Medicare Supplement Plans

Click on words in blue for definitions.

 

Medicare remains the primary payor; the supplement plan is the secondary payor.

Medicare Supplement plans (also called Medigap plans) are sold by private insurance companies and can help pay some or all of the medical costs that Medicare covers but for which you would have to pay co-payments, co-insurance or deductibles.

First Medicare pays its share of the covered medical costs, then the Medicare Supplement plan pays its share.

You can receive care from Medicare providers anywhere in the United States.

These plans are standardized by Medicare, and each plan must cover minimum, specific benefits.  However, insurance companies are allowed to offer additional benefits under each plan.

Medicare Supplement plans have a monthly premium, which you pay directly. It cannot be deducted from your Social Security or Railroad Retirement Board benefits.

Note:  Some people get their Medicare benefits by enrolling in their employer’s retirement health plan instead of enrolling in a Medicare Supplement plan.  Some rely on VA benefits, TRICARE, or other federal programs.

 

Supplement plans are standardized by Medicare and are identified by the letters A through N. Plans sold today are known as “Modernized” plans. Plans H, I and J are no longer offered for sale.

Insurance companies may offer some or all Medicare supplement plans.

 

Basic Benefits: All plans cover all of the following benefits:

    Part A: Hospital co-insurance plus an additional 365 days of
    hospitalization after Medicare benefits end; Hospice co-insurance

    Part B: Medical services co-insurance or co-payments (Plans K,
    L and N require insureds to pay a portion of these costs)

    First 3 pints of blood each year

 

Additional Benefits Offered:

Plan A Plan B Plan C Plan D Plan F Plan G Plan K Plan L Plan M Plan N
Part A Deductible No Yes Yes Yes Yes Yes 50% covered 75% covered 50% covered Yes
Part B Deductible No No Yes No Yes No No No No No
Part B Excess No No No No Yes Yes No No No No
Skilled Nursing Co-Insurance No No Yes Yes Yes Yes 50% covered 75% covered Yes Yes
Foreign Travel Emergency No No Yes Yes Yes Yes No No Yes Yes
Out of Pocket Limit $4,660 $2,330

 

Additional Information

Skilled Nursing co-insurance is for skilled care only, not long-term care.

Part B Excess is a 15% increase over the regular reimbursement a provider receives from Medicare. Medicare providers who “don’t accept assignment” are allowed to bill you for this excess amount.

Foreign Travel Emergency is medically necessary emergency care services which begin within 60 days of each trip outside of the US. Medicare does not cover this benefit, but certain Medicare Supplement plans do.

Out of Pocket Limit does not apply to plans other than Plan K and L. This is the maximum you would pay in a year for covered services after which the plan covers you at 100%.