Your Guide to Medigap
Medicare Supplement Insurance, or Medigap, pays for some of the costs that Medicare doesn’t cover. For help with copayments, coinsurance, and/or deductibles, you may want to look into getting a Medigap policy. In order to be eligible for Medigap, you must already have Medicare Part A and Medicare Part B. All standard Medigap plans will pay for Part A coinsurance and hospital costs for up to an additional year after your Medicare benefits are used up, but each plan offers different benefits.
There are ten standard Medigap plans, and insurance companies can choose which policies they would like to sell (although, if they do offer a Medigap policy, they must offer Plan A as well as Plan C or F). Our guide below goes through each of the standard Medigap plans, so you can decide which one is right for you.
Plan A – This Medigap plan covers all of your Part B coinsurance or copayments, as well as your Part A hospice care coinsurance or copayments. If you need a blood transfusion, it covers the cost of the first three pints of blood. It doesn’t cover your Part A or Part B deductibles, or the coinsurance for skilled nursing facility care. Medicare Supplement Plan A is not to be confused with Medicare Part A. Medicare Supplement Plan A refers instead to coverage that supplements aspects of Part A and Part B.
Plan B – Plan B has all the benefits of Plan A, but it also covers your Part A deductible.
Plan D – Plan D covers your deductible for Medicare Part A, your coinsurance or copayment for Medicare Part B, and the coinsurance for the cost of care at a skilled nursing facility. It will pay for the first three pints of blood if you need a blood transfusion. If you’re travelling abroad and need emergency care during the first 60 days, Plan D covers 80% of those costs after you meet a deductible for the year. Medicare Supplemental Plan D is not the same as Medicare Part D. Medicare Supplemental Plan D is medical insurance that supplements Part A and Part B coverage, while Medicare Part D is prescription drug coverage that covers the costs associated with prescription medications.
Plan M – Plan M includes the same coverage as Plan D, but instead of covering all of your Part A deductible, it only covers 50%. It is generally considered the middle ground between the general benefits package provided by Medigap Plan A and the more robust Plan F.
Plan N – Plan N is identical to Plan D, except that you may need to pay a copayment of up to $20 for some office visits and up to a $50 copayment for visits to the emergency room that don’t result in inpatient admission.
Plan C – Plan C covers everything included in Plan D, as well as your Part B deductible. Plan C is one of the most “complete” of the ten standard Medigap plans. Out of them all, only Plan F offers more coverage.
Plan F – Plan F is the most comprehensive of the standard Medigap plans. It includes all of the benefits of Plans C and D, plus it covers any Part B excess charges. Medicare Part B excess charges can occur if the physician charges more than the Medicare-approved amount. Most doctors accept the approved amount for a service or a procedure, but some do not. If you have Plan F, these excess charges will be covered.
There is also a high deductible option for Plan F, so you can get this comprehensive coverage without paying a very high premium. If you choose the high-deductible option, you have to pay for Medicare-covered costs up to $2,180 before Plan F will pay anything.
Plan G – Plan G is nearly identical to Plan F. Both cover everything included in Plan D, as well as any Part B excess charges. However with Plan G, your Part B deductibles are not covered.
Plan K – Unlike the previous plans, Plan K only pays a portion of your costs. It covers 50% of your Part B coinsurance or copayment, 50% of your hospice care coinsurance or copayment, 50% of your skilled nursing facility care coinsurance, and 50% of the costs of your first three pints of blood. It also covers 50% of your Part A deductible. Plan K does not cover any of your Part B deductible. Plan K also differs from the other plans in that there is an out-of-pocket limit of $4,960. Once you have met this amount, as well as your yearly Part B deductible, Plan K pays for 100% of covered services for the rest of the year.
Plan L – Plan L is just like Plan K, except it covers 75% of the listed costs, rather than just 50%. The out-of-pocket limit for Plan L is only $2,480, so once you’ve met your out-of-pocket limit and your yearly Part B deductible, covered services will be paid for by this plan for the rest of the year.
Medigap and Medicare insurance plans can be confusing, and it could take months for one person to sort through the hundreds of options available. Instead of spending your time searching online, making calls, and trying to compare all your options, call HealthMarkets. Our licensed insurance agents will work with you to find the Medicare Supplemental plan that’s right for your situation. And we do it all at no cost to you.