Medicare Part A and Part B (also known as Original Medicare) is the way over 50 million Americans cover their medical expenses in retirement. Sometimes, however, Original Medicare isn’t enough to cover your medical expenses. Seniors who are concerned about paying for healthcare costs out of pocket can choose to sign up for a supplemental Medigap plan.
The most popular Medigap plans are Plans F, G and N. Understanding the pros and cons of each plan is particularly important, because you don’t have a guaranteed right to change plans later on. Depending on your state, or unless you qualify under a special circumstance, you may be refused coverage by your insurance provider or have to pay higher premiums to switch plans after enrollment.
How supplemental plans work
Medicare Supplement Insurance, or Medigap, is different from Medicare Advantage plans. With Medigap, you subscribe to Parts A and B through Medicare, then purchase one of the 10 available supplemental plans. Medigap plans do not offer coverage for additional benefits outside of what’s included in Original Medicare. Instead, your Medigap plan helps to pay for healthcare costs after Medicare Part A and Part B pay their share.
Compare this to Medicare Advantage (also known as Medicare Part C). This is a private plan that includes Medicare Parts A and B and usually offers additional benefits, such as prescription drug coverage, dental, vision and hearing visits.
Medigap plans require you to pay your monthly premium for Part B to Medicare, as well as a Medigap premium to the private insurance provider you enroll with. Once you’re 65 years old and subscribe to Part B, you have a one-time, six-month open enrollment period to purchase a Medigap policy. During this period, your health insurance company cannot ask you questions about your health. If you miss the open enrollment period, your insurance company can ask about your health and deny coverage or charge you higher premiums based on your pre-existing conditions.
Medigap plans often charge higher premiums and can increase annually, but they require significantly lower out-of-pocket costs compared to Medicare Advantage plans. Medigap plans often include copayment and coinsurance coverage. Additionally, with Medigap coverage, you’re allowed to see any doctor in the United States who accepts Medicare. This offers a larger, more convenient selection of healthcare providers.
Standardized plans across 47 states
There are currently 10 available Medigap plans, which are standardized across all states except for Minnesota, Wisconsin and Massachusetts. These states have their own standardized plans. That means that the benefits and coverage for each plan will be the same across the country, even if the providers and premiums are not.
Since Medigap plans are provided by private insurance companies, they are not required to offer all 10 plans—but they must at least offer Plan A.
Read on for a description of the three most popular plans in detail.
Medigap Plan F
Medicare Plan F is by and large the most popular Medigap plan. Unfortunately, there’s a catch—it is no longer available to new Medicare subscribers as of January 1, 2020. If you signed up for Medicare before that date, you’ll be allowed to keep your plan. It simply is being phased out for new subscribers.
Plan F offers comprehensive, first-dollar coverage. This means that you won’t have to pay the deductibles for Part A and Part B before your insurance coverage kicks in. It’s a broad type of coverage that’s particularly good for seniors with chronic health conditions or who otherwise need to visit the doctor often.
Medigap Plan F covers the Part A and Part B deductibles, copayments and coinsurance. Any hospital coinsurance is covered for 365 days after your Part A benefits have been used, as well as your Part B excess charges. Hospice and skilled nursing care coinsurance is covered, as well as the first three pints of blood for approved procedures. Foreign travel emergency care is covered at 80 percent.
The tradeoff for this coverage is that you’ll pay more in premiums. Make sure that you fully consider what you can afford to pay out of pocket in an emergency versus what each plan will truly cost month over month before making a decision.
If Plan F’s broad coverage sounds appealing, but you need lower premiums, you can choose the high-deductible option. This requires you to pay $2,370 out of pocket (starting in 2021) for your care before your benefits kick in.
Medigap Plan G
If you’re not eligible for Plan F, not to worry. Plan G offers all the benefits Plan F does, except that there’s a $203 deductible (for 2021) you must meet before your Part B benefits kick in.
For anyone with chronic health conditions, this plan might be a great choice. Again, your premiums are higher, and you’ll pay a nominal deductible, but you have far more cost coverage and flexibility with this supplemental plan.
Another important consideration that applies to both Plans F and G is provider choice. If your healthcare provider doesn’t accept Medicare, they can charge you up to 15 percent more than standard Medicare charges. These excess charges are covered under Part B, giving you the freedom to visit any provider you prefer.
Medigap Plan G is becoming increasingly popular, especially now that Plan F is being phased out.
Medigap Plan N
Finally, Medigap Plan N is a good choice if you need to find a balance between affordable premiums and major out-of-pocket expenses. This is the third most popular Medigap plan, and like Plan G, there is no current intention to phase it out.
With Plan N, you get everything offered in Plan F, except for three things. First, your Part B deductible is not covered. Second, your Part B excess charges—the extra money you’ll pay to see a non-Medicare provider—are not covered. Third, although your Part B coinsurances are covered, you may have to pay $20 for select doctor copayments and $50 copayments for hospital visits that don’t result in admission.
If you’re relatively healthy but are afraid of getting stuck paying very high out-of-pocket costs in the event of an emergency, Plan N may be the best choice for you.
How to tell which plan is right for you
When you’re deciding between Medigap plans, it’s important to think about your long-term healthcare needs. If you have serious, chronic health conditions or your family medical history shows a likelihood of developing one, opting for broad coverage might be your best bet.
If you need greater flexibility in choosing your providers, you might want to pick a plan that will cover Part B excess charges. This is particularly important when you need access to specialists or need to ensure that you can see the same provider as long as possible.
However, if you want to keep your premiums lower while protecting yourself against the unexpected, plans like Plan N are usually good options. Although it’s hard to predict what life will bring, you’ll only be responsible for the Part B deductible, occasional copayments and excess charges if you need to see a non-Medicare provider.
Ultimately, your choice comes down to your individual health needs and budget. If you’re unsure about which plan to pick, contact SeniorCare Benefits for help. We’re happy to help you find a Medicare plan that meets your specific health and financial needs. To talk to one of our friendly agents, please call us at 1-888-230-0269.
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