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What is Medigap

Medigap

A Medigap policy is private health insurance that helps supplement Original Medicare. This means it helps pay some of the health care costs that Original Medicare doesn’t cover (like copayments, coinsurance, and deductibles). These are “gaps” in Medicare coverage. If you have Original Medicare and a Medigap policy, Medicare will pay its share of the Medicare-approved amounts for covered health care costs. Then your Medigap policy pays its share. A Medigap policy is different from a Medicare Advantage Plan (like an HMO or PPO) because those plans are ways to get Medicare benefits. In contrast, a Medigap policy only supplements the costs of your Original Medicare benefits. Note: Medicare doesn’t pay any of your expenses for a Medigap policy.

All Medigap policies must follow federal and state laws designed to protect you, and policies must be identified as “Medicare Supplement Insurance.” Medigap insurance companies in most states can only sell you a “standardized” Medigap policy identified by letters A through N. Each standardized Medigap policy must offer the same essential benefits, no matter which insurance company sells it. Cost is usually the only difference between Medigap policies with the same letter sold by different insurance companies.

In Massachusetts, Minnesota, and Wisconsin, Medigap policies are standardized in a different way. In some states, you may be able to buy another type of Medigap policy called Medicare SELECT. Medicare SELECT plans are standardized plans that may require you to see certain providers and may cost less than other plans.

What Medigap Policies Cover

This chart shows basic information about the different benefits that Medigap policies cover. If a percentage appears, the Medigap plan covers that use percentage, and you must pay the rest.

*Plan F is also offered as a high-deductible plan. With a high-deductible Plan F, you must pay for Medicare-covered expenses such as copays and deductibles up Plan deductible of $2,490 for 2022 before the policy pays anything.

*Plan N covers Basic Benefits after a $20 copay for office visits and a $50 copay for emergency room visits.

**Plans K and L pay 100% of hospitalization and preventive care Basic Benefits. All other Basic Benefits are paid at 50% for Plan K and 75% for Plan L. Once you reach the annual limit, the plan pays 100% of the Medicare copayments, coinsurance, and deductibles for the rest of the calendar year. The yearly out-of-pocket limit does NOT include costs from your provider that exceed Medicare-approved amounts (excess charges). For 2019, the out-of-pocket will be $6,220 for Plan K and $3,110 for Plan L.

  • Insurance companies selling Medigap policies are required to make Plan A available. If they offer any other Medigap policy, they must also offer either Medigap Plan C or Plan F.
  • Not all types of Medigap policies may be available in your state.
  • Plans D and G, effective on or after June 1, 2010, have different benefits than plans D or G bought before June 1, 2010.
  • Plans E, H, I, and J are no longer sold, but if you already have one, you can generally keep it.

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