Medicare Supplement plans are supplemental insurance policies that cover health care costs that are left behind by Original Medicare – Part A and B. This insurance is known by the name Medigap. In 47 states, Medicare Supplement plans are standardized, named alphabetically from letters A through N. Each Medicare Supplement plan offers a different level of coverage.
Medigap insurance policies are sold by private insurance companies and provide you coverage for some Medicare costs like deductibles, copayments, and coinsurance. Beneficiaries pay monthly premiums for Medigap directly to the insurance provider.
Medicare Supplement Plans Coverage
Medicare Supplement Plans are required to cover for same health services as Original Medicare, but with them, you will no longer be responsible for out-of-pocket costs like coinsurance, copayments, and deductibles. However, how much is covered depends on which type of supplement plan you choose to purchase. Have in mind that prescription drug coverage is not offered by any Medigap plan, so it would be wise to enroll in Medicare Part D to be covered for medications.
The minimum benefits plans must offer are:
- Part A coinsurance costs after additional 365 days are used up
- Part A coinsurance and copayments for hospice care
- Part B coinsurance and copayments
- First 3 pints of blood
Some Medigap plans offer additional benefits like:
- Part A deductible
- Part B deductible
- Part B excess charges
- Foreign travel emergency
- Part B coinsurance for preventive care
- Skilled nursing facility care coinsurance
But be aware that from January 2020 people who are new to Medicare cannot have Part B deductible covered. Because of these new rules, Medigap Plan C and Plan F are no longer available for new enrollees, but those beneficiaries enrolled in Plan C or F before January 2020 can keep them.
Medicare Supplement Plan Enrollment
To be eligible for any Medicare Supplement plan you must be already enrolled in Original Medicare – Part A and Part B. If you qualify, then you can enroll in the Supplement plan during Medigap Open Enrollment Period (OEP). Medigap OEP begins in the month when you turn 65 and enroll in Medicare Part B, and it lasts for six months. This is the ideal time to enroll because during Medigap OEP you have a guaranteed issue right to join without any assessment or medical underwriting. If you decide to enroll later, not during Medigap OEP, but instead during Annual Open Enrollment periods you may be denied based on your pre-existing conditions or you may pay higher premiums regarding your medical history.
Most Popular Medicare Supplement plans in Texas
In Texas, as well as in other U.S. countries, there are 10 Medicare Supplement plans available. They are listed alphabetically: Plans A, B, C, D, F, G, K, L, M, N. But, as stated before, regarding their range of benefits, not all of them are popular. In the state of Texas, three out of ten Medicare Supplement plans covers over 90% of Medicare beneficiaries in the Texas area. The most popular Medicare Supplement plan in Texas is Plan F, followed by Plan G and Plan N.
Medigap Plan F
Medicare Supplement Plan F is the most comprehensive plan on the market because it covers most benefits like coinsurance, deductibles, and copayments. With this plan, you do not have any other costs besides paying a monthly premium. Regarding that, plan F has the highest premium out of all Medicare Supplement plans, and in 2023, the premium can be as high as 400$ a month. But be aware that unless you were eligible for Medicare by Dec. 31, 2019, you cannot purchase Plan F, as well as Plan C. Beneficiaries who were already enrolled or who turned 65 prior to January 1, 2020, are still eligible for this plan.
Medigap Plan F has the widest coverage of all supplemental plans, including:
- Part A hospital costs and coinsurances, up to an additional 365 days after Medicare benefits are used
- Part A deductible
- Part A hospice care coinsurances and copayments
- Part B deductible (only for those eligible for Medicare before January 1, 2020)
- Part B coinsurances and copayments
- Part B excess charges
- First 3 pints of blood every year
- Skilled nursing facility care coinsurance
- Foreign travel emergency healthcare
Medigap premiums will vary based on the state the individual is seeking coverage in, which carrier they are purchasing from, and also individual factors like gender, age, tobacco use, and a few other details. In Texas, the average premium for Plan F is around $120 – $140 per month. With most carriers, the Medicare Plan F cost for males will be slightly higher than for females. In general, Medigap plan premiums are higher in states who have a higher cost of living.
Medigap Plan G
Medicare Supplement Plan G is a top-rated plan on the market and the second most purchased plan in Texas. Plan G covers almost all of the gaps left by Original Medicare at 100% which means that it pays everything that Medicare doesn’t pay, with exception of Medicare Part B deductible.
Medigap Plan G usually offers coverage for:
- Part A coinsurances and hospital costs
- Part B coinsurances and copayments
- Part A hospital coinsurance and copayments
- Part A deductible
- Part B excess charges
- Skilled nursing facility care coinsurance
- First 3 pints of blood every year
- 80% for foreign travel emergencies
Medicare Supplement Plan G has the highest monthly premium which can range from 100$ to 300$. However, only with plan G, there are no copayments. After you have met your deductible for every Part, you are fully covered.
Medigap Plan N
Medicare Supplement Plan N is one of the most popular Medicare Supplement plans and the third most purchased Medigap plan in Texas. It is a great alternative for Plans F and G because it has lower monthly premiums and still gives the most comprehensive coverage for given money.
Medigap Plan N offers coverage for:
- Part A coinsurance, up to an additional 365 days of hospital costs after Medicare benefits are dried out
- Part B coinsurance/copayment
- First 3 pints of blood for a medical procedure
- Skilled nursing facility care coinsurance
- Part A hospice coinsurance/copayment
- Part A deductible
- 80% of foreign travel emergencies
The only things not covered under Medicare Supplement Plan N are Part B deductible together with Part B excess charges.
Medigap Plan N does pay for the Part A inpatient deductible, copays, and coinsurance, except for a $50 copayment for visiting an emergency room. Plan N beneficiaries will also have a $20 copayment for every doctor`s office visit and they will also be responsible for the Part B deductible. You are also responsible for the Medicare Supplement Plan N premium which can go up to 180$ per month and the premium cost is not the same for every Medicare beneficiary. It depends on several factors, like age, gender, living area, etc.