| Medigap Overview |
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A Medigap policy is health insurance sold by private insurance companies to fill the “gaps” in coverage for the Original Medicare Part B Plan. Medigap policies help pay some of the health care costs that the Original Medicare Plan does not cover. If you are in the Original Medicare Plan and have a Medigap policy, then Medicare and your Medigap policy will pay both their shares of covered health care costs.
Overview of Medigap Plans A through J
The chart below gives you a quick look at the standardized Medigap Plans A through J (including Medicare SELECT) and their benefits. Every insurance company must make Medigap Plan A available if they offer any other Medigap policy. Some Medigap policies may not Basic Benefits: (Included in ALL Medigap Plans A through J) • Inpatient Hospital Care: Covers the Part A coinsurance plus coverage for 365 additional days after Medicare coverage ends. • Medical Costs: Covers the Part B coinsurance (generally 20% of the Medicare- approved amount) or copayments for hospital • Blood: Covers the first three pints of blood each year. Overview of Medigap Plans A through J
*Medigap Plans F and J also offer a high- deductible option. You must pay the first $ 2,000 (high- deductible in 2009) in Medigap- covered costs * before the Medigap policy pays anything. You must also pay a separate deductible for foreign travel emergency ($ 250 per year). Medigap Plan K and L 
Click here for information about the new Plan N coverage. Note: Once you meet the yearly limit, the Medigap policy pays 100% of the Medicare copayments, coinsurance, and deductibles for the rest of the calendar year. Charges from your doctor that exceed Medicare-approved amounts, called “excess charges,” are not covered and do not count toward the out- of- pocket limit. You will have to pay these excess charges.
What is Medicare SELECT? There is a type of Medigap policy called Medicare SELECT and is sold in some states. Medicare SELECT can be any of the standardized Medigap Plans A through L. However, you must use specific hospitals and in some cases, specific doctors to get your full insurance benefits (except in an emergency). Medicare SELECT policies generally cost less than other Medigap policies. However, if you do not use a Medicare SELECT hospital or doctor for non-emergency services, you will have to pay some or all of what Medicare does not pay. Medicare will pay its share of approved charges no matter which hospital or doctor you choose.
Medigap claim filing for Medicare Part B In most Medigap policies, when you sign the Medigap insurance contract you agree to have the Medigap insurance company get your Medicare Part B claim information directly from Medicare and then pay the doctor directly. Some Medigap insurance companies also provide this service for If your Medigap insurance company does not provide this service, ask your doctors if they “participate” in Medicare. (This means that they accept “assignment” for all their Medicare patients.) If your doctor does participate, the Medigap insurance company is required to pay the doctor directly if you request. If you have any questions about Medigap claim filing, call Massachusetts - Chart of standardized Medigap policies Basic benefits included in Medigap policies available in • Inpatient Hospital Care: Covers the Medicare Part A coinsurance plus coverage for 365 additional days after Medicare coverage ends. • Medical Costs: Covers the Medicare Part B coinsurance (generally 20%of the Medicare-approved amount). • Blood: Covers the first 3 pints of blood each year.
For more information on these Medigap policies, call your State Insurance Department or visit www.medicare.gov on the web. Under “Search Tools,” select “Compare Health Plans and Medigap Policies in Your Area.” Minnesota - Chart of standardized Medigap Policies
Medigap Plans K and L are also available in Minnesota. In addition, there are 2 basic plans. See below. Basic benefits included in Medigap policies available in Minnesota • Inpatient Hospital Care: Covers the Medicare Part A coinsurance. • Medical Costs: Covers the Medicare Part B coinsurance (generally 20%of the • Blood: Covers the first 3 pints of blood each year. * Pays 100% after you spend $1,000 in out-of-pocket costs for a calendar year. Note: The check marks in this chart mean the benefit is covered
Important: The Basic and Extended Basic benefits are available when you enroll in Part B, regardless age. If you return to work and drop Part B to elect your employer’s health plan, you will get 6-month Medigap open enrollment period after you retire from that employer and elect Part B again. Wisconsin - Chart of Standardized Medigap Policies
Medigap Plans K and L are also available in Wisconsin. In addition, there Basic benefits included in Medigap policies available in Wisconsin •Inpatient Hospital Care: Covers the Medicare Part A coinsurance. •Medical Costs: Covers the Medicare Part B coinsurance (generally 20%of the •Blood: Covers the first 3 pints of blood each year.
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