Medicare is one of the most popular health insurance programs in the United States, providing coverage for millions of seniors and disabled individuals. However, even with Medicare coverage, many beneficiaries may still face out-of-pocket expenses for medical services and treatments. That’s where supplemental insurance Medicare comes in. In this article, we’ll take a closer look at what supplemental insurance Medicare is, how it works, and why you might want to consider getting it.
What is Supplemental Insurance Medicare?
Supplemental insurance Medicare, also known as Medigap insurance, is a type of private health insurance designed to help fill the gaps in coverage left by Original Medicare. These policies are sold by private insurance companies and are regulated by federal and state laws. They are designed to provide additional benefits to help pay for things like copayments, coinsurance, and deductibles that are not covered by Original Medicare.
Supplemental insurance Medicare policies are standardized and are identified by letters (A, B, C, D, F, G, K, L, M, and N). Each lettered policy offers different benefits, but all policies of the same letter must offer the same benefits, regardless of which insurance company sells them. For example, if you purchase a Medigap Plan F policy from one insurance company, it must offer the same benefits as a Plan F policy from another company.
Who is Eligible for Supplemental Insurance Medicare?
To be eligible for supplemental insurance Medicare, you must be enrolled in Original Medicare (Part A and Part B). You cannot have both a Medicare Advantage plan and a Medigap policy at the same time. Additionally, you must live in the state where you are purchasing the policy and be at least 65 years old (or younger if you have a qualifying disability).
What Does Supplemental Insurance Medicare Cover?
Supplemental insurance Medicare policies can help pay for a variety of costs associated with healthcare, including:
Covered Benefits |
Medigap Plans That Cover This Benefit |
|---|---|
Part A coinsurance and hospital costs |
A, B, C, D, F, G, K, L, M, and N |
Part B coinsurance or copayment |
A, B, C, D, F, G, K, L, M, and N |
Blood (first 3 pints) |
A, B, C, D, F, G, K, L, M, and N |
Part A hospice care coinsurance or copayment |
A, B, C, D, F, G, K, L, M, and N |
Skilled nursing facility care coinsurance |
C, D, F, G, K, L, M, and N |
Part A deductible |
B, C, D, F, G, K, L, M, and N |
Part B deductible |
C, F, and high-deductible F |
Part B excess charges |
F and G |
Foreign travel emergency (up to plan limits) |
C, D, F, G, M, and N |
What Are the Different Types of Supplemental Insurance Medicare Policies?
There are 10 standardized types of supplemental insurance Medicare policies, each identified by a letter (A, B, C, D, F, G, K, L, M, and N). Here’s a breakdown of what each policy covers:
Medigap Plan A
Plan A is the most basic type of supplemental insurance Medicare policy. It covers the following benefits:
- Part A coinsurance and hospital costs up to an additional 365 days after Original Medicare benefits are exhausted
- Part B coinsurance or copayment
- First three pints of blood used in a medical procedure (annually)
Medigap Plan B
Plan B covers the same benefits as Plan A, plus:
- Part A deductible
Medigap Plan C
Plan C covers the same benefits as Plan B, plus:
- Part B deductible
- Part B excess charges
Medigap Plan D
Plan D covers the same benefits as Plan B, plus:
- Part A hospice care coinsurance or copayment
- Skilled nursing facility care coinsurance
Medigap Plan F
Plan F is the most comprehensive type of supplemental insurance Medicare policy. It covers the following benefits:
- Part A coinsurance and hospital costs up to an additional 365 days after Original Medicare benefits are exhausted
- Part B coinsurance or copayment
- First three pints of blood used in a medical procedure (annually)
- Part A hospice care coinsurance or copayment
- Skilled nursing facility care coinsurance
- Part A deductible
- Part B deductible
- Part B excess charges
- Foreign travel emergency (up to plan limits)
Medigap Plan G
Plan G covers the same benefits as Plan F, except for the Part B deductible.
Medigap Plan K
Plan K covers the following benefits:
- Part A coinsurance and hospital costs up to an additional 365 days after Original Medicare benefits are exhausted
- Part B coinsurance or copayment (50%)
- First three pints of blood used in a medical procedure (annually)
- Part A hospice care coinsurance or copayment
- Skilled nursing facility care coinsurance (50%)
Medigap Plan L
Plan L covers the following benefits:
- Part A coinsurance and hospital costs up to an additional 365 days after Original Medicare benefits are exhausted
- Part B coinsurance or copayment (75%)
- First three pints of blood used in a medical procedure (annually)
- Part A hospice care coinsurance or copayment
- Skilled nursing facility care coinsurance (75%)
- Part A deductible (75%)
Medigap Plan M
Plan M covers the following benefits:
- Part A coinsurance and hospital costs up to an additional 365 days after Original Medicare benefits are exhausted
- Part B coinsurance or copayment
- First three pints of blood used in a medical procedure (annually)
- Part A hospice care coinsurance or copayment
- Skilled nursing facility care coinsurance
- Foreign travel emergency (up to plan limits)
Medigap Plan N
Plan N covers the following benefits:
- Part A coinsurance and hospital costs up to an additional 365 days after Original Medicare benefits are exhausted
- Part B coinsurance or copayment (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 inpatient admission)
- First three pints of blood used in a medical procedure (annually)
- Part A hospice care coinsurance or copayment
- Skilled nursing facility care coinsurance
- Foreign travel emergency (up to plan limits)
Why Do You Need Supplemental Insurance Medicare?
Supplemental insurance Medicare can help cover the out-of-pocket costs associated with medical care that Original Medicare does not cover. Without a supplemental insurance Medicare policy, you may be responsible for paying these costs out of your own pocket, which can quickly add up and become a financial burden.
In addition, having a supplemental insurance Medicare policy can provide peace of mind knowing that you have additional coverage to help pay for medical expenses. This can be especially important if you have a chronic health condition or anticipate needing medical care in the future.
How to Choose a Supplemental Insurance Medicare Policy?
When considering supplemental insurance Medicare policies, there are a number of factors to take into account, including:
- The benefits offered by each policy
- The cost of the policy
- The financial stability of the insurance company
- The reputation of the insurance company
- Whether the insurance company offers any additional benefits or discounts
It’s important to compare policies from different insurance companies to find the one that best meets your needs and budget. You can do this by working with a licensed insurance agent or by using an online comparison tool.
FAQs
Q: Can I enroll in a Medigap policy if I have a Medicare Advantage plan?
A: No, you cannot have both a Medicare Advantage plan and a Medigap policy at the same time.
Q: When is the best time to enroll in a Medigap policy?
A: The best time to enroll in a Medigap policy is during your six-month Medigap Open Enrollment Period. This period starts on the first day of the month in which you are both 65 or older and enrolled in Medicare Part B.
Q: Can I change my Medigap policy after I’ve enrolled?
A: Yes, you can switch to a different Medigap policy at any time, but you may be subject to medical underwriting if you are outside of your Medigap Open Enrollment Period.
Q: Is there a difference between Medigap policies sold by different insurance companies?
A: No, all Medigap policies of the same letter offer the same benefits. However, the cost of the policy may vary depending on the insurance company.
Q: How much does supplemental insurance Medicare cost?
A: The cost of a supplemental insurance Medicare policy varies depending on a number of factors, including your age, location, and the policy you choose. It’s important to compare policies from different insurance companies to find the one that best meets your needs and budget.
Q: Does supplemental insurance Medicare cover prescription drugs?
A: No, supplemental insurance Medicare policies do not provide coverage for prescription drugs. To get prescription drug coverage, you will need to enroll in a Medicare Part D prescription drug plan.
Q: What happens if I don’t have a supplemental insurance Medicare policy?
A: If you don’t have a supplemental insurance Medicare policy, you may be responsible for paying the out-of-pocket costs associated with medical care that Original Medicare does not cover. This can quickly become a financial burden and may limit your access to medical care.
Conclusion
Supplemental insurance Medicare can provide important additional coverage for medical expenses not covered by Original Medicare. By understanding how these policies work and comparing policies from different insurance companies, you can find the one that best meets your needs and budget. Whether you are a senior or disabled individual, supplemental insurance Medicare can provide peace of mind and financial protection in the face of unexpected medical expenses.