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Deep Dive

Medicare Supplement Insurance (Medigap) Plans

Medicare Supplement (Medigap) plans are private insurance policies that help cover out-of-pocket costs not paid by Original Medicare (Parts A and B), such as deductibles and coinsurance. These plans help manage the remaining medical expenses after Medicare pays its share, filling any gaps in coverage. Medigap plans do not include prescription drug coverage, so a separate Part D plan may be needed. Medigap plans are not available to those with Medicare Advantage (MAPD) plans or those with Medicaid.

Overview of Medicare Supplement (Medigap) Plan Benefits

 

Benefit Plan A Plan B Plan C Plan D Plan F* Plan G* Plan K Plan L Plan M Plan N
Part A coinsurance and hospital costs ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
Part B coinsurance or copayment ✓ ✓ ✓ ✓ ✓ ✓ 50% 75% ✓ ✓**
Blood benefit (first 3 pints) ✓ ✓ ✓ ✓ ✓ ✓ 50% 75% ✓ ✓
Part A hospice care coinsurance or copayment ✓ ✓ ✓ ✓ ✓ ✓ 50% 75% ✓ ✓
Skilled nursing facility care coinsurance X X ✓ ✓ ✓ ✓ 50% 75% ✓ ✓
Part A deductible X ✓ ✓ ✓ ✓ ✓ 50% 75% 50% ✓
Part B deductible X X X ✓ X ✓ X X X X
Part B excess charge X X X X ✓ ✓ X X X X
Foreign travel emergency (up to plan limits) X X 80% 80% 80% 80% X X 80% 80%

 

✓ = The plan covers 100% of this benefit

X = The plan doesn’t cover this benefit

% = The plan covers that percentage of this benefit, and you’re responsible for the rest.

 

* Plans F and G offer a high‑deductible plan in some states (Plan F isn’t available to people new to Medicare on or after January 1, 2020.) If you get the high‑deductible option, you must pay for Medicare‑covered costs (coinsurance, copayments, and deductibles) up to the deductible amount of $2,870 in 2024 before your policy pays anything, and you must also pay a separate deductible ($250 per year) for foreign travel emergency care.

 

** Plan N pays 100% of the costs of Part B services, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don’t result in an inpatient admission.

 

Source: Medicare.gov.

 

Guaranteed Issue Rules

 

In New York and Connecticut, Medicare Supplement (Medigap) plans are guaranteed issue, meaning there is no medical underwriting if the plan is purchased within 63 days of losing creditable coverage, such as a Medicare Advantage plan. This allows individuals transitioning from Medicare Advantage to Original Medicare to enroll in any Medigap policy from any carrier without being denied coverage due to preexisting conditions.

 

Residents of New York must purchase their policy within the state, but once enrolled, their coverage applies nationwide. This means they can receive care anywhere in the U.S., and New York rules will still apply. However, non-residents may not be eligible to buy a Medigap policy in New York, even if they receive medical services there. Instead, they must follow the Medicare Supplement rules of their home state.

 

If someone applies after the 63-day window, they will still be approved, but preexisting conditions will not be covered for a waiting period equal to the time they delayed enrollment, up to a maximum of six months. 

 

Medicare Supplement rules and availability vary in other states.

 

Medicare Supplement (Medigap) Carriers 

NY State

Bankers Life Ins Co
(Capital Region, Central NY, Finger Lakes, Hudson Valley, Long Island, Mohawk Valley, New York City, North Country, Northern NY, Southern Tier, Western NY)

  • Phone number: 800-839-2731
  • Website: 

BlueCross BlueShield of Western New York
(Western NY)

BlueShield of Northeastern New York
(Capital Region, North Country)

EmblemHealth
(Capital Region, Central NY, Finger Lakes, Hudson Valley, Long Island, Mohawk Valley, New York City, North Country, Northern NY, Southern Tier, Western NY)

Excellus Health Plan Inc.
(Central NY, Finger Lakes, Mohawk Valley, North Country, Northern NY, Southern Tier)

Globe Life
(Capital Region, Central NY, Finger Lakes, Hudson Valley, Long Island, Mohawk Valley, New York City, North Country, Northern NY, Southern Tier, Western NY)

Humana
(Capital Region, Central NY, Finger Lakes, Hudson Valley, Long Island, Mohawk Valley, New York City, North Country, Northern NY, Southern Tier, Western NY)

Mutual of Omaha
(Capital Region, Central NY, Finger Lakes, Hudson Valley, Long Island, Mohawk Valley, New York City, North Country, Northern NY, Southern Tier, Western NY)

Transamerica
(Capital Region, Central NY, Finger Lakes, Hudson Valley, Long Island, Mohawk Valley, New York City, North Country, Northern NY, Southern Tier, Western NY)

UnitedHealthcare (AARP)
(Capital Region, Hudson Valley, Long Island, New York City, North Country)

Univera Healthcare West New York
(Western NY)