one of these Medigap plans with prescription drug coverage before that time, can keep the Medigap’s drug coverage.

  Medigap Plan H drug coverage is not considered “creditable coverage” - coverage that is as good as or better than the Medicare drug benefit. In most cases, people with Medicare who do not enroll in Part D when they are first eligible and do not have creditable coverage have to pay a premium penalty for enrolling late. However, there may be situations in which paying a penalty may still be financially beneficial if one's medication needs and/or the plans coverage has changed. (This plan type will not be available to new subscribers after June 1, 2010. See full article.)

• Medicare Advantage and Medigap
  If you join a Medicare Advantage Plan, your Medigap policy won’t work. This means it won’t pay any deductibles, copayments, or other cost-sharing under your Medicare Health Plan. Therefore, you may want to drop your Medigap policy if you join a Medicare Advantage Plan. However, you have a legal right to keep the Medigap policy. Note too that if you let your Medigap policy lapse and later decide to disenroll from Medicare Advantage you may not be able to purchase a Medigap policy. (More at Can I Buy a Medigap if Disenrolling from Medicare Advantage? MGH Community News, January 2015.)
• Medigap Changes
  • 2020 Medigap Changes- Iindividuals who are newly eligible for Medicare on or after January 1, 2020 will not be able to purchase Medigap Plan C or Plan F (including the Plan F high deductible option). For more information, see 2020 Medigap Changes- MGH Community News, April 2019
  • MGH Community News- March 2010, Several old plan types will no longer be sold, two new types will be added,and all new Medigap types will cover the cost sharing for all Part A Medicare eligible hospice care and respite care expenses.

• SHINE (Serving the Health Information Needs of Elders) -
  • SHINE Directory by Town A-Z.
• Program provides health insurance counseling services to elderly and disabled adults. SHINE counselors are trained to handle complex questions about Medicare, Medicare supplements, Medicare Health Maintenance Organizations, public benefits with health care components, Medicaid, free hospital care, prescription drug assistance programs, drug discount cards, and long-term health insurance.