What does Medigap not cover?
A Medigap policy pays your share of what Medicare covers. Drugs, dental, vision, hearing and long term care sit outside it. What to do about each gap.
- A Medicare Supplement pays your share of what Medicare covers, so if Medicare pays nothing, the supplement pays nothing.
- Drugs, routine dental, vision, hearing and long term custodial care sit outside it. Each one needs its own plan or your own money.
- Policies sold to people who became eligible after January 1, 2020 do not pay the yearly Part B amount you owe first.
A Medicare Supplement, also called Medigap, pays your share of what Medicare covers. That is the whole design, and it is also the limit. If Medicare pays nothing for a service, the supplement pays nothing either.
Prescription drugs
Supplements sold today include no drug coverage. You buy that separately, as a standalone Part D plan, meaning a plan sold on its own that covers only drugs.
Go without Part D and Medicare adds a permanent penalty to your premium, the monthly bill for the coverage.
See why you need Part D with a supplement.
Routine dental, vision and hearing
Medicare does not cover routine dental work, eyeglasses, or hearing aids, so a supplement cannot either. This gap surprises people more than any other.
You have options.
- Buy separate dental and vision policies. They sit fine alongside Original Medicare and a supplement.
- Pay out of pocket. For routine cleanings the price is often reasonable.
- Medical eye care is different. Cataract surgery and glaucoma treatment fall under Part B, the part of Medicare that pays for doctor visits, and your supplement pays your share.
See the full picture on dental, vision and hearing.
Long term custodial care
This is the largest money risk in retirement, and Medicare barely touches it. Medicare pays for skilled nursing care, the kind that needs a nurse or therapist, for a limited time after a qualifying hospital stay.
It does not pay for custodial care, ongoing help with bathing, dressing and daily living, at home or in a facility.
People cover that with long term care insurance, certain life insurance policies with a long term care rider, personal assets, or Medicaid once those assets are gone. See how Medicaid covers long term care in Texas.
Other things not covered
A supplement also pays nothing for these.
- Private duty nursing, a nurse you hire yourself.
- Cosmetic surgery.
- Routine foot care, with a few exceptions.
- Most care outside the United States, beyond the limited foreign travel emergency benefit on some plan letters.
- Anything Medicare decides was not medically necessary.
What varies by plan letter
A few items are covered by some letters and not by others.
- The yearly Part B deductible, the amount you pay before Medicare starts paying. No policy sold to anyone eligible after January 1, 2020 covers it.
- Part B excess charges, an extra amount a doctor may bill above what Medicare pays. Plan G covers them. Plan N does not.
- Office and emergency room copays, a set amount you pay at the visit. Plan N has small ones. Plan G does not.
- Foreign travel emergency care. Several letters include it, not all.
Those are the only real differences between letters, and you can see them all in advance, because the letters are standardized. One company's Plan G does not hide an exclusion that another company's leaves out.
The complete picture of what a supplement covers
A realistic setup on this path is Medicare Part A and Part B, a Medigap policy, a Part D plan, and possibly a separate dental and vision policy. Long term care is a planning question of its own.
A Medicare Advantage plan bundles most of those pieces together. When you compare the two, count every piece on the supplement side, or the comparison is not honest. See the comparison.
Decide which gaps you want covered, then price only those pieces. To walk through it with someone, call our McAllen office at (956) 687 3334, or enter your ZIP code in the plan pricing box on this page.
Common follow-up questions
Does Medigap cover dental?
No. Medicare does not cover routine dental, so the supplement has nothing to pay. Buy a separate dental policy if you want coverage.
Does Medigap cover long term care?
No. It pays your share of skilled nursing care for the limited time Medicare covers it, not ongoing help with bathing and dressing.
Does Medigap cover the Part B deductible?
Not on policies sold to anyone who became eligible for Medicare on or after January 1, 2020. That yearly amount is yours to pay.
Want this looked at properly?
We are an independent agency in McAllen serving Hidalgo, Cameron and Starr counties. There is no obligation to talk it through.
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Gerino Alejos
Licensed insurance agent · License 3128710 · NPN 18243381
Owner of McAllen Insurance Group, an independent agency on North 10th Street in McAllen. Works with clients across Hidalgo, Cameron and Starr counties on Medicare, Marketplace health, life and auto coverage. Se habla español.