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Learn » Medicare Supplement » Main Differences Between Medigap Plans

Main Differences Between Medigap Plans

All Medicare Supplement plans share a few core benefits, but most Medigap plans have additional coverage.

October 5, 2017 - By Hal Levy - read

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It can be puzzling to choose Medigap plans. But since all Medicare Supplement plans have standardized and time-tested benefits, your insurance is an easy puzzle to solve. Once you know the benefit pieces that make up these plans, you can assemble the coverage that matters most to you.

5 Core Benefits Provided by Medicare Supplement Plans:

You’ll get these additions to your Original Medicare benefits no matter which Medicare Supplement plan you join.

1. Medicare Part A Coinsurance and Hospital Costs: You’re insulated from hospital costs with all Medigap plans. Medigap will cover your daily coinsurance of $335, running from your 61st to 90th day in the hospital each year as an inpatient (Part A will pay for your first 60 days).

  • Medicare Supplement will also pay your $670 daily coinsurance from the 91st day onward, followed by the full costs of hospital care once that benefit runs out (Part A will not offer any help after the 91st day after 60 lifetime benefit days have been used up).

2. Part A Hospice Care Copayment or Coinsurance: Medicare Supplement plans will pick up your copayments for hospice pain and symptom management prescriptions.

  • Medigap will also take care of your 5 percent copayment for inpatient respite care, which gives time off for you and your primary caregiver if you’re faced with a life-limiting disease.

3. Medicare Part B Preventive Care Coinsurance: You won’t owe a copayment for most medical visits that prevent disease – such as vaccines or cholesterol screenings – with Original Medicare.

  • Some disease screenings will still carry Part B’s 20 percent co-payment. Medicare Supplement plans will keep you healthy by ensuring that preventive care is always easy to obtain.

4. Medicare Part B Copayment or Coinsurance: Medigap plans will handle your copayment for an unlimited amount of Medicare-covered outpatient care.

  • Without Medicare Supplement, you’d owe 20 percent of the Medicare-approved amount for most Part B services – including doctor’s visits, same-day outpatient surgery, and medical equipment. This benefit alone could save you tens of thousands of dollars in any single year.

5. Three Pints of Blood: Medigap plans will pay for your initial blood supply when you undergo a blood transfusion.

  • Without Medigap, those three pints could cost you anywhere from $400 to $1200. If you need more blood during the year, Original Medicare will cover the rest.

A Note On Mandatory Medicare Supplement Benefits:

Plan A, the most limited Medicare Supplement plan, is available in all states from every Medigap insurer. Plan A includes all of the above benefits. Other plans pack on more.

Plans K and L will only cover the above benefits in part – 50 percent for Plan K, and 75 percent for Plan L – until you reach a separate deductible. In 2017, that out-of-pocket deductible is $5,240 for Plan K and $2,620 for Plan L. Plans K and L will cover Part A hospital coinsurance and costs in full.

Optional Additional Benefits for Medicare Supplement Plans

1. Skilled Nursing Facility (SNF) Care Coinsurance: Skilled nursing facilities provide intensive physical and behavioral rehabilitation following a serious medical condition. If you’re discharged from the hospital following a stay of three days or more, but you’re not well enough to return to daily life, then you’ll likely be admitted to an SNF. SNF care can make all the difference for you to enjoy a full recovery.

If you have this as an additional Medicare Supplement benefit, your Medigap insurer will pay for your daily $167.50 coinsurance for days 21-100 in an SNF, and for your full costs once 101 days pass (Part A covers the first 20 days).

  • When will you want this benefit?
    • If you’re too healthy to stay in the hospital, but not strong enough to go home;
    • If you’re recovering from joint replacement surgery, brain damage, or another medical issue that landed you in the hospital; or
    • If unrelated medical issues like access to oxygen therapy, or personal issues like the need to find a caregiver, make it difficult to go from the hospital to your home without an intermediate step.
  • Plans that cover this:
    • Plans C, D, F, G, M, and N cover your SNF coinsurance in full. Plan K covers 50 percent of your costs, and Plan L covers 75 percent of your costs.

2. Part A Deductible: Some Medigap plans step in to pay for your $1,340 Part A hospital deductible. Hopefully you won’t need to use it.

  • When will you want this benefit?
    • If you visit the hospital for care that doesn’t exceed $1,340, this coverage will keep you from paying anything out-of-pocket.
    • Even if your medical costs for the year exceed (or barely exceed) your deductible, you’ll still need to pay that deductible in full. Let your Medigap plan cover as many services as possible.
  • Plans that cover this:
    • Plans B, C, D, F, G, and N will cover your Part A deductible in full. Plans K and M will cover 50 percent of your Part A deductible payments, and Plan L will cover 75 percent.

3. Part B Deductible: A couple of Medigap plans step in to pay for your $183 Part B outpatient deductible. Why pay this on your own?

  • When will you want this benefit?
    • Most people will reach their Part B deductible each year. If your deductible is covered in full, you won’t have to schedule your doctor’s visits in a way that takes advantage of your budget.
    • Don’t be ridiculous. You’ll always want this benefit, even if it only saves you $183.
  • Plans that cover this:
    • Plans C and F will cover your Part B deductible.

4. Part B Excess Charges: Some doctors who participate in Medicare don’t use Medicare-approved prices (also called “assignment”). In these cases, they’re allowed to charge 15 percent more than the Medicare-approved rate directly to you. Having this as an additional Medicare Supplement benefit means that your Medigap insurer covers these costs that bypass Part B.

  • When will you want this benefit?
    • If you want to see the widest possible range of doctors under Medicare or
    • If your favored physician doesn’t accept assignment.
  • Plans that cover this:
    • Plans F and G will cover your Part B excess charges.

5. Foreign Travel Emergencies: Medicare only works in America and its territories, including Puerto Rico and Guam. Many Medicare Supplement plans pay 80 percent of your emergency medical costs if you need to go to the hospital in other countries. This benefit gives you easy access to emergency care all over the world.

Expats should note that routine care must still be taken care of in the US or through a plan purchased in another country.

  • When will you want this benefit?
    • If you occasionally travel to other countries.
    • If you don’t want to deal with the hassle of separate health insurance while traveling.
  • Plans that cover this:
    • Plans C, D, F, G, M, and N will cover 80 percent of your foreign medical emergency costs after you pay a separate $250 deductible. There’s a $50,000 lifetime limit on this benefit.

How to Compare Medicare Supplement Plans (Plan-by-Plan Comparison) by from Ronald Barba

Taking the Next Steps

It’s good if some plans stand out to you. Choosing your Medicare Supplement plan type is an important long-term decision.

Thankfully, it’s completely free to speak with as many brokers as you like. Brokers aren’t allowed to charge you any additional fees on top of your plan’s monthly cost.

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