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Medigap Insurance, Medigap Plans, Medigap Policies and Medicare Supplements

Medigap
Medigap (Medicare Supplement Insurance) policies

–Are private health insurance (Medigap plans cover only the policyholder. Spouses must purchase separate policies.)
–Are sold by private insurance companies
–Supplement Original Medicare (help pay for “gaps” in Original Medicare coverage - like deductibles, coinsurance and copayments)
•Pay for Medicare-covered services provided by any doctor, hospital, or provider that accepts Medicare (the exception is Medigap SELECT policies that require you use specific hospitals, and in some cases, specific doctors to get full benefits.)
•May cover certain things Medicare doesn’t depending on the Medigap plan
–Must follow Federal and state laws that protect people with Medicare
–Must clearly be identified as “Medicare Supplement Insurance”
Medigap Insurance
In all states except Massachusetts, Minnesota, and Wisconsin, Medigap policies must be one of the standardized plans A, B, C, D, F, G, K, L, M or  N so they can be easily compared. Each plan has a different set of benefits and are the same for any insurance company. It’s important to compare Medigap policies, because costs can vary. (Note:  Each company decides which Medigap policies it will sell and the price for each plan, with state review and approval.)
A Medigap policy only works with Original Medicare (not with Medicare Advantage (MA) or other Medicare plans). It is illegal for anyone to sell you a Medigap policy if you:
–Are in a MA Plan (unless your enrollment is ending).
–Have Medicaid (unless Medicaid pays for your Medigap policy or only pays your Medicare Part B premium).
–Already have a Medigap policy (unless you cancel your old Medigap policy).
You may want to drop your Medigap policy if you join a Medicare Advantage Plan or other Medicare plan. Even though you are entitled to keep it, it can’t pay for benefits that you get under your MA or other Medicare plan and can’t pay any cost-sharing under these plans.
If you are in Original Medicare and you have a Medigap policy, you can go to any doctor, hospital, or other health care provider that accepts Medicare. However, if you have a type of Medigap policy called Medicare SELECT, you must use specific hospitals and, in some cases, specific doctors to get full insurance benefits.
Medicare Supplemental Insurance
This chart shows Medigap plans and their coverage available for sale effective June 1, 2010.
Each checkmark shows that that Medigap Plan covers 100% of the policy holders share of these Medicare-covered services.
If a percentage is provided, the plan covers that percent of the policyholder’s share of these Medicare-covered services.

Chart Footnotes:

*Plan F also offers a high-deductible plan. This means you must pay for Medicare-covered costs up to the deductible amount $2,000 in 2010 before your Medigap plan pays anything.

**After you meet your out-of-pocket yearly limit and your yearly Part B deductible ($155 in 2010), the Medigap plan pays 100% of covered services for the rest of the calendar year. Out-of-pocket limit is the maximum amount you would pay for coinsurance and copayments.

***Plan N pays 100% of the Part B coinsurance except up to $20 copayment for office visits and up to $50 for emergency department visits.

This chart appears on page 13 of the 2010 Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare.