What Are Medicare Supplements?
Medicare Supplements, or Medigap policies, can provide coverage for health care services and fees that Original Medicare does not cover. They are available through private insurance companies and are regulated by federal and state laws.
Medicare Supplements can only be used to help cover Original Medicare costs; they cannot be used with a Medicare Advantage Plan.
Each Medigap policy is labeled with a letter (Plan F, Plan G, Plan N, etc.) and offers different benefits, allowing you to select the one that best meets your needs.
Who Is Eligible For a Medicare Supplement Plan?
In order to purchase a Medicare Supplement plan, you must first enroll and stay in Original Medicare. There are certain restrictions regarding who is eligible for a Medicare Supplement; some states do not offer Medigap policies to those who are under 65 and on Medicare due to disability, End-Stage Renal Disease, or Amyotrophic Lateral Sclerosis.
How Do Medicare Supplement Plans Work?
Medicare Supplement plans are as they sound. They are there to supplement your Original Medicare benefits, so you are eligible to purchase them only after you’re enrolled. Any remaining costs, copays, or deductibles that your Original Medicare does not cover are paid by your Medicare Supplement plan. If you have met your annual Medicare Part B deductible, then a Medigap policy will pay the 20% of the bill that is not covered by Original Medicare.
Medicare Supplement plans do not include prescription drug coverage, so you must purchase Medicare Part D separately.
Types of Medigap Policies
There are 10 standardized Medigap policies that are offered in every state, with the exception of Massachusetts, Minnesota, and Wisconsin; these states have their own standardized Medigap policies. The benefits from these standardized plans remain the same across the country anywhere Medicare is accepted, although a plan’s premium cost differs from state to state. For example, if you live in North Carolina and are enrolled in Plan F, you will receive the same Plan F benefits even if you move to California.
Unlike an HMO or PPO Medicare Advantage Plan, when Medicare is your primary source of coverage, you are not confined to a certain network of doctors and hospitals; you may use any doctor or hospital that accepts Medicare.
However, if certain doctors do not accept Medicare, you will not be able to use your Medicare Supplement to see them even if the insurance company through which you receive your Medigap policy normally considers them “in-network.”
We recommend the following 4 Medicare supplement plans for those living in North Carolina:
Plan F gives patients full coverage by paying the entirety of any remaining costs not covered by Original Medicare. This includes Medicare Part A hospital costs, Medicare Part B copayments and excess charges, skilled nursing facility care coinsurance, and deductibles. Foreign travel emergency costs are covered up to 80%.
Plan G provides most of the same benefits as Plan F, but it does not cover the Medicare Part B deductible of $183
Plan N tends to have lower premiums and many of the same benefits as Plan F and Plan G. However, it does not cover Medicare Part B deductible and excess charges, and may require a co-pay of up to $20/visit
High-Deductible Plan F
Some insurance companies offer a high-deductible version of Plan F. This plan provides all the same benefits as Plan F, but only once a patient has reached a set deductible by paying Medicare-related costs. For 2017, the deductible is $2,180 before the plan starts covering costs.
Here are all the plans side by side:
|Medicare Supplement Benefits||A||B||C||D||K*||L*||M||F||G||N**||F
|Medicare Part A coinsurance hospital costs up to an additional 365 days after Medicare benefits are exhausted||X||X||X||X||X||X||X||X||X||X||X|
|Medicare Part B copayment or coinsurance coverage||X||X||X||X||50%||75%||X||X||X||X**||X|
|First 3 pints of blood||X||X||X||X||50%||75%||X||X||X||X||X|
|Part A hospice care coinsurance or copayment||X||X||X||X||50%||75%||X||X||X||X||X|
|Skilled Nursing Facility (SNF) care coinsurance||X||X||50%||75%||X||X||X||X||X|
|Medicare Part A deductible||X||X||X||50%||75%||50%||X||X||X||X|
|Medicare Part B deductible||X||X||X||X|
|Medicare Part B ‘excess charges’||X||X||X|
|Foreign travel emergency coverage (up to plan limits)||80%||80%||80%||80%||80%||80%||80%|
|Medicare Part B preventive care coinsurance||X||X||X||X||X||X||X||X||X||X||X|
|*Out of Pocket Limit||X||X|
**Plan N pays 100% of the Medicare Part B coinsurance costs, with the exception of a copayment of up to $20 for some office visits and up to $50 for emergency room visits that don’t result in the beneficiary being admitted as an inpatient.
Benefits Not Covered By Medigap Plans
There are health care services and supplies that most Medigap plans do not cover, including long-term care, routine vision and dental care, hearing aids, and prescription drugs.