Medicare Supplement Benefits and Plans
Medicare Supplement plans (also known as Medigap) are just what the name implies. They are supplemental policies that help offset the costs that Medicare enrollees must pay out of pocket — the “gap” between what Medicare Part A and Part B pay versus the total financial obligation for care that is received.
Many private health insurance companies offer Medicare Supplement plans. Bear in mind that these plans only cover overall out-of-pocket expenses associated with Medicare. Medicare Supplement plans should not be confused with Medicare Advantage plans, which are privatized versions of Medicare Part A and Part B.
Medicare Supplement Plan Comparison Chart
|Part A coinsurance and hospital costs*||Yes||Yes||Yes||Yes||Yes||Yes||Yes||Yes||Yes||Yes|
|Part B coinsurance or copayment||Yes||Yes||Yes||Yes||Yes||Yes||50%||75%||Yes||Yes|
|Part A hospice care coinsurance or copayment||Yes||Yes||Yes||Yes||Yes||Yes||50%||75%||Yes||Yes|
|Skilled nursing facility care coinsurance||No||No||Yes||Yes||Yes||Yes||50%||75%||Yes||Yes|
|Part A deductible||No||Yes||Yes||Yes||Yes||Yes||50%||75%||50%||Yes|
|Part B deductible||No||No||Yes||No||Yes||No||No||No||No||No|
|Part B excess charges***||No||No||No||No||Yes||Yes||No||No||No||No|
|Foreign travel exchange||No||No||80%||80%||80%||80%||No||No||80%||80%|
* Up to an additional 365 days after Medicare benefits are used up
** First 3 pints
*** This is the difference between what your doctor charges and what Original Medicare covers.
**** After you meet your out-of-pocket yearly limit and your yearly Part B deductible, the Medicare Supplement plan pays 100% of covered services for the rest of the calendar year.
Note: In Massachusetts, Minnesota, and Wisconsin, Medicare Supplement is standardized in a different way.
Plan Benefits Explained in Detail
Part A coinsurance and hospital costs:
Medicare Part A covers inpatient hospital, skilled nursing facility, and some home health care services. About 99% of Medicare beneficiaries do not have a Part A premium, since they have at least 40 quarters of Medicare-covered employment.
These Medigap plans offer an additional 365 days of coverage for inpatient care after Part A benefits are exhausted.
Part B coinsurance or copayment:
Medicare Part B covers outpatient services, doctor visits, and some home health care services. These Medigap plans cover any other coinsurance or copayments that Medicare requires.
If you are in the hospital and need blood, Medicare Part A covers all of your blood transfusion needs minus the first three pints. Most every Medicare Supplement plan offers some level of coverage for the first three pints of blood.
Part A hospice coinsurance/copayment:
If you become terminally ill and decide you no longer want treatment for your illness, Medicare Part A will provide coverage for hospice care in your home or at an inpatient hospice facility. Most Medigap plans will cover part or all of the coinsurance and copayment Medicare requires for this benefit.
Skilled nursing facility coinsurance:
If your doctor decides that you need daily skilled care given by, or under the direct supervision of, skilled nursing or therapy staff and you have a qualifying inpatient stay, you may be eligible for skilled nursing facility coverage.
While most Medicare Supplement plans do offer coverage for the coinsurance, Plan A and Plan B do not have any coverage for this benefit.
Medicare Part A deductible:
The Medicare Part A annual inpatient hospital deductible that beneficiaries pay when they are admitted to the hospital is $1,340 per benefit period in 2018. The Part A deductible covers beneficiaries’ share of costs for the first 60 days of Medicare-covered inpatient hospital care in a benefit period.
Medicare Part B deductible:
The Medicare Part B annual deductible that beneficiaries pay is $183 per benefit period in 2018. The Part B deductible covers beneficiaries’ share of costs for any Part B charges.
Medicare Part B excess charges:
Medicare Part B excess charges coverage provides additional payment to providers who do not accept Medicare assignments and who are allowed to bill up to 15% over what Medicare will cover for the service.
Most Medicare Supplement plans do not cover these extra charges, which can amount to a large sum, depending on the procedure.
Foreign travel exchange:
The foreign travel exchange benefit offers 80% coverage for emergency services if you are traveling internationally. Over half of the Medigap plans provide this type of coverage.