Medicare Supplemental(Medigap) Insurance
Insurance for services not covered by Medicare.
- Medicare Supplemental plans are sold by state-approved, health insurers:
- For a list of companies selling Medicare Supplemental plans in Kansas, see http://www.ksinsurance.org/consumers/medicare.htm
- Individual policies are limited by federal law to twelve specific formats (Plans A though L). Click here for the Summary Chart of Medicare Supplemental Plans.
- All insurers must use the same format, language, and definitions.
- All insurers must sell Plan A; insurers can choose which other plans to offer.
Eligibility
- Applicants must be enrolled in Medicare Part A and Part B.
- Upon initial eligibility for Medicare, beneficiaries a guaranteed open enrollment to purchase a Medicare supplemental plan. After this open enrollment window has passed, applications may be denied due to health conditions .
- A beneficiary may not need Medicare supplemental insurance if he or she is eligible for Medicaid or has access to private insurance coverage (e.g., employee or retiree coverage from individual’s or spouse’s employer or union) that pays for some or all health care costs not covered by Medicare.
Premiums
- Premiums vary depending on the Plan (A-L) and the insurer:
- For estimated premium rates for Medicare supplemental plans, use the following link: http://www.ksinsurance.org/consumers/medicare.htm
- Consult insurers or agents for most current premium information
- Not fixed by law and varies considerably by Plan, insurer, and region
- Or, for other information about Medigap visit:
Basic Benefits
- The following benefits are covered in each of the twelve plans:
- Medicare Part A coinsurance for hospitalization and 365 days of additional inpatient hospital care during the policyholder’s lifetime.
- Coverage for the coinsurance amount for Part B services (generally 20 percent of Medicare-approved amount) after meeting annual deductible.
- Coverage under Medicare Parts A and B for reasonable cost of the first three pints of blood or equivalent.
Additional Optional Benefits
The standardized Medicare supplemental plans other than Plan A, include the basic benefits listed above and one or more of the following selected additional benefits:
Optional Benefits Part A Deductible Part B Deductible Skilled Nursing Facility Coinsurance Excess Charges Under Part B At-home Recovery Preventive Care Emergency Foreign Travel Care |
Click here to view Benefit Information for Plans A through J .
References and Publications Available
- Medicare Supplement Insurance (Medigap) Policies and Protections
- Kansas Medicare Supplement Insurance Shopper’s Guide
To view an electronic copy of the Shopper’s Guide, click here: http://www.ksinsurance.org/consumers/medicare.htm
Medicare (Medigap) Supplement Insurance
The term “Medigap” refers to Medicare supplemental insurance (offered by private health insurance companies) that is designed specifically to supplement Medicare benefits by filling in some of the gaps in Medicare coverage. Examples of some of the gaps in Medicare coverage are:
- Deductibles – The amount a beneficiary pays for Medicare-approved expenses before Medicare starts to pay.
- Coinsurance – The part of each Medicare approved amount a Medicare beneficiary must pay after he or she has paid the deductible.
- Non-Covered Services – Services that Medicare does not pay for, but the patient does, such as hearing aids.