Medicare Supplement insurance can fill gaps in your Medicare coverage, but you’ll need to choose which plan works best for you. There are multiple types of Medicare Supplement insurance plans, also known as Medigap, and each offers different coverage options and costs you should consider before you sign up.
Read on to learn about the most common Medicare Supplement plans F, G, and N, and explore the benefits and drawbacks of each.
What Is a Medicare Supplement or Medigap Plan?
Medicare Supplement plans are insurance policies that work with Original Medicare to fill the cost-sharing portion that the beneficiary is responsible for out of pocket.
Unlike most insurance policies, Medicare supplements are standardized by Medicare. Standardization means that each plan letter is required to offer the same basic benefits to the beneficiary, regardless of the company.
What Does Medigap Cover?
Medigap policies cover the gaps that are the beneficiary’s responsibility with Medicare parts A and B. These include deductibles, coinsurance, or copays.
What Is Covered Under Medicare Supplement Plan F?
Plan F is considered the “Cadillac plan” of Medicare supplements.The beneficiary pays the monthly premium, and then Plan F pays the most common costs associated with Medicare for the beneficiary. This includes, but is not limited to:
- Medicare Part A coinsurance and hospice care coinsurance
- Medicare Part A deductible
- Medicare Part B coinsurance or copayment
- Medicare Part B deductible
- Part B excess charges
- The first three pints of blood used in a procedure
- Skilled nursing facility (SNF) care coinsurance
- Coverage outside of the United States (up to plan limits)
Plan F is no longer available to all Medicare beneficiaries. This change became effective on January 1, 2020.
Can you switch to Medicare Plan F even though it’s being discontinued?
It depends on your new to Medicare effective date. If you were eligible for Medicare prior to January 1, 2020, you’re allowed to switch to Medicare Plan F. If you’re currently on Plan F, you do not need to select a new plan if you don’t want to.
If for some reason you fall under Guaranteed Issue Rights and your effective date for Medicare is prior to January 1, 2020, you can sign up for Plan F.
However, if you were newly eligible for Medicare on or after January 1, 2020, you cannot switch to Plan F. If you qualify for Guaranteed Issue Rights, you can sign up for Plan G.
What Is Covered Under Medicare Supplement Plan G?
Medicare Supplement Plan G works similarly to Plan F. The main difference between the two plans is how Plan G interacts with the Part B deductible. With Plan F, the Medicare Supplement plan pays for the Part B deductible. Under Plan G, you are responsible for the Part B deductible only. Otherwise, all Part A deductibles, copays, and coinsurance are covered. Under Part B, after the deductible, the plan pays all other approved coinsurance and copays.
What Is Covered Under Medicare Supplement Plan N?
Medigap Plan N is the step-down option for Plan G. It offers the same basic services as Plan G, including Part A deductibles, copays, and coinsurance. However, it requires you to pay the Part B deductible and a portion of copay costs associated with doctor and emergency room (ER) visits that are not covered by Part A. Furthermore, doctors that do not accept Medicare assignment may assess you excess charges. See the table below for the additional costs associated with Plan N that are considered covered under Plan G.
|Doctor’s visits||Up to $20|
|ER visits that don’t result in admission||Up to $50*|
|Excess charges||Up to 15% of what Medicare approves for services|
Periods of observation are not considered an inpatient admission. Observations at an emergency room fall under Part B and would have a $50 copay, but an inpatient admission would not. Always remember to ask if the hospital is admitting you as an inpatient or just keeping you under observation if you have concerns about the billing.
What are excess charges?
Doctors have three choices when it comes to Medicare:
- Become a participating provider: Accepts Medicare and assignment.
- Become a nonparticipating provider: Accepts Medicare but chooses when to accept assignment.
- Do not accept Medicare.
When a doctor accepts Medicare but chooses to not accept Medicare assignment ― or accepts it on a case by case basis ― they are considered a nonparticipating provider. Nonparticipating providers still have to accept the benefit rate that Medicare sets for beneficiaries, but they are allowed to charge an additional administrative fee of 15%. These are called “excess charges.”
Nonparticipating providers are rare. The Kaiser Family Foundation notes that in all states except Alaska, Colorado, and Wyoming, the nonparticipating percentage is less than 2%.
It pays to use a participating provider if you plan to use Plan N, as Plan F and G cover all excess charges. Medicare has a great tool for determining if your provider accepts assignments. You can also search your area to determine which providers accept assignments. You can search your area for providers and specialties.
What Does Each Medicare Supplement Plan Cover?
|Coverage||Plan F||Plan G||Plan N|
|Part A deductible||Yes||Yes||Yes|
|Part B deductible||Yes||No||No|
|Hospital coinsurance after Part A benefits are used up||Yes||Yes||Yes|
|Part B excess charges||Yes||Yes||No|
|Skilled nursing care coinsurance||Yes||Yes||Yes|
|Foreign travel emergency care at 80%||Yes||Yes||Yes|
|Part B coinsurance or copay||Yes||Yes||Yes*|
*Plan N has a cost-sharing portion when it comes to Part B’s copay. For doctor visits, it’s up to $20. For ER visits that do not require admission, it’s up to $50.