Medigap Policies

  • What Medigap policies cover
    This chart shows basic information about the different benefits that Medigap policies cover. If a percentage appears, the Medigap plan covers that percentage of the benefit and you may pay the rest.

    * Plan F is also offered as a high-deductible plan by some insurance companies in some states. If you choose this option, this means you must pay for Medicare-covered costs (coinsurance, copayments, deductibles) up to the deductible amount of $2,180 in 2015 before your policy pays anything. **For Plans K and L, after you meet your out-of-pocket yearly limit and your yearly Part B deductible ($147 in 2015), the Medigap plan pays 100% of covered services for the rest of the calendar year. *** Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don’t result in an inpatient admission.
  • What Medigap polices don't cover
    Generally, Medigap policies don’t cover long-term care (like care in a nursing home), vision or dental care, hearing aids, eyeglasses, or private‑duty nursing. (Limited vision coverage is provided for medical conditions such as cataracts, glaucoma, and macular degeneration, etc.)
  • Types of coverage that are NOT Medigap policies
    • Medicare Advantage Plans (Part C), like an HMO, PPO, or Private Fee-for-Service Plan
    • Medicare Prescription Drug Plans (Part D)
    • Medicaid
    • Employer or union plans, including the Federal Employees Health Benefits Program (FEHBP)
    • TRICARE
    • Veterans’ benefits
    • Long-term care insurance policies
    • Indian Health Service, Tribal, and Urban Indian Health plans
    • Qualified Health Plans sold in the Health Insurance Marketplace