The following is what you need to know:
What does Medicare Cover?
Medicare covers services (like lab tests, surgeries, and doctor visits) and supplies (like wheelchairs and walkers) considered medically necessary to treat a disease or condition.
If you're in a Medicare Advantage Plan or other Medicare plan, you may have different rules, but your plan must give you at least the same coverage as the original Medicare. Some services may only be covered in certain settings or for patients with certain conditions.
In general, Part A covers:
• Hospital care
• Skilled nursing facility care
• Nursing home care (as long as custodial care isn't the only care you need)
• Hospice
• Home health services
Medically necessary services:
Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.
Preventive services:
Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best. You pay nothing for most preventive services if you get the services from a health care provider who accepts assignment.
In general, Part B covers:
• Clinical research
• Ambulance Services
• Mental Health
• Inpatient
• Outpatient
• Partial hospitalization
• Getting a second opinion before surgery
• Limited outpatient prescription drugs
Neither Part A nor Part B cover all of your healthcare needs. For the areas that are not covered or allow for a "gap" in coverage, there are Medicare Gap Plans offered by insurance carriers and must be purchased through the carrier direct or a state licensed insurance agent like Advocate Insurance Services.
Compare Medigap plans side-by-side
The chart below shows basic information about the different benefits Medigap policies cover. Yes = the plan covers 100% of this benefit No = the policy doesn't cover that benefit % = the plan covers that percent of this benefit N/A = not applicable
| Medigap Benefits | Medigap Plans | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| A | B | C | D | F* | G | K | L | M | N | |
| Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up |
Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
Part B |
Yes | Yes | Yes | Yes | Yes | Yes | 50% | 75% | Yes | Yes*** |
| Blood (first 3 pints) | Yes | Yes | Yes | Yes | Yes | Yes | 50% | 75% | Yes | Yes |
| Part A hospice care coinsurance or co-payment | Yes | Yes | Yes | Yes | Yes | Yes | 50% | 75% | Yes | Yes |
| Skilled nursing facility care | No | No | Yes | Yes | Yes | Yes | 50% | 75% | Yes | Yes |
| coinsurance | ||||||||||
| Part A deductible | No | Yes | Yes | Yes | Yes | Yes | 50% | 75% | 50% | Yes |
| Part B deductible | No | No | Yes | No | Yes | No | No | No | No | No |
| Part B excess charges | No | No | No | No | Yes | Yes | No | No | No | No |
| Foreign travel exchange (up to plan limits) | No | No | Yes | Yes | Yes | Yes | No | No | Yes | Yes |
| Out-of-pocket limit** | N/A | N/A | N/A | N/A | N/A | N/A | $4800 | $2400 | N/A | N/A |
* 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.
** After you meet your out-of-pocket yearly limit and your yearly Part B deductible, the Medigap plan pays 100% of covered services for the rest of the calendar year.
*** Plan N pays 100% of the Part B coinsurance, except for a co-payment of up to $20 for some office visits and up to a $50 co-payment for emergency room visits that don't result in inpatient admission.