This chart shows basic information about the different benefits that Medigap policies cover. If a percentage appears, the Medigap plan covers that percentage of the benefit.
The remaining percentage is your obligation.
| Benefits | Medicare Supplement Insurance (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) | 100% | 100% | 100% | 100% | 100% | 100% | 100% | 100% | 100% | 100% | |
| Part B coinsurance or copayment | 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 care coinsurance /copayment | 100% | 100% | 100% | 100% | 100% | 100% | 50% | 75% | 100% | 100% | |
| Skilled nursing facility coinsurance | - | - | 100% | 100% | 100% | 100% | 50% | 75% | 100% | 100% | |
| Part A deductible | 100% | 100% | 100% | 100% | 100% | 100% | 50% | 75% | 100% | 100% | |
| Part B deductible | - | - | 100% | - | 100% | - | - | - | - | - | |
| Part B excess charge | - | - | - | - | 100% | 100% | - | - | - | - | |
| Foreign travel (up to plan limits) | - | - | 80% | 80% | 80% | 80% | - | - | 80% | 80% | |
| Out-of-pocket max limit | NA | NA | ## | ## | ## | ## | $6,620 | $3,310 | NA | ## | |
NA – Not Applicable
* Plans F and G also offer a high-deductible plan in some states. With this option, you must pay for Medicare-covered costs (coinsurance, copayments, and deductibles) up to the deductible amount of
$2,490 in 2022 before your policy pays benefits. (Plans C and F are not available to people who were newly eligible for Medicare on or after January 1, 2020.)
For Plans K and L, 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.
## The Plan G maximum out-of-pocket (MOOP) is equal to the Medicare Part B deductible. The Plan N MOOP is equal to the Part B deductible plus office visit copays when you avoid excess charges. The High Deductible Plans G-HD and F-HD MOOP is equal to the Medigap deductible. That is $2,490 for 2022.
*** Plan N pays 100% of the Part B coinsurance. However, there may be a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that do not result in inpatient admission.
