Medicare Supplemental Insurance Coverage

Medigap policies, also referred to as Medicare supplemental insurance plans, are policies which supplement or extend through gaps in original Medicare coverage, as set forth in Medicare Plan A (hospital insurance) and Medicare Plan B (medical insurance). Medicare supplemental insurance coverage is not a plan which add vision, dental, health and wellness, long-term care, or hearing insurance to original Medicare. Instead, these are plans which are simply extensions of the existing Medicare coverage. They may help you cover health care costs, such as deductibles, copayments, and coinsurance amounts. There are nine primary areas in Medicare supplemental insurance coverage:

  1. Medicare Part A Coinsurance and Hospital Stays
  2. Medicare Part B Coinsurance or Copayment
  3. Blood (the first three pints)
  4. Part A Hospice Care Copayment or Coinsurance
  5. Skilled Nursing Facility Care Coinsurance
  6. Medicare Part A Deductible
  7. Medicare Part B Deductible
  8. Medicare Part B Excess Charges
  9. Foreign Travel Emergency

These nine Medicare supplemental insurance coverage areas are combined in different ways in 14 different standard Medigap policies. The various Medicare-approved private insurance companies must offer the established standard coverage, but they can set differing prices on the same coverage. The standard policies are designated by the letters of the alphabet from A through N. Standard policies E, H, I, and J have been discontinued. If patients currently have them, they can continue to use them, but they are no longer being sold.

Available Supplemental (Medigap) Insurance Policies

  • Plan A – The Medicare supplemental insurance policy designated as A provides coverage for Medicare Part A coinsurance and hospital stays (up to 365 days after the Medicare Part A benefits are used), Medicare Part B coinsurance or copayment, blood (the first three pints), and Part A hospice care copayment or coinsurance.
  • Plan B – Medigap B policies cover all the areas the A policies do, as well as Medicare Part A deductible costs.
  • Plan C – The standard policies that go by the letter C have all the benefits of the B policies, plus Skilled Nursing Facility Care coinsurance, Medicare Part B deductible costs, and Foreign Travel Emergency (up to plan limits).
  • Plan D – The D Medigap policies have the same benefits as the C plans, but without coverage for Medicare Part B deductible costs.
  • Plan F – Medicare supplemental insurance coverage for the F plans includes 100% coverage for all nine categories of benefits. However, this comes with a high deductible. In 2012, patients with Medigap F policies have to meet a $2,070 deductible before the Medigap insurance pays anything at all.
  • Plan G – The Medigap plans designated as the letter G have eight of the nine areas of coverage. The only one that is missing is the Medicare Part B Deductible coverage.
  • Plan K – K policies cover 100% of Medicare Part A coinsurance and hospital stays (up to 365 days after the original Medicare benefits are used up), plus 50% of Medicare Part B Coinsurance or Copayment, blood (the first three pints), Part A Hospice Care Copayment or Coinsurance, Skilled Nursing Facility Care Coinsurance, and Medicare Part A Deductible costs. Plan K also has an out-of-pocket limit set at $4,660.
  • Plan L – These standard L policies cover 100% of Medicare Part A coinsurance and hospital stays (up to 365 days after the original Medicare benefits are used up), plus 75% of Medicare Part B Coinsurance or Copayment, blood (the first three pints), Part A Hospice Care Copayment or Coinsurance, Skilled Nursing Facility Care Coinsurance, and Medicare Part A Deductible costs. Plan K also has an out-of-pocket limit set at $2,330.
  • Plan M – The M policies provide Medicare supplemental insurance coverage for 100% of Medicare Part A Coinsurance and Hospital Stays, Medicare Part B Coinsurance or Copayment, Blood (the first three pints), Part A Hospice Care Copayment or Coinsurance, Skilled Nursing Facility Care Coinsurance, and Foreign Travel Emergency. It also covers 50% of the Medicare Part A Deductible.
  • Plan N – The Medigap N policies cover everything except for Medicare Part B Deductible and Medicare Part B Excess Charges. Part B Coinsurance is covered fully, except for some $20 copays for doctor visits and $50 emergency room copays.

The A-N designations for standard Medicare supplemental insurance coverage are the practice in almost all the states. However, Massachusetts, Minnesota, and Wisconsin use a different designation system. Massachusetts refers to two different plans: Core plan and Supplement 1 Plan. Minnesota has two plan options, the Basic Plan and the Extended Basic Plan. Wisconsin offers a Basic Plan with Optional Riders. If you live in these states, you can find more information about Medicare supplemental insurance coverage for each plan on the www.Medicare.gov website.

There is another type of Medigap policy called Medigap SELECT. These policies include a requirement that the patient use a network of hospitals and physicians in some states in order to receive full Medicare supplemental insurance coverage.

Supplemental Insurance Does Not Cover:

  • Additional coverage for Medicare Part C, Advantage Plans
  • Medigap premium
  • Part B premium
  • Services provided by private contract doctors or excess charges from non-assignment doctors.
  • Additional coverage for Medicare Part D, Prescription Drug Plans
  • Spousal insurance
  • SELECT Plans may require you to use certain doctors and providers and may not cover others.
  • Cannot be used as extra coverage for military, federal employee or any other private health plan.
  • Cannot be used with another Supplemental plan.
  • Generally does not work with Medicaid (some exceptions).
  • Most plans do not cover long-term care
  • Most plans do not cover outpatient drugs
  • Most plans do not cover vision, hearing or dental care
  • Most plans do not cover private-duty nursing