Understand Medigap and what does it cover and not covered

What is a Medigap policy?


A Medigap (also called “Medicare Supplement Insurance”) policy is private health insurance that is designed to supplement Original Medicare. Th is means it helps pay some of the health care costs (“gaps”) that Original Medicare doesn’t cover (like copayments, coinsurance, and deductibles). Medigap policies may also cover certain things that Medicare doesn’t cover. If you are in Original Medicare and you have a Medigap policy, Medicare will pay its share of the Medicare-approved amounts for covered health care costs. Then your Medigap policy pays its share. (Note: Medicare doesn’t pay any of the costs for you to get a Medigap policy.) Also, a Medigap policy is different than a Medicare Advantage Plan (like an HMO or PPO) because it’s not a way to get Medicare benefits.

Every Medigap policy must follow Federal and state laws designed to protect you, and it must be clearly identified as “Medicare Supplement Insurance.” Medigap insurance companies can only sell you a “standardized” Medigap policy identified by letters A through L. Each standardized Medigap policy must off er the same basic benefi ts, no matter which insurance company sells it. Cost is usually the only difference between Medigap policies sold by different insurance companies.

In Massachusetts, Minnesota, and Wisconsin, Medigap policies are standardized in a different way. See pages 44–46. In some states, you may be able to buy another type of Medigap policy called Medicare SELECT (a Medigap policy that requires you to use specific hospitals and in some cases specific doctors to get full benefits)



Some examples of costs you could pay if you have Original Medicare and don’t have a Medigap 
policy



Medicare Part B Coinsurance or 
Copayment for other than preventive 
services




YOU PAY all coinsurance, generally 20% of the Medicare-approved amount for most covered services aft er you meet the $165 yearly Part B deductible. You also pay any copayment.



Medicare Part A Coinsurance and all costs aft er hospital benefits are exhausted


For each benefi t period, YOU PAY $267 per day for days 61—90,
$534 per day for days 91—150 (while using your 60 lifetime reserve
days), and all costs aft er 150 days.



What Medigap policies don’t cover
Medigap policies don’t cover long-term care (like care in a nursing home), vision or dental care, hearing aids, eyeglasses, and private-duty nursing.

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