Page Reviewed / Updated - Mar. 2016
Medicare Supplemental insurance is often referred to as Medigap. Medigap policies are supplemental Medicare insurance policies sold by private companies to fill the “gaps” in Medicare plans. There are 10 standardized plans defined by federal law, referred to as Plans A, B, C, D, F, G, K, L, M and N. Not all 10 plans are available in every state, nor does each insurance company choose to offer all plans.
Medigap plans are intended to fill the “gaps” in Medicare insurance. Since most long term care for seniors is not covered by Medicare, this is a considerable “gap”. However, even the most comprehensive of the Medigap plans does not cover long term care needs for the elderly. These policies do not pay for assisted living, Alzheimer's, custodial or adult day care. At best, they supplement nursing home care on a temporary basis and help with hospice coverage.
When a senior is in recovery mode following an accident or procedure, some plans will help in limited capacity with skilled nursing care, but this is short term only. Medicare pays for 100% of skilled nursing care for 20 days and they pay 80% of the cost for 80 more days. Some Medigap plans will pay for the remaining 20% for the remaining 80 days, meaning a senior can receive 100 days of skilled nursing care with very little out of pocket cost.
Medicare supplemental plans benefits extend on the benefits of Medicare. There are 10 different plans; each offers a different level of benefit. Plans do not provide seniors with cash payments; instead seniors make lower payments to their medical providers.
Benefits differ depending on which of the 10 different policies an individual purchases. For skilled nursing care, Medicare pays 100% for 20 days and 80% for 80 more days. Most Medicare supplemental policies will cover the remaining 20%, seniors can therefore receive up to 100 days of nursing home care with little out-of-pocket cost. No Medicare Supplemental Insurance / Medigap policies pay for assisted living, memory care or other forms of non-medical, personal care. Medical care is covered for people who reside in assisted living, but not room and board or personal care received in those residences. To be clear, non-medical adult day care (sometimes called adult day social care) and non-medical, in-home care (sometimes called personal, custodial or companion care) are not covered.
Some of the more robust plans also will pay an “at-home recovery benefit” of up to $40 per visit for 40 visits. This covers custodial care but only for an hourly visit and again only on a short term basis after an illness, injury, or surgery.
To best understand and compare benefits of the different plans, visit the Medicare.gov webpage.
Costs will differ for each of the plans. The older the policyholder is, the more they pay for this type of insurance. One should expect to pay a minimum of $100 / month for those aged 65 and $200 / month for those over 75.
Plans are sold by private companies but coverage is mandated by the state and federal laws, therefore providers all offer very similar policies. Consequently, shopping for a Medicare supplemental insurance policy by price is a smart strategy.
It is best to purchase a policy within 6 months of enrollment in Medicare as during this time, insurers are required to accept applicants regardless of pre-existing conditions.
Medigap plans are sold directly by private companies. Click here to find Medicare Supplemental Insurance in your area.