As Original Medicare (Parts A and B) doesn’t pay all your health care costs, purchasing supplemental coverage can be a wise choice. When you stick with the Medicare coverage you get through the government, you’re responsible for paying 20% out-of-pocket in coinsurance for inpatient and outpatient services.
Additionally, Medicare doesn’t cover some services you may have previously thought it would – including dental, vision, and hearing care. The best option(s) for you to choose as supplemental insurance with your Medicare depends upon your health and budget needs. It is important to be familiar with all the options first, so you can make the best choice.
Deciding What Coverage You Need
You may be familiar with Medicare Supplement plans, but they are not the only supplemental coverage option for Medicare. There is also Medicare Advantage, which usually includes coverage for dental, vision, and hearing care, as well as a component that helps pay for prescription drugs.
With low or no monthly premiums, Advantage plans can be affordable options for people on a strict budget. Yet, for maximum savings on an Advantage plan, you’ll need to find a plan with a network that includes your providers.
Advantage plans can also be a sensible option for people under 65 on Medicare due to disability. Not every state requires companies selling Medigap policies to make them available to individuals under 65, and they usually only offer the most basic benefits to those eligible due to disability.
Part D and Ancillary Plans
Medicare Supplement plans do not include the extra benefits that Advantage plans do, but they – and Original Medicare – also don’t subject beneficiaries to networks. When you pair your Medicare with a Supplement plan, you can continue to use your coverage at any provider who accepts Medicare assignment. This includes most doctors in the United States.
To obtain prescription drug coverage, you’ll need to purchase a standalone Part D plan. It’s prudent to do this as soon as possible after obtaining Parts A and B – regardless of whether you get Medigap or are currently on any medications. Otherwise, you’ll incur a penalty that never goes away for as long as you have Part D.
If your spouse or you are still working when you become eligible and you have creditable prescription drug coverage under an employer plan, you’re safe to delay Part D. But, once you lack creditable coverage for prescriptions, you’re vulnerable to the penalty. It is worth the monthly premium that comes with a Part D plan to avoid racking up penalties in the future, even if you aren’t currently using your prescription drug plan.
Ancillary plans are also available for people who have Original Medicare – with or without Medigap. As Medigap covers what Medicare does, you’ll have very limited coverage for dental, vision, and hearing care. Policies bundling all three types of coverage are available for affordable prices to pair with your Medicare for comprehensive coverage.
Medicare Supplement Plans
It’s important to be familiar with your Medicare Supplement options if you choose to go with this type of coverage. Also known as Medigap, all of these plans pair with Original Medicare and cover the 20% coinsurance Medicare leaves for the beneficiary. Each plan also includes varying levels of additional coverage. Monthly premiums are higher for plans that include more comprehensive coverage.
Options for Medicare Supplement Coverage
Medicare Supplement plans are standardized by the federal government, meaning the benefits of each type of plan are the same regardless of the company selling the plan. In most states, they are identified by letters, from A through N. The plan name indicates the level of benefits the policy covers.
However, premiums for the same plan can vary between carriers for the same person, even though the benefits will be the same between companies offering that plan. Additional factors also contribute to determining an individual’s Medigap premium, including age, location, and tobacco use.
There are currently 12 different Medicare Supplement plan options, including high-deductible versions of two plans. For the most basic benefits at a lower premium, Plan A is available. It covers the coinsurance for Part A and Part B, plus the first three pints of blood. Plan B covers what Plan A covers, plus the Part A deductible – meaning you won’t have to pay out-of-pocket to reach full inpatient coverage.
Plan C covers everything Plan B pays for, plus skilled nursing facility coinsurance, foreign travel emergency costs, and the Part B deductible. Because of the Part B deductible coverage, this plan is not available to people eligible for Medicare after 2020. For newer beneficiaries who want all the benefits of Part C that are available to them, Plan D offers what Plan C does, except for the Part B deductible.
Top 3 Medicare Supplement Plans
The most popular plans are Plan F, Plan G, and Plan N. Plan F covers the most of any Medigap plan, including all the above, plus Part B excess charges. As it includes coverage for the Part B deductible, it is also not available to beneficiaries eligible after 2020.
Plan G is the most popular Medigap plan for new beneficiaries. It covers everything Plan F covers except for Part B excess charges.
To round out the list of the top three Medigap plans, Plan N offers the same benefits as Plan G, minus excess charges – which are rare, even if your state allows them. Additionally, beneficiaries need to pay small copays on this plan, which has the lowest monthly premiums of the top three.
Lower Premium Medigap Options
High-Deductible Plan F and High Deductible Plan G cover what the standard versions cover, with lower monthly premiums and higher deductible amounts you must reach before you obtain full coverage. Like the standard version of Plan F, High Deductible Plan F is only available to those eligible before 2020.
Lastly, there are three cost-sharing plans – Plan K, Plan L, and Plan M. These plans at least partially cover everything other Medigap plans do, except for the Part B deductible and excess charges. The cost-sharing aspect keeps the premiums for these plans relatively low.