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Main Differences Between Medigap Plans

Healthcare Writer

Last updated March 24th, 2020

Reviewed by Diane Omdahl

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It can be puzzling to choose Medigap plans. But since all Medicare Supplement plans have been 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.

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.

Medicare Part A Coinsurance and Hospital Costs

You’re insulated from hospital costs with all Medigap plans. Part A covers hospitalization. The first 60 days is subject to a deductible, an optional benefit.

  • Medigap will cover your daily coinsurance of $352 in 2020, running from your 61st to 90th day in the hospital each year as an inpatient. 
  • Medicare supplement plans will cover the $704 copayment for days 91-150. These are lifetime reserve days that do not have to be used in the same benefit period but can be used only once in a lifetime. 
  • After those days are exhausted, the supplement will cover up to 365 days. 

Part A Hospice Care Copay or Coinsurance

Medicare supplement plans will cover your hospice costs for drugs and respite care. However, there is no cost sharing for hospice or outside respite care.

  • Medigap will also take care of your five percent coinsurance for inpatient respite care, which gives short-term relief to allow a caregiver to rest and recover if you’re faced with a terminal disease.

Medicare Part B Coinsurance

Medigap plans will handle 20% of coinsurance for Medicare-covered outpatient care, after meeting the deductible.

  • 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.

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

Any Medigap plan will cover the four standard benefits listed above. Plans K and L add cost-sharing.

Plans K and L will only cover the four benefits in part – 50 percent for Plan K, and 75 percent for Plan L – until you reach a separate deductible. In 2020, that out-of-pocket deductible is $5,880 for Plan K and $2,940 for Plan L. 

Optional Additional Benefits for Medicare Supplement Plans

Skilled Nursing Facility (SNF) Care Copay

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

Part A covers up to 100 days; there is no cost sharing for the first 20 days, and then $176 for the next 80 days, which this optional Medicare Supplement benefit will cover. After 100 days, neither Medicare nor Medigap covers staying in an SNF.

  • When will you want this benefit?
    • If you need skilled nursing or therapy to improve your condition and maintain your ability to function after being in the hospital; or
    • If you’re recovering from joint replacement surgery, brain damage, or another medical issue that landed you in the hospital.
  • 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.

Part A Deductible

Some Medigap plans step in to pay for your $1,408 Part A hospital deductible. Hopefully, you won’t need to use it.

  • When will you want this benefit?
    • If you are admitted to the hospital for up to 60 days.
  • 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.

Part B Deductible

A couple of Medigap plans step in to pay for your $198 Part B outpatient deductible. Note: Newly eligible beneficiaries can no longer purchase plans that cover this cost.

  • When will you want this benefit?
    • Most people will reach their Part B deductible each year. If your deductible is covered in full, outpatient visits won’t affect your budget beyond that.
  • Plans that cover this:
    • Plans C and F will cover the Part B deductible.

Part B Excess Charges

Some doctors who participate in Medicare don’t use standard Medicare prices. In these cases, they’re allowed to charge up to 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 additional costs.

  • When will you want this benefit?
    • If you want to see the widest possible range of doctors under Medicare or
    • If you want to ensure that you have the best coverage in all situations.
  • Plans that cover this:
    • Plans F and G will cover your Part B excess charges.

Foreign Travel Emergencies

Medicare only works in America and its territories, including Puerto Rico and Guam. This benefit will pay up to 80% for medically necessary emergency care outside the United States.

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.
  • 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 deductible of no more than $250. There’s a $50,000 lifetime limit on this benefit.

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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