What Is Medigap

Published: Wednesday, July 25 2018
Last Updated: 3 months ago

Medicare Part A covers hospital insurance and Medicare Part B covers non-hospital medical services. Both have coverage of up to 80% of the cost of either category of services. Medicare recipients must then consider where they will get the funds for the 20% of medical costs that are not covered under these plans. That is where a Medicare Supplement Plan or Medigap insurance comes in.

What is Medigap (Medicare Supplement Plans)?

Medicare has 4 parts:

It also has 10 Supplemental Plans lettered A through N. Medicare Supplement Plans A and B are different than Medicare Parts A and B. Medicare supplemental plans are the same as Medigap plans—the terminology is interchangeable but the coverage for each Medicare supplemental plan is different. They are only available through private insurance companies and are meant to fill the “gaps” in coverage that exist between the Original Medicare Parts A and B.

What Is Medigap To A hospital Or Doctor?

It is a non-network plan that is accepted across the US by any doctor or hospital that accepts Medicare. There is also not a specific enrollment period for Medicare supplemental plans. You are simply eligible to pursue Medicare supplemental insurance the day after you have enrolled and been approved for the Original Medicare package of Parts A and B.

Do You Have To Pay Extra for Medicare Supplemental Plans?

Depending on which supplemental plans you choose, there is a separate premium for each one. These additional premiums are all based on the state, zip code and county that you reside in, whether you are female or male, and if you are a smoker. Pricing between insurance companies is competitive even though the same criteria is used to determine premium Medigap rates.

Are Medicare Supplement Plans Private?

Only Medicare plans A and B are entitlement programs available through the federal government. The Medicare supplemental plans are all purchased through private insurance companies. These private Medigap plans include the following:

  • Medicare Supplement Plans A through D
  • Medicare Supplement Plans F and G
  • Medicare Supplement Plans K through N

How Does a Medicare Supplement Plan Work?

Medicare Supplement plans work by filling in the gaps in the coverage provided by Original Medicare, or Medicare Part A and B. Coverage will vary between Medigap plans, but for the most part, your Medicare Supplement plan will cover out-of-pocket expenses you get stuck with.

Do You Need Medicare Part A and B?

In order for a plan to work, you need to have coverage first under both Medicare plans A and B or else the “gap” that a Medicare supplemental insurance needs to cover doesn’t actually exist.

Does Coverage Vary By Medigap Plan?

Each of the plans has its own unique coverage that is designed to eliminate specific gaps in coverage from the Original Medicare plans A and B. This includes at least 20% of leftover costs resulting in a hospital stay, doctor visit, or outpatient care. Hospital deductibles and emergency treatment are also covered under Medicare supplement plans. Each plan has its own standardized benefit to offer in one or more of these categories of care.

What Do Medigap Plans Cover?

Each of the 10 Medigap plans covers the following medical costs:

  • Medicare Supplement Insurance Plan A: This is not the same as Medicare Part A which is part of the “Original Medicare” coverage. This supplemental plan has minimal coverage compared to most of the other plans with coverage for the Original Medicare Parts A and B coinsurance, the first 3 pints of blood during hospitalization, and copays for hospice care.

  • Medicare Supplement Insurance Plan B: This supplement covers the same things as Medigap Plan A but additionally gives a policyholder coverage for the Original Medicare Part A deductible.

  • Medicare Supplement C Insurance: This is considered one of the more comprehensive Medicare supplemental insurance plans because it pays for all the deductibles, copays, and coinsurance costs under the Original Medicare Part A (for hospital services) and B (for outpatient and doctor visit services).

  • Medicare Supplement D Insurance: This Medigap is commonly confused with “Part D” which is Medicare prescription drug coverage. Medigap D is very much the same coverage as Medigap C with the only difference being that Medicare Supplement D does not cover the deductible amount for Original Medicare Part B.

  • Medicare Supplement F Insurance: This Medigap supplement is the most all-inclusive because it does not make any distinctions between what is not covered in the Original Medicare Parts A and B in terms of additional cost—it literally covers anything that is left in terms of the hospital, outpatient or doctor visit charges. This means it is the easiest to understand in terms of assessing your supplemental insurance coverage, and also the most popular Medigap coverage among Medicare recipients.

  • Medicare Supplement G Insurance: Medicare G Plan is most like the Medicare F supplement in that it covers everything that the F plan covers except the Original Medicare Part B deductible which is $183 as of 2018 federal pricing premiums. The following Medicare supplement plans have coverage based on a specific percentage:

  • Medigap Insurance Plan K: Although this plan covers all of the hospital costs incurred through coinsurance under Original Medicare Part A, the standard percentage of coverage for any other charges is 50%. Some costs beyond the 50% that are paid, are not covered at all. Because of the limited scope of coverage for this supplemental plan, many private insurance companies do not offer it.

  • Medigap Insurance Plan L: This plan is similar to supplemental plan K in that it covers 100% of the cost of Original Medicare Part A coinsurance, but its percentage of other covers increases to 75% with some of the additional charges also not being covered at all. This plan is rarely offered through private insurance as a supplemental to Original Medicare because it is also limited in the scope of its coverage for policyholders.

  • Medigap Insurance Plan M: This is a newer plan that has only been offered in the last eight years, and it was created so that Medicare recipients who are looking for a supplemental insurance to the Original Medicare Parts A and B can have 100% coverage on all categories of medical procedures under these plans. The excess charges incurred from Plan B as well as the $183 deductible are not covered though, but it does cover at least 50% of the Part A deductible if you have not put in enough work years and need to buy Part A yourself. As of 2018, this deductible is between $232-$422 per month depending on the coverage you chose.

Medigap coverage under the final of the ten Medigap plans gives the least amount of coverage for people who consider themselves in good health and in need of minimal supplemental coverage:

  • Medigap Insurance Plan N: For anyone who finds themselves over the age of 65 and still in relatively good health without having to visit the doctor too often, this plan is a solid choice for supplemental coverage. The deductible on Original Medicare Part B is not covered, nor are the excess charges that may result from outpatient care or doctors’ visits. There is also a cost-sharing component to the copays where the policyholder must pay $20 for every doctor visit and $50 when they go to the emergency at a hospital or urgent care center.

Travel outside of the US and Supplemental Coverage: All the Medicare supplemental plans with the exception of plans K and L offer overseas medical coverage of up to 80% for Medicare-approved medical services. An annual $250 deductible must be met in order for this percentage of coverage to be available. If you plan on traveling outside of the US for more than 60 consecutive days, then any medical emergency that occurs beyond this time will not be covered.

What is not Covered Under Medigap Insurance?

  • After 2006, Medicare supplemental insurance no longer offered prescription coverage because of the federal Medicare Part D program which offered prescription coverage to all Medicare participants.
  • If you have a Medicare Medical Savings Account Plan, you cannot legally obtain supplemental insurance coverage.
  • There is also no coverage for dental, vision, hearing aids, private nursing care either in the home or at a senior living facility.

Can You Switch Your Medicare Supplemental Insurance Plan?

In very specific cases only does the federal government allow supplemental policyholders to switch their coverage from one supplement to another, that is why it is so important to understand the specific coverage for each supplemental plan before choosing one. Some of the specific circumstances that may allow for switching coverage are the following:

  • You're still under the open enrollment time frame
  • You have very specific circumstances or what are called guaranteed issue rights

But, if you are under these types of circumstances, switching a plan can be much easier to do:

  • Moving out of state
  • A new supplemental policy is introduced that offers benefits, not in your current plan
  • Enrollment in a supplemental policy for less than six months and you have a pre-existing condition

Can You Drop Your Medicare Supplemental Plan?

Because a supplemental insurance policy is a guaranteed renewable policy and not dependent upon any assessment of new medical conditions, a private insurance company cannot cancel your policy. So, if you choose to discontinue your supplemental coverage, you must contact your insurance carrier and inform them that you would like to drop the policy.