Medicare provides basic health coverage, but it doesn’t cover everything.
This is where Medicare Supplement Insurance (Medigap) comes into play.
Medigap plans help cover the out-of-pocket costs that Original Medicare doesn’t, such as copayments, coinsurance, and deductibles. Without additional protection, these costs can add up to many thousands of dollars over the course of your retirement.
Choosing the right Medigap plan can significantly affect your healthcare experience and expenses.
But how to choose the right one? That’s where you need to know your Medigap ABCs!
Medigap plans are standardized, with identical benefits in 47 out of the 50 states. The available plan designs each have a letter designation, running from Plan A through Plan N in these 57 states. (Minnesota, Massachusetts, and Wisconsin each have a slightly different letter system)
Each state can have many carriers. But a Plan A at one carrier must have the same benefits and exclusions as a Plan A at all the other carriers, and so forth.
In this blog we are going to learn the “ABCs of Medigap” so you will be empowered to make the best healthcare choices for you and your loved ones.
Understanding Medigap Plans
Medigap plans are standardized, so any plan with the same letter offers the same basic benefits, regardless of the insurance company or location.
Prices can vary between different insurers offering the same lettered plan, though, so do your research. The most popular Medigap plans are Plans A, G, the high-deductible Plan G, and Plan N, which we will dive into next.
It’s important to note that Plans F and C are no longer available to new Medigap enrollees.
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Plan A: Basic Benefits for Lower Costs
Plan A is the most basic of all Medigap plans, covering essential benefits like Medicare Part A and Part B coinsurance and hospital costs for up to an additional 365 days after Medicare benefits are exhausted.
It’s suitable for those with very low income who need minimal extra coverage.
Here are some important points about Plan A:
1. Coverage Details
Medicare Plan A mainly covers inpatient hospital stays, skilled nursing facility care, hospice care, and home health care.
This includes costs associated with hospital rooms (semi-private), meals, general nursing, and medications administered as part of inpatient treatment, along with surgeries and laboratory tests during hospital stays.
2. Cost Structure
You do not pay a monthly premium for Medicare Part A if you or your spouse have paid Medicare taxes while working for a certain period.
However, Plan A still has a deductible for hospital admissions and coinsurance for extended stays in hospitals and skilled nursing facilities.
3. Eligibility Criteria
Individuals are eligible for Medicare Part A at 65, but if you are under 65 you might qualify earlier if you have received Social Security Disability Insurance for certain disabilities or have End-Stage Renal Disease.
Enrollment is automatic for those already receiving Social Security benefits.
4. Hospital Stay Requirements
For a hospital stay to qualify under Medicare Part A, it must consist of at least two nights under medically necessary inpatient care.
5. Exclusions
Medicare Part A does not cover all aspects of inpatient care.
Exclusions include private room costs unless medically necessary, private-duty nursing, personal care items, and separate charges for television and phone service in hospital rooms.
Part A does not cover doctor’s services during the stay; these are typically covered under Medicare Part B.
Plan G: Comprehensive Coverage
For those who can afford it, Plan G is a favorite for its extensive coverage.
It covers all out-of-pocket costs except the Medicare Part B deductible, which is $240 as of 2024. Although it can be on the pricey side, Plan G offers comprehensive benefits.
Here are the top four things you need to know about Medicare Plan G:
1. Comprehensive Coverage
Plan G is the most comprehensive Medigap plan available, covering a wide range of out-of-pocket costs including copayments, coinsurance, and deductibles for Medicare Parts A and B, except for the Medicare Part B deductible.
2. Popularity and Availability
It is a popular choice among new Medicare beneficiaries due to its extensive coverage. Almost every insurance company that offers Medigap policies has Plan G available.
3. High-Deductible Option
Plan G also offers a high-deductible option, which has lower premiums but requires paying a deductible of $2,800 in 2024 before the plan starts paying benefits.
This can be a great option if you’re in good health who don’t expect to need much health care in the near future, and who can afford to pay $2,800 without wincing, in the event you need care.
4. Foreign Travel Emergency Benefits
Medigap Plan G includes up to $50,000 in foreign travel emergency benefits, providing coverage for emergencies that occur outside the United States.
Plan N: A Balance of Cost and Coverage
Plan N is nearly identical to Plan G but includes copays for doctor visits and emergency room trips that don’t result in admission.
It’s a good middle-ground option for those who want comprehensive coverage but are willing to pay small copays for lower premiums. It also generally carries a slightly lower premium compared to Plan G policies from the same carrier and Zip code.
Things to know about Medicare Plan N:
1. No Coverage for excess charges
Medigap Plan N does not cover Medicare Part B excess charges, unlike Plan G.
Excess charges are relatively rare since most providers who accept Medicare cannot impose them. Eight states (Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont) prohibit excess charges altogether.
Residents of these states might consider Plan N or the high-deductible Plan N as viable options.
2. Copayments for Visits
Unlike most Medigap plans, Plan N includes copayments for certain medical visits.
Expect to pay up to $20 for doctor’s office visits and up to $50 for emergency room visits that don’t result in an inpatient admission. However, visits to urgent care centers typically do not incur a copay.
3. Exclusions
Plan N does not cover the Medicare Part B deductible or Part B excess charges.
This means you’ll be responsible for paying the Part B deductible yourself, and you might have to pay excess charges if a doctor charges more than what Medicare approves.
4. Foreign Travel Emergency Coverage
Plan N provides 80% coverage for emergency healthcare services needed while traveling abroad, up to the plan limits.
This benefit is particularly valuable for those who travel internationally and want the peace of mind knowing they have some coverage outside the U.S.
Additional Coverage Considerations
Drug and Long-Term Care Insurance
It’s important to understand that no Medigap plan includes coverage for outpatient prescription drugs or long-term care insurance.
You’ll need to enroll in separate Part D (drug coverage) and long-term care insurance policies to cover these expenses.
Foreign Travel Benefits
While Original Medicare allows you to receive healthcare from any provider across the U.S. and its territories, it generally does not cover medical expenses incurred outside the U.S.
This limitation can be a big concern if you love to travel internationally.
Medigap plans can provide the necessary coverage for your international travels, giving you peace of mind.
When Does Medicare Cover International Medical Expenses?
Medicare may cover your medical expenses in a few specific scenarios while traveling outside the U.S.:
- If you have a medical emergency in the U.S. but a foreign hospital (like those in Canada or Mexico) is closer than a U.S. hospital, Medicare will cover your treatment.
- Emergency services are also covered if you are traveling through Canada between Alaska and another state.
- If a foreign hospital is closer to your home than any U.S. hospital, you can receive treatment there, even if it’s not an emergency.
- Additionally, Medicare may cover medically necessary healthcare services on a cruise ship, provided the ship is either docked at a U.S. port or within six hours of one.
What Medigap Plans Cover Foreign Travel?
For international travelers, Medigap plans C, D, F, G, M, and N offer emergency healthcare coverage abroad, which is crucial when you’re traveling outside of the U.S.
These plans typically cover 80% of the billed charges for emergency care abroad after you meet a $250 deductible. For those with high-deductible plans like F or G, the annual deductible ($2,800 in 2024) must be met first, along with the $250 deductible for travel benefits, before the travel coverage begins.
If you anticipate traveling outside the U.S. in your retirement years, don’t take the chance of being left uncovered while you’re abroad.
To join a Medigap plan that includes foreign travel benefits, be sure to speak with an HSA for America Personal Benefits Manager to help you pick the right option for your needs.
Lifetime Benefit Limits on Foreign Travel Benefits
While Medigap provides substantial coverage for emergencies abroad, it has a lifetime limit of $50,000 for foreign travel emergency benefits.
Once this limit is reached, no further benefits for international medical expenses are available under Medigap.
If you are a frequent traveler or planning an extended stay abroad, it may be wise to consider additional private travel insurance. This can act as secondary coverage, filling in gaps that Medigap does not cover, and is generally more affordable than primary travel insurance.
Massachusetts, Minnesota, and Wisconsin Considerations
It’s also important to be aware that Medigap policies in Massachusetts, Minnesota, and Wisconsin are standardized differently.
For instance, Massachusetts offers foreign-travel emergency healthcare coverage under its Supplement 1 and 1A plans, while Minnesota’s Basic and Extended Basic plans pay 80% of foreign-travel emergency costs.
In Wisconsin, the core Medicare supplement plan does not include foreign-travel benefits, but insurers may offer this as an additional benefit.
For help navigating your Medigap options in these states, make an appointment with one of HSA for America’s expert Personal Benefits Managers for an individualized consultation.
Medigap Vs. The Medi-Share 65+ Health Sharing Plan
An excellent alternative to Medigap is Medi-Share 65+, an affordable non-insurance healthcare-sharing program that offers similar benefits to Medigap.
It’s a faith-based, Christian health sharing community. It’s not insurance. Instead, it’s a non-profit association of like-minded, health-conscious individuals who agree to help share the medical expenses of their fellow members.
While it covers many of the same types of expenses as Medigap, it operates on a sharing model and may include limitations based on the organization’s guidelines, such as adherence to a biblical lifestyle.
Top 5 Benefits of Medi-Share 65+
1. Significant Cost Savings
Medi-Share 65+ is noted for its affordability, especially when compared to Medigap Plan G or Plan N insurance premiums.
Medi-Share 65+ costs just $99 per month for ages 65 through 74, and $150 for ages 75 and up. This compares very favorably with Plan G and Plan N premiums in nearly all areas in the U.S.
2. Community and Support
Medi-Share 65+ is community-oriented, joining members in a nationwide network that shares not only medical costs but also provides spiritual and emotional support.
3. Comprehensive Coverage Options
Medi-Share 65+ helps members pay for a wide range of medical expenses that go beyond what Medicare covers, including sharing in Medicare deductibles and copays, office visits, skilled nursing facility care, hospital bills, and durable medical equipment.
4. Choose Your Doctor
Medi-Share 65+ allows members to choose any provider that accepts Medicare, offering crucial flexibility for seniors who may require specialized care or prefer to continue seeing their long-time doctors.
Medigap plans also allow you to choose your doctor. However, Medicare Advantage plans limit members to their networks of approved doctors and other providers for non-emergency care.
5. Added Benefits and Discounts
Medi-Share members enjoy additional benefits such as discounts on dental and vision care, savings on diabetes care supplies, hearing aids, and even LASIK surgery through the Select Savings Card.
Medi-Share 65+ and Pre-Existing Conditions
Because Medi-Share 65+ is a health sharing plan, not a health insurance plan, it doesn’t share costs for pre-existing conditions right away. You could have a waiting period of as long as six months before those costs become fully shareable under the plan.
However, if you enroll during your initial Medigap eligibility period, or during the Fall Enrollment Period that runs from October 15th through December 7th each year, Medi-Share is currently waiving the waiting period on pre-existing conditions.
Enroll in Medi-Share 65+ Today
You can easily self-enroll in Medi-Share 65+. It only takes a few minutes to enroll and it’s a simple process. To self-enroll, just click on the link, and follow the prompts.
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Final Thoughts
When selecting a Medigap plan, consider your health needs, financial situation, and lifestyle.
More comprehensive plans like G and N are generally preferable for those who want peace of mind and less worry about out-of-pocket expenses. Medi-Share 65+ is a great alternative with lower monthly costs compared to these Medigap plans per month.
Got questions? We are happy to help!. Contact a Personal Benefits Manager today for a free consultation. We’ll to discuss your options and find thethat plan that best suits your needs and budget.
For Further Reading: MediShare 65+ Health Sharing Program vs. Medigap Plan G | Medicare Open Enrollment: What’s it all About? | Medigap Shopping Tips: Don’t Overpay!
Mike Montes is a Personal Benefits Manager at MediGap Advisors. Mike has a passion for bringing clarity to those confused about Medicare. He is an authority on Medicare, Medicare supplement plans, Medicare Advantage plans, and Part D prescription drug plans. Read more about Mike on his Bio page.