Medicare Supplements

Medicare Supplement plans, also known as Medigap plans, are designed to help pay out-of-pocket costs that are left by Original Medicare. There are 10 standardized supplement plans, which go from letter A to N and each of them offers a different range of coverage. Because they are standardized, it means that each plan letter provides the same benefits nationwide (exceptions are Wisconsin, Minnesota, and Massachusetts).

What Is Medicare Supplemental Insurance?

Medicare Supplemental Insurance only works alongside Original Medicare. Original Medicare only covers 80% of costs which means that Medicare beneficiaries need to cover the rest 20%. That 20% of the cost beneficiaries pay in the form of deductibles and copays or coinsurance. With supplement plans, you can be covered for Part A and Part B deductibles and coinsurance, but what amount of coverage you are going to get depends on the plan letter you choose. In addition to that, those plans don’t provide extra benefits like dental, vision hearing, and drug prescriptions. You can’t purchase any supplemental plan if you have Medicare Advantage, because if you have Medicare Advantage it becomes your primary source of coverage instead of Original Medicare.

With Medicare Supplemental insurance all costs are predictable, benefits are the same regardless of carrier, policies are renewable as long as you pay monthly premiums, no network restrictions, and referrals to see specialists are not required.

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Medicare Supplement Eligibility and Enrollment

Every beneficiary who is eligible for Medicare is eligible for the Medicare Supplement plan. To purchase a Medigap policy, you must be enrolled in Original Medicare first. Every U.S. citizen is eligible for Original Medicare if is 65 or older, younger but collecting Social Security Disability benefits for at least two years, and has ESRD or ALS.

The best time to purchase a Medicare Supplement plan is during the Medigap Open Enrollment period. This period begins the first month of your Part B effective date, and if you enroll during this 6-month open enrollment window you have a guaranteed issue right, which means that you can’t be turned down based on pre-existing health conditions. However, if you miss this Initial Enrollment Period, you can buy a Medigap policy, at any other time of the year, but be aware that you maybe will need to fill out a health questionnaire, and your insurer can turn you down based on your health conditions.

Medicare Supplement Costs

The cost of Medigap plans often depends on your living area (ZIP Code) and policy provider. Some can have lower and some of them can have higher monthly premiums. Also, based on a plan letter that signifies the amount of coverage you are going to get, premiums can vary from 40$ to 300$ per month. There are also 3 types of pricing methods that determine the cost of your policy: community-rated, issue-age, and attained age. Community-rated pricing is not based on gender or age, the premium cost is the same for everyone, whilst an issue-age pricing method counts the costs based on your age when enrolling. Attained age pricing method will increase the monthly premium as you get older, regardless of your enrollment time.

Medicare Supplement Coverage By Each Letter

There are 10 standardized Medigap plans under federal law. Some states offer High Deductible Plan F and Plan G, so today you can choose between 12 different Medigap policies. None of them covers the Part B deductible, which is 226$ in 2023. Due to MACRA, plans can no longer offer coverage for Part B deductible, so Plan C, Plan F, and High Deductible Plan F are no longer available for beneficiaries that weren’t eligible for Medicare prior to the 1st of January 2020. Other plans that are most comprehensive on the market, and are available to new Medicare beneficiaries are plan G and Plan N.

Therefore Medicare Supplement plans to provide coverage for:

Medicare Part A hospital stay coinsurance up to 365 additional days after Medicare benefits are dried out: all plans
Medicare Part B coinsurance or copay: all plans, but Plan L covers 75%, whilst plan K covers 50% of the cost. Plan N covers 100% except for 20$ of coinsurance for some office visits, and up to 50$ for the emergency room that isn’t considered an inpatient
Medicare Part B preventive care coinsurance: all plans
First three blood prints: all plans, but only Plan L covers 75% and Plan K 50% of the cost
Medicare Part A hospice care coinsurance or copay: all plans, except plan L, cover 75% and plan K covers 50%
Skilled nursing facility care coinsurance: all plans except Plans A and B. Plan L covers 75%, and Plan K 50%.
Medicare Part A deductible (1600$): all plans, except plan A. Plan L covers 75%, Plan K and M cover 50%
Medicare Part B deductible: none of the plans are eligible for new Medicare beneficiaries. Plans that cover it are plans F and C, but those are not available for people that weren’t eligible for Medicare prior to January the 1st 2020.
Medicare Part B excess charges: only plans F and G cover Part B excess charges, as well as High Deductible plan F and High Deductible plan G.
Foreign travel emergencies: all plans, except plans A, B, K, and L

One important thing beneficiaries need to know is that Plan K, L and M are cost-sharing plans, but plan M covers the widest range of all 3 because only Part A deductible is covered 50%, other benefits, except Part B deductible and Part B excess charges are covered 100%.

Since Plans L and K are mostly cost-sharing plans, they have the maximum out-of-pocket limit policyholders can spend before your insurer starts to pay for everything for the rest of the year. MOOP for plan L is 3470$ and for plan K is 6940$.

Learn More About Medigap Plans

We know that world of Medicare can be tricky. If you are new to this and have any additional questions about Medigap policies, costs, enrollment, and coverage, our insurance agents at Turning 65 Solutions can help you find the best option. Give us a call at 830-328-4353, and let’s begin your Medicare journey!

830-217-6711