Medicare Supplement Help

Original Medicare pays for many healthcare services and supplies, but it usually does not cover all of your needs. Private insurance companies sell Medicare supplement insurance policies that can help pay some of the healthcare costs that Original Medicare doesn't cover. These costs include copayments, coinsurance, and deductibles. Some policies even cover medical care when you travel outside the United States. Medicare supplement insurance policies are also called Medigap policies.

Medigap policies are standardized and must follow federal and state laws. These policies must be clearly identified as “Medicare supplement insurance.” Insurance companies can sell you only a “standardized” policy identified in most states by letters A through N.

  Medicare supplement insurance (Medigap) plans
Benefits A B C D F* G K L M N
Medicare Part A coinsurance and hospital costs (up to an additional 365 days after Medicare benefits are used) 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Medicare 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%
Medicare Part A deductible   100% 100% 100% 100% 100% 50% 75% 100% 100%
Medicare Part B deductible     100%   100%          
Medicare Part B excess charges         100% 100%        
Foreign travel emergency (up to plan limits)     100% 100% 100% 100%     100% 100%
Out-of-pocket limit in 2013             $4,800 $2,400    
(Plans E, H, I, and J are no longer available to buy, but if you already have one of those policies, you can keep it)

If a percentage appears, the Medigap plan covers that percentage of the benefit and you're responsible to pay the rest.

* Plan F also offers a high-deductible plan in some states. If you choose this option, you must pay for Medicare-covered costs (coinsurance, copayments, deductibles) up to the deductible amount of $2,110 in 2013 before your policy pays anything.

** 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 an inpatient admission.

In some states, you may be able to buy a type of Medigap policy called Medicare SELECT (a policy that requires you to use specific hospitals and, in some cases, specific doctors or other healthcare providers to get full coverage). If you buy a Medicare SELECT policy, you have the right to change your mind within 12 months and switch to a standard Medicare supplement policy.

Important Medigap Facts

  • You must have Part A and Part B.
  • You pay a monthly premium for your Medigap policy in addition to your monthly Part B and Part D premiums.
  • A Medigap policy only covers one person. Spouses must buy separate policies.
  • You can't have prescription drug coverage in both your Medigap policy and a Medicare Drug Plan.
  • It's important to compare Medigap policies since the costs can vary and may increase, as you get older. Some states limit Medigap premium costs.

The best time to buy a Medigap policy is during your Open Enrollment Period. This 6-month period is important because you can buy any Medigap policy sold within your state, even if you have health problems. The open enrollment period automatically starts the month you're 65 and enrolled in Medicare Part B. After this enrollment period, your option to buy a Medigap policy may be limited and it may cost more.

If you have a Medigap policy and join a Medicare Advantage Plan (like an HMO or PPO), you may consider dropping your Medigap policy. Your Medigap policy can't be used to pay your Medicare Advantage Plan copayments, deductibles, and premiums.