Medigap | What Medigap Plans Cover

Did You Know:

Some Medigap policies cover routine yearly check-ups, Medicare Part B excess charges and foreign travel emergency health care expenditures.

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	.	.	.	.	.	.	.	.	.	.
Part A deductible		.	.	.	.	.	.	.	.	.
Part B deductible			.			.				.
Skilled nursing care co-payment			.	.	.	.	.	.	.	.
Foreign travel emergency care			.	.	.	.	.	.	.	.
Part B excess charges (100%)						.			.	.
Part B excess charges (80%)							.
At-home recovery				.			.		.	.
Preventive services					.					.
Prescription drugs (up to $1,250)*								.	.
Prescription drugs (up to $3,000)*										.

*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."