Medicare is the federal government health coverage program for adults over 65 years of age and people with certain disabilities. However, it does not cover all out-of-pocket healthcare costs. Medicare supplement plans, or Medigap policies, can help.
Medigap plans can help a person pay for out-of-pocket costs, including:
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
This article explains how Medicare supplement plans work, how to find one, and how to work out which plan is best.
A person can choose to enroll in Medicare parts A and B. However, these may not cover all healthcare costs. People with Medicare will still have to pay different deductibles and coinsurances based on the type of care they receive.
Medicare supplement plans can help a person reduce out-of-pocket costs on Medicare parts A and B. For this reason, insurance providers called the supplement plan “Medigap.”
However, since January 1, 2020, Medigap has not covered the Part B deductible.
Medicare supplement plans are optional. To buy a plan, a person must have Medicare parts A and B. Medigap plans cover copayments, deductibles, and coinsurance, as well as other benefits that vary between policies.
People who purchase a Medicare supplement plan pay a monthly premium on top of what they already pay for Medicare. Although this adds an extra monthly cost, it reduces the amount of money a person will need to spend out-of-pocket on treatment.
If a person has more than one insurance policy, they will have decided on a primary or secondary payer. Medicare parts A and B, which would serve as the primary payer, administer their coverage first.
Afterward, Medigap coverage takes over to fund the out-of-pocket costs of treatment and any other agreed costs, such as treatment received outside the United States on some Medigap plans.
People considering a Medicare supplement plan should bear in mind their medical or lifestyle needs. These plans cover more than just out-of-pocket costs from Medicare and may provide additional benefits for some people.
Currently, 10 Medicare supplement plans are available. These are:
Coverage varies between each of the 10 plans. For example, Plan A does not cover skilled nursing care, but Plan F does.
Medicare supplement plans 2020
Due to the recent ruling that prevents Medicare supplement plans from funding the Part B deductible, Medigap plans C and F are no longer available for new enrollees.
However, people who joined these plans before January 1, 2020 will be able to continue using them.
Private insurance companies sell Medigap plans. Not every company has to offer every available plan. However, all companies must make sure that they follow state and federal regulations established by Medicare.
Regulations state that a specific Medigap plan must provide the same level of basic coverage, regardless of which private insurer provides it. For instance, a person choosing Plan M from one company will receive the same coverage as a different person who bought that same plan from another company.
This also means that coverage is the same across different states. For example, coverage on Plan M will be the same in California as it is in Arizona.
However, Wisconsin, Minnesota, and Massachusetts have all set their own standards for administering Medigap policies. People who live in one of these states should check with Medicare directly to confirm their local standards.
A person should consider the following factors when choosing a plan:
- A person is eligible to buy a Medicare supplement plan when they first enroll in Medicare parts A and B. A 6-month Initial Enrollment Period allows individuals to purchase supplement plans without denial due to a preexisting condition.
- After this enrollment period, insurance companies may turn a person down from coverage or charge higher premiums.
- For coverage through a Medicare supplement plan, each person must have their own policy. For instance, married individuals must have separate policies.
- Medicare supplement policies have “guaranteed renewable” status. This means that the company cannot cancel the policy as long as a person continues to pay their premium.
- Usually, Medicare supplement plans do not cover vision care, dental care, eyeglasses, or private-duty nursing.
A range of different plans are available with several different insurance providers.
There are several things a person should take into account when deciding which Medicare supplement plan is best for them. The chart below compares the plans side by side.
“Yes” under a plan letter means that it covers 100% of the benefit. “No” under a plan letter means that it does not cover that benefit.
Part A coinsurance includes coverage for an extra 365 days worth of hospital costs after using Medicare Part A.
For some treatments, healthcare providers can charge more than the Medicare-approved amount for services, though there is a legal limit to how much they can charge.
Some Medicare supplement plans cover the excess charge. Please scroll along the table for further information.
|Part A coinsurance||Yes||Yes||Yes||Yes||Yes||Yes||Yes||Yes||Yes||Yes|
|Part B coinsurance||Yes||Yes||Yes||Yes||Yes||Yes||50%||75%||Yes||Yes|
|Blood (1st 3 pints)||Yes||Yes||Yes||Yes||Yes||Yes||50%||75%||Yes||Yes|
|Part A hospice coinsurance||Yes||Yes||Yes||Yes||Yes||Yes||50%||75%||Yes||Yes|
|Skilled nursing care coinsurance||No||No||Yes||Yes||Yes||Yes||50%||75%||Yes||Yes|
|Part A deductible||No||Yes||Yes||Yes||Yes||Yes||50%||75%||50%||Yes|
|Part B deductible||No||No||Yes||No||Yes||No||No||No||No||No|
|Part B excess charge||No||No||No||No||Yes||Yes||No||No||No||No|
|Foreign travel exchange||No||No||80%||80%||80%||80%||No||No||80%||80%|
|Out-of-pocket limit 2020||N/A||N/A||N/A||N/A||N/A||N/A||$5,880||$2,940||N/A||N/A|
It is challenging to pinpoint the average cost of a Medicare supplement plan, as they vary widely. Many factors can affect the price of a plan, and plans may range from under $100 per month to several hundred.
Supplement plan costs may depend on the following:
- which insurance provider is administering the plan
- the age of the enrollee
- which plan they choose
- where they live
Usually, more expensive plans provide more benefits. Plans with a higher deductible typically have a lower monthly cost than other plans. However, if the deductible is high, a person will have to spend more on eligible medical treatments before the insurer starts to fund treatment.
Insurance companies also use various factors to adjust the cost of a Medicare supplement plan, including:
- Issue-age-related: The monthly premium depends on the age of the person buying it.
- Community rate: The insurance provider does not rate the cost of a plan using the enrollee’s age.
- Attained-age-related: The cost of the coverage increases alongside a person’s age.
Medicare supplement plans are not the same as Medicare Advantage plans.
People use Medicare Advantage plans as an alternative to Medicare parts A and B. Private companies sell and administer them, just as they do Medicare supplement plans. They provide bundled plans that may cover more than separate Medicare plans, such as dental or vision care.
However, a person cannot have parts A and B and an Advantage plan at the same time.
Medicare supplement plans are insurance coverage policies that work in addition to Medicare parts A and B.