August 2019: Medigap Plans

What are Medigap Plans?

Medigaps are health insurance policies that offer standardized benefits to work with Original Medicare (not Medicare Advantage). They are sold by private insurance companies. If you have a Medigap, it pays part or all of certain remaining costs after Original Medicare pays first. Medigaps may also cover health care costs that Medicare does not cover at all, like care received when traveling abroad.

Remember, Medigaps only work with Original Medicare. If you have a Medicare Advantage Plan, you cannot buy a Medigap. 

Some costs are covered by all Medigaps. These include:

  • Part A hospital coinsurance. All Medigap policies pay for the Part A hospital daily coinsurance charge for days 61 through 90 that you spend as a hospital inpatient during a benefit period, as well as the daily coinsurance charge for up to 60 hospital inpatient lifetime reserve days. All Medigap policies also cover the full cost of 365 additional inpatient hospital days during your lifetime.
  • A benefit period is the way that Original Medicare measure your use of inpatient hospital and skilled nursing facility (SNF) services. Your benefit period begins the day you are admitted to the hospital as an inpatient and ends when you have been out of a hospital or SNF for more than 60 consecutive days.
  • Part B coinsurance. All Medigaps pay for the 20% coinsurance for Medicare-covered outpatient medical services, like x-rays, durable medical equipment, and doctor’s visits. The Medigaps that cover a portion, but not all, of the Part B coinsurance (Plans K, L, and N) will pay the entire Part B coinsurance for certain preventive services that Medicare does not cover at 100%. For example, glaucoma screenings are preventive services that Medicare covers at 80% of its approved rate. If you have Medigap Plan N, it will cover the full 20% coinsurance for that service when you receive it from a provider who accepts assignment. 
  • First three pints of blood. All Medigaps pay for part or all of the cost of your first three pints of blood. 
  • 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, 2010. Respite care is care you receive as a hospital inpatient while your usual caregiver rests. 

Some Medigaps cover all or part of the following costs:

  • Part A skilled nursing facility (SNF) coinsurance. Some Medigaps pay for your SNF coinsurance charge 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 Medicare providers. These providers do not take assignment, which means they do not agree to accept the Medicare-approved amount for services as payment in full. Non-participating 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 care abroad during the first two months of your trip, up to a lifetime limit of $50,000, after you meet a deductible.

Choosing a Medigap Plan

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. Four other plans (E, H, I and J) stopped being sold to new members in 2010, but some people still have these plans. Each lettered plan pays for a certain set of benefits. The benefits are the same no matter which company sells the plan.

Listed below are things you should consider when choosing a Medigap plan. Note: Massachusetts, Minnesota, and Wisconsin have different Medigap plans.

Plan A offers the most basic coverage, covering a core set of coverage gaps. 

Plan F is the most comprehensive Medigap. Plan F covers all Medigap benefits. Plans C and G are also very comprehensive. 

Plans K and L only cover part of your Part B coinsurance. Both plans pay 100% of your coinsurance after you reach an out-of-pocket maximum. 

Medigap plans are guaranteed renewable. That means that as long as you pay the premium, you can keep your plan. However, premiums may change yearly. 

Shop around. Different insurance companies charge different premiums for the exact same plan. 

If you’d like more information on Medigap plans, you can contact Connexion Insurance Solutions at the number below.