Medigap Purpose: Medicare supplement (Medigap) policies fill coverage gaps in Original Medicare (Parts A and B). They do not apply to Medicare Advantage (Part C) plans.
Eligibility: Available to those 65+ who apply within 6 months of enrolling in Medicare Part B. Policies are guaranteed renewable.
Standard Plans: Must conform to one of 10 standardized plans (A–N). Plan A includes core benefits; other plans add more. No prescription drug coverage (available via Part D).
Medicare SELECT: A managed care alternative to Medigap, requiring care from a network of providers. Labeled with the base plan type (e.g., “Medicare SELECT Plan B”).
Purpose of Medicare Supplement Plans
Medigap policies, sold by private insurers, cover gaps in Original Medicare (Parts A and B), such as:
Part A deductible and hospital/nursing home copayments
Part B deductible and 20% copayment
Key Point: Medigap policies cannot duplicate Medicare coverage or cover non-medically necessary services (e.g., cosmetic surgery). They may cover extras like emergency care abroad.
Eligibility and Enrollment
Available to those 65+ who apply within 6 months of Medicare Part B enrollment, regardless of health status.
Insurers cannot deny coverage based on medical history during this open enrollment period.
Policies are guaranteed renewable; premiums may increase but apply uniformly to all policyholders.
Key Point: Selling multiple Medigap policies to one person is prohibited.
Standardized Medigap Plans
All Medigap plans must include Plan A’s core benefits. Plans C and F (including high-deductible Plan F) are only available to those eligible before January 1, 2020. Plans A, B, D, G, K, L, M, and N are available to all.
Benefit
Plan A
Plan B
Plan C*
Plan D
Plan F*
Plan G
Plan K
Plan L
Plan M
Plan N
Part A coinsurance (days 61–90)
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Part A coinsurance (60 reserve days)
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Additional 365 days hospital care
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
First 3 pints of blood (yearly)
Yes
Yes
Yes
Yes
Yes
Yes
50%
75%
Yes
Yes
Part B coinsurance
Yes
Yes
Yes
Yes
Yes
Yes
50%
75%
Yes
Yes w/co-pays
Part A hospice cost-sharing
Yes
Yes
Yes
Yes
Yes
Yes
50%
75%
Yes
Yes
Part A deductible
Yes
Yes
Yes
Yes
Yes
50%
75%
50%
Yes
Skilled nursing coinsurance
Yes
Yes
Yes
Yes
50%
75%
Yes
Yes
Part B deductible
Yes
Yes
Part B excess charges
Yes
Yes
Foreign travel emergency (80%)
Yes
Yes
Yes
Yes
Yes
Yes
*Plans C and F only for those eligible before Jan 1, 2020. Plan F has a high-deductible option.
Medicare SELECT
Medicare SELECT is a managed care alternative to Medigap, requiring care from a network of providers. It’s labeled with the base plan type (e.g., “Medicare SELECT Plan A”) and is less expensive due to network restrictions.
Key Point: Medicare SELECT only supplements Parts A and B, not Medicare Advantage (Part C).
No Prescription Drug Coverage
Medigap plans sold today cannot include prescription drug coverage, which is available through Medicare Part D.
Test Your Knowledge!
Question: Medicare supplement policies must include coverage for all the following EXCEPT: