One of the most important decisions you’ll make in retirement is the type of Medicare plan you choose. And if you’re considering purchasing supplemental coverage, choosing the right Medigap policy is the next big step.
There are 11 different types of Medicare Supplement plans. Your options, however, may be limited depending on where you live. These plan types are lettered A through N, and they vary both in the type of benefits they offer and in price. Remember, Medicare Supplement works in addition to Original Medicare. You’ll need to stay enrolled in Parts A and B and find a Part D Prescription Drug Plan.
It’s important to note that Medicare supplement plans are standardized by the Centers for Medicare and Medicaid Services (CMS). This means each carrier is required to cover the same basic benefits depending on the letter designation. Some carriers may offer additional benefits, and pricing can be different as well. This is why it’s important to start the selection process by understanding what supplement plan you need based on benefits.
The following chart provides you the exact benefits for each type of supplement plan:
|Part A Coinsurance & Hospital Benefits||2|
|Part B Coinsurance or Copayment||50%||75%||3|
|Blood (first 3 pints)||50%||75%|
|Part A Hospice Care Coinsurance or Copayment||50%||75%|
|Skilled Nursing Facility Care Coinsurance||50%||75%|
|Medicare Part A Deductible||50%||75%||50%||3|
|Medicare Part B Deductible|
|Medicare Part B Excess Charges|
|Foreign Travel Emergency (up to plan limits)||80%||80%||80%||80%||80%||80%|
1 Plan F also offers a high-deductible plan. In 2018, you would have to pay $2,240 before your policy pays anything. Typically, this is a trade-off for a lower premium.
2 A check indicates that coverage is 100% of the Medicare allowable amount. A percentage number indicates the proportion of the Medicare allowable amount covered.
3 Plan N has a copayment of up to $20 for physician office visits and up to $50 for emergency room visits (which may be waived in certain circumstances).
4 Plans K and L pay 100% after the out-of-pocket limit is reached. In 2018, the out-of-pocket limits for Plan K and Plan L were $5,240 and $2,620, respectively.
As you can see from the table above, Plan F offers the most comprehensive coverage while Part A covers the least. The premiums for these plans can range from as low as $60 to as high as $500, depending on several factors including your gender, tobacco use, plan area, and the insurance company you choose. Note that Medicare Supplement plans are the only plan type allowed to charge more based on your gender, age, and health status. They also do not include coverage for prescription drug, vision or dental benefits.
We’d typically recommend looking into supplement coverage if you don’t want to be restricted by a provider network and you don’t need vision or dental coverage.
Finding a Plan Based on Your Needs
To help find your best fit, here a few questions to help narrow the selection.
Do you need coverage while traveling abroad?
Foreign travel coverage only applies to the first 60 days of a trip. It doesn’t include the first $250, and there is a lifetime cap of $50,000. If you are planning to travel to exotic new locations, this is a great benefit.
On the flip side, if you have no intention to leave the county, excluding plans that include foreign travel coverage is an easy way to save money.
If you plan to travel more while you’re young, you could enroll in a plan with foreign travel coverage and switch once you’re traveling less. However, remember that you may be subject to underwriting that could result in higher premiums when switching plans.
Plans with Foreign Travel coverage: C, D, F, G, M, and N
Will you need coverage for a Skilled Nursing Facility?
Original Medicare (Part A) already covers the first 20 days at a Skilled Nursing Facility assuming you were first admitted to a hospital for 3 days. With Part A alone, days 21-100 will cost you $167.50 (in 2018) each day. Some Medicare Supplement plans cover those days making up to 100 days free of charge.
A Skilled Nursing Facility offers rehab for a condition that led to your admission to a hospital. It is not to be mistaken for a retirement home. Most seniors will have at least one stay in a Skilled Nursing Facility when recovering from a condition such as a hip replacement or stroke. The average stay lasts 28 days. With Original Medicare alone, 28 days costs $1,340. Assuming you have one stay lasting 28 days, how many years will you be paying an additional monthly premium to cover this? Consider whether this is worth the additional monthly premium you’ll be paying.
Plans with Skilled Nursing Facility coverage: C, D, F, G, M, N and some coverage for K and L
Do you need excess charges coverage?
Medicare has approved amounts for what doctors can charge for their services. Doctors are able to charge up to 15% on top of approved amounts. Plans with excess charge coverage will cover that additional 15%. While this can be valuable, some estimates show that only 5% of doctors charge an excess amount. Also, Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont all disallow excess charges. Excess charges are most common at research institutions. This means you’ll likely need it if you are going to a specialist at a university. If you’re concerned that your doctor might charge in excess, you can check with their office or use this tool to see if your doctor accepts Medicare-approved amounts.
Plans with Excess Charge coverage: F and G
Do you foresee having a lot of out-of-pocket costs?
Plans K and L are the only plans that include an out-of-pocket maximum. Once you reach your out-of-pocket maximum, the plan will cover 100% of your covered expenses. While these plans have less coverage, you will have the comfort of knowing the most you’ll need to pay for covered expenses.
Want the most comprehensive coverage?
If you’re looking for the most comprehensive level of coverage, consider a Plan F. In 2016, 55% of all Medicare Supplement recipients were enrolled in a Plan F. Unsurprisingly, Plan F is the most expensive plan. You can save money on premiums by choosing a High Deductible version of Plan F. While the deductible is high, you will have that extra “rainy day” coverage for a cheaper premium.
Quick tip to save money
Don’t Pay Too Much for Part B Deductible: the only difference between Plan G and F is that Plan F covers the Part B Deductible. The Part B Deductible is $183 in 2018. If there is a Plan G that is at least $15.25 per month less than a Plan F, you’re getting a better deal. The majority of Plan G’s are cheaper!
The same logic applies to other plans as well. For example, take Plan C and N. The difference again is the Part B Deductible. Check if there’s a Plan N that’s cheaper by $15.25 per month.
Plan Premiums Increase
Once enrolled, your plan premium will likely increase every year. Many plans will increase as you get older. Other plans will have a fixed premium generally at a higher upfront cost. Visit medicare.gov for more information about rating methods.
Enrolling in a plan
Now that you’ve done your research and have identified the type of Medigap plan that most closely aligns with your needs, you can begin browsing and comparing the plans available in your area by visiting Renew’s Medicare Marketplace.
If you are already enrolled in a Medicare Supplement, but you want to switch to a different type of Medigap policy, the process can be a bit tricky. Because Medigap insurance has no annual open enrollment periods, most experts suggest to purchase the most comprehensive Medigap policy you can afford during the “Medigap open enrollment” period, which is the first six months after enrolling for Medicare Part B. This is the only time period in which you are guaranteed to be accepted by whichever Medigap policy you choose without the fear of higher premiums or outright rejection.
While it is possible to change from one Medigap policy to another at a later date, Medigap carriers will then be within their rights to raise your premiums based on your age, health, or pre-existing conditions, and, they are also within their rights to refuse to sell you coverage. If you do find yourself in this position, you will need to contact these carriers directly to apply for the new policy.