How To Easily Compare Medigap Plans For 2015
It is not easy to compare and understand the many different Medicare Supplement (Medigap) Plans A, B, C, D, F, G, K, L, M and N, with all their different benefits and costs. To get a better understanding, read our explanation and comparison below, which explains in simple ‘layman’s terms’ all your options.
What You Need To Know About Medigap Plans In 2015
Medigap plans, also referred to as Medicare supplement plans or supplemental insurance, are offered by private insurance companies, approved by the federal government and CMS/Medicare.
There are 10 standardized plans, defined by letters from A through N. Available for 2015 are A, B, C, D, F, High Deductible F, G, K, L, M and N. All plans cover basic benefits, and each has different additional benefits. Which plans are available to you depends on your local area.
Each plan comes with a different set of benefits to compensate for gaps under the healthcare law, helping you cover some or all of the cost for co-payments and deductibles that are not covered by traditional Medicare. Every insurance provider must give you the exact same benefits for the plan you select – but each insurer is free to set its own price. Since the cost can vary greatly among insurance companies, it is important to comparison shop, before you decide which Medigap policy is best for you.
How And When Can I Buy Medigap?
You have a guaranteed issue right to join a Medigap plan, regardless of past or current health issues, when you first become eligible for Medicare, but only for 6 months during your Medigap Open Enrollment Period, which starts the first month you turn 65 and are enrolled in Medicare Part B.
After that – except in specific circumstances -, insurers may use ‘underwriting, which means any health issues you have or had will be considered, and may influence your acceptance or monthly premium. Read more about the exceptions at Medicare.gov.
It is important to know that your Medicare Part A and B are still your primary coverage, if you purchase a Medigap plan. If a health care provider accepts Medicare, they will typically accept your Medicare supplemental insurance. Unlike Medicare advantage plans, there is no network of providers you must use. You may see any doctor that accepts Medicare. When it’s time to pay your bill, Medicare will first pay its share, and then your supplemental insurance will take care of the remainder, to the extend as it is covered by the plan you select.
General Benefits, Coverage, Premiums And Out-Of-Pocket Expenses Of Medigap Policies
All plans include Medicare Part A (hospital) coinsurance and coverage for hospital benefits (Plan N has $20 copay for office visits; $50 copay for ER).
All plans include Medicare Part B (doctor’s visits) coinsurance or copayment, blood (first three pints), hospice care coinsurance or copayment (Plan K only to 50%, and Plan L to 75%).
As you may know, Medicare only pays 80% of your approved medical costs. If you want additional coverage, select plans C or F to cover most of your Medicare-approved charges, or plans F or G if you also want to cover the ‘excess charges’ for everything that Medicare doesn’t cover for hospital and doctor’s visits.
The exact benefits and costs vary from plan to plan and are briefly explained in the following.
Costs/Premiums Comparison For Medigap Plans A Through N
Medigap plans A, B, C, D, F, High Deductible F, G have higher monthly premiums, but limit your out-of-pocket costs.
Medigap Plans F and G are the only supplemental policies covering costs known as ‘Medicare Part B excess charges’ (the difference between what a health care provider may charge and what Medicare will pay for outpatient services). In case you need treatment that exceeds the Medicare approved amount, Plan F and G will help shield your from unforeseen out-of-pocket expenses. While Plan F pays for 100% of those charges, Plan G covers only a percentage.
Plans K, L, M and N have lower premiums, but require you to pay coinsurance. However, you are protected with an annual out-of-pocket limit.
Please note the original Medicare Part A (Hospital insurance) and Part B (Outpatient insurance) are not the same as Medigap policies plan A and plan B.
Medigap Plan A
Medigap Plan A offers basic coverage for hospitalization, medical expenses, blood and hospice care, at moderate monthly premiums and lower out of pocket costs. Plan A is ideal for seniors who want to add coverage to traditional Medicare, but don’t anticipate needing a lot of medical services. Basically, with Plan A you don’t pay for extra coverage you may never use — however, if you need more medical care than expected, you will face out of pocket expenses.
Medigap Plan B
Plan B includes the same basic benefits as Plan A (see above), plus coverage for your Medicare Part A (Hospital) deductible.
Plan B may be right for you if you want to be covered for basic services (same as plan A), but add more more coverage for hospital expenses.
Medigap Plan C
Plan C adds extra coverage to the basic benefits by covering most of your medical expenses for Medicare-approved charges (at a higher premium). Plan C may be right for you if you want to make sure your primary medical needs are covered, at predictable monthly expenses.
Medigap Plan F and High Deductible F
With Medigap Plan F, you will receive the most complete Medicare coverage available. Basically, it pays for everything that Medicare doesn’t cover at the hospital and for doctor’s visits, so you won’t have any out of pocket costs. Of course, this full coverage come with a higher monthly premium.
If you select the high deductible option of Plan F, you will have a high deductible of more than $2,000 (which also may go up each year), before your insurance starts paying, but a lower monthly premium.
Medigap Plan G
Medigap Plan G is the second most comprehensive supplemental plan offered. It was created for persons who want basic coverage for hospitalization, but are willing to pay the Part B deductible out of pocket.
The only difference between Plan F and G is the coverage of the Medicare Part B deductible for doctor’s office charges. Plan F covers this deductible while Plan G does not. Therefore, most insurers offer Plan G at a lesser premium than F.
Medigap Plan K
Unlike the before mentioned plans A through G, Plan K pays only a percentage of your medical costs not covered by Medicare. In case of an unforseen illness or injury, you are however protected of the plan’s annual out-of-pocket limit. Once you reach this limit, the plan pays 100% of Medicare-approved costs until the end of the year. Plan K is a good fit for seniors who prefer a lower monthly premium, but still want to be covered if unforseen medical services should become necessary.
Medigap Plan L
Similar to Plan K, Plan L is for those who prefer an affordable premium, but still want coverage for a wide variety of medical services in case they should be needed. Compared to Plan K, Plan L has a slightly higher premium, but covers a higher percentage of your costs at a lower annual out-of-pocket amount and out-of-pocket limit.
Medigap Plan N
Plan N provides more coverage than Plan K and L, by still maintaining a lower premium than the Plans A, B, C, F and G. Except the monthly premium, your sole out-of-pocket expenses are a small copay for doctor office visits or emergency rooms.
Medigap Plan Overview Chart
|Medicare Part A Coinsurance and Hospital Costs up to an additional 365 days after Medicare benefits are used up|
|Medicare Part B Coinsurance or Co-payment||50%||75%||Copay|
|Blood (First Three Pints)||50%||75%|
|Part A Hospice Care Coinsurance or Copayment||50%||75%|
|Skilled Nursing Facility Care Coinsurance||–||–||50%||75%|
|Medicare Part A Deductible||–||50%||75%||50%|
|Medicare Part B Deductible||–||–||–||–||–|
|Medigap Plan F also has a high deductible option. If you select the high deductible plan F you have to pay the first $2,070 (deductible) in MediGap-covered costs before the MediGap policy pays anything. Medigap Plan N pays 100% of the Part B coinsurance, except for an insured copayment of up to $20 for some doctor’s office visit and up to $50 for each emergency room visit (emergency room copay waived if admitted as an inpatient). Medigap Plans K & L: After you meet your out-of-pocket yearly limit and your yearly Part B deductible, the plan pays 100% of covered services for the rest of the calendar year.|
We hope this brief overview over the currently available Medigap plans in 2015 has helped you understanding your options.
Please keep in mind that no Medigap plan will provide prescription drug benefits, which means that you need to purchase a separate Part D plan (PDP) to help with your medication expenses.
You also will not have dental and vision, or hearing aids coverage. If dental, vision or hearing aids are important to you, you will have to look for separate insurance.
You may also check out this article to find out whether Medicare Advantage plans may be an option for you in lieu of Medigap.
Make sure to compare rates from different insurance providers before deciding on any Medicare plan!
DISCLAIMER: As the information provided on this website may be incomplete, or incorrect, or have changed since this post was published, we urge you to consult with a Medicare professional to go over all your options, and help you find the best plan, at the best price, for your individual health care needs. To find a Medigap policy in your area, you may also check out the Medigap plan finder at Medicare.gov.
More about Medigap Insurance:
By: Joseph Rosario