Page Reviewed / Updated - August 21, 2019
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 original Medicare (Part A and Part B) plans. To be clear, a Medigap plan is not beneficial for persons who have Medicare Advantage plans (Medicare Part C). Stated differently, Medicap will not provide any additional coverage.
There are 10 standardized Medigap 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. Please note that starting January 2020, Plans C and F will no longer be offered to newly eligible Medicare recipients. However, persons who enroll in these plans prior to this date will be able to continue with the same plan.
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 (personal care), 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 approximately 80% of the cost for 80 more days. Some Medigap plans will pay for the remaining approximately 20% for the remaining 80 days, meaning a senior can receive 100 days of skilled nursing care with very little out of pocket cost.
The benefits of Medicare supplemental plans 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. As mentioned previously, for skilled nursing care, Medicare pays 100% for 20 days and approximately 80% for 80 more days. Most Medicare supplemental policies will cover the remaining approximately 20%. Seniors can therefore receive up to 100 days of nursing home care with little out-of-pocket cost. No Medicare Supplement 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. Private insurance companies sell Medigap policies, and the state and federal laws mandate coverage. Therefore, providers all offer very similar policies. Consequently, shopping for a Medicare supplemental insurance policy by price is a smart strategy.
The price of some Medigap policies are not based on the policyholder’s age, while age is factored into the price of other plans. For example, with some plans, the cost is based on the policyholder’s current age and the cost increases as one gets older. With other plans, the cost is based on the age of the policyholder when the plan was purchased. (The plan is less expensive for individuals who purchase it at a younger age). When comparing Medigap insurance plans from different insurance companies, it’s important to ask how the polices are priced. Across the nation, the average monthly rate for a Medigap plan is under $200.
It is best to purchase a policy within 6 months of enrollment in Medicare. 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.