Medigap Plan D is Medicare supplement insurance. It helps pay almost all the health care costs of your basic Original Medicare benefits, except for the Medicare Part B deductible and excess charges. Emergency care is covered anywhere you travel worldwide.
Now available on all Priority Health Medigap plans:
- Assist America for global emergency travel assistance
- If you are a new member, a 6.5% reduction on your monthly premium
- Opportunity to receive a 12% household discount on your monthly premium
- Hearing aid program powered by TruHearing
- Vision discounts from EyeMed
- Access to a fitness program with the Active&Fit Direct program
- Up to 50% off standard pricing for personal emergency response system with Connect America
For complete details of what this plan covers, read the Plan D certificate (PDF).
The chart below shows what Original Medicare pays, what this plan pays and what you'll pay in 2025. The amount Original Medicare pays changes every year on Jan. 1. Benefits paid by Medigap plans will automatically change when Original Medicare coverage changes.
Medicare Part A
Hospitalization
Coverage per benefit period for semi-private room and board, general nursing and miscellaneous services and supplies.
| Original Medicare pays | Plan D pays | You pay |
|---|---|---|---|
First 60 days | All but $1,676 | $1,676 | Nothing |
Days 61-90 | All but $419 a day | $419 a day | Nothing |
Day 91 and after (while using 60 lifetime reserve days) | All but $838 a day | $838 a day | Nothing |
Once lifetime reserve days are used, additional 365 days | Nothing | 100% | Nothing |
Beyond the additional 365 days | Nothing | Nothing | All costs |
Skilled nursing facility care
Coverage per benefit period. You must meet Medicare's requirements, including having been in a hospital for at least 3 days and entered a Medicare-approved facility within 30 days after leaving the hospital.
| Original Medicare pays | Plan D pays | You pay |
|---|---|---|---|
First 20 days | 100% | Nothing | Nothing |
Days 21-100 | All but $209.50 a day | Up to $209.50 a day | Nothing |
Day 101 and after | Nothing | Nothing | All costs |
Blood
| Original Medicare pays | Plan D pays | You pay |
|---|---|---|---|
First 3 pints | Nothing | 3 pints | Nothing |
Additional blood after first 3 pints | 100% | Nothing | Nothing |
Hospice
Available as long as your doctor certifies you are terminally ill and you elect to receive these services
| Original Medicare pays | Plan D pays | You pay |
|---|---|---|---|
Hospice care | 100% | Nothing | Nothing |
Outpatient prescription drugs | All but $5 per prescription | $5 per prescription | Nothing |
Inpatient respite care | 95% | 5% | Nothing |
Medicare Part B
Physician and outpatient services
You must meet your Part B deductible once each calendar year (Jan. 1 - Dec. 31). Once you have been billed $257 in Medicare-approved amounts for covered services, you have met your Part B deductible for the calendar year.
Medical expenses: In or out of the hospital and outpatient hospital treatment, such as physician's services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment.
| Original Medicare pays | Plan D pays | You pay |
|---|---|---|---|
First $257 of Medicare-approved amounts | Nothing | Nothing | $257 |
Remainder of Medicare-approved amounts after first $257 | 80% | 20% | Nothing |
Part B excess charges: Charges above Medicare-approved amounts | Nothing | Nothing | All costs |
Medicare preventive care
| Original Medicare pays | Plan D pays | You pay |
|---|---|---|---|
First $257 of Medicare-approved amounts when applicable | Nothing | Nothing | $257 |
Medicare approved amounts (after deductible is met) when applicable) | 80% | 20% | Nothing |
Blood
| Original Medicare pays | Plan D pays | You pay |
|---|---|---|---|
First 3 pints | Nothing | 3 pints | Nothing |
Next $257 of Medicare-approved amounts (Part B deductible) | Nothing | Nothing | $257 |
Remainder of Medicare-approved amounts | 80% | 20% | Nothing |
Clinical laboratory services
| Original Medicare pays | Plan D pays | You pay |
|---|---|---|---|
Tests for diagnostic services | 100% | Nothing | Nothing |
Medicare Parts A & B
Home health care
Medicare-approved services
| Original Medicare pays | Plan D pays | You pay |
|---|---|---|---|
Medically necessary skilled care services and medical supplies | 100% | Nothing | Nothing |
First $257 of Medicare-approved amounts for durable medical equipment | Nothing | Nothing | $257 |
Remainder of Medicare-approved amounts for durable medical equipment | 80% | 20% | Nothing |
Other benefits: Services not covered by Medicare
Foreign travel
Emergency care services beginning during the first 60 days of each trip outside the U.S.
| Original Medicare pays | Plan D pays | You pay |
|---|---|---|---|
$250 Foreign travel deductible that must be met once each calendar year | Nothing | Nothing | $250 |
Remainder of charges up to a lifetime maximum of $50,000 (Member pays all amounts over $50,000) | Nothing | 80% | 20% |
When you exhaust your Medicare Part A benefits, Priority Health then pays whatever amount Medicare would have paid for, for an additional 365 days. During this time the hospital can't bill you for any difference between its billed charges and the amount Medicare would have paid.