Medigap Plans Effective on or After June 1, 2010

How to read the chart:

If a check mark appears in a column of this chart, the Medigap policy covers 100% of the described benefit.  If a row lists a percentage, the policy covers that percentage of the described benefit.  If a row is blank, the policy does not cover that benefit.  Note: The Medigap policy covers coinsurance only after you have paid the deductible (unless the Medigap policy also covers the deductible.)

 

Medigap Benefits

A

B

C

D

F *

G

K

L

M

N

Medicare Part A Coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up

Medicare Part B Coinsurance or Copayment

50%

75%

**

Blood (First 3 Pints)

50%

75%

Part A Hospice Care Coinsurance or Copayment

50%

75%

Skilled Nursing Facility Care Coinsurance

 

 

50%

75%

Medicare Part A Deductible

 

50%

75%

50%

Medicare Part B Deductible

 

 

 

 

 

 

 

 

Medicare Part B Excess Charges

 

 

 

 

 

 

 

 

Foreign Travel Emergency (Up to Plan Limits)

 

 

 

 

Out-of-Pocket Limit***

-

-

-

-

-

-

$4,660

$2,330

-

-

* Plan F also offers a high-deductible plan.  If you choose this option, this means you must pay for Medicare-covered costs up to the deductible amount of $2,140 in 2014 before your Medigap plan pays anything.

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

*** After you meet your out-of-pocket yearly limit and your yearly Part B deductible ($147 in 2014), the Medigap plan pays 100% of covered services for the rest of the calendar year.