Medigap Policies Compared

Medigap policies are designed to fill the "gaps" in health insurance provided under original Medicare, Parts A and B. These supplemental policies must provide standardized coverage as specified by the federal government.

Through May 31, 2015, 12 standardized Medigap policies could be sold, identified as plans A, B, C, D, E, F, G, H, I, J, K, and L. Effective June 1, 2015, plans E, H, I, and J could no longer be sold, and new plans M and N were added. Individuals who purchased a plan E, H, I, or J before June 1, 2015 may keep those plans.

The following tables compa re and contrast the major components of the different policies. Not all policies are available in all states. The policies shown are not available to residents of the states of Massachusetts, Minnesota, or Wisconsin; there are separate standardized policies for residents of those states.

Medigap Plans Sold on or After June 1, 2015

What's Included?

• Core benefits: Plans A-G, M and N - For Part A hospitalization, cover 100% of all copayments except that for days 1-60 of hospitalization ($1,260 in 2015), plus adding 365 lifetime days of hospital coverage after the standard benefit of 150 days is exhausted; 100% of Part B coinsurance amounts after meeting the yearly deductible ($147.00 in 2015); the first three pints of blood. Plans K and L - For Part A hospitalization, cover 100% of all copayments except that for days 1-60 of hospitalization, plus adding 365 lifetime days of hospital coverage after the standard benefit of 150 days is exhausted; for Part B, Plan K pays 50% of the coinsurance amount after the annual deductible is met; Plan L pays 75% of the Part B coinsurance amount after the annual deductible is met; Plan K pays 50% of the cost of the first three pints of blood; Plan L pays 75% of the cost of the first three pints of blood.
• Part A skilled nursing: Plans C-G, M and N - Pay 100% of the coinsurance amount Plans C-G, M and N - Pay 100% of the coinsurance amount ($157.50 per day in 2015) for days 21-100 in a skilled nursing facility. Plans K and L - Pay the percentage shown of the coinsurance amount for days 21-100 in a skilled nursing facility.
• Part A deductible: Plans B-G, and N - Pay 100% of the Part A deductible ($1,260 in 2015} for the first 60 days of hospitalization. Plans K, L, and M - Pay the percentage shown of the Part A deductible for the first 60 days of hospitalization.
• Part A hospice: Plans A-G, M and N - Pay 100% of the Part A hospice copayment. Plans K and L - Pay the percentage shown of the Part A hospice copayment.
• Part B deductible: Plans C and F - Pay 100% of the annual Part B deductible ($147.00 in 2015).
• Part B excess charges: Plans F and G - Pay 100% of the Part B excess charges.
• Emergency foreign travel: Plans C-G, M and N - The insured pays a $250 deductible and then 20% of any remaining costs of emergency health care. This benefit is typically limited to a $50,000 lifetime maximum and the first 60 days of each trip.
• Part B preventive care: All plans - Pay 100% of the coinsurance for preventive care.

Medigap Plans Sold Through May 31, 2015

What's Included?

• Core benefits: Plans A-J - For Part A hospitalization, includes 100% of all copayments except that for days 1-60 of hospitalization ($1,260 in 2015), plus adding 365 lifetime days of hospital coverage after the standard benefit of 150 days is exhausted; 100% of Part B coinsurance amounts after meeting the yearly deductible ($147.00 in 2015); the first three pints of blood. Plans K and L - Includes all copayments except that for days 1-60 of hospitalization, plus adding 365 lifetime days of hospital coverage after the standard benefit of 150 days is exhausted ;for Part B, Plan K pays 50% of the coinsurance amount after the annual deductible is met; Plan L pays 75% of the coinsurance amounts after the annual deductible is met; Plan K pays 50% of the cost of the first three pints of blood; Plan L pays 75% of the cost of the first three pints of blood.
• Skilled nursing: Plans C-J - Pay 100% of the coinsurance amount ($157.50 per day in 2015) under Part A for days 21-100 in a skilled nursing facility. Plans K and L - Pay the percentage shown of the coinsurance amount for days 21-100 in a skilled nursing facility.
• Part A deductible: Plans B-J - Pay 100% of the Part A deductible ($1,260 in 2015) for the first 60 days of hospitalization. Plans K a nd L - Pay the percentage shown of the Part A deductible for the first 60 days of hospitalization.
• Part B deductible: Plans C, F,and J - Pay 100% of the annual Part B deductible Plans C, F, and J - Pay 100% of the annual Part B deductible ($147.00 in 2015).
• Part B excess charges: Plans F, I, and J - Pay 100% of the Part B excess charges. Plan G - Pays 80% of the Part B excess charges.
• Emergency foreign travel: Plans C-J - The insured pays a $250 deductible and then 20% of any remaining costs of emergency health care. This benefit is typica lly limited to a $50,000 lifetime maximum and the first 60 days of each trip.
• At home recovery:Plans D, G, I, or J - If Medicare covered home health benefits are provided, the policy may pay up to $40 per visit for other, non-Medicare covered visits, with a yearly maximum of $1,600.
• Part B preventive care: All plans - Pay 100% of the coinsurance for preventive care.

Prescription Drug Benefits

A few Medigap policies issued before 2006 included a prescription drug benefit. However, beginning January 1,2006, Medicare began a separate prescription drug coverage benefit. Medigap policies issued January 1, 2006 or later do not include prescription drug benefits.

Medigap Policies

Medigap policies are supplemental health insurance policies sold by private insurers, designed to fill some of the "gaps" in health coverage provided by Medicare. Although Medicare covers many health care costs, you still have to pay certain coinsurance and deductible amounts, as well as paying for services that Medicare does not cover.

Who Can Buy a Medigap Policy?

Generally, you must be enrolled in the original Medicare Parts A and B before you need to purchase a Medigap insurance policy. Other types of health insurance coverage, such as Medicare Advantage, other Medicare health plans, Medicaid, or employer-provided health insurance, do not work with Medigap policies.

Standardized Policies

Under federal regulations, private insurers can only sell "standardized " Medigap policies. Through May 31, 2010,there were 12 standardized Medigap policies, termed plans A,B, C, D, E, F, G, H, I, J, K, and L. Effective June 1, 2010, plans E, H, I, and J could no longer be sold, and plans M and N were added. Individuals who purchased a plan E, H, I,or J before June 1, 2010 may keep those plans.

The standardized policies allow you to compare "apples with apples." For example, a plan F policy will provide the same benefits, no matter which insurance company it is purchased from. However, a plan C policy will provide different coverage than a plan D policy. All Medigap policies must provide certain "core" benefits.

These standardized plans are not available to those living in Massachusetts , Minnesota, or Wisconsin; there are separate Medigap policies available for residents of these states.

Choosing a Policy

There are two primary factors to consider when choosing a Medigap policy.

• Needed benefits: Carefully consider what benefits you are most likely to need; you may not need the most comprehensive plan.
• Cost: Once you have decided which benefits you will need, shop for the policy that provides those benefits at the lowest cost.

Policy Costs Can Differ

• Discounts: Some insurers may offer discounts to certain classes of people, such as women, non-smokers, or married couples.
• Medical underwriting: An insurance company may require you to fill out a detailed questionnaire on your health. The information you provide is used to determine whether or not a policy wilt be issued, or what premium to charge.
• Pre-existing conditions: If you have a "pre-existing condition," a known health problem, before you apply for a Medigap policy, you may have to wait up to six months before that problem is covered.
• High deductible: here are two options for Plan F: (1) a standard option, and (2) a "high deductible" option. Choosing the high deductible option means that you must pay more of the costs before the policy begins to provide benefits. Monthly premiums for high deductible policies are typically less.
• Medicare SELECT: Medicare SELECT policies a re sold in a few states by a few insurers. Except for emergencies, these policies require you to use pre-selected hospitals and physicians.
• Guaranteed renewable:Medigap policies issued after 1992 are generally guaranteed renewable. This means that as tong as you pay the premiums, are honest about health issues, and the insurance company doesn't go bankrupt, the insurer can't drop your coverage. In some states, policies issued before 1992 may not be guaranteed renewable.
• Insurer pricing methods: The table below shows three common methods by which an insurance company wilt price its Medigap policies:

Other Resources

Professional guidance in dealing with any aspect of a Medigap policy is strongly recommended. Other available resources include:

• Medicare: The federal government's Centers for Medicare & Medicaid Services (CMS) has a great deal of information available on their website at www.medicare.gov. You can also reach them by phone at (800) 633-4227. TTY users should call (877) 486-2048.
• State Health Insurance Assistance Programs: Many states operate health insurance assistance programs designed to provide assistance and information regarding Medicare, Medigap policies, and long-term care policies.
• State insurance department: Each state has an insurance department that regulates the sale of all types of insurance within the state. These state agencies can provide information about Medigap policies.