Medigap

Introduction

Private insurance that supplements Medicare.

Medigap covers health care not covered by Medicare, i.e. fills the gap, including:

• deductables /copayments for Medicare Part A, Medicare part B

Examples:

• copayment for days 21-100 of skilled care in a nursing home, not covered by Medicare Part A.
• coverage for 20% of charges not covered by Medicare part B
  • durable medical equipment
• coverage for 50% of mental health care not covered by Medicare part B

Medigap does not cover

• long-term care
• dental care
• eyeglasses
• hearing aids
• private duty nurses
• out-of-pocket Medicare Advantage costs

Notes

• 12 types of plans A-L (higher letter provides higher benefit)
• within the 1s 6 months of enrollment in Medicare part B, beneficiaries are entitled to purchase any Medigap plan at advertised prices
• after 6 months, Medigap insurers can refuse anyone or charge higher premiums