Medigap Plan A Benefits
Medicare Supplement Plan A is also known as Medigap Plan A. All insurance companies selling Medicare Supplements are required to make Plan A available.
And, like all Medigap plans, Plan A is “standardized” meaning the same benefits are offered no matter which insurance provider you choose.
Example: A Medigap Plan A with Aetna is exactly the same as a Medigap Plan A with Cigna. The only difference is, different insurance companies can charge different rates for the exact same plan.
So, what benefits does Medigap Plan A cover?
- 100% of all Medicare Part A coinsurance and hospital costs - which is the copays for days 61-90 ($335/day) and days 91-150 ($670/day) in hospital; also provides payment in full for 365 additional lifetime days.
- 100% of the Part B Coinsurance - which is the 20% coinsurance for Part B services, such as doctor’s services, laboratory and x-rays, durable medical equipment. Also covers coinsurance for hospital outpatient services.
- 100% of the cost of the first 3 pints of blood.
- 100% of the Medicare Part A hospice care coinsurance for respite care and other Part A-covered services.
So, what benefits doesn’t Medigap Plan A cover?
- Medicare Part A hospital deductible - which is $1340 per each sixty-day benefit period.
- Skilled nursing facility care coinsurance - which is $167.50/day from days 21-100 in a skilled nursing facility per each benefit period.
- Medicare Part B excess/limiting charges which can be 15% more than Medicare’s approved charge when a provider does not take assignment.
- Foreign Travel Emergency - which covers 80% of emergency care costs when outside the United States, after annual $250 deductible, up to a maximum lifetime benefit of $50,000.
Medigap Plan A for Disabled People Under 65
If you qualify for Medicare early due to a disability, Medigap Plan A may be the right policy for you. This policy is made available in most states to people UNDER the age of 65 and is available for purchase during your open enrollment period (i.e. when you first become eligible to Part B) without underwriting.
Although Medigap Plan A has fewer benefits then other plans, the cost of this plan can be disproportionately higher for people UNDER age 65. In some instances, we have seen the rates as much as 2-3 times higher than what a typical 65-year old will pay.
Additionally, people who qualify for Medicare early due to a disability, often have higher medical costs than the average 65-year-old. So, due to the “higher” loss ratios the insurance companies typically pass those costs onto the policyholder in the form of higher premiums.
For this reason, if you become disable UNDER the age of 65, you may want to look into enrolling into a Medicare Advantage plan.
Here’s why . . .
Because, the rates for a Medicare Advantage plan are the same for everyone enrolled, regardless of age, gender, and or health. Later when you are turning 65, you can use open enrollment period to change to a Medicare Supplement plan which may better suit your health care needs.
For most people over age 65, Medigap Plan A may not be a good fit because it is not as comprehensive as a Plan F, Plan G, or Plan N.
If you’re like most people when it comes to Medicare, you may feel like your “spinning-your-wheels” just trying to figure it all out.
If so, you’re not alone . . .
Give us a call at 1 (844) 280-0785 and let us do all the heavy lifting for you . . .
|Medicare Supplement Insurance Plans (Medigap)|
|Part A coinsurance and
hospital costs (up to an
additiona 365 days after
Medicare benefits are used)
|Part B coinsurance or
|Blood (first 3 pints)||100%||100%||100%||100%||100%||100%||50%||75%||100%||100%|
|Part A hospice care
coinsurance or copayment
|Skilled nursing facility care
|Part A deductible||100%||100%||100%||100%||100%||50%||75%||50%||100%|
|Part B deductible||100%||100%|
|Part B excess charges||100%||100%|
|Foreign travel emergency
(up to plan limits)
* Plan F is also offered as a high-
dedutible plan by some issuers in
some states. If you choose this
option, this means you must pay for
Medicare-covered costs (coinsurance,
copayments, deductibles) up to the
deductible amount of $2240 in 2018
before your policy pays anything.
** Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don't result in an inpatient admission.
*** For Plans K and L, after you meet your out-of-pocket yearly limits and your yearly Part B deductible ($183 for 2018), the Medigap plan pays 100% of covered services for the rest of the calendar year.