MEDIGAP INSURANCE PLANS & COSTS
Once you attain the age of 65, there are a couple of important decisions that you have to make. One of these decisions is concerning your healthcare options. You can opt for either one of these two plans: Medicare Advantage Plan or the Medigap Policy. But what is the difference between Medicare, Medicare Advantage, and Medigap?
Medicare, on its own, consists of four sections: Part A, the hospital insurance; Part B, the health insurance; and Part C, which is known as the Medicare Advantage Plan. The Medicare Advantage Plan offers an alternative to the basic Medicare plan by offering additional benefits such as prescription drug coverage. Lastly, Part D offers prescription drug coverage for individuals, who have not purchased the Medicare Advantage to begin with.
You’re probably wondering, “What about Medigap?” Well, this article will explain Medigap coverage while highlighting the various plans found under this policy and their respective costs.
What is Medigap?
The Medicare Insurance policy does not cover all your medical expenses, which is what led to the invention of Medigap. More specifically, the Original Medicare policy does not include co-insurance, co-payments and deductibles. If you only have Medicare Parts A and B plans, the remaining expenses can soar very fast.
As its name implies, Medigap Insurance is designed to fill the gaps or loopholes found in the original Medicare plan. Medigap, which is also referred to as Medicare Supplement Insurance, can be purchased from private insurers. It works alongside the Medicare Part A and Part B coverage. The supplemental insurance plans covered by Medigap are lettered as Plans A through N. Each plan has distinct benefits and premiums. Overall, each of these plans will have some or all of these nine benefits:
The Medigap Insurance Benefits Chart
Medigap Insurance Benefits
- ✓ Coinsurance and hospital expenses of Medicare Part A for at least one year after your Medicare benefits deplete
- ✓ Coinsurance or copayment for Medicare Part B
- ✓ Blood (the first three pints)
- ✓ Hospice care coinsurance or copayment for Part A
- ✓ Coinsurance for expert nursing facility care
- ✓ Deductibles for Medicare Part A
- ✓ Deductibles for Medicare Part B
- ✓ Medicare Part B additional charges
- ✓ Foreign travel emergency (up to a particular limit)
Comparing Medigap Plans
Once you attain the age of 65, there are a couple of important decisions that you have to make. One of these decisions is concerning your healthcare options.
When you compare all of the Medigap policies, Plan A is the most rudimentary coverage. It is mandatory for all private Medigap insurers to provide Medigap Part A. But, there’s a catch. You need to have Medicare Part A and Part B to become eligible for Medigap Plan A.
Since it’s only a basic insurance cover, it may not cover all your healthcare expenses. However, if you’re on a limited budget or are receiving Medicare insurance due to a disability, you will find this an excellent plan.
Altogether, the Medigap Plan A provides all the aforementioned benefits with the exception of coinsurance for skilled nursing, Part A and B deductibles, the excess charges of Part B, emergency during an overseas trip, at-home recovery, preventive, dental, and vision care. It means that for any of these expenses, you’d have to pay from your own pocket.
When you enroll for Medigap Plan B, all your medical services and supplies will be taken care of. This plan is quite similar to a typical health insurance policy since it covers common health care expenses such as laboratory tests, surgery, and consultations.
Furthermore, it caters for all your medical supplies such as walkers, crutches, wheelchairs and other accessories. As is the case with Medigap Plan A, you only receive the Plan B benefits if you already have Medicare coverage.
For this plan, you’re required to pay a monthly premium, which differs from one individual to another. This premium is dependent on your income level. For instance, persons earning $85,000 or less will need to pay a premium of $104.9 every month. If your salary is between $85,000 and $107,000, your monthly premium is $146.90 and if your income ranges between $107,000 and $160,000, your monthly premium is $209.80. People earning more than $214,000 have to pay a monthly premium of $335.70. However, these figures are subject to change depending on the private insurer that you choose.
When it comes to health insurance policies, Medigap is one of these companies that put the interests of senior citizens at heart. Medigap part C, sometimes referred to as the Medicare Advantage, helps the elderly achieve more Medicare benefits.
Medigap Plan C provides the basic coverage, the coinsurance for excess hospital expenses from Part A, preventive care coinsurance from Medicare Part B, the coinsurance for Part B for extra services other than preventive care, professional nursing care coinsurance and emergency services that may arise from foreign travels. If Medigap Plan C does not meet all your requirements, you should enroll for their Plan D.
This plan covers all the nine aforementioned benefits except for two of them namely, the deductibles and additional charges for Medicare Part B. It’s crucial to point out that all Medigap Plan D policies are identical regardless of the insurance company that you go to.
One question that many seniors ask is: “Am I eligible for Medigap Plan D?” Essentially, it can be purchased by any Medicare enrollee as long as they enroll within a six-month period after attaining 65 years. This is the same time during which one becomes viable to acquire Medicare Part B. In this duration (called the Open Enrollment Period), no insurance firm has a right of denying you this policy or charging you extra because of a present medical condition.
Medicare Supplemental Insurance Plan F is the most preferred by individuals across all age-groups. One thing that attributes to its popularity is the fact that it covers the excess charges from Medicare Part A and B. Ideally, this means that if you go beyond the allotted limit of your medical services, this Medicare Plan will cover you.
There’s only one other plan that provides this benefit. With Medigap Plan F, you can go for medical checkups without worrying sick about being forced to pay extra for services not covered by Medicare. Other benefits included in this insurance policy include hospital stays, Medicare coinsurance, blood transfusions, hospice services, nursing care, excess charges, travel insurance, and Medicare Part A and B.
Since it offers the most benefits, Medigap Plan F is also the priciest. Their monthly premium can cost you a fortune. The cost for this policy varies significantly depending on your age, medical history, current health status and location. Each individual is assessed separately to determine how much they should pay to receive Plan F benefits.
Medigap Plan G is no far cry from the Plan F. In fact, the only difference is that with Plan G, you have to pay the deductible for Medicare Part B, which is catered for in Plan F. As a result, the premiums for Medigap Plan G are more affordable than for Plan F.
Similarly to Medigap Plan F, this policy covers the excess charges of Medicare Part B, but only up to 80%. Also, you will miss out on a couple of benefits when you enroll for plan G including preventive care and the copayments for hospice care.
With Medigap Plan K, you will receive partial coverage for a designated group of services, which are not covered by the Original Medicare Plan. The only benefit that is fully covered under this plan is the coinsurance for Medicare Part A.
Medigap Plan K is known for offering low-priced premiums but higher deductibles. In summary, it offers 50% coverage for these benefits:
- Additional health care services
- The coinsurance and copayments for Medicare Part B
- Three pints of drawn blood
- The hospice copayments and the deductible for Medicare Part A
This plan aims at increasing the benefits that consumers receive from Medigap. For instance, this policy allows you to choose your preferred healthcare facility or doctor to handle your medical services. Contrary to the Medicare Advantage Plan, it’s not a must that you choose a doctor from a network. The benefits offered under Medigap Plan M include:
- Every service covered under Plan A
- Half of the hospital deductible incurred under Medicare Part A
- Full coverage of the copayments for checkups and emergency room visits
- Full coverage of the coinsurance for nursing facilities approved by Medicare
- Emergency costs during foreign travels
This can be described as the cheaper version of Medigap Plan F. You’ll receive a vast range of benefits such as:
- Full coverage on the coinsurance cost of Medicare Part A
- Full coverage on the deductible for Part A
- Full coverage of Hospice Coinsurance
- Three pints of blood
- Emergency Travel care
- Full coverage on the coinsurance for Part B
For more comprehensive information on the benefits offered under each plan, you can visit their website on https://www.medicare.gov/supplement-other-insurance/compare-medigap/compare-medigap.html
Medigap offers a range of plans, which are labeled A to N. Each Plan offers full or partial coverage of certain benefits. When choosing a specific insurance plan, consider the reputation of the insurance firm, your age, and type of medical services that you need.