8 Little Known Facts About Medicare Supplements Seniors Should Know

Not every type of Medicare supplement is sold in each state, and the differences amongst the many plans can be mind-boggling. To add to the confusion, Prescription Plan, Part D, which helps many seniors afford the medications they need, is not a Medicare supplement, just a prescription drug plan that works with Medicare. The same is true for Part C and Plan C–they are entirely different, and it’s important to understand the differences.

Also, some Medigap plans have been discontinued or have different coverages, if you bought them years ago. In this article, you’ll see some facts about Medicare Supplements, also called Medigap, which may clarify some confusion you may have about the various plans so you can decide which one(s) you need.

1. Insurance Companies That Sell Medigap Policies Must Offer Medigap Plan A

The reason that Medigap Plan A must be offered before other plans is because Plan A is the most standardized Medigap plan and covers the most important gaps in original Medicare.

The fact that laws dictate that Plan A must be offered also explains why it’s the most commonly bought Medicare plan. Medigap Plan A is also not the same as Medicare Part A. Yes, they sound similar but Plan A is a supplement that helps pay copays, hospital costs and even blood transfusion costs. Part A is hospital insurance.

To sell other Medicare supplement policies, insurers must also offer either Plan C or Plan F (see more on these below) to people who were eligible for Medicare before January 1, 2020, but haven’t enrolled yet. They are allowed to offer Plan D or G, instead of Plan C or F, to Medicare recipients who enrolled on or after January 1, 2020.^[4]

2. Medigap Plans Sold to New Medicare Recipients Do Not Cover the Part B Deductible

While Medigap or Medicare supplements cannot pay for the Part B deductible, they can cover other costs like copays and coinsurance. They can also buy more time if you’re hospitalized or need to stay at a skilled-nursing facility after you reach the limit set by Medicare.

Plan C used to cover the Part A deductible in full until January 1, 2020, when it stopped being sold. If you had the plan prior to 2020, you can keep it. Some people have been grandfathered in. Here’s more on Part C below.

3. Plan C & Plan F Aren’t Offered to Those Who Turned 65 on or after January 1, 2020

This also holds true for some Medicare recipients under age 65. Now, don’t confuse Medicare Plan C with Medicare Advantage, which is wholly different and yet a very good option to consider in place of the original Medicare plan you may have initially signed up for when you turned 65.

If you were eligible for Medicare prior to January 1, 2020 and have a Medigap Plan C, you may want to consider keeping it. It is the only supplement that covers the deductibles for both Parts A and B.^[7]

Let’s delve deeper by going over Medicare Plan C vs Part C.

What Is Medicare Plan C?

Plan C is a Medicare Supplement unlike Part C, which is an private insurance alternative to original Medicare. It covers the following

• Pays the coinsurance for Medicare Part A (hospitalization).
• Covers an additional 365 days in a hospital or skilled-nursing facility after Medicare coverage ends.
• Pays for up to three pints of blood.
• Pays Medicare Part A’s coinsurance for hospice care.
• Covers the deductible for Part A and Part B, which includes doctor visits and hospital or skilled-nursing care.
• Emergency care during foreign travels is covered up to limits.

What Is Medicare Part C?

You can switch from original Medicare to Medicare Part C whether you became eligible for Medicare before or after 2020. Medicare Part C, also called MA, is not a Medicare Supplement but rather a substitute for Medicare Part A and Part B, which is the government issued Medicare most people think of when they apply for the subsidized health plan for seniors age 65 and older.

Like any other type of health insurance plan, each Medicare Part C plan has its own network, and you can choose between an HMO or PPO plan. You may or may not have an additional premium, but Medicare Part C also includes a prescription drug plan so you don’t need to buy Medicare Part D for prescription drug coverage. Some plans include dental, vision and hearing coverages.

A good Medicare Advantage plan may have more benefits for a small extra cost or no additional cost at all. Some MA plans even offer gym memberships, wellness programs, transportation to medical appointments and coverage for over-the-counter medications.

4. Plans D and G That Began on or After June 1, 2010 Have Different Benefits Than Plans D or G Bought Prior to June 1, 2010.

Benefits of Plan D Bought Before June 1, 2010

Do not confuse Medigap Plan D with Medicare Part D. Plan D Benefits include:

• Pays Part A coinsurance
• Pays for 365 days in hospital after Medicare limits are reached.
• Covers Part A deductible.
• Pays Part A hospice care coinsurance or copayment.
• Pays Part B coinsurance or copayment.
• Covers skilled nursing facility care coinsurance.
• Covers blood transfusion up to three pints.
• Covers foreign travel emergency costs.^[3]

Benefits of Plan D Bought After June 1, 2010

Plan D after June 1, 2010:

• All of the same benefits as offered now except the following bullet points.
• No longer covers preventive care benefits, which are included in Part B coverage.
• No longer do enrollees have to pay 100% of their retail drug costs, thereby eliminating the “Medicare doughnut hole.”^[3]

Benefits of Plan G Bought Before June 1, 2010

• Pays for Part A copay (hospital).
• Pays for Part B coinsurance.
• Pays for up to three pints of blood.
• Covers 80% of Part B excess charges benefit.
• Covers foreign travel emergency costs.
• Pays for Part B coinsurance after deductible is met.^[6]

Benefits of Plan G Bought After June 1, 2010

• Pays for Part A (hospital).
• Pays Part A copay.
• Pays Part A coinsurance.
• Pays Part B coinsurance.
• Pays for up to three pints of blood.
• Pays the Part A deductible.
• Pays a daily skilled nursing home coinsurance.
• Pays Part B annual deductible.
• Pays 100% Part B excess charges.
• Covers foreign travel emergency costs.
• Covers hospice care.^[5]

5. Plans E, H, I, and J Are No Longer Sold, but if You Have a Plan, You Can Keep It

Plan E Benefits

• Pays Part A copayment.
• Pays Part B coinsurance.
• Covers up to 3 pints of blood.
• Pays the Part A deductible.
• Pays the skilled-nursing Facility copayment.
• Pays 80% of foreign emergency care costs.^[2]

Plan H Benefits

• Pays 20% of remaining Medicare approved costs if there is a balance.
• Pays the Part A Deductible.
• Pays the skilled nursing coinsurance.
• Covers foreign travel emergency costs.

Plan I Benefits

• Pays for Part B excess charges.
• Pays the Part A deductible.
• Pays for skilled nursing coinsurance.
• Covers foreign travel emergency costs.

Plan J Benefits

• Pays copayments for Part A and Part B services.
• Pays for 365 days of hospital stay after Medicare coverage ends.
• Pays both Part A and Part B deductibles.
• Pays Part B excess charges.
• Pays coinsurance for Part A and Part B.
• Covers up to three pints of blood.
• Pays for hospice care coinsurance or copayment.
• Pays for skilled nursing care coinsurance.
• Covers foreign travel emergency costs.
• Some plans include prescription drug coverage.^[1]

6. Plans F & G Offer High-deductible Plans

A high-deductible plan is cheaper but you pay out-of-pocket until you reach your deductible.

Plan G is the only high-deductible plan available to new Medicare enrollees in most states, except Massachusetts and Washington, D.C.

Plan F is available in 47 states, but availability varies according to location. Massachusetts, Minnesota, and Wisconsin have their own versions of Medigap Plan F.^[5]

7. Plans K & L Will Cover 100% of Approved Services

Of course this won’t happen at first. You must first meet the deductible Part B deductible and the yearly limit for out-of-pocket expenses.

8. Plan N and Plan M Demystified

Plan N pays for Part B services. However, you will still be responsible for $20 copays for doctor visits and $50 copays for hospital emergency room visits. It is the only Medigap plan with a copay.^[8][9]

Plan N Coverage

• Medicare Part A deductible
• Coinsurance for Medicare Parts A
• Coinsurance for Part B
• Up to three pints of blood
• 80% of any medical costs you have during foreign travel.
• Annual Part B deductible
• Skilled-nursing facility coinsurance.
• Hospice care coinsurance or copayment
• Part B excess charge.^[9]

Plan M Coverage

• Coinsurance for Medicare Parts A
• 100% of copayment or coinsurance for Part B
• Up to three pints of blood
• Medical costs during foreign travel (up to limits, as per plan).
• Skilled-nursing facility coinsurance.
• Hospice care coinsurance or copayment
• 50% of Part A deductible.^[8]