Medicare Advantage is grabbing headlines lately, as just over half of Medicare beneficiaries choose this private health insurance alternative. But, when you do so, you can run into barriers like prior authorizations and network limitations. Staying in Original Medicare helps to lessen those headaches – but can often come with significant out-of-pocket costs. Fortunately, private insurance carriers sell Medicare Supplement, or Medigap, plans to help address the gaps in Medicare Part A and Medicare Part B.
In 47 states, (Massachusetts, Minnesota, and Wisconsin do things their own way), there are 10 standardized Medicare Supplement plans, each labeled A through N. These plans are all offered by private insurance carriers, and help to offset deductibles, coinsurance, and other costs you’d be liable for under Medicare Parts A and B.
This means one carrier’s Plan A is the same as another’s Plan A; one carrier’s Plan G is the same as the other’s. However, these plans can differ in what they’ll cost you, and whether they’ll include any additional benefits, such as dental, vision, or hearing discount programs.
If you’re eligible and enrolled in Medicare Parts A and B, you can also enroll in a Medicare Supplement plan at any time. However, there are some specific times which you can enroll without being medically underwritten – meaning you can’t be charged higher premiums or denied for your pre-existing health conditions.
The best time to enroll is during your Medicare Supplement Open Enrollment period. This special six-month period begins when you are both eligible for Medicare and enroll in Part B for the first time. During this window, you may enroll in any Medicare Supplement plan. And, carriers cannot upcharge you due to your health history, nor can they reject your application. If you think a Medicare Supplement might be right for you, it’s important to take advantage of these protections.
You’ll have the same protections, called guaranteed-issue rights, after a qualifying event. If, for example, your Medicare Supplement plan closes, you move out of the coverage area of your plan, or you disenroll from a Medicare Advantage plan within the first 12 months of becoming eligible for Medicare, you may have a guaranteed-issue right. However, in this situation, you’ll only have 63 days of protection from medical underwriting and plan rejections.
Outside of these two situations, you may enroll in a Medicare Supplement of your choice at any time. However, carriers will have the right to ask you questions about your health history and may charge you more in premium if you have certain health conditions. They may also deny your application.
Plan G and Plan N are among the most popular Medicare Supplements sold today. That’s because they both offer significant protection from out-of-pocket medical costs. Neither will eliminate these costs, but they can make them more manageable. Let’s examine the plans side by side:
|
Benefit |
Medicare Supplement Plan G |
Medicare Supplement Plan N |
|
Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used |
Yes |
Yes |
|
Part B coinsurance or copayment |
Yes |
Yes (except $20 copay for doctor visits, $50 copay for ER visits) |
|
Blood benefit (first three pints) |
Yes |
Yes |
|
Part A hospice care coinsurance or copayment |
Yes |
Yes |
|
Skilled nursing facility care coinsurance |
Yes |
Yes |
|
Part A deductible |
Yes |
Yes |
|
Part B deductible |
No |
No |
|
Part B excess charge |
Yes |
No |
|
Foreign travel emergency (up to plan limits) |
80% |
80% |
You’ll notice there’s a lot of similarities. Both plans will pay your Part A deductible and any coinsurance you’d be responsible for during your hospital stay. They’ll also pay your share of hospice care and/or skilled nursing facility care, should you need either. Both will cover your first three pints of blood during a transfusion (Medicare will pick up the rest). And, they’ll both pick up the tab for 80% of your costs whenever you have a medical emergency while you’re overseas.
There are two key differences, though. First, Plan G will pay for your entire share of Part B costs. This means that you’d owe nothing at the counter when you see your doctors, or when you visit an emergency room. Plan N will cover the majority of your Part B costs – however, you’d be responsible for a $20 copay each time you visit a doctor, and a $50 copay if you need to go to the emergency room.
The second key difference is in how the plans cover excess charges. You may see doctors who don’t accept Medicare’s reimbursement rate for services. Those doctors may legally charge you 15% above and beyond what Medicare would pay – this surcharge is called an “excess” charge. A Plan G will cover these charges for you, a Plan N will not.
Every situation is unique, and we’d encourage you to talk to one of our licensed agents to evaluate yours. But, there are some common truths we’ve found talking to clients.
Plan N’s reduced benefits come with a reduced premium. The national monthly premium for these plans is around $111; it’s closer to $148 for a Plan G. So, for budget-conscious consumers, a Plan N could make a lot of sense.
However, if you see the doctor often, those copays and/or excess charges can add up fast – just two doctor visits in a month could see your premium savings go up in smoke. As such, people who do seek care often, or expect to , may find the more predictable Plan G costs are a better fit.
Whether you’ve decided on a Plan G or a Plan N, or need to talk it over, we’ve got your back. We’ll help you weigh your options and shop for a carrier with premiums that fit your budget. And, we’ll help you find the right-fitting plan to cover your prescription drugs. Talk to one of our licensed experts today.