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Medigap and Medicare Advantage are both coverage options for people with Medicare, but Medigap policies supplement original Medicare, while Medicare Advantage is a private insurance alternative to federally run Medicare. They’re very different, and their unique types of coverage can’t be combined.
Only those enrolled in original Medicare, which includes Part A hospitalization and Part B doctor and outpatient care, can purchase Medigap, also called Medicare supplement insurance. People choose to purchase Medigap to pay for some health care costs that Medicare doesn’t cover. While it’s not government run, federal rules standardize Medigap policies, which are sold through private insurers, to cover out-of-pocket Medicare expenses, such as deductibles and copayments.
Medigap insurers can offer up to 10 different plans, each labeled with a letter. See the table below for details. Plans with the same letter include the same benefits, even if different insurance companies offer them, but the premiums can vary widely.
What Medigap plans cover in part or in whole:
- 20 percent Part B coinsurance for physician visits and other outpatient services.
- Part A daily coinsurance for days 61 to 90 in the hospital for each benefit period; $408 a day in 2024.
- Part A daily coinsurance for up to 60 lifetime reserve days; $816 a day in 2024.
- Up to 365 additional days in the hospital in your lifetime after Medicare benefits are used up.
- First three pints of blood.
- Coinsurance costs for hospice care.
Some Medigap plans also cover:
- Part A hospital deductible: $1,632 per benefit period in 2024.
- Coinsurance costs for skilled nursing facilities: $204 for days 21 through 100 in 2024.
- Foreign travel emergencies.
You can go to any doctor who accepts Medicare — Medigap will fill in the gaps. But Medigap doesn’t cover prescription drugs, so if you have traditional Medicare and want drug coverage, you’ll need to get a stand-alone Part D prescription drug policy.
More on Medicare
Will Original Medicare Survive the Medicare Advantage Boom?
New enrollees increasingly opting for the private insurance alternative to the federally-run programUnderstanding Medicare’s Options: Parts A, B, C and D
Making sense of the alphabet soup of health care choicesHow Much Does Medicare Cost?
Monthly premiums, other out-of-pocket expenses can add up