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Section 2: The Parts of Medicare 
 

Medicare Supplement Insurance, aka Medigap

With original Medicare, this helps pay deductibles, copays, other out-of-pocket expenses


ESTIMATED READ TIME: 4 MINUTES

  

IN THIS ARTICLE

 

•  About Medigap
•  What Medigap does, doesn’t cover
•  What you pay for Medigap
•  How Medigap handles preexisting conditions
•  When should you sign up for Medigap?

About Medigap

 

If you sign up for parts A and B of original Medicare, also known as traditional Medicare, you can use any doctors or hospitals that accept Medicare payments. But you’ll still have out-of-pocket costs, such as deductibles, copayments and other expenses.

 

If you have retiree health insurance or Tricare military health care, that coverage may help fill in Medicare’s gaps. Otherwise, you can buy a Medicare supplement policy, better known as a Medigap policy, from a private insurer to help pay some of your out-of-pocket costs. If you choose a private Medicare Advantage plan, you won’t be eligible for Medigap.

 

Private insurers sell Medigap plans, but federal rules standardize the coverage. Insurers can offer up to 10 different plans, each labeled with a letter. Plans with the same letter include the same benefits, even if different insurance companies offer them. And they can have different premiums.

 

illustration of an umbrella with a plus sign next to it

What Medigap does, doesn’t cover

 

All Medigap plans fully or partially pay for:

 

  • Part A hospital coinsurance or copays
  • Part B coinsurance or copays for doctor visits and other outpatient services
  • 365 extra hospital days beyond Part A’s lifetime reserve days
  • First three pints of blood for transfusions
  • Hospice care coinsurance or copays

 

Medigap plans may also help pay for:

 

  • Part A deductible
  • Part A skilled nursing facility coinsurance. The first 20 days have no copay, but after that comes a $194.50 daily copay for each benefit period. Many Medigap plans cover all or part of that fee.
  • Part B deductible, but this coverage is not available for those newly eligible for Medicare in 2020 or beyond
  • Part B excess charges. You may have to pay up to 15 percent more if your doctor charges more than the Medicare-approved amount.
  • Cost of foreign travel emergency care up to plan limits

 

What Medigap doesn’t cover:

 

  • Long-term care
  • Prescription drugs, except for some plans sold before Jan. 1, 2006
  • Private-duty nursing
  • Routine dental exams, cleanings and X-rays
  • Routine eye exams and eyeglasses
  • Routine hearing tests and hearing aids
  • Days in a skilled nursing facility beyond the 100 days per benefit period covered in Part A

 

What you pay for Medigap

 

PREMIUM

 

Even though each lettered Medigap plan must provide the same coverage, insurers can charge different premiums for a policy that has the same letter. Generally, the more generous the coverage, the higher the premium. Pricing also can be different based on these three methods:

 

Attained-age policies base premiums on your current age, so the premiums will rise as you get older. They also can increase because of inflation.

 

Community-rated policies charge the same premium regardless of your age.

 

Issue-age policies base premiums on your age at the time of purchase. Premiums can increase because of inflation and other factors but not because of your age.

 

Although the premium for an attained-age policy may initially be lower than the others, it will increase over time. Also, some pricing types are not available in all states.

 

MEDIGAP coverage and costs

 

A dot • below means a plan covers 100 percent of your out-of-pocket costs; a blank means you pay the costs. Note that average premiums are higher for men than women because Medigap insurers tend to pay more for their claims.

 

Benefits and Costs Plans
A
B C1 D F1,2 G2 K3 L3 M N4
 Part A hospital coinsurance
 and up to 365 extra hospital days
 Part A deductible   50% 75% 50%
 Part B coinsurance
 or copayment
50% 75%
 Part B deductible                
 Part B excess charge                
 Blood, first 3 pints 50% 75%
 Emergencies during foreign
 travel, up to plan limits
    80% 80% 80% 80%     80% 80%
 Hospice care coinsurance
 or copayment
50% 75%
 Skilled nursing facility
 care coinsurance
    50% 75%
 Out-of-pocket limit N/A N/A N/A N/A N/A N/A $6,620 $3,310 N/A N/A
Average premiums for men5 $2,031 $2,452 $2,913 $2,283 $2,624 $2,138 $1,168 $1,945 $2,232 $1,963
Average premiums for women5 $1,832 $2,219 $2,641 $2,063 $2,370 $1,929 $1,176 $1,775 $2,025 $1,529

 

Source: Medicare.gov

1Plans C and F aren’t available to people newly eligible for Medicare after 2019.

2Plans F and G also offer a high‑deductible version in some states. You must pay Medicare-covered costs — coinsurance, copays and deductibles — up to the deductible amount, $2,490, before your plan starts paying.

3Plans K and L pay 100% after you reach your annual out-of-pocket limit and your Part B deductible.

4Plan N pays 100% of your Part B coinsurance, except for up to a $20 copay for emergency room visits that don’t result in inpatient admission.

N/A means not applicable.

Note: Massachusetts, Minnesota and Wisconsin have different standardized Medigap policies than the rest of the country.

5Average annual 2022 Medigap premiums for standard plans for people age 65 (Source: Weiss Ratings)

 

How Medigap handles preexisting conditions

 

Carefully consider the advantages and disadvantages of signing up for original Medicare versus Medicare Advantage. If you have a health problem now — or develop one later in life — and you have coverage through Medicare Advantage, it may be difficult to buy a Medigap policy if you want to switch to original Medicare.

 

After you sign up for Medicare Part B, you have six months to buy any Medigap policy in your area. If you want to sign up or switch policies after that, insurers in many states can refuse to sell you a policy or can charge you more because of preexisting conditions.

 

In certain circumstances, you have the right to buy a Medigap policy regardless of existing health problems. These include being enrolled in a Medicare Advantage plan that leaves the business or moving out of a plan’s service area.

 

When should you sign up for Medigap?

 

Whenever you’ve enrolled in parts A and B of original Medicare is the right time to explore your Medigap options — whether that’s during the seven-month initial enrollment period surrounding your 65th birthday or later.

 

The clock starts ticking on your six-month Medigap enrollment period the first day of the month you have Part B. During that time, you can’t be rejected for any Medigap policy sold in your area even if you have health problems, and you’ll get the best available rate.

 

Later, it won’t be as easy to buy a plan. Insurers can decide not to cover your preexisting conditions, charge you higher premiums or say no altogether.
 

    

Part D: Prescription Drugs