If you decide to enroll in original Medicare, one way you can help pay the extra costs the program doesn’t cover is to buy a supplemental — or Medigap — insurance policy. Here’s what you need to know if you’re in the market for a supplemental policy.
They are sold by private insurance companies but regulated by states and the federal government. Original Medicare pays 80 percent of covered Part B health care services. Medigap insurance typically covers the 20 percent that is your responsibility to pay, along with some other health care costs. In contrast, a Medicare Advantage plan doesn’t allow supplemental insurance, even though it does have various out-of-pocket costs.
You may be eligible for a policy offered by a past or present employer. If you qualify for Medicaid, it too will pick up most out-of-pocket medical costs. About 36 percent of original Medicare enrollees buy a private Medigap plan.
The federal government, not insurers, determines what coverage a Medigap policy provides (except in three states: Massachusetts, Minnesota and Wisconsin). There are 10 federally approved plans, each known by a letter: A, B, C, D, F, G, K, L, M and N. They’re standardized, meaning plans with the same letter name must provide the same basic benefits regardless of the insurer or location.
Starting in 2020, a cost-cutting move by Congress ended sales of Medigap plans C, F and high-deductible F to individuals newly eligible for Medicare. These plans may still be available if you became eligible for Medicare before Jan. 1, 2020. And if you already have one, you can keep it.
This means you’ll likely have several choices of plans that have the same letter but are offered by different insurers in your locale. What they charge can vary dramatically.
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You can buy any Medigap plan available in your state — and insurers can’t turn you down or charge you more due to preexisting health conditions — during the six months after you initially sign up for Medicare Part B. After that, you could be denied or charged higher monthly premiums.
Vision insurance plans designed for members and their families See more Insurance offers >Connecticut and New York let Medicare beneficiaries buy a Medigap plan at any time without being denied. Other states (including California, Idaho, Illinois, Louisiana, Maryland, Missouri, Nevada, Oregon and Washington) let you switch plans at designated times.
For example, a 65-year-old nonsmoking man in Fort Myers, Florida, could pay $64 a month for a Plan K policy or $263 for Plan D. A 65-year-old nonsmoking woman in Wichita, Kansas, might pay $32 a month for a high-deductible Plan G policy versus $455 for a regular Plan G.
It’s pretty simple: Pay less, get less coverage. For example, plans A and B don’t offer coverage for big-ticket, out-of-pocket costs for stays at skilled nursing facilities. Likewise, high-deductible plans require you to pay thousands up front (up to $2,700 in 2023) before coverage kicks in. Lower-cost policies can be fine if you are relatively healthy, but if something goes wrong, your personal costs can skyrocket. Think long-term.
The best place for more information is your State Health Insurance Assistance Program (SHIP). You can find one in your state at shiphelp.org. SHIP counselors can give you personalized help choosing a plan. Start early, because these services become increasingly busy toward the end of Medicare open enrollment (Dec. 7 ).
AARP asked a group of experts to give Medicare enrollees some advice about Medigap plans. These experts included: Bonnie Burns, a consultant for California Health Advocates, a nonprofit organization focused on Medicare advocacy and education; Tricia Neuman, executive director for the Program on Medicare Policy at KFF, a not-for-profit organization focused on health policy research; and Ray Walker, director of the Medicare Assistance Program at the Oklahoma Insurance Department. Here’s their advice: Plans that offer more comprehensive coverage: C, F (if eligible), G These generally have higher premiums but cover the majority of Medicare cost-sharing. C and F even pay your annual Part B deductible ($226 in 2023); G does not. Plans that provide good coverage for less money: D, N D plans cover almost everything that C, F and G plans do, but not Part B “excess” charges by some doctors; nor do they cover the Part B annual deductible. Under Plan N, you pay $20 for most doctor visits and a $50 copay for some emergency room visits. Plans that are sensible if you have chronic health conditions: C, D, F, G, N These have good coverage for doctor visits and lab tests, as well as time in the hospital and extended stays at skilled nursing facilities. Plans for saving a buck — but read the fine print: High-deductible F or G; K, L These plans tend to have the lowest monthly premiums because you must pay a deductible ($2,700 in 2023 for high-deductible F and G) or reach an out-of-pocket limit ($6,940 for Plan K) before full coverage kicks in. Plans that make sense if you don’t expect to visit the hospital or need skilled nursing: A, B Plans A and B cover many routine costs but don’t cover skilled nursing facility coinsurance ($200/day after 20 days); Plan A doesn’t cover Medicare Part A hospital deductibles. Worst plans for hospital coverage: A, K, L, M Medicare’s Part A hospital deductible is $1,600, and you pay it with each new hospital admission. Plan A doesn’t cover it; Plan M pays half; and Plans K and L cover a percentage (50 and 75 percent, respectively) until you reach your out-of-pocket limit.
