Medicare Supplement (Medigap): Standardized Plan Types

Medicare Supplement insurance, commonly referred to as Medigap, is a type of private health insurance designed to fill the "gaps" in Original Medicare (Part A and Part B). While Original Medicare covers many healthcare services and supplies, it does not cover everything. Beneficiaries are often left with significant out-of-pocket costs, such as deductibles, coinsurance, and copayments.

Medigap policies are sold by private insurance companies, but they are strictly regulated by both federal and state governments. For those preparing for the complete Life & Health exam guide, it is essential to understand that these plans do not replace Medicare; rather, they work alongside it. To be eligible for a Medigap policy, an individual must generally be enrolled in both Medicare Part A and Part B.

Every insurance company that offers Medigap policies must make Plan A available. Plan A represents the "Core Benefits" or basic coverage that is included in all other Medigap plan types. If you understand the benefits of Plan A, you have the foundation for understanding all other lettered plans.

The core benefits of Plan A include:

• Medicare Part A Coinsurance: Covers the daily coinsurance amount for hospital stays after the Medicare benefit is exhausted, up to an additional number of days in a lifetime.
• Medicare Part B Coinsurance: Usually covers the remaining percentage of the Medicare-approved amount for physician services and outpatient care after the deductible is met.
• Blood: Covers the cost of the first three pints of blood each year.
• Hospice Care: Covers the Part A coinsurance or copayment for outpatient drugs and inpatient respite care.

Beyond the core benefits of Plan A, other Medigap plans (such as B, C, D, F, G, K, L, M, and N) offer varying combinations of additional coverage. When studying for practice Life & Health questions, pay attention to these specific definitions:

• Medicare Part A Deductible: This is the amount a beneficiary must pay before Part A coverage begins for hospital services. Most plans (except Plan A) cover this deductible.
• Skilled Nursing Facility (SNF) Coinsurance: Medicare Part B does not cover the daily coinsurance for SNF care after a certain number of days; many Medigap plans fill this gap.
• Medicare Part B Excess Charges: If a doctor does not "accept assignment" (the Medicare-approved amount), they may charge up to a certain percentage above that amount. Only Plan F and Plan G cover these excess charges.
• Foreign Travel Emergency: Since Original Medicare generally does not cover healthcare outside the United States, several Medigap plans provide a limited benefit for emergency care during international travel.

The Medigap Open Enrollment Period is a one-time window that begins when an individual is age 65 or older and enrolled in Medicare Part B. During this period, an insurance company cannot use medical underwriting to refuse a policy or charge more due to pre-existing conditions. This is known as guaranteed issue.

Furthermore, all Medigap policies are guaranteed renewable. This means the insurance company cannot cancel the policy as long as the policyholder continues to pay the premiums. The company cannot cancel the policy because of changes in the insured's health status.