A Medicare Supplement Insurance policy (also called a Medigap policy) is health insurance sold by insurance companies to fill gaps in your Original Medicare coverage.

Medigap policies are used to help assist you in paying for your copayments, or deductibles of Medicare covered services.

Medicare Supplement Insurance companines can only sell you a “standardized” Medigap policy identified by letters A, B, C, D, F, High-Deductible F, G, K, L, M and  N.

Since a Medicare Supplement Insurance company can only sell you a “standardized” Medigap policy each policy must offer the same basic benefits, no matter which insurance company provides the insurance.

The Medicare Open Enrollment Period is the six month period beginning on the first day of the month in which you are enrolled in Medicare Part B.  If you are on Medicare under age 65, you will also have a six month Open Enrollment Period when you reach age 65.  This is the best time to purchase a Medicare supplement because an insurance company cannot turn you down and or charge more due to a health problem.  Insurance companies can apply up to a six-month waiting period for pre-existing conditions to your medigap policy, but that can be eliminated or shorten if you have had prior credible coverage. A pre-existing condition is a condition for which medical advice was given or treatment was recommended by or received from a physician within six months before the effective date of coverage.

How to read the Medigap chart below: If a check mark appears in the column, this means that the Medigap policy covers that benefit up to 100%. If a column lists a percentage, this means the Medigap policy covers that benefit at that percentage rate. If no percentage appears or if the column is blank, this means the Medigap policy doesn't cover that benefit. Note:The coverage of coinsurance only begins after the deductible has been satisfied.

Medigap Benefit
A
B
C
D
F*
G
K
L
 M N
Medicare Part A Coinsurance and Medigap Coverage for Hospital Benefits
Medicare Part B Coinsurance or Copayment
50%
75%

 

 ***

Blood (First Three Pints)
50%
75%

 

 

Part A Hospice Care Coinsurance or Copayment
 
 
 
 
 
50%
75%

 

 

Skilled Nursing Facility Coinsurance
 
 
50%
75%

 

 

Medicare Part A Deductible
 
50%
75%

 50%

 

Medicare Part B Deductible
 
 
 
 
       
Medicare Part B Excess Charges
 
 
 
 
       
Foreign Travel Emergency (Up to Plan Limits)
 
 
   
 
 
Medicare Preventative Care Part B Coinsurance
 
 
 
 
 
 
 
 
 
 

2012 out-of-pocket limit:

$4,660** $2,330**

*Plan F also has a high deductible option. This high deductible plan pays the same benefit as Plan F after one has paid a calendar year $2,070 deductible.  Benefits from a high deductible Plan F will not begin until out-of-pocket expenses exceed $2,070.  Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy/certificate.

**After you meet your out-of-pocket yearly limit and your $140 yearly Part B deductible, the plan pays 100% of covered services for the rest of the calendar year.
 
*** Plan N pays 100% of the Part B coinsurance except up to $20 copayment for office visits and up to $50 for emergency department visits.

 

Basic Benefits

• Coinsurance for days 61-90 ($289 per day) and days 91-150 ($578 per day) in hospital

• Payment in full for 365 additional hospital days

• Pays generally 20% coinsurance for physician and other Medicare Part B services

Medicare Part A Hospital Deductible

• The 2012 deductible is $1,156

Skilled Nursing Facility (SNF) Coinsurance

• $144.50 a day for days 21-100 in a Skilled Nursing Facility in 2012

Medicare Part B Yearly Deductible

• The 2012 deductible is $140

Medicare Part B Excess Charges

• Difference between doctor's charge and Medicare's approved amount

• Up to 15% above the Medicare approved charge which is the doctor’s maximum charge

Foreign Travel Emergency

• Pays 80% of the cost of emergency care during the first two months of each trip after you pay a $250 deductible

• Lifetime maximum of $50,000