Carriers

Search by State

Types of Coverage

Health Plans

Health News

Articles & Research

Get a Quote

Over 65 and Looking for Health Insurance?

Health Insurance Options - Overview The Original Medicare Plan Medicare Part D Medicare Advantage Plans Other Medicare Options Long Term Care Joining and Switching Plans Other Insurance Options Senior Health Carriers Glossary

Enter Your Zip Code Below to Learn More: Are you over the age of 65? Yes No

Medicare Supplements - Medigap

Medicare does not cover all of your health care costs. For details on what costs are not covered, please see our table on Projected Medicare Costs. In general, you will end up paying for deductibles, for amounts above what Medicare agrees to pay, and for all services Medicare doesn’t cover. These include expenses such as an extended hospital stays, emergency care while traveling outside the United States, and certain kinds of in-home care (such as help with cooking, bathing and cleaning).

To fill in these “gaps” in your health coverage, you might want to buy a Medigap policy. Medigap plans—also called Medicare Supplement Insurance—are offered by private companies that have been specially approved by Medicare. They must follow federal and state laws. Anyone who is enrolled in Medicare Parts A or B is eligible to purchase a Medigap plan. It’s a good idea to enroll as soon as possible—during the first six months after you turn 65—since waiting might mean you are denied coverage.

The cost of a Medigap plan depends on its benefits. The more comprehensive the coverage, the higher the monthly cost to you. None of the Medigap plans cover long-term care to help you eat, bathe or dress; private nursing; dental or vision care; or hearing aids.

Request a free online quote from Health Insurance Carriers offering Medigap coverage in your area >>

Return to the Original Medicare page >>

 

In most states, there are 12 standardized Medigap policies. Massachusetts, Minnesota and Wisconsin follow different guidelines. If you live in one of these states, check with your state insurance department. The plans are titled A through L, offering generally increasing coverage as you move up the alphabet. We’ll explain the basics of the plans below.

Each of the 12 Medigap Plans (A-L) fills different “gaps” in the Medicare coverage. The plan that’s right for you will depend on your particular situation. Do you, for example, plan to travel outside the country? If so, you may want to choose a plan (C through J) that covers emergency care outside the U.S.

Another consideration is cost. In general, the more services a plan covers, the more you will pay in your premium each month.

The most basic Medigap plan (not surprisingly) is Plan A. Every other plan must offer the same basic elements that Plan A offers, plus additional benefits. Please refer to the table below for a side-by-side feature comparison.

 

Plan A
Under Medicare, you pay $256 per day for hospital stays over 60 days.  Plan A (and all the other plans) covers the cost of a hospital stay from days 61 to 150. There is also once-in-a-lifetime coverage for days 150 to 365.

Once you’ve paid your deductible, all the plans covers the remaining portion (20%) of your doctor’s services not paid by Medicare. They also cover the remaining portion (50%) of mental health services.

All of the Medigap plans pay for the first three pints of blood for a transfusion. (Medicare covers any additional blood.)

Return to Top of Plan Descriptions >>

 

Plans B-J
Plans B through J cover your deductible for a hospital visit. This amount is $1024 in 2008.

Return to Top of Plan Descriptions >>

 

Plans C-J
Should you require a stay in a skilled nursing home, Medicare requires you pay $128 per day (in 2008) for each day over 20. Plans C to J cover this amount for days 21-100.

Return to Top of Plan Descriptions >>

 

Plans C,F and J
These plans cover your Medicare Part B deductible. For 2008, this is $135.

Return to Top of Plan Descriptions >>

 

Plans F, I and J
Medicare tells doctors (“assigns”) how much it will pay for any given service. Some doctors charge more than Medicare assigns. When a doctor does not “accept assignment” in this way, you the patient must pay the difference. Plans F, I and J pay 100% of this additional charge.

Return to Top of Plan Descriptions >>

 

Plan G
Plan G covers a little less—80%—of  charges from doctor who doesn’t “accept assignment”

Return to Top of Plan Descriptions >>

 

Plans D, G, I and J
Medicare covers at-home care only if it is “skilled,” such as changing a sterile dressing. Sometimes a patient needs time to recover at home with everyday assistance, such as cooking, help with bathing or using the bathroom. Medicare does not cover such “custodial” care.

Plans D, G, I, and J do offer some coverage for at-home care. The patient must receive skilled home health as well. The custodial care is available for up to eight weeks after the skilled care has ended. There is a $40 limit per visit, with a $1,600 yearly maximum.

Return to Top of Plan Descriptions >>

 

Plans E and J
These plans cover up to $120 per year of preventive care, such as routine check-ups or hearing tests.

Return to Top of Plan Descriptions >>

 

Plans H, I and J
These plans used to offer a variety of prescription drug coverage. Since Medicare has changed its coverage in this area as of January 1, 2006, check with your insurance company and with Medicare to find the best coverage for you.

Return to Top of Plan Descriptions >>

 

Request a free online quote from Health Insurance Carriers offering Medigap coverage in your area >>

Return to the Original Medicare page >>

 

How Medigap works

When you see a doctor or go to the hospital, the bill first goes to Medicare, then to your Medigap insurance company. The amount your Medigap pays depends on which policy you have chosen. Finally the portion of the bill, if any, that is not covered by either policy comes to you.

Each month, you will pay your Part B premium and a separate premium to the company that offers your Medigap insurance.

As of January 2006, Medicare offers prescription drug coverage. This was previously handled through Medigap insurance. If you already have a Medigap plan that offers drug coverage, you may save money by switching to the Medicare plan. Please refer to Medicare Prescription Coverage or consult Medicare directly for more information.

 

What if I can’t afford a Medigap policy?

As with other areas of Medicare, there is help available for anyone with income or savings. For more information, please see Help for People with Limited Income and Resources.

 

Click any Benefit or Plan to Highlight. Clicking the upper left cell clears the highlighting.

	A	B	C	D	E	F	G	H	I	J	K	L
Hospital stay costs for days 61-150	*	*	*	*	*	*	*	*	*	*	*	*
Once in lifetime hospital stay costs for days 150-365	*	*	*	*	*	*	*	*	*	*	*	*
20% of doctor's services unpaid by Medicare (after deductible)	*	*	*	*	*	*	*	*	*	*	*	*
50 % of mental health services unpaid by Medicare (after deductible)	*	*	*	*	*	*	*	*	*	*	*	*
First 3 pints of blood	*	*	*	*	*	*	*	*	*	*	*	*
Hospital deductible ($1024 in 2008)		*	*	*	*	*	*	*	*	*
Skilled Nursing Home - your share of bill for days 21-100 ($119/day)			*	*	*	*	*	*	*	*
Foreign Travel emergency care (80%, after $250 deductible, up to a limit)			*	*	*	*	*	*	*	*
Part B deductible ($135 in 2006)			*			*				*
100% of charges from doctor who doesn't "accept assignment"						*			*	*
80% of charges from doctor who doesn't "accept assignment"							*
At-home "non-skilled" assistance (with certain limitations*)				*			*		*	*
Preventive care, such as routine check-ups (limited to $120/year)					*					*
Used to offer Prescription Drug coverage.								*	*	*

*limitations of at-home care coverage
Patient must be receiving skilled home health care that is covered by Medicare
Non-skilled available for 8 weeks after skilled care has ceased.
Limit to $40 per visit, seven visits per week ($1,600/ year limit)

 

Request a free online quote from Health Insurance Carriers offering Medigap coverage in your area >>

Return to the Original Medicare page >>