Medicare

What Is Medigap Insurance and Are You Eligible?

Depending on the plan, Medigap policies may help patients cover out-of-pocket costs that are not covered by Medicare Part A and B.

What Is Medicare Supplement Insurance and Are You Eligible scaled

Also called Medicare Supplement, Medigap insurance plans help fill in the “gaps” in Original Medicare by covering a portion of the out-of-pocket costs left over after Medicare Part A and B coverage. The exact coverages depend on the type of plan that is purchased and which state you live in.

Medigap plans are offered by private insurance companies, but are standardized by the federal government, though some states have placed further guidelines on them, resulting in state-specific options and limitations. In general, Medigap insurers work with Original Medicare and each plan type offers the same benefits, even across insurers. In most states, Medicare supplement plans are named A through N. 

When looking into Medigap plans, you may also read about Medicare Advantage plans — also called Medicare Part C. Unlike Medigap, Medicare Advantage combines Parts A and B and may include Part D prescription coverage as well, rolling all healthcare coverage into a single plan with the exact coverages depending on the plan you choose. Medicare supplement insurance, on the other hand, is an addition to your existing Original Medicare plan. Keep in mind that Medigap policies only can be combined with Original Medicare and not Medicare Advantage. 

What Does Medigap Cover?

Medigap policies are standardized and identified by letters, and must follow federal and state guidelines. Common Medigap coverages include:

  • Copays: This is an out-of-pocket expense that patients must pay each time they receive medical care or a medical item, such as a prescription. It is generally a set amount, such as paying $20 every time you pick up medication under your Part D plan.
  • Coinsurance: This is the percentage of the cost of a service that you share with Medicare. With Part B, Medicare typically pays 80% and the patient pays 20%. 
  • Deductibles: This is the amount of money the patient must pay out of pocket for healthcare before Medicare starts paying for the costs. 
  • Hospitalization: With Part A, there’s a deductible that applies to each benefit period for inpatient care in a hospital setting. If you must remain in the hospital for more than 60 days, there is a per-day coinsurance that patients must cover out of pocket. 
  • Lab work: Doctors may order diagnostic tests for infection detection or disease screening. These lab tests are typically covered by Medicare if they are ordered by a Medicare-approved physician that accepts the Medicare assignment. 
  • Medical equipment: Durable medical equipment (DME), including blood sugar meters, hospital beds, crutches, walkers, and wheelchairs, may be covered by Medicare if a doctor prescribes it for use at home and it is medically necessary. 
  • Medical care outside of the United States: Medicare recipients who travel abroad can choose a Medigap plan that provides limited coverage for foreign travel emergency health care. If you need healthcare services while traveling outside of the United States, it’s important to understand that Original Medicare does not cover emergency healthcare services or supplies outside of the U.S. 

However, there are some things that Medicare supplement insurance typically does not cover, such as vision or dental care, eyeglasses, hearing aids, private-duty nursing, or long-term care. 

Types of Medigap Plans

There are a total of 10 Medigap plans, but 2 are no longer available to new enrollees unless you became eligible for Medicare before January 1, 2020, but chose not to enroll at that time. Insurance companies may not offer every plan, but they are required to offer Medigap Plan A if they offer any Medigap plans at all. 

BenefitsPlan APlan BPlan CPlan DPlan FPlan GPlan
K
Plan
L
Plan MPlan N
Part A coinsurance and hospital costs for up to 365 additional days after Medicare benefits are disbursedYesYesYesYesYesYesYesYesYesYes
Part B coinsurance or copaymentYesYesYesYesYesYes50%75%Yes100% coinsurance; but copays may still apply
Part A hospice care coinsurance or copaymentYesYesYesYesYesYes50%75%YesYes
Part A deductibleNot coveredYesYesYesYesYes50%75%50%​Yes
Part B deductibleNot coveredNot coveredYesNot coveredYesNot coveredNot coveredNot coveredNot coveredNot covered
Part B excess chargeNot coveredNot coveredNot coveredNot coveredYes100%Not coveredNot coveredNot coveredNot covered
Out-of-pocket limitN/AN/AN/AN/AN/AN/A$6,620 in 2022$3,310 in 2022N/AN/A
Blood (first three pints)YesYesYesYesYesYes50%75%YesYes
Skilled nursing facility care coinsuranceNot coveredNot coveredYesYesYesYes50%75%YesYes
Foreign travel exchange up to plan limitsNot coveredNot covered80%80%80%80%Not coveredNot covered80%80%
Source: Medicare.gov; accessed August 29, 2022

Plan A coverage

  • Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up: Yes
  • Part B coinsurance or copayment: Yes
  • Blood (first three pints): Yes
  • Part A hospice care coinsurance or copayment: Yes
  • Skilled nursing facility care coinsurance: Yes
  • Part A deductible: No
  • Part B deductible: No
  • Part B excess charge: No
  • Foreign travel exchange up to plan limits: No

Plan B coverage

  • Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up: Yes
  • Part B coinsurance or copayment: Yes
  • Blood (first three pints): Yes
  • Part A hospice care coinsurance or copayment: Yes
  • Skilled nursing facility care coinsurance: Yes
  • Part A deductible: Yes
  • Part B deductible: No
  • Part B excess charge: No
  • Foreign travel exchange up to plan limits: No

Plan C coverage

Plan C is no longer available to those who became eligible for Medicare on or after January 1, 2020. Those who were covered by Plan C before January 1, 2020, can keep their plan. If you were eligible for Medicare prior to January 1, 2020, but did not enroll, you may still be able to purchase Plan C. 

  • Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up: Yes
  • Part B coinsurance or copayment: Yes
  • Blood (first three pints): Yes
  • Part A hospice care coinsurance or copayment: Yes
  • Skilled nursing facility care coinsurance: Yes
  • Part A deductible: Yes
  • Part B deductible: Yes
  • Part B excess charge: No
  • Foreign travel exchange up to plan limits: Yes

Plan D coverage

  • Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up: Yes
  • Part B coinsurance or copayment: Yes
  • Blood (first three pints): Yes
  • Part A hospice care coinsurance or copayment: Yes
  • Skilled nursing facility care coinsurance: Yes
  • Part A deductible: Yes
  • Part B deductible: No
  • Part B excess charge: No
  • Foreign travel exchange up to plan limits: Yes

Plan F coverage

Plan F is no longer available to those who became eligible for Medicare on or after January 1, 2020. Those who were covered by Plan F before January 1, 2020, can keep their plan. If you were eligible for Medicare prior to January 1, 2020, but did not enroll, you may still be able to purchase Plan F. 

  • Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up: Yes
  • Part B coinsurance or copayment: Yes
  • Blood (first three pints): Yes
  • Part A hospice care coinsurance or copayment: Yes
  • Skilled nursing facility care coinsurance: Yes
  • Part A deductible: Yes
  • Part B deductible: Yes
  • Part B excess charge: Yes
  • Foreign travel exchange up to plan limits: 80%

Plan G coverage

  • Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up: Yes
  • Part B coinsurance or copayment: Yes
  • Blood (first three pints): Yes
  • Part A hospice care coinsurance or copayment: Yes
  • Skilled nursing facility care coinsurance: Yes
  • Part A deductible: Yes
  • Part B deductible: No
  • Part B excess charge: Yes
  • Foreign travel exchange up to plan limits: 80%

Plan K coverage

  • Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up: Yes
  • Part B coinsurance or copayment: 50%
  • Blood (first three pints): 50%
  • Part A hospice care coinsurance or copayment: 50%
  • Skilled nursing facility care coinsurance: 50%
  • Part A deductible: 50%
  • Part B deductible: No
  • Part B excess charge: No
  • Foreign travel exchange up to plan limits: No
  • Out-of-pocket limit: $6,620

Plan L coverage

  • Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up: Yes
  • Part B coinsurance or copayment: 75%
  • Blood (first three pints): 75%
  • Part A hospice care coinsurance or copayment: 75%
  • Skilled nursing facility care coinsurance: 75%
  • Part A deductible: 75%
  • Part B deductible: No
  • Part B excess charge: No
  • Foreign travel exchange up to plan limits: No
  • Out-of-pocket limit: $3,310

Plan M coverage

  • Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up: Yes
  • Part B coinsurance or copayment: Yes
  • Blood (first three pints): Yes
  • Part A hospice care coinsurance or copayment: Yes
  • Skilled nursing facility care coinsurance: Yes
  • Part A deductible: 50%
  • Part B deductible: No
  • Part B excess charge: No
  • Foreign travel exchange up to plan limits: 80%

Plan N coverage

  • Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up: Yes
  • Part B coinsurance or copayment: Yes
  • Blood (first three pints): Yes
  • Part A hospice care coinsurance or copayment: Yes
  • Skilled nursing facility care coinsurance: Yes
  • Part A deductible: Yes
  • Part B deductible: No
  • Part B excess charge: No
  • Foreign travel exchange up to plan limits: 80%

Medigap Plans for Those Living in Massachusetts, Minnesota, or Wisconsin

Though Medicare supplement insurance must offer federally standardized policy options, some states have slightly different plan setups. Massachusetts, Minnesota, and Wisconsin in particular structure some of their Medigap policies outside of the typical Plans A through N. Learn more about state-specific Medigap rules by contacting your state’s Department of Insurance.

Medigap in Massachusetts

Core plan covers: 

  • Basic benefits
  • 60 days per calendar year of inpatient days in mental health hospitals
  • State-mandated benefits

Supplement 1 plan covers: 

  • Basic benefits
  • Part A: inpatient hospital deductible
  • Part A: skilled nursing facility coinsurance
  • Part B: deductible
  • Foreign travel emergency
  • 120 days per calendar year of inpatient days in mental health hospitals
  • State-mandated benefits

Supplement 1A plan covers: 

  • Basic benefits
  • Part A: inpatient hospital deductible
  • Part A: skilled nursing facility coinsurance
  • Foreign travel emergency
  • 120 days per calendar year of inpatient days in mental health hospitals
  • State-mandated benefits 

Medigap in Minnesota

Basic plan includes basic benefits, plus:

  • Part A: skilled nursing facility coinsurance provides 100 days of care
  • 80% of foreign travel emergency
  • 50% of outpatient mental health
  • Medicare-covered preventive care
  • 20% of physical therapy
  • State-mandated benefits

Extended basic plan: 

  • Basic benefits plus
  • Part A: inpatient hospital deductible
  • Part A: skilled nursing facility coinsurance provides 120 days of care
  • Part B: deductible
  • 80% of foreign travel emergency 
  • 50% of outpatient mental health
  • 80% of usual and customary fees
  • Medicare-covered preventive care
  • 20% of physical therapy
  • 80% of coverage while in a foreign country
  • State-mandated benefits

Medigap in Wisconsin

Basic plan covers basic benefits, plus:

  • Part A: skilled nursing facility coinsurance includes 175 days per lifetime in addition to Medicare’s benefit of inpatient mental health coverage
  • 40 home health care visits in addition to those paid for by Medicare
  • State-mandated benefits

Cost-sharing plans: 

  • 50% and 25% cost-sharing plans are also available and are similar to Plans K and Plans L

Enrolling in Medigap

If you are eligible and enrolled in Medicare Part A and B, you can choose to purchase a Medigap policy. Open enrollment starts the first month you have Medicare Part B, or when you are 65 or older, and lasts for 6 months. If you choose a Medigap policy during your 6-month open enrollment period, you do not have to undergo a health exam to get coverage and you can maximize your choices.

While you can apply for a Medigap policy after your open enrollment period, you may be asked to go through a medical exam that includes a blood draw, urine sample, blood pressure test, and other basic health status measurements. Those with poor health may pay more for a policy or have a difficult time getting approved.  

What To Consider When Comparing Medigap Plans

Medigap doesn’t limit you to a specific network of healthcare providers, so choose a plan based on the amount of coverage it provides, your budget, and your lifestyle, keeping in mind that plan pricing varies. If you enroll during your Medigap open enrollment period, you don’t have to go through medical underwriting, which means that no matter your health status, your Medigap policy price is the same as someone with excellent health.

Medigap plans could help you minimize your out-of-pocket healthcare expenses so you can get affordable treatment for comprehensive healthcare during your retirement years. Medicare supplement plans may not be right for every situation, but understanding your options will help you decide whether this type of coverage could help you manage healthcare costs.