What’s the Difference Between Medicare Supplement Insurance Plans and Medigap Plans?
Medicare Supplement and Medigap are different names for the same type of health insurance plan – you can use either name. To explain the terms themselves, you can think of “Medigap“ as a plan that fills in some of the “gaps“ for benefits that Original Medicare (Part A and Part B) doesn’t cover. You can think of “Medicare Supplement“ as a plan that adds to or supplements Original Medicare coverage by paying for some of Medicare’s out-of-pocket costs. You may find both terms used by the Centers for Medicare & Medicaid Services (CMS), the government entity that administers Medicare.
Medicare Supplement insurance plans and Medigap plans: Don’t be confused
While shopping, don’t be confused into thinking that you can get a better price on Medigap plan than a Medicare Supplement insurance plan or that a Medicare Supplement insurance plan offers more coverage than a Medigap plan. They are the same type of plan. Insurance companies that sell Medicare Supplement (Medigap) insurance plans must follow federal and state laws designed to protect you and must clearly label their plans as “Medicare Supplement Insurance.“ The term “Medigap“ may be used more colloquially because it is shorter.
Now that you understand that “Medicare Supplement“ and “Medigap“ are the same type of health insurance plan, for simplicity sake, we will be referring the plan as “Medicare Supplement“ from this point forward.
Understanding Medicare Supplement insurance plans: What Medicare Supplement insurance may pay for
Medicare Supplement insurance plans are sold by private insurance companies and can help you pay for out-of-pocket costs for services covered under Original Medicare. Different Medicare Supplement insurance plans pay for different amounts of those costs, such as copayments, coinsurance, and deductibles. The plans are “standardized“ with lettered names, meaning that a Medicare Supplement insurance Plan K sold by one insurance company covers the same benefits as a Medicare Supplement insurance Plan K sold by another company. The price, however, may differ. Most states offer up to 10 Medicare Supplement insurance plans labeled A-N, (E, H, I, J are no longer sold). Massachusetts, Minnesota and Wisconsin have different types of Medicare Supplement insurance plans.
All 10 of these Medicare Supplement insurance plans cover 100% of Medicare Part A coinsurance, but beyond this one benefit the plans differ. For example, while the other eight plans cover the first three pints of blood needed in a medical procedure at 100%, Medicare Supplement insurance Plan K covers blood at 50% and Plan L covers blood at 75%. Only Medicare Supplement insurance plans C, D, F, G, M and N may cover foreign travel emergencies (at 80%, up to plan limits). And only Plan F may covers the Medicare Part B deductible.
There are certain expenses that Medicare Supplement insurance plans generally don’t cover, such as long-term care, routine vision or dental care, hearing aids, eyeglasses, and private-duty nursing. As of 2006, Medicare Supplement insurance plans stopped offering prescription drug coverage. If you want prescription drug coverage, you may be able to enroll in a stand-alone Medicare Prescription Drug Plan (Part D).
Enrolling in Medicare Supplement insurance
To enroll in a Medicare Supplement insurance plan, you must have Medicare Part A and Part B and live within the plan’s service area. In some cases, you might not be accepted into a plan – see Medicare Supplement Enrollment for information about the best times to apply and other details. Medicare Supplement insurance cannot be combined with most Medicare Advantage plans or Medical Savings Account (MSA) plans. Because Medicare Supplement insurance plans differ, you might want to determine which benefits you want and which plan you want before you enroll.
Types of insurance that are not Medicare Supplement insurance include Medicare Advantage plans, Medicare Prescription Drug Plans, Medicaid, and veterans’ benefits.
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