Medicare Supplement insurance, often called Medigap, helps with some of the medical out-of-pocket costs and deductibles Original Medicare does not cover.
What are some of the costs Medicare doesn’t cover?
There are three types of payments the insured person is responsible for and not covered by Original Medicare. These are:
Copayments
Are usually a fixed amount; it is the amount you are required to pay as shared costs for the benefits, such as a copay for a physcian visit.
Coinsurance
Usually, a percentage that is paid once the deductible is paid. This may involve medical expenses such as lab work costs and hospital stays for an extended period of time.
Deductibles
Usually, an annual amount that needs to be fulfilled before Medicare Supplement insurance begins paying.
Does Medicare Supplement insurance cover Original Medicare Part B copayments and coinsurance?
Yes. Depending on the plan you choose, you may have 100% coverage or some variation. The Medicare Part B deductible is not covered by Medicare Supplement insurance. This is an annual amount you pay on Plan C or Plan F.
Some of the following variations according to the plan chosen are:
- Plans A, B, C, D, F, G, M, and N cover coinsurance and copays. However, if you choose the option of a high deductible with Plan F or G (these two high deductible plan options have a lower premium payment), you will have to satisfy the deductible first before the copays and coinsurance coverage begins. The high deductible Plan F and G in 2023 are both $2,700.
- Plans K and L will cover Medicare Part B coinsurance and copayments for the rest of the calendar year once the out-of-pocket yearly limit is satisfied. Until the limit is met, Plans K and L will cover 50% and 75% of the covered services.
- Plan N pays 100% of the Medicare Part B coinsurance. The copayment is up to $20 for some office visits and up to $50 copayment for emergency room visits that do not result in inpatient admission.
Most Medicare Supplement insurance plans cover the Medicare Part A coinsurance and coverage for inpatient stays once Medicare coverage ends
Part A coinsurance and hospital costs are covered by all 10 Medicare Supplement insurance plans. This includes 365 days after the Medicare benefits are exhausted for inpatient care.
Medicare Part A deductible is covered by Plans B, C, D, F, G, M, and N. Plan A of a Medicare Supplement insurance does not cover the deductible for Medicare Part A, which in 2023 is $1600.
Plans K and L cover 50% and 75% of the deductible. The insured must pay the rest of the deductible.
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What’s included in foreign travel emergency care?
Traveling outside the U.S., you can still be covered for emergency care with a lifetime limit of $50,000. Plans can vary: Plans C, D, G, F, M, and N cover foreign travel emergency care if it begins during the first 60 days of your trip, and if Medicare doesn’t otherwise cover the care. These plans will pay 80% of the billed charges for foreign travel deemed a medically necessary emergency outside the U.S. after the insured satisfies the $250 deductible for the year.
What is Part B excess charge?
Plan G and Plan F are the only Medicare Supplement insurance plans that will pay excess charges. Excess charges are defined as the amount a physician or health care provider can legally charge and is higher than the Medicare approved amount for that service. Plan G and Plan F provide the difference between the allowed excess charge and the Medicare approved amount.
Out of Pocket Limit
For most of the 10 Medicare Supplement Insurance plans, there is not an out-of-pocket limit for approved services. The two plans that have an out-of-pocket limit are Plan K and Plan L. In 2023, those plans are $6,940 and $3,470. Once these limits are satisfied for approved services, both plans pay 100% for the remainder of the calendar year.
What services are not covered by Medicare and Medicare Supplement insurance?
Some services are not covered by Original Medicare or Medicare Supplement insurance, including:
- Long-term care (a nursing home or memory center)
- Vision or dental care
- Hearing aids
- Eyeglasses
- Private-duty nursing
With 10 Medicare Supplement insurance plans, there are many choices which can fit the budget and medical needs of different people.
Speaking to a licensed Medicare Supplement insurance agent can be helpful in determining your next steps for ensuring your medical needs are covered.
Sources:
Medicare.gov, https://www.medicare.gov/health-drug-plans/medigap, accessed 2023.