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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