Medicare Supplement Basics
When you reach age 65, you are eligible to enroll in Medicare, our federal health insurance program. Sounds like your health insurance coverage gets simpler by this age, right? Well, not really. This governmental health insurance may not be comprehensive in covering all your health care costs, so you might want to consider buying Medicare supplement insurance as well.
Medicare supplement insurance — also referred to as a Medigap policy because it is used to fill in the gaps in your Medicare — is private health insurance designed to supplement Medicare. It helps pay your health care costs that Medicare does not pay, including copayments, coinsurance and deductibles.
There are many standardized Medicare supplement insurance plans and must follow federal and state laws designed to protect you. These various policies help you lower your out-of-pocket expenses and get more health insurance coverage. Medicare supplement insurance plans are neither connected with nor endorsed by the United States government or the federal Medicare program.
All policies offer the same basic benefits but some offer additional benefits, so you can choose which one meets your needs.
With one of our Medicare Supplement plans, you can choose the providers you want to see – no network restrictions, no referrals. You can see any provider anywhere in the United States and U.S. territories as long as the provider, doctor or hospital accepts Original Medicare. There are no network requirements.
Use your Medicare Part A and Part B covered benefits – then the policy covers your cost sharing amounts. You may have little to no out-of-pocket cost.
As a Medicare Supplement member, you do not need any of the following:
- No primary care provider (PCP)
- No referrals to see a specialist
- No prior authorization for services. If the service is covered by Original Medicare (Part A & B), then it is covered under your Medicare Supplement plan—your provider will always bill Original Medicare first and then bill your Medicare Supplement policy carrier.
Compare Medigap plans side-by-side
The chart below shows basic information about the different benefits Medigap policies cover.
No = the policy doesn’t cover that benefit
% = the plan covers that percentage of this benefit
N/A = not applicable
| Medigap Benefits | Medigap Plans | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| A | B | C | D | F* | G | K | L | M | N | |
| Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
| Part B coinsurance or copayment | Yes | Yes | Yes | Yes | Yes | Yes | 50% | 75% | Yes | Yes*** |
| Blood (first 3 pints) | Yes | Yes | Yes | Yes | Yes | Yes | 50% | 75% | Yes | Yes |
| Part A hospice care coinsurance or copayment | Yes | Yes | Yes | Yes | Yes | Yes | 50% | 75% | Yes | Yes |
| Skilled nursing facility care coinsurance | No | No | Yes | Yes | Yes | Yes | 50% | 75% | Yes | Yes |
| Part A deductible | No | Yes | Yes | Yes | Yes | Yes | 50% | 75% | 50% | Yes |
| Part B deductible | No | No | Yes | No | Yes | No | No | No | No | No |
| Part B Excess charge | No | No | No | No | Yes | Yes | No | No | No | No |
| Foreign travel exchange (up to plan limits) | No | No | 80% | 80% | 80% | 80% | No | No | 80% | 80% |
| Out-of-pocket limit** | N/A | N/A | N/A | N/A | N/A | N/A | $5,240 for 2018
$5,560 for 2019 |
$2,620 for 2018
$2,780 for 2019 |
N/A | N/A |
* Plan F also offers a high-deductible plan. If you choose this option, this means you must pay for Medicare-covered costs up to the deductible amount of $2,240 in 2018 ($2,300 in 2019) before your Medigap plan pays anything.
** After you meet your out-of-pocket yearly limit and your yearly Part B deductible, the Medigap plan pays 100% of covered services for the rest of the calendar year.
*** Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don’t result in inpatient admission.
Starting January 1, 2020, Medigap plans sold to new people with Medicare won’t be allowed to cover the Part B deductible. Because of this, Plans C and F will no longer be available to people new to Medicare starting on January 1, 2020. If you already have either of these 2 plans (or the high deductible version of Plan F) or are covered by one of these plans before January 1, 2020, you’ll be able to keep your plan. If you were eligible for Medicare before January 1, 2020, but not yet enrolled, you may be able to buy one of these plans.
For additional information, review “A Guide to Health Insurance for People with Medicare” developed jointly by the Centers for Medicare & Medicaid Services (CMS) and the National Association of Insurance Commissioners (NAIC) or “Medicare & You” the U.S. government Medicare handbook developed by CMS.
Who can Buy a Supplement policy?
What is not covered?
Please note that some Medicare Supplement plans may offer additional benefits or a discount program, which might include some from this list.