Medicare Supplement Plans

What are Medicare Supplement Plans?

If you’re one of the many millions of baby boomers turning 65 or retiring soon, you’re probably thinking about Medicare Supplement plans.  You’re likely wondering how you can possibly afford both Medicare premiums and premiums for a Medicare supplement insurance policy.  This may be even more of a worry if you’re not going to have a part-time job after you retire at age 65.

To decide if you’re going to need help to fill the gap in coverage that’s left after Medicare pays 80% of your medical bills, your first step should be to learn some basic facts about what Medicare and Medicare supplement policies cover.

Original Medicare Part D is prescription drug coverage and pays for generic and brand-name prescription drugs.

CLICK ONE OF THE MEDICARE SUPPLEMENT PLANS BELOW FOR FULL DESCRIPTION

For more information or to request a quote:

It's important to note that with all Medicare Supplement plans, Medicare must pay first in order for the plan to "fill the gap."  If Medicare does not pay for the charge, none of the Supplement plans will pay anything.  YOU will pay all charges.  Once Medicare pays their share, each Supplement plan will pay their portion of the bill and YOU will pay any remainder, if there is one.

What Medicare pays for

Original Medicare Part A is hospital coverage that pays for:

  • Inpatient hospital services
  • Skilled nursing facility care (after a hospital stay)
  • Home health care
  • Hospice Care
  • All but the first 3 pints of blood you receive per calendar year

 

Original Medicare Part B is medical coverage and pays for:

  • Medical expenses
  • Home health care
  • Clinical laboratory services
  • Outpatient treatment
  • Durable medical equipment and supplies
  • Preventive health care including exams, screenings and shots
  • Chemotherapy and Radiation Therapy
  • Radiological and non-radiological diagnostics
  • Emergency services
  • Certain specialty drugs administered at the doctor's office that require special care or observation.  I.E. injections, infusions (IV's), etc.

Medicare Part D is prescription drug coverage and pays for generic and brand-name prescription drugs.  Although Part D plans are considered optional, not having creditable prescription drug coverage can create a late enrollment penalty, once drug coverage is obtained.

What Medicare DOES NOT pay for

  • Medical care while traveling outside the U.S.
  • Cosmetic surgery
  • Routine or preventive care of the feet
  • Eye exams or eyewear
  • Hearing exams or hearing aids
  • Custodial care (long term Care)
  • More than 100 days of skilled nursing home care following a hospital stay
  • Homemakers services
  • Private-duty nursing care
  • Dental cleanings, fillings, extractions, dentures, or other non-medical, major dental procedures
  • Acupuncture
  • Massage therapy
  • Naturopathy
  • Most medical services that are either considered experimental, or not determined to be medically necessary
  • Routine Physical (not to be confused with annual wellness exams, preventative services, or a set of packaged diagnostic tests that are scheduled annually or more often, which generally are covered)
  • Prescription Drugs other than some drugs administered by Doctors (such as injections, IV's, or certain specialty drugs that are paid through Medicare Part B).  In order to cover most prescriptions, a Medicare Prescription Drug plan (Part D) must be added.

It might be noted that many of the items listed above "not covered by Medicare" might actually be included in benefits provided by various Medicare Advantage Plans (Medicare Part C).  Remember that if Medicare does not pay for a particular service, none of the Supplement plans will pay anything.  Some will opt to get a stand alone insurance policy for uncovered items.  Many will opt for a Medicare Advantage Plan for this reason.

According to Medicare.gov, there are 10 standard Medicare supplement insurance plans – A, B, C, D, F, G, K, L, M and N – and each offers different benefits that are set by the U.S. government.

All 10 Plans offer these basic benefits:

  • Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are gone
  • Part B coinsurance or copayment
  • Part A hospice care coinsurance or copayment
  • The first 3 pints of blood

If you choose plans K, L or M, you’ll share a greater portion of the costs through higher coinsurance and copayment rates. And like Medicare, Medicare supplement insurance generally doesn’t cover long-term care, vision care, dental care, hearing aids, eyeglasses or private-duty nursing.

Standardized Medicare Supplement Plan Chart

Benefits Plan A Plan B Plan C* Plan D Plan F* Plan G Plan K Plan L Plan M Plan N
Medicare Part A coinsurance
and hospital costs (up to an additional 75 days after Medicare benefits are used)
Basic Benefits Basic Benefits Basic Benefits Basic Benefits Basic Benefits Basic Benefits Hospitalizations and preventative care paid at 100%; other basic benefits paid at 50% Hospitalizations and preventative care paid at 100%; other basic benefits paid at 75% Basic Benefits including 100% Part B coinsurance Basic Benefits including 100% Part B coinsurance except up to $20 copayment for office visit and up to $50 copayment for ER
Skilled Nursing Facility care coinsurance N/A N/A 100% 100% 100% 100% 50% 75% 100% 100%
Part A deductible N/A 100% 100% 100% 100% 100% 50% 75% 50% 100%
Part B deductible N/A N/A 100% N/A 100% N/A N/A N/A N/A N/A
Part B excess charges# N/A N/A N/A N/A 100% 100% N/A N/A N/A N/A
Foreign travel emergency (up to plan limits) N/A N/A 100% 100% 100% N/A N/A N/A 100% 100%
* When available, the High Deductible version of Plan F has a plan deductible of $2340. Out-of-pocket limit of $5,880; paid at 100% after limit reached # Out-of-pocket limit of $2,940; paid at 100% after limit reached #

Basic Benefits

  • Part A Hospital
    • 61-90 days - $371/day
    • 91-150 days - $742/day (lifetime reserve days)
    • Beyond 120 days - 100% for 365 days
  • Parts A & B blood deductibles (1st three pints)
  • Part B Coinsurance - 20% of Medicare-approved charges
  • Part A Hospice care coinsurance or copayment
  • Preventative care

* Plan F and Plan C are only available if your Medicare Part A effective date is prior to 1/1/2020

# Part B excess charges include a 15% increase in allowed charges that Medical Providers may add to your bill (as of January 2021, which is an increase from the 10% allowed in previous years).  We see this most often with outpatient surgery, but could occur in any situation.  Most Supplement plans do NOT pay this added charge.  (Part B excess charges do not apply to Medicare Advantage Plans).  All applicable Part B excess charges are NOT included in the out-of-pocket maximum charges for Plan K or Plan L, which could significantly increase expected charges for isolated situations.  

Part A deductible for 2021 is $1,484

Skilled Nursing Coinsurance for 2021 (days 21-100) is $185.50/day

Part B deductible for 2021 is $203

Rev. 11/2021