Medicare Supplement (Medigap) Plans

If you have Original Medicare (Plan A & Plan B) you have got reliable coverage, just not complete coverage. Medicare Part A & Part B pay most but not all doctor and hospitalization expenses. A Medicare Supplement or Medigap policy can fill in the gaps and pay costs you would otherwise have to pay.

There is a lot to be said for a Medicare Supplement or Medigap plan. First, unlike Medicare Advantage Plans, there is no network. You can visit any physician or healthcare provider that accepts Medicare. Medigap plans are guaranteed renewable (Once issued, they can’t be taken away except for non-payment of premium.)

A Medicare Supplement or Medigap plan generally will pay 20% of the costs Original Medicare (Part A & Part B) do not pay. Your providers and Medicare will coordinate your claims payment behind the scenes automatically with little or no effort on your part. You will have little or no paperwork to file, due to Medicare and Medicare Supplement plans working together to pay your covered healthcare costs.

In addition, there are some Medigap plans your premium and Part B deductibles are your only out-of-pocket costs. Medigap or Medicare Supplement plans are designed to help with both expected and unexpected costs with fewer or even no surprises. For a competitive monthly premium, you can get the peace of mind that comes with knowing some of your medical costs may be covered.

Here are some of the benefits with a Medicare Supplement also known as Medigap plan:

  • You can see any provider that accepts Medicare patients

  • You can see a specialist who accepts Medicare patients without a referral

  • You can go to any hospital or healthcare facility that accepts Medicare

  • You can get medical care anywhere in the US when you’re traveling

  • There are some Medigap/Medicare Supplement plans that may even cover emergency care while traveling outside of the US

  • You can never be canceled as long as you pay your premium and are truthful on your application

PLEASE NOTE: Typically, you must be 65 or older and you must be enrolled in Original Medicare (Part A & B). You might be eligible for Medicare Supplement/Medigap plan if you are disabled through Social Security or Railroad Retirement Board or if you have ESRD End-Stage Renal Disease.

As covered earlier, Medicare has 4 parts available:

  • Medicare Part A – Inpatient Hospital Benefits

  • Medicare Part B – Outpatient and Physician Visits

  • Medicare Part C – Medicare Advantage Plans

  • Medicare Part D – Prescription Drug Plans (Stand Alone or Combined with Part C Medicare Advantage Plans

Medicare Supplement Plans are regulated and Standardized by the Federal Government. All insurance companies providing Medicare Supplement or Medigap Plans must offer the same plans. The only difference is the premium that they charge. Here is the government chart showing all plans that are available. This chart shows basic information about the different benefits that Medigap policies cover. If a percentage appears, the Medigap plan covers that percentage of the benefit, and you must pay the rest.

 

Medicare Supplement Insurance (Medigap) Plans

Benefits

A

B

C

D

F*

G*

K

L

M

N

Medicare Part A coinsurance and hospital costs (up to an additional 365 days after Medicare benefits are used)

100%

100%

100%

100%

100%

100%

100%

100%

100%

100%

Medicare Part B coinsurance or copayment

100%

100%

100%

100%

100%

100%

50%

75%

100%

100%

***

Blood (first 3 pints)

100%

100%

100%

100%

100%

100%

50%

75%

100%

100%

Part A hospice care coinsurance or copayment

100%

100%

100%

100%

100%

100%

50%

75%

100%

100%

Skilled nursing facility care coinsurance

   

100%

100%

100%

100%

50%

75%

100%

100%

Part A deductible

 

100%

100%

100%

100%

100%

50%

75%

50%

100%

Part B deductible

   

100%

 

100%

         

Part B excess charges

       

100%

100%

       

Foreign travel emergency (up to plan limits)

   

80%

80%

80%

80%

   

80%

80%

 

Out of  pocket limit in 2021**

 

$6,220

$3,110

* Plans F and G also offer a high-deductible plan in some states (Plan F isn’t available to people new to Medicare on or after January 1, 2020.) If you get the high-deductible option, you must pay for Medicare-covered costs (coinsurance, copayments, and deductibles) up to the deductible amount of $2,370 in 2021 before your policy pays anything, and you must also pay a separate deductible ($250 per year) for foreign travel emergency services.

**Plans K and L show how much they’ll pay for approved services before you meet your out-of-pocket yearly limit and your Part B deductible ($203 in 2021). After you meet these amounts, the plan will pay 100% of your costs for approved services for the rest of the calendar year.

*** 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.