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What Medigap Plans Cover

There are 12 standard Medigap plans A-L. Every Medigap plan from A-J includes "core" benefits that help pay for:

  • Medicare Part A co-payment for days 61-150 of a hospital stay
  • Up to 365 days in the hospital once you use all of your Medicare hospital benefits
  • Medicare Part B co-payments after the $124 deductible
  • The first three pints of blood if you need a transfusion
Medigap Plan A covers only these core benefits. Plans B-J provide additional benefits as seen in the chart below:

Coverage

A

B

C

D

E

F

G

H

I

J

Core Benefits

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Part A deductible

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Part B deductible

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Skilled nursing care co-payment

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Foreign travel emergency care

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Part B excess charges (100%)

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Part B excess charges (80%)

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At-home recovery

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Preventive services

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Prescription drugs (up to $1,250)*

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Prescription drugs (up to $3,000)*

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*Starting in January 2006, you will not be able to purchase a new Medigap policy with prescription drug coverage.

Medigap plans K and L were created by the Medicare Modernization Act of 2003 (MMA) and introduced in 2005. They are cheaper than plans A-J, but require higher out-of-pockets costs. Both include:

  • Payment of $228 per day for days 61-90 of a hospital stay
  • Payment of $456 per day for days 91-150 of a hospital stay
  • Up to 365 days in the hospital once you deplete your Medicare hospital benefits

Plan K pays:

  • 50% of co-payments for Medicare Part B services after the $110 deductible
  • 100% of coinsurance for preventative services
  • 50% of the first three pints of blood if you need a transfusion
  • 50% of hospice cost-sharing for all Medicare Part A covered expenses and respite care
  • $4,000 out-of-pocket annual limit; then the plan pays for all of your Part A and Part B co-payments for the rest of the year
  • Skilled nursing facility coinsurance (50%)
  • Medicare Part A Deductible (50%)

Plan L pays:

  • 75% of co-payments for Medicare Part B services after the $110 deductible
  • 100% of coinsurance for preventative services
  • 75% of the first three pints of blood if you need a transfusion.
  • 75% of hospice cost-sharing for all Medicare Part A covered expenses and respite care.
  • $2,000 out-of-pocket annual limit; then the plan pays for all of your Part A and Part B co-payments for the rest of the year
  • Skilled nursing facility coinsurance (75%)
  • Medicare Part A Deductible (75%)

Note: Standard Medigap benefits are different for people in Massachusetts, Minnesota, and Wisconsin.

For more information on what Medigap plans cover, read the Centers for Medicare and Medicaid Services publication, "Choosing a Medigap Policy: A Guide to Health Insurance for People With Medicare."