РусскийMedicare Supplements
Medigap is Medicare Supplement Insurance that helps fill “gaps” in Original Medicare (Part A, Part B) and is sold by private companies. Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. A Medicare Supplement Insurance (Medigap) policy can help pay some of the remaining health care costs, like:
Copayments
Coinsurance
Deductibles
Some Medigap policies also cover services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, here’s what happens:
Medicare will pay its share of the Medicare-Approved Amount for covered health care costs.
Then, your Medigap policy pays its share.
A Medigap policy is different from a Medicare Advantage Plan. Those plans are ways to get Medicare benefits, while a Medigap policy only supplements your Original Medicare benefits.
You may want a completely different Medigap policy (not just your old Medigap policy without the prescription drug coverage). Or, you might decide to switch to a Medicare Advantage Plan that offers prescription drug coverage. If you decide to drop your entire Medigap policy, you need to be careful about the timing. If you still have questions, feel free to give us a call at 616-600-8444 or fill out a “Contact Us” form in the right top of the page or “Get Help Now” in the left corner of the page. We will gladly make Medicare easy for you.
Four things to know about Medigap policies
1. You must have Medicare Part A and Part B.
2. A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you’ll each have to buy separate policies.
3. Any standardized Medigap policy is guaranteed renewable even if you have health problems. This means the insurance company can’t cancel your Medigap policy as long as you pay the premium.
4. Some Medigap policies sold in the past cover prescription drugs. But, Medigap policies sold after January 1, 2006 aren’t allowed to include prescription drug coverage. If you want prescription drug coverage, you can join a Medicare Prescription Drug Plan (Part D). If you buy Medigap and a Medicare drug plan from the same company, you may need to make 2 separate premium payments. Contact the company to find out how to pay your premiums.
What policies are available?
Every Medigap policy must follow federal and state laws designed to protect you, and it must be clearly identified as “Medicare Supplement Insurance.”
All policies offer the same basic benefits but some offer additional benefits, so you can choose which one meets your needs. In Massachusetts, Minnesota, and Wisconsin, Medigap policies are standardized in a different way.
As of January 1, 2020, Medigap plans sold to new people with Medicare aren’t allowed to cover the Part B deductible. Because of this, Plans C and F are not 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.
How to compare Medigap policies
The chart below shows basic information about the different benefits Medigap policies cover.
% = the plan covers that percentage of this benefit
The Medigap policy covers coinsurance only after you’ve paid the deductible (unless the Medigap policy also pays the deductible).
| 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 | 100% | 100% | 100% | 100% | 100% | 100% | 100% | 100% | 100% | 100% |
| Part B coinsurance or copayment | 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 copayment | 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 charge | 100% | 100% | ||||||||
| Foreign travel exchange (up to plan limits) | 80% | 80% | 80% | 80% | 80% | 80% | ||||
| Out-of-pocket limit (2021)*** | ||||||||||
| $5,880 | $2,940 | |||||||||
* Plans F and G also offer a high-deductible plan in some states. With this option, you must pay for Medicare-covered costs (coinsurance, copayments, and deductibles) up to the deductible amount of $2,340 in 2020 ($2,370 in 2021) before your policy pays anything. (Plans C and F aren’t available to people who were newly eligible for Medicare on or after January 1, 2020.)
** For Plans K and L, 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.
Medigap policies generally don’t cover long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing.
If you still have questions, feel free to give us a call at 616-600-8444 or fill out a “Contact Us” form in the right top of the page or “Get Help Now” in the left corner of the page. We will gladly make Medicare easy for you.
Medigap in Massachusetts
If you live in Massachusetts, you have guaranteed issue rights to buy a Medigap policy, but the policies are different.
Basic benefits
Inpatient hospital care: covers the Part A coinsurance plus coverage for 365 additional days after Medicare coverage ends.
Medical costs: covers the Part B coinsurance (generally 20% of the Medicare-approved amount).
Blood: covers the first 3 pints of blood each year.
Part A hospice coinsurance or copayment.
Medigap plans
Core Plan
Covers
Basic benefits.
60 days per calendar year of inpatient days in mental health hospitals.
State-mandated benefits (yearly Pap tests and mammograms. Check your plan for other state-mandated benefits).
Doesn’t cover
Part A: inpatient hospital deductible.
Part A: skilled nursing facility coinsurance.
Part B: deductible.
Foreign travel emergency.
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 including yearly Pap tests and mammograms. Check your plan for other state-mandated benefits.
*Note: Supplement 1 Plan (which includes coverage of the Part B deductible) will no longer be available to people who are new to Medicare on or after January 1, 2020. These people can buy Supplement 1A Plan. However, if you were eligible for Medicare before January 1, 2020 but not yet enrolled, you may be able to buy Supplement Plan 1.
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 including yearly Pap tests and mammograms. Check your plan for other state-mandated benefits.
Compare these plans side-by-side
| Medigap Benefits | Medigap Plans | |||
|---|---|---|---|---|
| Core Plan | Supplement 1 | Supplement 1A | ||
| Basic benefits |  |
 |
 |
|
| Part A: inpatient hospital deductible |  |
 |
||
| Part A: skilled nursing facility coinsurance |  |
 |
||
| Part B: deductible |  |
|||
| Foreign travel emergency |  |
 |
||
| Inpatient days in mental health hospitals | 60 дней в календарном году | 120 дней в календарном году | 120 дней в календарном году | |
| State-mandated benefits (yearly Pap tests and mammograms) |  |
 |
||
If you still have questions, feel free to give us a call at 616-600-8444 or fill out a “Contact Us” form in the right top of the page or “Get Help Now” in the left corner of the page. We will gladly make Medicare easy for you.
Medigap in Minnesota
If you live in Minnesota, you have guaranteed issue rights to buy a Medigap policy, but the policies are different.
Basic benefits
Inpatient hospital care: covers the Part A coinsurance
Medical costs: covers the Part B coinsurance (generally 20% of the Medicare-approved amount)
Blood: covers the first 3 pints of blood each year
Part A hospice and respite care cost sharing
Parts A and B home health services and supplies cost sharing
Medigap plans
The Basic and Extended Basic benefits are available:
When you enroll in Part B
Regardless of your age or health problems
You’ll get another 6-month Medigap Open Enrollment Period if both of these apply:
You return to work.
You drop Part B to elect your employer’s health plan.
You’ll get this open enrollment period after you retire from that employer when you can elect Part B again.
Basic Plan
Covers:
Basic benefits
Part A: skilled nursing facility (SNF) coinsurance (provides 100 days of SNF care)
80% of foreign travel emergency
50% of outpatient mental health
Medicare-covered preventive care
20% of physical therapy
State-mandated benefits (diabetic equipment and supplies, routine cancer screening, reconstructive surgery, and immunizations)
Doesn’t Cover:
Part A: inpatient hospital deductible
Part B: deductible
Usual and customary fees
Coverage while in a foreign country
Extended Basic Plan
Basic benefits:
Basic benefits
Part A: inpatient hospital deductible
Part A: skilled nursing facility (SNF) coinsurance (provides 120 days of SNF 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 (diabetic equipment and supplies, routine cancer screening, reconstructive surgery, and immunizations)
* The plan pays 100% after you spend $1,000 in out-of-pocket costs for a calendar year.
**Coverage of the Part B deductible will no longer be available to people who are new to Medicare on or after January 1, 2020. However, if you were eligible for Medicare before January 1, 2020 but not yet enrolled, you may be able to get this benefit.
Compare these plans side-by-side
| Medigap Benefits | Medigap Plans | |
|---|---|---|
| Basic | Extended Basic | |
| Basic benefits | 100% | 100% |
| Part A: inpatient hospital deductible | – | 100% |
| Part A: skilled nursing facility coinsurance | 100%
(Provides 100 days of SNF care) |
100%
(Provides 120 days of SNF care) |
| Part B: deductible | – | 100% |
| Foreign travel emergency | 80% | 80% |
| Outpatient mental health | 50% | 50% |
| Medicare-cover preventative care | 100% | 100% |
| Physical therapy | 20% | 20% |
| Coverage while in a foreign country | – | 80% |
| State-mandated benefits (diabetic equipment and supplies, routine cancer screening, reconstructive surgery, and immunizations) | 100% | 100% |
Minnesota versions of Medigap Plans K, L, M, N are available. Minnesota versions of high-deductible F are available to people who had or were eligible for Medicare before January 1, 2020.
If you still have questions, feel free to give us a call at 616-600-8444 or fill out a “Contact Us” form in the right top of the page or “Get Help Now” in the left corner of the page. We will gladly make Medicare easy for you.
Medigap in Wisconsin
If you live in Wisconsin, you have guaranteed issue rights to buy a Medigap policy, but the policies are different.
Basic benefits
Inpatient hospital care: covers the Part A coinsurance
Medical costs: covers the Part B coinsurance (generally 20% of the Medicare-approved amount)
Blood: covers the first 3 pints of blood each year
Part A hospice coinsurance or copayment
Medigap plan
Basic Plan
Covers
Basic benefits
Part A: skilled nursing facility coinsurance
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
Important plan information
Plans known as “50% and 25% Cost-sharing Plans” are available. These plans are similar to standardized Plans K (50%) and L (25%). A high-deductible plan ($2,340) is also available.
Insurance companies are also allowed to offer these riders to a Medigap policy:
Part A deductible
Additional home health care (365 visits including those paid by Medicare)
Part B deductible
Part B excess charges
Foreign travel emergency
50% Part A deductible*
Part B copayment or coinsurance
* Coverage of the Part B deductible will no longer be available to people who are new to Medicare on or after January 1, 2020. However, if you were eligible for Medicare before January 1, 2020 but not yet enrolled, you may be able to get this benefit.
If you still have questions, feel free to give us a call at 616-600-8444 or fill out a “Contact Us” form in the right top of the page or “Get Help Now” in the left corner of the page. We will gladly make Medicare easy for you.
Medigap & travel
Your Medigap policy may offer additional coverage for health care services or supplies that you get outside the U.S.
Standard Medigap Plans C, D, F, G, M, and N provide foreign travel emergency health care coverage when you travel outside the U.S.
Plans E, H, I, and J are no longer for sale, but if you bought one before June 1, 2010 you may keep it. All of these plans also provide foreign travel emergency health care coverage when you travel outside the U.S.
Medigap coverage outside the U.S.
If you have Medigap Plan C, D, E, F, G, H, I, J, M or N, your plan:
Covers foreign travel emergency care if it begins during the first 60 days of your trip, and if Medicare doesn’t otherwise cover the care.
Pays 80% of the billed charges for certain medically necessary emergency care outside the U.S. after you meet a $250 deductible for the year.
Foreign travel emergency coverage with Medigap policies has a lifetime limit of $50,000.
If you still have questions, feel free to give us a call at 616-600-8444 or fill out a “Contact Us” form in the right top of the page or “Get Help Now” in the left corner of the page. We will gladly make Medicare easy for you.
Source of information www.medicare.gov