Medicare Supplement Insurance, also called Medigap, covers some of Original Medicare’s out-of-pocket costs. In most states, there are up to 10 standardized Medigap policies to choose from, and each plan provides a unique mix of basic benefits. However, the costs vary widely from insurer to insurer. Here’s what you should know before you select a policy.
Comparing Medigap Plans
The cost of Medigap policies can vary widely because each insurer sets its own premiums. However, each Medigap plan of the same type offers the same basic benefits no matter where you live. For example, Medigap Plan A sold by a company in one state will offer the same basic benefits as Medigap Plan A sold by a different company in another state.
Refer to the chart below to see how each of the 10 standardized Medigap plans compare.
|Medicare Supplement Benefits||A||B||C||D||F1||G||K2||L3||M||N4|
|Part A co-insurance and hospital costs||✓||✓||✓||✓||✓||✓||✓||✓||✓||✓|
|Part B co-insurance or co-payment||✓||✓||✓||✓||✓||✓||50%||75%||✓||✓|
|First 3 pints of blood||✓||✓||✓||✓||✓||✓||50%||75%||✓||✓|
|Part A hospice care co-insurance or co-payment||✓||✓||✓||✓||✓||✓||50%||75%||✓||✓|
|Co-insurance for skilled nursing facility||✓||✓||✓||✓||50%||75%||✓||✓|
|Medicare Part A deductible||✓||✓||✓||✓||✓||50%||75%||50%||✓|
|Medicare Part B deductible||✓||✓||✓|
|Medicare Part B excess charges||✓||✓||✓|
|Foreign travel emergency||80%||80%||80%||80%||80%||80%|
|1. Plan F offers a high-deductible plan. This plan requires you to pay a $2,300 deductible in 2019 before it covers anything. 2. Plan K has an out-of-pocket yearly limit of $5,560 in 2019. After you pay the out-of-pocket yearly limit and yearly Part B deductible, it pays 100% of covered services for the rest of the calendar year. 3. Plan L has an out-of-pocket yearly limit of $2,780 in 2019. After you pay the out-of-pocket yearly limit and yearly Part B deductible, it pays 100% of covered services for the rest of the calendar year. 4. Plan N pays 100% of the Part B coinsurance, except for 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.|
When You Buy Your Medigap Policy Can Determine How Much You Pay.
The ideal time to purchase a Medigap plan is during your six-month Medigap open enrollment period. During this period, insurers can’t deny you coverage or charge you more due to health issues. If you fail to enroll during your open enrollment period, insurers can use medical underwriting to increase your premium or deny you coverage altogether.
Covering Medicare’s Out-of-Pocket Costs
In 2019, some of the out-of-pocket costs you can expect to pay for your Original Medicare coverage include:
- Medicare Part A deductible: $1,364 per benefit period
- Medicare Part B deductible: $185 per year
- Hospital inpatient coinsurance: Days 61-90 = $341 coinsurance per day of each benefit period. Days 91 and beyond = $682 coinsurance per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime). Beyond lifetime reserve = all costs.
It’s important to remember that Medicare Supplement Insurance does not replace your Original Medicare benefits. Rather, Medicare Supplement Insurance works alongside Original Medicare to help fill in some of the above coverage gaps.
Insurance companies that sell Medigap policies aren’t required to offer every option. However, every insurer that sells Medigap is required to offer Medigap Plan A and either Plan C or Plan F.
All Medigap plans must offer coverage for:
- Medicare Part A coinsurance for hospital care
- Medicare Part A coinsurance or copay for hospice care
- Medicare Part B coinsurance or copay
- First three pints of blood
Each policy must be clearly identified as “Medicare Supplement Insurance,” and it must follow federal and state laws designed to protect you.