Medigap Outline

Medigap Policies

A Medigap policy is a health insurance policy sold by private insurance companies to fill "gaps" in Original Medicare Plan coverage. Every Medigap policy must follow federal and state laws designed to protect you, and they must be clearly identified as “Medicare Supplement Insurance.” Insurance companies can sell you only a “standardized” policy identified in most states by letters A through D, F through G, and K through N. All policies offer the same basic benefits, but some offer additional benefits so you can choose which one meets your needs. In Massachusetts, Minnesota, and Wisconsin, Medigap policies are standardized in a different way..

Choosing A Medigap Policy: A Guide To Health Insurance For People With Medicare

Outline of Medicare Supplement Coverage

(Benefit Plans A-N)

The chart below shows basic information about the different benefits that Medigap policies cover. If a percentage appears, the Medigap plan covers that percentage of the benefit, and you’re responsible for the rest. Some plans may not be available in your state as indicated below.

  A B C D F* G K L M N
 Medicare Part A Coinsurance and hospital costs (up to an additional 365 days after Medicare benefits are used) 100%100%100% 100% 100% 100% 100% 100% 100% 100% 
 Medicare Part B Coinsurance or Copayment 100%100%  100% 100% 100% 100% 50% 100% 100% 100%**
 Blood (First 3 pints) 100% 100% 100% 100% 100% 100% 50% 75% 100% 100%
 Part A Hospice Care Coinsurance or Copayment 100% 100% 100% 100% 100% 100% 50% 75% 100% 100%
 Skilled Nursing Facility Care Coinsurance   100% 100% 100% 100% 50% 75% 100% 100%
 Medicare Part A Deductible  100% 100% 100% 100% 100% 50% 75% 50% 100%
 Medicare Part B Deductible   100%  100%     
 Medicare Part B Excess Charges     100% 100%    
 Foreign Travel Emergency (Up to Plan Limits)   80% 80% 80% 80%   80% 80%
 Out-of-Pocket Limit       $4,960 $2,480  

*Plan F also offers a high-deductible plan in some states. If you choose this option, this means you must pay for Medicare-covered costs (coinsurance, copayments, and deductibles) up to the deductible amount of $2,180 in 2016 before your policy pays anything.

**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.

This web site may contain concepts that have legal, accounting and tax implications. It is not intended to provide legal, accounting or tax advice. You may wish to consult a competent attorney, tax advisor, or accountant.