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Medigap
Private insurance that supplements Medicare.
Medigap covers health care not covered by Medicare, i.e. fills the gap, including:
- deductables /copayments for Medicare Part A, Medicare part B
Examples:
- copayment for days 21-100 of skilled care in a nursing home, not covered by Medicare Part A.
- coverage for 20% of charges not covered by Medicare part B
- durable medical equipment
- coverage for 50% of mental health care not covered by Medicare part B
Medigap does not cover
- long-term care
- dental care
- eyeglasses
- hearing aids
- private duty nurses
- out-of-pocket Medicare Advantage costs
Notes:
- 12 types of plans A-L (higher letter provides higher benefit)
- within the 1s 6 months of enrollment in Medicare part B, beneficiaries are entitled to purchase any Medigap plan at advertised prices
- after 6 months, Medigap insurers can refuse anyone or charge higher premiums
References
- Geriatrics Review Syllabus, American Geriatrics Society,
5th edition, 2002-2004
- Geriatric Review Syllabus, 9th edition (GRS9)
Medinal-Walpole A, Pacala JT, Porter JF (eds)
American Geriatrics Society, 2016
- Geriatric Review Syllabus, 11th edition (GRS11)
Harper GM, Lyons WL, Potter JF (eds)
American Geriatrics Society, 2022
- Medicare.gov. What's Medicare Supplement Insurance (Medigap)?
https://www.medicare.gov/supplements-other-insurance/whats-medicare-supplement-insurance-medigap