What does Medigap not cover?
Prescriptions, dental, vision, hearing and long term care. Here is why, and what to do about each gap.
A Medicare Supplement pays your share of what Medicare covers. That is the whole design, and it is also the limit. If Medicare does not cover something, there is nothing for the supplement to pay.
Prescription drugs
Supplements sold today include no drug coverage. You add a standalone Part D plan, and going without accrues a permanent penalty.
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 surprises people more than any other gap.
Options:
- Buy standalone dental and vision policies, which pair fine with Original Medicare and a supplement
- Pay out of pocket, which for routine cleanings is often reasonable
- Note that medical eye care such as cataract surgery and glaucoma treatment is covered under Part B, and your supplement pays your share of that
See the full picture on dental, vision and hearing.
Long term custodial care
The biggest financial exposure in retirement and the one Medicare barely touches. Medicare covers skilled nursing for a limited period after a qualifying hospital stay. It does not cover ongoing help with bathing, dressing and daily living, whether at home or in a facility.
Options are long term care insurance, certain life insurance policies with long term care riders, personal assets, or Medicaid once assets are depleted. See how Medicaid covers long term care in Texas.
Other things not covered
- Private duty nursing
- Cosmetic surgery
- Routine foot care, with limited exceptions
- Most care outside the United States, beyond the limited foreign travel emergency benefit on some plan letters
- Anything Medicare deems not medically necessary
What varies by plan letter
Some items are covered by certain letters and not others.
- The annual Part B deductible. Not covered by plans sold to anyone newly eligible after January 1, 2020.
- Part B excess charges. Plan G covers them, Plan N does not.
- Office and emergency room copays. Plan N has small ones, Plan G does not.
- Foreign travel emergency. Included in several letters, not all.
These are the only real differences between letters, and they are entirely predictable because the plans are standardized. There is no hidden exclusion buried in one carrier's Plan G that is absent from another's.
The complete picture
A realistic setup on the supplement path is Medicare Parts A and B, a Medigap policy, a Part D plan, and possibly a separate dental and vision policy. Long term care is a separate planning question entirely.
When comparing that against a Medicare Advantage plan that bundles most of it, count all the pieces or the comparison is not honest. See the comparison.
Common follow-up questions
Does Medigap cover dental?
No. Medicare does not cover routine dental, so there is nothing for the supplement to pay. Buy a standalone dental policy if you want coverage.
Does Medigap cover long term care?
No. It covers skilled nursing coinsurance for the limited period Medicare covers, not ongoing custodial care.
Does Medigap cover the Part B deductible?
Not on plans sold to anyone who became eligible for Medicare on or after January 1, 2020.
Want this looked at properly?
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