How does Medicare Supplement work?
Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. Medicare Supplement Insurance (Medigap) policies sold by private companies, can help pay some of the remaining health care costs for covered services and supplies, like copayments, coinsurance, and deductibles. Some Medigap policies also offer coverage for services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S.
Generally, Medigap doesn’t cover long-term care (like care in a nursing home), vision or dental care, hearing aids, eyeglasses, or private-duty nursing. Most Medigap plans DO NOT offer prescription coverage. However, a part D Prescription Plan is available with Medigap.
Medigap plans are standardized Medigap must follow federal and state laws designed to protect you, and they must be clearly identified as “Medicare Supplement Insurance.” Insurance companies can sell you only a “standardized” plan, identified in most states as plans A – D, F, G, and K – N. All plans offer the same basic benefits, but some offer additional benefits so you can choose which one meets your needs.
What else should I know about Medigap?
- Before you can buy Medicare Supplement Insurance (Medigap), you must have Part A and Part B.
- You pay the private insurance company a monthly premium for Medigap in addition to the monthly Part B premium you pay to Medicare. Also, if you buy Medigap and a Medicare drug plan from the same company, you may need to make 2 separate premium payments. Contact the company to find out how to pay your premiums.
- A Medigap policy only covers one person. Spouses must buy separate coverage.
- You can’t have drug coverage in both Medigap and your Medicare drug plan.
- It’s important to compare Medigap policies since the costs can vary between policies for exactly the same coverage.
How do I compare Medigap plans?
It is important to note that each plan’s premium is different and IS NOT standardized with all the carriers. One carrier’s Pan N premium will be different than another carrier. Here’s an overview of what each plan covers:
Plan A: covers 100% of your Part A coinsurance, your Part B coinsurance and the 1st 3 pints of blood if you need a transfusion.
Plan B: covers everything Plan A covers. It also covers your Part A deductible.
Plan C: covers everything Plans A and B cover. It also covers your Part B deductible and 80% of your costs if there’s an emergency while traveling overseas (subject to plan limits).
Plan D: covers everything Plans A and B cover. It also has 80% foreign travel emergency coverage. Foreign travel coverage limits may apply.
Plan F: covers everything Plans A, B and C cover. It also covers Part B excess charges. If doctors don’t accept Medicare assignment, they can charge up to 15% more of the Medicare-approved amount. This plan covers that 15% difference.
Plan G: covers everything Plan F does. The only difference is that it does not cover your Part B deductible.
Plan K: covers 100% of your Part A coinsurance. It covers 50% of your Part B coinsurance, your 1st 3 pints of blood and your Part A deductible. It has an out-of-pocket limit of $5,880 in 2020.
Plan L: covers 100% of your Part A coinsurance. It covers 75% of your Part B coinsurance, your 1st 3 pints of blood and your Part A deductible. It has an out-of-pocket limit of $2,940 in 2020.
Plan M: covers 100% of your Part A coinsurance, your Part B coinsurance, and the 1st 3 pints of blood. It covers 50% of your Part A deductible and has 80% foreign travel emergency coverage.
Plan N: covers everything Plan M does, but it also covers 100% of your Part A deductible. Plan N is unique in that it has copays. You may have a copay of up to $20 for an office visit and up to $50 for an emergency room visit that doesn’t involve an inpatient admission.
If you started Medicare on or after January 1, 2020, you can’t purchase Plans C or F.
* Plans F and G also offer a high-deductible plan in some states. With this option, you must pay for Medicare-covered costs (coinsurance, copayments, and deductibles) up to the deductible amount of $2,340 in 2020 before your policy pays anything. (You can’t buy Plans C and F if you were newly eligible for Medicare on or after January 1, 2020. See previous page for more information.)
** For Plans K and L, after you meet your out-of-pocket yearly limit and your yearly Part B deductible ($203 in 2021), the Medigap plan pays 100% of covered services for the rest of the calendar year.
*** Plan N pays 100% of the Part B coinsurance. You must pay a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don’t result in an inpatient admission.