Thinking about a Medicare Supplement Plan to cover the gaps in Original Medicare? This guide provides all the information you need to understand Supplemental plans and determine if they're the right choice for you.
Medigap plans serve as a valuable bridge to fill the gaps in Original Medicare coverage. These supplemental insurance plans, provided by private insurers, assist with costs such as deductibles, coinsurance, and copays. By familiarizing yourself with the various Medigap plans and how they work, you can make informed choices to secure the comprehensive healthcare coverage you need and deserve during retirement.
Medicare Part A Gaps – Hospital and Skilled Nursing Fees
Gap 1: The $1,632 deductible covers up to 60 days in the hospital, whether your stay is one day or the full 60 days.
Gap 2: If your hospital stay extends beyond 60 days, you’ll enter the second gap, where a $408 daily copay applies from days 61 to 90. For stays over 90 days, you’ll face a daily $816 copay from days 91 to 150.
Gap 3: Regarding skilled nursing, Medicare covers the first 20 days at no cost. From days 21 to 100, you’ll incur a daily $204 copay.
Medicare Part B Gaps – Outpatient and Doctor Services
Gap 4: This includes the annual $240 deductible.
Gap 5: After you meet the Part B deductible, Medicare covers 80% of the costs, leaving you responsible for the remaining 20%. This coinsurance gap is ongoing.
Gap 6: Excess charges arise when a doctor, who accepts Medicare patients, does not accept Medicare-approved rates as full payment. You may be responsible for up to an additional 15% of the bill.
Since Supplemental/Medigap plans are designed to supplement Medicare, they function similarly to Original Medicare. When visiting a healthcare provider, you should present both your Medicare A and B card and your Supplemental/Medigap card. The provider will first bill Medicare for the services rendered. After Medicare pays its share, it will send the remaining balance to your Supplemental/Medigap insurer. The specific Supplmental/Medigap plan you choose will determine any additional amount you might owe.
Supplemental/Medigap plans do not require pre-authorization and are valid for life as long as you continue to pay the premiums. These plans are also portable, providing consistent coverage across the United States, as they are federally standardized just like Original Medicare.
The great news is that you have the flexibility to change your Supplemental/Medigap plan at any time during the year. Although you can make changes whenever you wish, you may need to go through medical underwriting. If you pass this process, your new premium might be higher based on your current health status.
When considering a change in your Supplemental/Medigap plan, take into account factors such as any shifts in your healthcare needs and the cost differences between plans. Consulting with a Medicare broker can also be beneficial, helping you evaluate your options and ensure a smooth transition if you decide to switch plans.
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The cost of your Medicare Supplement plan varies based on your Supplemental/Medigap carrier, your location, your health status (especially if you enroll outside of your Initial Enrollment Period), and other factors. On average, countrywide, the monthly premium for a Supplemental/Medigap policy is around $155.
The G Plan is the most comprehensive Medicare Supplement/Medigap plan available and is often the top choice for those not eligible for Plan F. It covers all gaps except for the $240 Medicare Part B deductible. Additionally, the G Plan usually has a lower premium compared to Plan F, with an average monthly cost of $125.
The N Plan is the next most popular choice for those who are not eligible for Plan F. This Supplemental/Medigap plan covers four of the six gaps, excluding the Part B deductible and excess charges. It also includes copays of $20 for doctor visits and $50 for emergency room visits. On average, beneficiaries with the N Plan pay around $100 per month.
While the N Plan is a more affordable option among popular Supplemental/Medigap plans, it’s important to be aware that excess charges that were mentioned earlier are still your responsibility, which could result in unexpected out-of-pocket expenses.
Plan F is one of the most sought-after Medicare Supplement plans due to its comprehensive coverage, addressing all six gaps in Original Medicare. However, this plan is no longer available to new enrollees and is only accessible to those born on or before January 1, 1955.
Due to its extensive coverage, Plan F is also the most expensive Medigap plan, with an average monthly premium of around $175.
When deciding between a Medicare Supplemental plan (Medigap) and a Medicare Advantage plan, it’s important to understand how each option addresses the gaps left by Original Medicare:
Structure: Medigap is supplemental insurance that works alongside Original Medicare (Parts A & B). You pay a separate premium for a Medigap plan, which helps cover costs like deductibles, coinsurance, and copays. Medicare Advantage plans, on the other hand, replace Original Medicare with coverage provided by a private insurance company, making it your primary coverage.
Networks: Medigap plans generally allow you to see any doctor or healthcare provider who accepts Medicare. Medicare Advantage plans often have provider networks that restrict the number of covered healthcare professionals you can see, with some exceptions for emergencies.
Costs: Many Medicare Advantage plans offer lower or even $0 premiums compared to Medigap plans and may include benefits such as drug coverage, as well as dental, vision, and hearing services. Medigap plans usually have higher premiums and require separate plans for prescription drugs and other ancillary services, but they tend to have lower out-of-pocket costs overall compared to Medicare Advantage plans.
Ultimately, choosing the right plan depends on your individual needs and budget. It’s best to consider these factors to determine which plan best fits your situation.
No matter when you choose to enroll in Medicare, Martindale Financial Group will be here to help you.
We help you understand your eligibility and determine the best time to enroll in Medicare based on your unique circumstances.
At Martindale Financial Group, our mission is to make Medicare easy to understand so you can enjoy your retirement with confidence. Explore our blog or visit our YouTube channel for valuable info on Medicare and Social Security.
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Dain Martindale is an Independent Insurance Agent offering Medicare, Life, and Health care products at affordable rates and can write policies for most major carriers. Licensed in Florida serving the Tarpon Springs community and beyond.
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Currently we represent most major carriers in your area. You can always contact Medicare.gov or 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) for help with plan choices.
