Medicare Supplement (Medigap) Basics

In all but three states (Massachusetts, Minnesota, and Wisconsin), you can buy any one of up to 10 standardized Medigap policies (see chart below) that are sold in your state. Plan A is the “basic” benefit package and is included in all the other plans. Insurance companies must give you the benefits offered under each policy.

Federal law lets states allow an insurer to add “new and innovative benefits” to the benefits in a standardized policy. Check with your insurance company to find out if these benefits are available.

This chart shows basic information about the different benefits that Medigap policies cover. If a percentage appears, the Medigap plan covers that percentage of the benefit, and you must pay the rest. (This is only intended as a summary, contact us for specific information or www.medicare.gov)

Medicare Supplement Insurance (Medigap) Plans
Benefits A B C D F G K L M N
Medicare Part A coinsurance and hospital costs (up to an additional 365 days after Medicare benefits are used) 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Medicare Part B coinsurance or co-payment 100% 100% 100% 100% 100% 100% 50% 75% 100% 100% ***
Blood (first 3 pints) 100% 100% 100% 100% 100% 100% 50% 75% 100% 100%
Part A hospice care coinsurance or co-payment 100% 100% 100% 100% 100% 100% 50% 75% 100% 100%
Skilled nursing facility care coinsurance 100% 100% 100% 100% 50% 75% 100% 100%
Part A deductible 100% 100% 100% 100% 100% 50% 75% 50% 100%
Part B deductible 100% 100%
Part B excess charges 100% 100%
Foreign travel emergency (up to plan limits) 80% 80% 80% 80% 80% 80%
Part A deductible- $1316 for 2017 Out-of-Pocket Limit in 2017**
Part B deductible- $183 for 2017 $5,120 $2,560

* Plan F is also offered as a high‑deductible plan by some insurance companies in some states. If you choose this option, this means you must pay for Medicare‑covered costs (coinsurance, copayments, deductibles) up to the deductible amount of $2,200 in 2017 before your policy pays anything.

**For Plans K and L, after you meet your out‑of‑pocket yearly limit and your yearly Part B deductible ($183 in 2017), 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 an inpatient admission.

Medicare SELECT is a type of Medigap insurance policy. If you buy a Medicare SELECT policy, you are buying one of the 10 standardized Medigap plans A through N. With a Medicare SELECT policy you need to use specific hospitals and doctors to get full insurance benefits (except in an emergency). For this reason, Medicare SELECT policies generally have lower premiums.

If you do not use a Medicare SELECT provider for non-emergency services, you will have to pay what Medicare doesn’t pay. Medicare will pay its share of approved charges no matter what provider you choose. Medicare SELECT might not be offered in your state.

For more information on Medigap policies, you can either contact us with specific questions or go to www.medicare.gov, click on “Medigap Compare.”

As you shop for a Medigap policy, keep in mind that each company’s benefits are alike, so they are competing on service, reliability, and price. Compare premiums and make sure that the insurance company is honest and reliable before buying.
There are many situations when your health coverage changes (like losing your Medicare managed care plan or employer coverage) that can affect what Medigap policies you can buy and when. For more information on your rights to buy a Medigap policy in these situations, contact us.