Medicare covers many health care costs, but it does not pay all of your health care costs. There are some costs that you may have to pay. These are sometimes called the “gaps” in Medicare coverage.
Some people pay for the gaps with a secondary, or supplemental, health plan. Examples are retiree insurance or coverage from the Veterans Administration.
You also can cover these gaps by buying a Medigap policy.
What are the current gaps in Medicare?
If your only insurance is Medicare Parts A and B, you will need to pay for some of the services Medicare does not cover, or gaps. These gaps can cost a lot, especially if you do not have other insurance to help pay for the costs.
Some of the costs you may have to pay for:
- Part A hospital deductible: ($1,216 per year in 2014)
- Part B annual deductible: ($147 per year in 2014)
- Most outpatient services and medical supplies: 20% of the total amount Medicare approves
- Part A hospitalization days 61-90: ($304 per day in 2014)
- Part A hospitalization days 91-150: ($608 per day in 2014)
- Skilled Nursing Facility care days 21-100: ($152 per day in 2014)
- Skilled Nursing Facility care after 100 days: The entire cost (unless you have long-term care insurance or Medicaid)
- Blood: The cost of the first three pints
- Other costs
How does Medigap work?
Medigap is a type of insurance that covers the gaps in Medicare costs. You can buy it from private insurance companies in your state. Medigap is also called Medicare Supplement Insurance.
There are 11 different standard Medigap plans that can be sold, except in Massachusetts, Minnesota, and Wisconsin. (These states have their own standardized plans you can buy.) The 11 standard plans are labeled A-D, F, high-deductible F, G, and K-N. Each of these plans covers different services; view a comparison chart of plans.
You can learn about these plans in our Choosing a Policy section.
What doctors can I see with Medigap?
With Medigap, you can see any doctor, whether the doctor accepts Medicare assignment or not. Note, however, that Medigap plans generally do not pay for care received outside of the United States, except for medically necessary emergency care that occurs during the first 60 days of your trip. Learn more.
Who do I pay?
- If your doctor “accepts assignment,” meaning he or she agrees to be paid the Medicare-approved amount for a service, your Medigap insurance company usually pays your doctor directly.
- If your doctor does not accept Medicare assignment, you may have to send claims to your insurance company and pay the doctor yourself.
How else can I cover the gaps?
Private Medicare Advantage plans can also help to cover some of the gaps in coverage. You can find out more about the difference between Medicare Advantage vs. Medigap plans in this section.
You also can pay for the gaps in Medicare with secondary insurance. This insurance may pay first, before Medicare pays, and can include employer/union insurance, TRICARE, Tribal or Indian Health Service benefits, and more. Learn more about the coordination of these benefits with Medicare.