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Medicare Supplement Plans (Medigap)

How does Medigap work?

Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. Medicare Supplement Insurance (Medigap) policies sold by private companies, can help pay some of the remaining health care costs for covered services and supplies, like copayments, coinsurance, and deductibles. Some Medigap policies also offer coverage for services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S. Generally, Medigap doesn’t cover long-term care (like care in a nursing home), vision or dental services, hearing aids, eyeglasses, or private-duty nursing.

Medigap plans are standardized

Medigap plans 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 plan, identified in most states as plans A – D, F, G, and K – N. What that means is that Plan G from Companies A, B & C must all offer the exact same basic benefits. However, there can be differences in premiums. Some plans offer additional benefits such as discounts for dental or vision, so you can choose which one meets your needs.

How do I compare Medigap plans?

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 copayment100%100%100%100%100%100%50%75%100%100%
Blood (first 3 pints)100%100%100%100%100%100%50%75%100%100%
Part A hospice care coinsurance or copayment100%100%100%100%100%100%50%75%100%100%
Skilled nursing facility care coinsurance100%100%100%100%50%75%100%100%
Part A deductible100%100%100%100%100%50%75%50%100%
Part B deductible100%100%
Part B excess charges100%100%
Foreign travel emergency (up to plan limits)80%80%80%80%80%80%
Out-of-pocket limit in 2021**$6,220$3110
* Plans F and G also offer a high-deductible plan in some states. With this option, you must pay for Medicare-covered costs (coinsurance, copayments, and deductibles) up to the deductible amount of $2,370 in 2021 before your policy pays anything. (You can’t buy Plans C and F if you were new to Medicare on or after January 1, 2020. See previous page for more information.) ** For Plans K and L, after you meet your out-of-pocket yearly limit and your yearly Part B deductible ($203 in 2021), the Medigap plan pays 100% of covered services for the rest of the calendar year. ***Plan N pays 100% of the Part B coinsurance. You must pay a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don’t result.

What else should I know about Medigap?

  1. You must be enrolled in Original Medicare Parts A & B. You must continue to pay Original Medicare Part B premium ($170.10 for 2022) and Part A premium (if you do not qualify for a premium-free Pat A).

  2. You will have a monthly premium that is paid to a private insurance company.

  3. Medigap, which is the same as Medicare Advantage plans, only cover one person. Spouses need a separate plan.

  4. You will need a separate Prescription Drug plan because Medicare Supplement plans do not include drug coverage.

  5. All Medigap policies must provide the same coverage, but insurance companies are allowed to charge different premiums.

  6. The best time to buy a Medigap policy is during your open enrollment when you are first eligible at age 65. This is the only time you are eligible with no health questions being asked. You may not be able to get it at a later date because of pre-existing health conditions or it my cost more.

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