As you read please keep in mind:
When PART is mentioned in a sentence: Defines an actual PART of Original Medicare.
When PLAN is mentioned in a sentence: Defines a Medicare Supplement or Medigap policy.
PART A deductible is $1316- and is NOT an annual deductible.
PART B deductible is $183- and is an annual deductible.
What is Medigap?
Also known as a Medicare Supplement, Medigap is private health insurance that supplements Original Medicare. This means it helps pay some of the health care costs (Gaps) that Original Medicare doesn’t cover (like copayment, coinsurance and deductibles).
How does a Medigap or Medicare Supplement Pay?
Medicare pays first and the Medicare Supplement pays second. Original Medicare does not pay any of the cost for you to purchase a Medigap policy. When distinguishing the difference between a Medicare Advantage Plan and Medicare Supplement policy remember that a Medicare Advantage Plan “takes the place of” Original Medicare and a Medicare Supplement Plans fill in the gaps of Original Medicare.
How do I know which Medicare Supplement Plan is right for me?
When researching Medigap Plans remember: That ALL plans are standardized – this means regardless of which company you choose the plan’s benefits are the same. In other words Medicare Supplement Plan F with ABC Company is exactly like USA Company’s Medicare Supplement plan F. A Plan F Supplement is often described as the “Cadillac plan.” This is because you have virtually NO out of pocket expenses except for your premium every month. It is not uncommon for a person new to Medicare to start out with a plan F supplement and as time goes by and premiums increase consider a lesser plan to lower premiums. Plan F Supplement picks up 100% of the Part A Hospital deductible of $1316 (no an annual deductible) and the Part B physicians’ services deductible of $183 (annual deductible). It also pays 100% of all the days in the hospital and picks up the first three pints of blood. This is the preferred plan because of its simplicity. There are no costs related to services or facilities. Original Medicare pays first and the rest is paid by the Plan F Supplement. There is automatic claim service which means you file no claims or have to keep up with who’s paying what, when. Plan G Supplement is often considered the next best plan after the Plan F Supplement. The Plan G Supplement picks up 100% of the Part A Hospital deductible of $1316 (not an annual deductible). However, Plan G Supplement does NOT pick up the Part B deductible of $183 (annual deductible). You would be responsible for the Part B deductible. Once this deductible is met, it pays exactly like a Plan F Supplement. Medicare Supplement Plan A (Supplement) has the least amount of benefits. It provides “basic benefits” meaning Hospitalization Part A (Original Medicare) coinsurance for 365 additional days after Medicare benefits end. Also, Part B coinsurance (generally 20% of Medicare approved expenses) or copayments for hospital outpatient services. This plan has the least amount of benefits and least amount of premium. Medicare Supplement Plan B (Supplement) covers “basic benefits” and the Part A deductible of $1,184. And Part B coinsurance 20% of Medicare approved expenses. Medicare Supplement Plan C (Supplement) covers “basic benefits”, Skilled Nursing Facility Coinsurance-($148 a day), Part A deductible of $1316, Part B deductible of $183, Part B coinsurance of 20% , and foreign travel emergency. Medicare Supplement Plan D (Supplement) covers “basic benefits”, Skilled Nursing Facility Coinsurance-($148 a day), Part A deductible of $1316, but NOT the Part B deductible of $183, Part B coinsurance of 20%, and covers foreign travel emergency.
Medicare Supplement Plan M (Supplement) covers “basic benefits”, Skilled Nursing Facility Coinsurance ($148 a day), 50% of the Part A deductible which is $592 and Part B coinsurance of 20% and foreign travel emergency. Medicare Supplement Plan N (Supplement) covers “basic benefits”, 100% of Part A deductible ($1316), Skilled Nursing Facility Coinsurance-($148 a day), Part B coinsurance of 20%, except up to a $20 copayment for office visits and up to $50 copayment for ER visit and foreign travel emergency. A brief definition of “Skilled Nursing Facility/Care: The first 20 days is picked up by Medicare after that you will pay $148 a day.
It is important to remember that there must be at least a 3 day stay in a hospital before eligible for Skilled Nursing. Also, Skilled Nursing is not nursing home or long term care. It is short term coverage where you will receive rehabilitation which may include occupational, speech, physical therapies.
This break down in Medicare Supplement plans will help you determine which plan will work for you. And remember that the cost of each plan is based on which plan you choose. The plan with the most benefits will be the most expensive and the plan with the least amount of benefits will cost less. Just like your home or auto insurance-the more risk you take the lower the premium, the least amount of risk you take means more premium cost to you, because you are giving more of the risk to the insurance company.