Medicare is a government-funded and run health insurance program. To be eligible for Medicare, you must: be 65+ years old; have collected SSDI more than 24 months; or have been diagnosed with end-stage renal disease (ESRD) or ALS. Medicare coverage is broken down into 4 parts:
Medigap plans are additional insurance you can purchase to help pay deductibles, co-payments, co-insurance amounts, and other expenses original Medicare does not cover. You can buy a Medigap policy from any licensed insurance company in your state. You will pay an additional monthly premium for a Medigap plan, in addition to premiums for other Medicare parts. Medigap plans are standardized, meaning every insurer offers plans lettered A-N.
|Coverage||Plan A||Plan B||Plan C||Plan D||Plan F||Plan G||Plan K||Plan L||Plan M||Plan N|
|Medicare Part A Co-insurance & Hospital Costs (Up to an additional 365 days after Medicare benefits are used)||100%||100%||100%||100%||100%||100%||100%||100%||100%||100%|
|Medicare Part B Co-insurance or Co-payments||100%||100%||100%||100%||100%||100%||50%||75%||100%||100%|
|Blood First 3 Pints||100%||100%||100%||100%||100%||100%||50%||75%||100%||100%|
|Part A Hospice Co-insurance or Co-payments||100%||100%||100%||100%||100%||100%||50%||75%||100%||100%|
|Skilled Nursing Facility Co-insurance||x||x||100%||100%||100%||100%||50%||75%||100%||100%|
|Medicare Part A Deducible||x||100%||100%||100%||100%||100%||50%||75%||50%||100%|
|Medicare Part B Deductible||x||x||100%||x||100%||x||x||x||x||x|
|Medicare Part B Excess Charges||x||x||x||x||100%||100%||x||x||x||x|
|Foreign Travel Emergency (up to plan limits)||x||x||80%||80%||80%||80%||x||x||80%||80%|
|Out of Pocket Maximum||$5,880||$2,940|
The percentage shown is the amount the Medigap plan covers.
Note: Individuals who become eligible for Medicare after 1/1/2020, will no longer be able to purchase Medigap Plans F or C. Any individuals who already have Plans F or C will be able to keep those plans.
To qualify for a Medigap plan, you must be enrolled in Medicare Part A and B. Part A and B together are referred to as “Original Medicare.” For a more in-depth breakdown of Medicare Parts A and B, see our Quick Guide to Medicare – Extended.
You can buy a Medigap plan during your Medicare initial enrollment period (IEP), which automatically begins three months before the month you turn 65 and lasts 7 months. If you sign up for a Medigap plan during the IEP, you
cannot be denied coverage. But if you wait to buy a plan outside of the IEP, you may face a pre-existing condition exclusion period of up to 6 months and/or the plan may cost more. Once you have a Medigap plan, it is automatically eligible for renewal, regardless of any health problems. Your Medigap plan can only be canceled if you fail to pay the premiums.
If you are under 65, and have Medicare because of a disability, your state may not require insurance companies to sell you a Medigap plan. Visit TriageCancer.org/StateLaws for more information.
Part B of Medicare has a 20% co-insurance amount. Most chemotherapies are covered under Medicare Part B, which can create high out-of-pocket costs. Buying a Medigap plan that covers Part B’s 20% co-insurance can greatly reduce your out-of-pocket costs. These examples show how:
Last updated: 10/2023
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