When you buy Medicare, you will have to familiarize yourself with the terms and conditions offered within your plan. Original Medicare, which is the standard Medicare benefit for which most Americans qualify, is designed to offer expansive coverage. However, it will not cover 100% of the costs of all medical care, and you will usually be responsible for paying for a share of these prices.
However, if you are concerned that you might have a hard time paying for these shares of medical costs, then you might find a solution within a Medigap plan, also known as a Medicare supplements. They can help substantially reduce the costs of certain services, if you know how to leverage them appropriately.
Let’s take a closer look at some of the costs that Medigap plans might cover.
How Medigap Plans Work
Under Original Medicare (Part A & Part B coverage), you might be responsible for paying a certain percentage of your medical costs out of your own pocket. However, though Original Medicare can substantially reduce the cost of care as opposed to going uninsured, your out-of-pocket obligations could still be a burden on your wallet, and no one wants to experience that challenge.
To help Medicare patients cover these costs, private insurers now offer Medicare supplement (Medigap) plans. These are policies that are both approved by the Medicare system and guaranteed to assist you in covering the outstanding costs left over by your Original Medicare coverage.
There are numerous Medigap plans on the market today, typically labeled as:
• Plan A
• Plan B
• Plan C
• Plan D
• Plan F
• Plan G
• Plan K
• Plan L
• Plan M
• Plan N
Though each state’s laws might influence certain aspects of certain plans, in general, if you purchase Plan A from one insurer, then you will have the same coverage as a Plan A option offered by another. However, Plan A will offer different coverage than Plan B, etc.
As a result, it’s important to pay attention to the coverage offered within each Medigap plan option before making a final decision on your coverage. Below, we’ve outlined some of the costs commonly covered by these plans. However, be sure to ask your agent what yourprecise policy covers.
Part A Coinsurance and Hospital Costs
Medicare Part A covers costs related to inpatient medical care (surgeries, overnight stays, day treatments, etc.). Under this benefit, policyholders are required to pay a coinsurance cost, which is a percentage of the full cost of care you received. This cost will vary based on the number of days of inpatient care you receive.
All Medigap plans will offer policyholders coverage for 100% their coinsurance responsibilities under Part A.
Part B Coinsurance & Copayments
Medicare Part B pays for everyday medical costs (I.e checkups, lab draws, etc.) and certain outpatient services. Most Medicare Part B coinsurance rules apply a 20% patient responsibility for care. Or, you might be required to pay a nominal copayment for certain costs.
Medigap plans A – G and M will cover 100% of your coinsurance costs, while plans K and L will pay 50% and 75% respectively. Plan N will not cover the first $20 of some office visits, and the first $50 of ER visits that don’t lead to admissions.
Under plans A – G and M – N, you will have coverage for 100% of the costs of the first three pints of blood received in a transfusion. Plans K & L will pay 50% and 75% respectively.
Part A Hospice Care Coinsurance or Copayments
If a Medicare patient needs hospice care, then plans A – G and M – N will pay 100% of their coinsurance and/or copayment costs. Plans K & L will pay 50% and 75% respectively.
Skilled Nursing Care
If a Medicare patient needs skilled nursing care, then plans C – G and M – N will pay 100% of their coinsurance and/or copayment costs. Plans K & L will pay 50% and 75% respectively. Plans A & B will not cover these costs.
Medicare Part A Deductible
The Medicare Part A deductible in 2021 is $1,484 per policy period. This is an out-of-pocket cost that policyholders are obligated to pay before their plan will pay any share of costs for certain services.
Medigap Plan A will not include this coverage, while Plans K & M will cover 50% of the cost. Plan L will cover 75% of the cost. The remaining plans will cover 100% of the costs that go toward your deductible.
Medicare Part B Deductibles
Like Part A, Part B includes a deductible worth $203 in 2021. Only Plans C and F will cover this cost.
Medicare Part B Excess Charges
Certain physicians can charge patients more than the Medicare-approved amount for certain services. However, if you have Medigap Plans F & G, then you will have coverage for 100% of these costs.
Foreign Travel Care
If you need to receive medical care while traveling internationally, then your Medicare will not pay for these services. However, plans C – G and M – N will pay up to 80% of these costs.
There are out-of-pocket limits included on plans K & L, and policyholders cannot have their Original Medicare premiums covered by a Medigap plan. Additionally, these plans are only available to Original Medicare participants, not those who have Medicare Advantage plans.
To learn more about covered costs, speak to one of our agents.