August 2023: Medigap Policies
Medigap Policies
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.
Choosing a Medigap policy
Insurance companies may offer up to 10 different Medigap policies to choose from: A, B, C, D, F, G, K, L, M, and N. Each lettered policy is standardized. This means that all policies labeled with the same letter have the same benefits, no matter which company provides them, though prices vary. Note: Massachusetts, Minnesota, and Wisconsin have different Medigap plans.
Listed below are things you should consider when choosing a Medigap plan. Make sure to review the Medigap plan benefits chart on the following page for additional information.
- Plan A offers the most basic coverage, but it is often the least expensive.
- Plans F, C, and G are the most comprehensive Medigaps, but they generally cost more.
- Plans F and C are only available to you if you were eligible for Medicare before January 1, 2020.
- 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 policy.
Medigap policy benefits
For policies sold on or after June 1, 2010
| A | B | C* | D | F* | G | K | L | M | N | |
| Hospital copayment
Copays for days 61-90 ($400) and days 91-150 ($800) in hospital; Payment in full for 365 additional lifetime days. |
X | X | X | X | X | X | X | X | X | X |
| Part B coinsurance
Coinsurance for Part B services such as doctors’ services, laboratory and x-ray services, durable medical equipment, and hospital outpatient services. |
X | X | X | X | X | X | 50% | 75% | X | Except $20 for doctors visits and $50 for emergency visits |
|
First three pints of blood
|
X | X | X | X | X | X | 50% | 75% | X | X |
| Hospice care
Coinsurance for respite care and other Part A-covered services |
X | X | X | X | X | X | 50% | 75% | X | X |
| Skilled nursing facility (SNF) copay
Covers $200 a day for days 21-100 each benefit period. |
X | X | X | X | 50% | 75% | X | X | ||
| Hospital deductible
Covers $1,600 in each benefit period. |
X | X | X | X | X | 50% | 75% | 50% | X | |
| Part B annual deductible
Covers $226 (Part B deductible) |
X | X | ||||||||
| Part B excess charges
100% of Part B excess charges (Under federal law, the excess limit is 15% more than Medicare’s approved charge when provider does not take assignment) |
X | X | ||||||||
| Preventive care
100% of coinsurance for Part B-covered preventive care services after the Part B deductible has been met |
X | X | X | X | X | X | X | X | X | X |
| Emergency care outside the U.S.
80% of emergency care costs during the first 60 days of each trip, after an annual deductible of $250, up to a maximum lifetime benefit of $50,000. |
X | X | X | X | X | X |
Plans C and F are only available to you if you became newly eligible for Medicare before January 1, 2020. This chart doesn’t apply to Massachusetts, Minnesota, and Wisconsin. Those states have their own Medigap system.