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Medigap plans are supplemental insurance policies that
pay for some of the out-of-pocket costs that Medicare does not pay.
- The chart below does not include the Plans in Massachusetts, Minnesota,
and Wisconsin, which are different.
- Medigap Plans are required to be labeled A through N. These labeled
Plans must contain the same benefits regardless of which company sells them.
- The benefits listed on the left are covered by a Plan if the word "Yes"
is indicated below the Plan's label (below the A, B, etc.) If the Plan has a
blank box across from any benefit listed, then that Plan does not cover that
benefit.
- Since the labeled Plans below have the same benefits regardless of which
company sells it, this allows a comparison of premiums between
different insurance companies for the same Medigap Plan.
- Insurance companies do not have to sell all the Medigap Plans listed below.
| Updated on June 1, 2010 |
“Yes”
means the Plan includes this benefit for every company that sells the Plan |
| Medicare Benefits |
A |
B |
C |
D |
F 1 |
G |
K |
L |
M |
N |
Hospital co-pay for days 151- 365 and
Part B co-pay for preventive services after deductible has been paid |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
| Part B co-pay |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
50% |
75% |
Yes |
Yes 3 |
| Blood (first 3 pints) |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
50% |
75% |
Yes |
Yes |
| Hospice Care |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
50% |
75% |
Yes |
Yes |
| Skilled nursing co-pay for days 21-100 |
|
|
Yes |
Yes |
Yes |
Yes |
50% |
75% |
Yes |
Yes |
| Part A deductible |
|
Yes |
Yes |
Yes |
Yes |
Yes |
50% |
75% |
50% |
Yes |
| Part B deductible |
|
|
Yes |
|
Yes |
|
|
|
|
|
| Part B excess charges |
|
|
|
|
Yes |
Yes |
|
|
|
|
| Foreign travel emergency care. Covers 80% of cost for medically
necessary emergency care, after a $250 deductible. Expenses must occur
during first 60 days outside the U.S. up to a lifetime benefit of
$50,000 |
|
|
Yes |
Yes |
Yes |
Yes |
|
|
Yes |
Yes |
| Annual Out-of-Pocket Limit 2 |
|
|
|
|
|
|
$4,620 2 |
$2,310 2 |
|
|
1 Plan F also offers a less expensive
option that has a higher deductible before the Plan pays for anything.
2 For Plans K & L, after the annual out-of-pocket
limit (last line above) is met, the Plan pays for all other costs for the remainder of the
calendar year.
3 For Plan N, Part B co-pay is after $20
deductible for doctor
visits or after $50 deductible for emergency room visits.
| NOTE: Plans E, H, I, and J are not available any more. However, anyone who
has one of the plans may keep it. Contact your insurance company for more information. |
- There is a limited open enrollment period when Medicare eligible beneficiaries can enroll in Medigap
Plans regardless of pre-existing conditions. The open enrollment period is the
first 6 months after you become eligible for Medicare Part B.
- Medigap Plans and traditional Medicare coverage don't cover eye exams, eyeglasses, hearing aids, or
dental care. However, some Medicare approved HMOs may cover some of these.
- Medicare and Medigap Plans don't cover medical care received outside of the U.S.
unless listed above.
- Medicare and Medigap Plans don't cover long-term custodial care at home or in a nursing home.
Medicare fully covers 20 days of short-term skilled care in a skilled nursing facility, after
a hospital stay of 3 days or longer, and partially covers days 21 to 100.
There are long-term care (LTC)
insurance policies (separate from Medigap polices) which cover
care at home or in a nursing home. These policies have different limitations, such as:
- Some LTC policies pay cash once you meet eligibility requirements which can be
spent on the care of your choice.
- Other LTC policies only cover care in a specifically defined location.
- Most policies have an elimination or exclusion period during which the policy doesn't pay.
- There may be a waiting period between the time you sign-up and when the policy starts.
- Consider a rider to protect against inflation if the costs of care should rise.
- An insurance company's definition of a covered service may not mean what you think. Skilled
nursing home care, for example, is not the same as long-term or custodial nursing home care.
- Finally, some LTC policies require that the patient have a certain number of limitations
of everyday activities before it will pay.
Ask your insurance agent about the definition of each covered service, as well as,
how much the LTC policy costs.
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