Medicare Supplement (Medigap) insurance plans are considered some of the most comprehensive and flexible options for Medicare beneficiaries.
Key Benefits:
- No Provider Network: You can use any doctor or hospital in the U.S. that accepts Medicare.
- No Referrals Needed: Most plans allow you to see specialists without referrals.
- Comprehensive Coverage: These plans help cover costs not paid by Medicare Part A (Hospital) and Part B (Medical), including coinsurance, copayments, and deductibles.
Medicare Supplement Plans are sold by private insurance companies and standardized across the U.S.
Medicare Part A and Part B Overview
Medicare Part A – Hospital Coverage
- Covers:
- Inpatient hospital stays
- Skilled nursing facility care (up to 100 days, following a 3-day inpatient hospital stay)
- Hospice care and some home health care
- Does Not Cover:
- Custodial or long-term care
- Costs (2025):
- $1,676 deductible per benefit period
- Free for 99% of beneficiaries (if you or your spouse paid Medicare taxes for 10 years).
Medicare Part B – Medical Coverage
- Covers:
- Outpatient care, doctor visits, and preventive services
- Durable medical equipment (e.g., wheelchairs, walkers)
- Physical and speech therapy
- Costs (2025):
- Monthly premium: $185.00 (base rate)
- Annual deductible: $257
- Generally covers 80% of outpatient services after deductible.
Income-Related Monthly Adjustment Amount (IRMAA):
If your income exceeds certain limits, you may pay additional premiums. See the IRMAA Chart (2024) for details.
Medicare Supplement Plan Features
- Pays Remaining Costs: Covers coinsurance, copayments, and deductibles not paid by Medicare Parts A & B.
- Guaranteed Coverage: If you apply within your Medigap Open Enrollment Period (six months after your Medicare Part B effective date), you are guaranteed coverage without underwriting.
- Plan Standardization: Medicare standardizes plans (A-N), ensuring identical coverage regardless of the insurer.
Popular Plans:
- Plan G: Provides the most comprehensive coverage for beneficiaries born in 1955 or later.
- Plan N: Offers slightly lower premiums with fewer benefits than Plan G.
Medicare Supplement Plan Benefits Chart
| Benefits | Plan G | Plan N |
|---|---|---|
| Part A coinsurance & hospital costs | 100% | 100% |
| Part B coinsurance/copayments | 100% | 100%* |
| Blood (first 3 pints) | 100% | 100% |
| Hospice care coinsurance/copayment | 100% | 100% |
| Skilled nursing facility coinsurance | 100% | 100% |
| Part A deductible | 100% | 100% |
| Part B excess charges | 100% | Not covered |
| Foreign travel emergency (up to limits) | 80% | 80% |
* Plan N requires copayments for certain services.
Medicare Part D – Prescription Drug Coverage
Medicare Part D provides coverage for outpatient prescription drugs and is administered by private insurance companies.
Key Features:
- Covers many medications, including vaccines like shingles shots.
- Follows four payment phases:
- Deductible Phase: You pay up to $590.
- Initial Coverage Phase: Copayments/coinsurance until total retail drug costs reach $2,000.
- Catastrophic Coverage Phase: You won’t have to pay out-of-pocket for covered Part D drugs for the rest of the calendar year.
Review Annually:
Part D plans can change yearly. Review your plan during the Annual Enrollment Period (October 15 – December 7) to ensure it meets your needs.
Medication Restrictions:
- Prior Authorization: Requires approval before coverage.
- Quantity Limits: Limits the number of doses covered.
- Step Therapy: Requires trying lower-cost drugs before covering higher-cost options.
Late Enrollment Penalties
If you delay enrolling in Part D without creditable drug coverage:
- You may incur a late enrollment penalty added to your premium for the rest of your life.
- Enroll within two months of losing creditable coverage or during the Annual Enrollment Period.
Need Assistance?
Navigating Medicare Supplement and Part D plans can be complex. Contact us for personalized support in selecting the right coverage for your needs.
Call us at 314-890-9200 or schedule an appointment today!
(314) 890-9200