Medigap policies are offered as supplemental coverage for “Original Medicare” – as such they must be labeled and standardized to meet federal and state guidelines. Most states (excluding Massachusetts, Minnesota, and Wisconsin) sell 10 different categories of alphabetized policies (A, B, C, D, F, G, K, L, M and N).
After paying your policy deductible (unless your Medigap plan covers your deductible) each lettered policy will cover in whole or in part, different costs associated with your medical insurance costs.
A policy may cover assistance with a Part B co-insurance, and/or co-payment or co-insurance for care provided in a skilled nursing facility in addition to other supplemental coverage areas. Each alphabetized (lettered) option will cover the identified service in one of four ways:
- Coverage of 100 percent of the stated benefit
- Coverage of a percentage of the stated benefit
- No coverage for the stated benefit
- The stated benefit is not applicable (N/A) for the selected policy
To view a full chart of coverage options, please go to Medicare.gov: (http://medicare.gov/supplement-other-insurance/compare-medigap/compare-medigap.html)
If you reside in Massachusetts, Minnesota, or Wisconsin there are different standardizations around how Medigap policies are standardized. You will need to reference the following information to understand how these policies are administered and standardized:
What is the difference between a Medicare Advantage Plan and a Medigap insurance policy?
A Medicare Advantage Plan is an insurance plan that is purchased by an individual from a contracted private provider, who will administer his or her health insurance. The purchased plan changes how someone accesses healthcare (such as an HMO, PPO, or fee-for-service plan), which may result in different coverage levels, depending upon the specific policy that is selected.
If you have a Medicare Advantage Plan, it replaces the co-pays and co-insurances offered through the original Medicare benefits plan. Most Medicare Advantage Plans will also provide prescription-drug coverage. Please note that you cannot purchase a supplemental Medigap Policy if you select a Medicare Advantage Plan.
A Medigap policy is just a supplement to the original Medicare benefits plan (A and B) and may include increased coverage of things such as co-pays, as well as co-insurance that Medicare doesn’t cover. If a person has a Medigap policy, bills will be paid first through the original Medicare plan, and then go through the supplemental Medigap policy for additional coverage. Also, since you cannot purchase a supplemental Medigap Policy if you select a Medicare Advantage Plan, a Medigap policy cannot be used toward co-pays or co-insurance with a Medicare Advantage Plan.
For More Information
Visitors to MSAA’s online My Health Insurance Guide are invited to browse throughout the different sections for more information on the different parts of Medicare as well as other insurance options, or to view our Healthcare Insurance Glossary, online webinars and video, or our new publications.