Some costs are covered by all Medigaps. These include:
- Part A hospital coinsurance. All Medigap policies pay for the Part A hospital daily coinsurance charge for days 61 through 90 that you spend as a hospital inpatient during a benefit period, as well as the daily coinsurance charge for up to 60 hospital inpatient lifetime reserve days. All Medigap policies also cover the full cost of 365 additional inpatient hospital days during your lifetime.
- A benefit period is the way that Original Medicare measures your use of inpatient hospital and skilled nursing facility (SNF) services. Your benefit period begins the day you are admitted to the hospital as an inpatient and ends when you have been out of a hospital or SNF for more than 60 consecutive days.
- Part B coinsurance. All Medigaps pay for the 20% coinsurance for Medicare-covered outpatient medical services, like x-rays, durable medical equipment, and doctors’ visits. The Medigaps that cover a portion, but not all, of the Part B coinsurance (Plans K, L, and N) will pay the entire Part B coinsurance for certain preventive services that Medicare does not cover at 100%. For example, glaucoma screenings are preventive services that Medicare covers at 80% of its approved rate. If you have Medigap Plan N, it will cover the full 20% coinsurance for that service when you receive it from a provider who accepts assignment.
- First three pints of blood. All Medigaps pay for part or all of the cost of your first three pints of blood. If you are hospitalized and the hospital needs blood for a medical procedure or blood transfusion, then your Medigap will pay for the first three pints. If you do not have a Medigap, you will be responsible for this cost.
- Part A hospice care coinsurance or copay. All Medigaps cover the full cost of hospice coinsurance charges and copays for hospice-related drugs and respite care, as long as the Medigap was purchased on or after June 1, 2010. Respite care is care you receive as a hospital inpatient while your usual caregiver rests.
Some Medigaps cover all or part of the following costs:
- Part A skilled nursing facility (SNF) coinsurance. Some Medigaps pay for your SNF coinsurance charge for all of your covered days in a benefit period.
- Part A deductible. Some Medigaps pay for your Part A inpatient hospital deductible, which is the amount you owe out of pocket at the beginning of a benefit period.
- Part B deductible. The Part B deductible is the amount you owe out of pocket before Part B begins to cover the cost of your outpatient care.
- Part B excess charges. Excess charges may only be charged by non-participating Medicare providers. These providers do not take assignment, which means they do not agree to accept the Medicare-approved amount for services as payment in full. Non-participating providers can charge up to 15% more than the Medicare-approved cost for services. If you have a Medigap that covers excess charges, your Medigap will reimburse you if you see a non-participating provider who bills for excess charges.
- Foreign travel. With very few exceptions, Medicare does not cover services you receive in a foreign country, but some Medigaps cover emergency health care when you are abroad. These Medigaps cover 80% of the cost of emergency care abroad during the first two months of your trip, up to a lifetime limit of $50,000, after you meet a deductible.
You can use this table to compare the different costs that Medigaps supplement.
|Part A coinsurance||✔||✔||✔||✔||✔||✔||✔||✔||✔||✔|
|Part B coinsurance||✔||✔||✔||✔||✔||✔||50%||75%||✔||✔**|
|Blood (first 3 pints)||✔||✔||✔||✔||✔||✔||50%||75%||✔||✔|
|Part A hospice care coinsurance or copay||✔||✔||✔||✔||✔||✔||50%||75%||✔||✔|
|Part A SNF coinsurance||✔||✔||✔||✔||50%||75%||✔||✔|
|Part A deductible||✔||✔||✔||✔||✔||50%||75%||50%||✔|
|Part B deductible||✔||✔|
|Part B excess charges||✔||✔|
|Preventive care coinsurances||✔||✔||✔||✔||✔||✔||✔||✔||✔||✔|
|Foreign travel emergency (up to plan limit)||80%||80%||80%||80%||80%||80%|
*Plans K and L pay 100% of your Part A and Part B coinsurances after you spend a certain amount out of pocket. The 2019 out-of-pocket maximum is $5,560 for Plan K and $2,780 for Plan L.
** Except $20 for doctors’ visits and $50 for emergency visits.
Medigap Plan F has a high deductible option, which has a lower premium than the Plan F without a deductible. If you buy the high deductible Plan F then you will pay for Medicare-covered costs out of pocket up to the yearly-determined deductible amount. In 2019 this amount is $2,300. Once you meet your deductible the Medigap will begin to pay for some or all of the costs after Original Medicare pays. You will then no longer be responsible for all of your out-of-pocket costs, such as deductibles or Part B coinsurances.
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