Medigap Schedule Showing Benefits Not Covered By Medicare

Medigap Schedule Showing Benefits Not Covered By Medicare

A useful tool for understanding Medigap coverage is the following schedule that shows various gaps in Medicare coverage filled by Medigap Plans A, B and C. If there is interest in gaps in coverage such as prescription drugs and 100% of Part B excess charges benefit they are included in detail below the heading “Extra Benefits Not Covered By Medicare.”

The National Association of Insurance Commissioners deserve credit for their help in designing insurance policies that perfectly cover the cost gaps in Medicare services, as well as completely covering some of the services not met under Medicare. Furthermore, since the plans are standardized (same ten plans in all states, except Minnesota, Massachusetts and Wisconsin), and use the same Medicare language, the insurance decisions of the consumers have been made easier, with one “caveat” — prescription drugs.

In New York State Plan J is the only one not offered to individual Medicare beneficiaries. It is sold by one insurance company, which offers this plan and others through groups (membership organizations).

Medicare Year 2004





Deductibles and Co-Insurance (Patients’ Responsibility)

  A    B    C

Part A-Hospital Insurance

No Yes Yes

Deductible-$876 for the first 60 days (per benefit period)

  Yes Yes Yes

Co-payments — $219 a day for the 61st-90th each benefit period and

Yes Yes Yes


$438 a day for each lifetime reserve day (60 days) after the 90th day (Medigap’s 365 lifetime days covers days 91-150 after reserve days are used up, and beyond day 150 of a hospital stay)

No No Yes

Skilled Nursing Facility co-payment — $105.00 a day for the 21st-100th day each benefit period


Part B-Medical Insurance

No No Yes

Deductible-$109.50 per year

Yes Yes Yes

Coinsurance-20% of the Medicare approved charge, except some hospital outpatient services and certain other outpatient services, for which the patient pays a fixed co-payment amount, which may vary according to the service.





Extra Benefits Not Covered By Medicare

 No No Yes

Foreign travel emergencies outside the US beginning the first 60 days of each trip — $250 Deductible, 80% up to $50000




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