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Medicare Supplement (Medigap) Insurance
Do you have fairly frequent doctor or hospital visits? If so, you may already know that Medicare Part A and Part B come with out-of-pocket costs you have to pay. You might be able to save money with a Medicare Supplement plan. Medicare Supplement, or Medigap, plans fill in the “gaps” in coverage left behind by Original Medicare, Part A and Part B, such as deductibles, coinsurance, and copayments.
In 47 states, there are 10 standardized Medicare Supplement plans that are denoted by the letters A through N (plans E, H, I, and J are no longer sold). The private insurance companies offering these plans do not have to offer every Medicare Supplement plan, but they must offer at least Plan A. If an insurance company chooses to offer any Medicare Supplement plans in addition to Plan A, it must offer either Plan C or Plan F along with any other standardized Medicare Supplement plans it offers.
Please note that although the names may sound similar, the “parts” of Medicare, such as Part A and Part B, are not the same as Medigap Plan A, Plan B, etc.
Medicare Supplement plan coverage
Each Medicare Supplement plan offers a different level of coverage, but each lettered plan must include the same standardized benefits regardless of insurance company and location. For example, Medicare Supplement Plan G in Florida includes the same benefits as Plan G in North Dakota. Please note that if you live in Massachusetts, Minnesota, or Wisconsin, your Medicare Supplement insurance options are different than in the rest of the country. Medicare Supplement plans do not have to cover vision, dental, long-term care, or hearing aids, but all plans must cover at least a portion of the following basic benefits:
- Medicare Part A coinsurance costs up to an additional 365 days after Medicare benefits are exhausted
- Medicare Part A hospice care coinsurance or copayments
- Medicare Part B coinsurance or copayments
- First three pints of blood used in a medical procedure
Some plans include additional coverage. For example, Medicare Supplement Plan F, the most comprehensive standardized Medigap plan, carries the following additional benefits:
- Medicare Part A deductible
- Medicare Part B deductible
- Part B excess charges
- Part B preventive care coinsurance
- Skilled Nursing Facility (SNF) care coinsurance
- Foreign travel emergency care (80% of Medicare-approved costs, up to plan limits)
Some plans may include additional innovative benefits.
Medicare Supplement plan enrollment and eligibility
To be eligible to enroll in a Medicare Supplement plan, you must be enrolled in both Medicare Part A and Part B. A good time to enroll in a plan is generally during the Medigap Open Enrollment Period, which begins on the first day of the month that you are both age 65 or older and enrolled in Part B, and lasts for six months. During this period, you have the guaranteed-issue right to join any Medicare Supplement plan available where you live. You may not be denied coverage based on any pre-existing conditions during this enrollment period (although a waiting period may apply). If you miss this enrollment period and attempt to enroll in the future, you may be denied coverage or charged a higher premium based on your medical history. In some states, you may be able to enroll in a Medigap plan before the age of 65.
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