Last updated on June 30th, 2016
Medigap Insurance Plans Help Supplement Medicare Part A and Medicare Part B
*While young people are not in the market for Medicare, they have parents and grandparents that are. So it is important to have an idea of what Medicare involves.
Medicare was designed to help pay for medical costs for people aged 65 older, people of all ages with disabilities, and people with End Stage Renal Disease. However, Original Medicare does not pay for everything and still leaves the member exposed to many out-of-pocket expenses. Fortunately there are ways to help cover these costs. Private insurers sell Medigap (or Medicare Supplement) plans that fill in the financial gaps that Medicare leaves open. One thing to note is that all Medigap plans are the same among all insurers. An AARP Plan A is the same as an Aetna Plan A. The difference is how they are priced.
Original Medicare typically requires a deductible for inpatient and outpatient services followed by a 20% coinsurance. Medigap Plan A basically eliminates the coinsurance.
You are still required to pay the deductibles for Part A and Part B, but once the deductible is met, Plan A pays for the rest. This includes pints of blood. It pays for the first 3 pints of blood and then picks up the 20% member portion for blood in an outpatient setting.
Medigap Plan A does not pay anything extra for Skilled Nursing Facilities that are not covered by Medicare Part A.
Medigap Plan B is very similar to Plan A. The only addition is that Plan B pays for the patient deductible that the member is responsible for under Medicare Part A. All other plan provisions are the same for Medigap Plan B as Medigap Plan A.
Medigap Plan C has the same provisions as Plan B – which built upon Plan A – but it also pays for two extra things.
- Plan C pays for the Medicare Part B deductible. So with Plan C you will not have a Medicare Part A or Medicare Part B deductible to pay.
- Plan C pays for emergency medicare care outside of the United States. Medicare DOES NOT pay for this emergency service. You must have a Medigap policy to have emergency insurance coverage outside of the United States. And then, this only covers the first 60 days of each visit outside of the country. The medicare care requires a small deductible, and then the Medgap plan pays 80% of charges up to a $50,000 lifetime maximum benefit.
Medigap Plan F would be considered the “Cadillac” Medigap plan. Plan F pays for more services than any other Medigap plan. It covers everything that Plan C covers, plus the Medicare Part B excess charges that are above the Medicare-approved amounts.
Medigap Plan F still does not cover inpatient hospital stays beyond the additional 365 days after the lifetime reserve days are used. These extra days are still the responsibility of the member.
Plan F also does not cover more than 100 days of Skilled Nursing Inpatient Care.
If you want to spend the money for the best Medigap insurance plan, Plan F is the way to go.
Medigap Plan K is a “50%” plan. It provides the following coverages for charges under Medicare Part A.
- 50% of the Medicare Part A deductible, after which it pays for 100% of hospitalization costs.
- 50% of the Skilled Nursing per day charge for days 21-100.
- 50% of the first 3 pints of blood in an inpatient setting.
- 50% of Hospice charges.
Plan K provides the following coverage for charges under Medicare Part B.
- Portion of preventive benefits not paid for by Medicare Part B.
- 50% of coinsurance required by the member (10% of charges).
- 50% of the cost of pints of blood (excluding Part B deductible).
- 50% of cost of durable medical equipment.
There is also a member out-of-pocket limit.
Medigap Plan L is very simple. You take a look at Plan K and substitute 70% for 50%. In addition, the member out-of-pocket limit is half of the out-of-pocket limit under Plan K.
Medigap Plan N incorporates copays into Medicare Supplement plans. Like Plan F, it pays for virtually all of the Medicare Part A charges. For Medicare Part B charges, it still requires a deductible. However, after the deductible is paid, Plan F pays for the member’s 20% coinsurance, except for a copay charged for office visits and emergency room visits. If the emergency room visit turns into an inpatient stay then the copay is waived.
Medigap Plan N also pays for pints of blood and durable medical equipment after the Medicare Part B deductible is met.
Plan N pays the same foreign travel emergency benefit as the other plans mentioned here.
What is the Cost of Medigap Insurance Plans?
What you pay for a Medigap insurance plan depends on several factors, including your age and zip code. Contact your Medigap insurance company for more details on the premiums required for each plan.
The amount you pay at the medical service provider depends on if the provider accepts Medicare assignment. Charges from providers that accept assignment will most likely result in lower costs for the Medicare recipient.