What are Medicare Supplement Plans (Medigap)?
- Medicare only covers 80% of your medical expenses from hospitals/doctors
- Supplement Plans (Medigap) help pay the remaining “gaps” that you normally would have to pay (20% coinsurance, deductibles, copays, excess charges)
MEDICARE SUPPLEMENT (MEDIGAP)
How your medical bills are paid
Your doctor or hospital provides a medical service and bills Medicare
Medicare A&B Pays
Medicare pays the approved portion of the bill and sends the excess amount to the Medigap Plan
Medigap Plan Pays
- Your Medigap Plan pays the amount left over, according to the plan’s terms
Why get Medicare Supplement Plans (Medigap)?
FREEDOM & FLEXIBILITY
- Covers ALL or MOST of your out-of-pocket costs for Medicare-approved services (predictable healthcare costs and avoid any surprises)
- Visit ANY doctor, specialist, or hospital that takes Medicare, anywhere in the U.S.
- NO restrictive networks– perfect for “snow-birds” and those who travel to different areas
- NO referrals needed to visit specialists
- Guaranteed Renewable as long as premiums are paid on time
- Foreign Travel Emergency benefits cover you when traveling outside the U.S. on vacation
How to compare Medicare Supplement Plans (Medigap)?
- Federally standardized plans designated by a letter (Plan F, G, N, etc.) that cover certain benefits
- Insurance companies that sell these “letter plans” must cover these same specific benefits
(Plan F with Company ABC covers SAME EXACT BENEFITS as Plan F with Company XYZ)
- Main difference is each company can charge DIFFERENT PREMIUMS for the same exact benefits ($158 Plan N with Company ABC vs $200 Plan N with Company XYZ)
- COMPARING PRICE FOR COVERAGE IS IMPORTANT, the experienced licensed brokers at Medicare Sharks take a deeper dive into company statistics by researching how often they increase rates, how long they’ve been in the Medicare Supplement market, financial strength ratings and customer service experience.
- Let the experts at Medicare Sharks help you compare plan benefits and rates from top-rated companies in your area!
Medigap Plans Comparison Chart 2023
Helps to reduce out-of-pocket costs that Medicare does not pay. There are 12 Medicare Supplement policies which are standardized plans A, B, C, D, F/HDF, G/HDG, K, L, M, and N (plan availability may vary by state). Only applicants first eligible for Medicare Part A before 2020 may purchase Plans C, F, & HDF.
Hospitalization: Part A coinsurance plus coverage for 365 additional days after Medicare benefits end.
Medical Expenses: Part B coinsurance (generally 20% of Medicare approved expenses) or copayments for hospital outpatient services. Plans K, L, and N require insureds to pay a portion of the Part B coinsurance or copayment.
Blood: First 3 pints of blood each year.
Hospice: Part A coinsurance for eligible hospice/respite care expenses.
Skilled Nursing Facility Coinsurance After 20 days - $200 per day coinsurance as much as $16,000
Part A Deductible: $1,600 in 2023
Part B Deductible Annual: $226 in 2023
Part B Excess Doctor Charges: When a provider accepts Medicare assignment rates, it means that provider won’t bill you above the Medicare-allowable rate by a participating provider. Providers who don’t participate in Medicare-assignment can bill you up to 15% more than the Medicare allowable amount at their discretion which is called Part B excess charges. Statistics suggest that as many as 95% of primary care providers accept assignment. A slightly smaller number of specialist physicians accept it as well. Not all nonparticipating providers will add Part B excess charges if you don’t have a Medigap plan, so you may only rarely see Part B excess charges.
Foreign Travel Emergency: Plan will pay up to 80% of your medical emergency costs after a $250 deductible. It will only pay for emergencies during the first 60 days that you are out of the country. It is also limited to a lifetime benefit of $50,000.
Plan HDF & Plan HDG usually have a lower premium then the traditional Plan F & Plan G, but they require first paying a plan deductible of ($2,700 in 2023) before the plan begins to pay. You will pay the 20% of the Medicare-approved amount until you reach the deductible for the calendar year. Once the plan deductible is met, the plan pays 100% of covered services for the rest of the calendar year. Plan HDG does not cover the Medicare Part B deductible. However, Plan HDF & Plan HDG count your payment of the Medicare Part B deductible toward meeting the calendar year plan deductible.
Plan N pays 100% of Medical Expenses (Part B Coinsurance) except for a copayment of up to $20 for some office visits and up to $50 copayment for emergency room visits that do not result in an inpatient admission. The emergency room copayment is waived if the insured is admitted to any hospital, and the emergency visit is covered as a Medicare Part A expense.
Plan K & Plan L pay 100% of covered services for the rest of the calendar year once you meet the out-of-pocket yearly limit ($6,940 for Plan K, $3,470 for Plan L in 2023). The out-of-pocket annual limit does NOT include the charges from your provider that exceed Medicare-approved amounts, called ‘excess charges’. You will be responsible for paying excess charges. The out-of-pocket annual limit may increase each year for inflation.
Plan F pays for ALL Medicare-approved services
You pay NOTHING out-of-pocket for these services
$0 Additional Costs Out-of-Pocket
Plan G pays for ALL Medicare-approved services AFTER you pay annual deductible
$226 Annual Deductible in 2023
$0 Additional Costs Out-of-Pocket
Plan N pays for ALL Medicare-approved services AFTER you pay annual deductible & possible copay
$226 Annual Deductible in 2023
Possible up to $20 Copays for some office visits
Possible up to $50 Copays for E.R. unless admitted
Possible up to 15% above Medicare-approved amount for Part B excess doctor charges (very rare)
PLAN HDF & HDG
Plan HDF & HDG pays for ALL Medicare-approved services AFTER you pay plan’s annual deductible
$2,700 Annual Deductible in 2023
You will pay the 20% of the Medicare-approved amount until you reach the deductible for the calendar year. Once the plan deductible is met, the plan pays 100% of covered services for the rest of the calendar year. Plan HDG does not cover the Medicare Part B deductible. However, Plan HDF & Plan HDG count your payment of the Medicare Part B deductible toward meeting the calendar year plan deductible.
All Medicare Supplement Plans (Medigap) provide superior coverage and freedom of choice!
- Visit ANY provider that accepts Medicare – ANY doctor, specialist, hospital nationwide!
- NO Restrictive Networks (Covered no matter where you are in the US) (Does not “replace” Medicare)
- NO Referrals needed for specialists
- Guaranteed Renewable as long as the premiums are paid on time
- Foreign Travel Emergency benefits to cover policyholders who travel overseas (great for cruises)
DILEMMA – Medicare Supplement or Medicare Advantage?
At some point everyone reaches the crossroad
Original Medicare does not cover all the costs. Although a low or no premium may seem more appealing than a set premium Medicare Supplement Plan, on closer inspection our licensed experts have found that a no premium plan may have higher out-of-pocket costs over the year and end up costing more long term. Having a predictable set cost for your healthcare can be a better option so that you fit it into your budget and avoid costly surprises. Understanding the difference between a Medicare Advantage vs Medicare Supplement will be crucial in protecting your finances in the short term and long term. There’s no one-size-fits-all answer to this dilemma so you have to consider your health, age, finances and look at the short term and long term healthcare needs. Just because your friend or sister may have one plan, does not mean that it will be the best for you! Use our expertise to discuss the options and find the best plan that works for your healthcare needs!
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