How Do Medicare Supplement Plans Work?

How do Medicare Supplement Plans work?

Medigap plans help cover the cost of expenses that Medicare typically passes onto you. These gaps, such as your deductibles, coinsurance, or copayments, must be paid by you when accessing specific health care services. A Medicare Supplement Plan can help cover the cost of these services. 

A Medigap plan means ‌Medicare pays the first portion of the medical cost, and then your Medigap plan also pays its share. Depending on the plan you choose, this can mean you don’t have any out-of-pocket costs for your medical care. 

Different ‌Medicare Supplement Plans

There are ten standard Medicare Supplement Plans available and each plan must follow strict guidelines established by Medicare. These standardized plans are named by using a specific letter. They include Medigap Plan A, B, C, D, F, G, K, L, M, and N.  (Note:  Plans C and F are no longer available to people new to Medicare on or after January 1, 2020)

Each of these Medigap plans offers the same benefits regardless of the insurance provider you select. The difference is the monthly premium charged by each provider. At Health Plans of NC, our experienced local Medicare agents can help you find the right plan for your budget. We typically find that the most popular plans are G or N.

The key benefits of a Medicare Supplement Plan

Taking out a Medicare Supplement Plan offers a range of benefits worth exploring. Some of these include: 

• The ability to choose your healthcare provider: there are no networks to worry about, so you can see the doctor you want for your health care as long as they accept Medicare.

• You don’t need a referral: which means you can visit a specialist without needing to organize a referral. 

• Understanding your costs: you don’t need to worry about any unexpected out-of-pocket medical expenses throughout the year.

• Guaranteed renewal: your policy will automatically renew regardless of your health condition. 

What’s not covered

There are some restrictions and limitations of Medigap plans, which can include: 

• No coverage for hearing aids, eyeglasses, or contact lenses

• No retail prescription drugs

• No coverage for custodial or long-term care requirements

• No coverage for routine vision, dental or hearing exams

The different components of Medicare Supplement Plans

Some benefits of a Medicare Supplement plan as identified by Medicare include: 

Coinsurance for Medicare Part A: All Medicare Supplement Plans include this benefit. This coinsurance covers the cost of your daily hospital copays, which you start collecting after spending 60 days in the hospital. 

Coinsurance for Medicare Part B: Each Medicare Supplement Plan includes this benefit. Medicare Part B only covers the cost of 80% of your outpatient expenses. So the coinsurance benefits pay the remaining amount. 

Costs for blood transfusions: This benefit covers the price of the first three pints of blood you may require as part of a blood transfusion. Because blood is expensive, this benefit can save you a lot of money. Medicare pays for the fourth pint and above. 

Coinsurance for Part A Hospice care: Your Medicare Supplement Plan pays for hospice care not covered by Medicare, meaning you rarely have to pay anything for hospice care. 

Coinsurance for Skilled Nursing Facility: Original Medicare offers 100 days of skilled nursing facility care after being hospitalized to help assist with your recovery. Medicare covers the cost for the first 20 days, but a Medigap plan that includes Skilled Nursing Facility coverage means you’re also covered for the additional 80 days. 

Medicare Part A deductible: In 2022, the Medicare Part A inpatient hospital deductible if you’re admitted to the hospital is $1,556. You may be required to pay this multiple times throughout the year if you have more than one inpatient hospital stay over 60 days apart.

Medicare Part B deductible: In 2022, this amount is $233. Unless your Medigap plan offers this benefit, you’ll pay this amount annually for any doctor’s visits, lab work, or physical therapy. 

Medicare Part B excess charges: Some health care providers don’t accept Medicare’s designated rates and will charge you up to 15% more than what Medicare is willing to pay. Unless you have a Medigap plan that covers this excess, you’ll be required to pay. Both Medicare Supplement Plan F and Medicare Supplement Plan G cover Medicare Part B excess charges. 

Foreign travel emergency: Original Medicare doesn’t include any coverage if you’re outside the US. Some Medigap plans include a foreign travel benefit, which typically pays 80% of your health costs, up to a specific limit after a small deductible. 

Selecting your Medicare Supplement Plan

Although Medicare Supplement Plans are standardized, some things are essential to check and understand before selecting the right supplement for your health needs. 

Understanding your premiums is probably the most critical first step when assessing Medigap plans. Your premium is the monthly amount you’ll pay for your coverage. Our Medicare agents NC can help compare Medigap insurance premiums in your area to find the most affordable option for you.  

Another essential consideration is rate trend history. Most insurance policies show you the annual rate increase for their plans, which typically contends with medical inflation. Therefore, rate trend history can indicate how much your plan is likely to increase each year. Our North Carolina agents recommend looking at the rate increases of your preferred insurance provider over the past three years and comparing these to other providers to understand what you can expect in terms of premium increases. 

Finally, it’s possible to access reports or grades on the financial stability of the insurance provider. Our Medicare agents NC can access this information, which can help you decide on the right coverage for your health care. 

Need more help with your Medicare Supplement Plan?

At Health Plans of NC, our experienced and dedicated local agents in North Carolina can provide you with details about which Medigap insurance providers offer the best option for your needs. If you want to find out what are the best Medicare supplement plans available for you, get in touch with us today to find out more or compare plans online.