Original Medicare can have gaps in coverage that will leave you with massive healthcare bills. In order to help offset some of these extra costs, you can elect to purchase Medicare Supplement Coverage, also known as Medigap.
A Medigap policy is private health insurance that is designed to cover the “gaps” left over from your government provided Original Medicare plan.
In most states, there are 10 Medigap plan types available for purchase that have all been standardized by the Federal Government. Medigap Plan A is one of these 10 standardized plans.
Make sure not to confuse Medigap Plan A it with Medicare Part A. Medicare Part A covers hospital related expenses and is managed by the Federal Government.
The 10 standardized Medigap plans cover varying degrees of your Original Medicare deductibles, copays, and coinsurance. When purchasing a plan in most states, you’ll be able to decide between the following options: A, B, C, D, F, high deductible F, G, high deductible G, K, L, M, N.
If you live in Massachusetts, Minnesota, or Wisconsin, you will have a different set of plans which we’ll cover in detail below.
Medigap Plans are Standardized
A very important point to remember is that all Medigap plan types are standardized. Meaning, any Medigap Plan A you purchase will have the same benefits no matter which insurance carrier you purchase it from. This is the same for all 10 Medigap plan types — no matter which carrier you choose, the benefits will always be the same.
However, the prices offered for a Medigap plan can be different depending on the insurance carrier. For example, a Medigap Plan A from Aetna and a Medigap Plan A from Humana will have exactly the same benefits, but they can differ on price. This means that in general, it’s best to pick the plan type you want first (A, B, C, etc…) and then choose the carrier who is selling it for the lowest price.
What is Different About Plan A
Medigap Plan A is generally known as the most basic of all Medicare Supplement plans. It offers a base level of coverage that is at a minimum matched by every other Medicare Supplement plan
Is Medicare Supplement Plan A Popular?
Medicare Supplement Plan A is not particularly popular, but it is a great fit for certain individuals.
While not necessarily the cheapest plan option and certainly not the most comprehensive plan option, Plan A is perfect for someone who wants a base level of coverage to back up their Original Medicare plan in the event that something major happens.
How Much Will Medicare Supplement Plan a Cost Me?
Despite having the most basic level of coverage, Medigap Plan A is not necessarily your cheapest option. Click here to get a quote for a Medigap Plan A in your area.
What Does Medigap Plan A Cover?
- Medicare Part A coinsurance and hospital costs up to 365 days after Original Medicare benefits are exhausted
- Medicare Part B coinsurance
- First three pints of blood for a medical procedure
- Medicare Part A hospice care coinsurance
Coinsurance is the amount left over after the 80% covered by Original Medicare
What Does Medigap Plan A Not Cover?
Medicare Supplement Plan A offers only a basic level of coverage, leaving a lot of areas that you could be stuck paying for yourself.
Medigap Plan A doesn’t offer coverage for:
- Skilled Nursing Facility care coinsurance
- Medicare Part A deductible ($1,364 for each benefit period you use in the year)
- Medicare Part B deductible ($185 per year in 2019)
- Medicare Part B excess charges
- Foreign travel emergency coverage
Medicare Supplement Plans in Massachusetts
In Massachusetts, Medicare Supplement Core is the most basic coverage. The basic benefits included in all plans in Massachusetts are:
- Hospitalization Part A copayments
- Part B coinsurance
- First 3 pints of blood
- 60 days per calendar year in addition to Medicare’s coverage of 190 lifetime days
Medicare Supplement Plans in Minnesota
In Minnesota, the basic Medicare supplement plan must have a level of coverage that will provide:
- Medicare Part A inpatient hospital coinsurance amounts, and 100% of all Medicare part A eligible expenses for hospitalization not covered by Medicare, after satisfying the Medicare Part A deductible
- Co-payment amount of Medicare Part A eligible expenses for the calendar year incurred for skilled nursing facility care
- Part B coinsurance amount
- 80% of emergency care incurred during foreign travel
- The first three pints of blood
- 100% of immunizations not otherwise covered under Part D of the Medicare program and routine screening procedures for cancer screening including mammograms and pap smears
- 80% of coverage for all physician prescribed medically appropriate and necessary equipment and supplies used in the management and treatment of diabetes not otherwise covered under Part D of the Medicare program
- Medicare Part A eligible hospice care and respite care expenses
- Part A or B home health care services and medical supplies subject to the Medicare Part B deductible amount
Medicare Supplement Plans in Wisconsin
In Wisconsin, the minimum mandated benefits for Medicare Supplement polices are:
- Skilled Nursing Facilities – Medicare supplement and Medicare select policies cover 30 days of skilled nursing care in a skilled nursing facility.
- Home Health Care – Medicare supplement and Medicare select policies cover up to 40 home care visits per year in addition to those provided by Medicare if you qualify.
- Kidney Disease – Medicare supplement and Medicare select policies cover inpatient and outpatient expense for dialysis, transplantation, or donor-related services of kidney disease in an amount not less than $30,000 in any calendar year.
- Diabetes Treatment – Medicare supplement and Medicare select policies cover the usual and customary expenses incurred for the installation and use of an insulin infusion pump or other equipment or non-prescription supplies for the treatment of diabetes.
- Chiropractic Care – Medicare supplement and Medicare select policies cover the usual and customary expenses for services provided by a chiropractor under the scope of the chiropractor’s license.
- Hospital and Ambulatory Surgery Center Charges and Anesthetics for Dental Care – Medicare supplement and Medicare select policies cover hospital or ambulatory surgery center charges incurred and anesthetics provided in conjunction with dental care for an individual with a chronic disability or an individual with a medical condition requiring hospitalization or general anesthesia for dental care.
- Breast Reconstruction – Medicare supplement and Medicare select policies cover breast reconstruction of the affected tissue incident to a mastectomy.
- Colorectal Cancer Screening – Medicare supplement and Medicare select policies cover colorectal cancer examinations and laboratory tests.
- Coverage of Certain Health Care Costs in Cancer Clinical Trials – Medicare supplement and Medicare select policies cover certain services, items, or drugs administered in cancer clinical trials in certain situations.
Why it’s a Good Idea to Buy a Medigap Plan
People who went without a Medicare Supplement or Medicare Advantage plan spent an average of $5,374 on out-of-pocket costs in 2016, according to a study by the Commonwealth Fund.
Medicare Supplement Plan A is just one of the Medigap plans available. It’s important to compare Medigap plans, and Medicare Advantage plans, and choose the option that’s best for your healthcare needs (now and down the road) and your budget.
When to Buy a Medigap Plan
The best time to purchase a Medicare Supplement plan (Medigap) is during your initial enrollment period. Your Initial enrollment period is the first six months after you’re both 65 years old and enrolled in Medicare Part B. The typical enrollee will coordinate their Medigap policy to begin on the month they turn 65.
You can still buy a Plan A later, but you may have to go through medical underwriting. Underwriting could mean higher premiums or having a pre-existing condition not covered.
Can I get Medicare Supplement if I have a Medicare Advantage plan?
You cannot have a Medicare Supplement Plan A with Medicare Advantage.
Medicare Advantage (Part C) is a private alternative to replace Original Medicare (Parts A & B) and typically offers additional benefits. Medicare Advantage plans often limit your coverage to a particular network of healthcare providers. Plans that allow you to see out-of-network providers charge you more.
You must be enrolled in Medicare Parts A & B to be eligible to apply for a Medicare Advantage plan.
You may pay a premium for your Medicare Advantage plan, in addition to your Part B premium. To be clear, you will still need to pay your Part B premium.
Shop for Medicare Supplement Plan A
Look at Medicare Supplement Plan A prices with no obligation. Enter your zip code, birthdate, gender and tobacco status to get the most accurate prices. Or, shoot us an email at [email protected], or speak with a licensed insurance agent by calling 917-408-3690.