Protecting against high out of pocket health care costs is a major priority for many people in Medicare. One of the most effective ways to do this is with Medicare Supplement Insurance. In this short article, we’ll review the details of Medicare Supplement Plans in Idaho.
While Original Medicare, Parts A and B, provide very comprehensive coverage, this government program doesn’t cover every expense you’ll incur while on Medicare. Instead, there are a number of costs that you’ll be required to pay out of pocket. These costs will include:
Most of these costs will be encountered throughout the year; only the Part B deductible is an annual cost. The real bad news about these costs is that you’ll pay them all year; there’s no limit to how much you can pay. This is very unlike traditional health insurance, which comes with an annual Out of Pocket Maximum (OOPM). Instead, with Original Medicare, your costs are uncapped. This is one of the primary reasons people choose to get Medicare Supplement Insurance.
Medicare Supplement Insurance, which is also commonly referred to as Medigap, is a very precise product that works only with Original Medicare. You can’t use your Medigap plan as a standalone coverage; it only pays costs that are left over from Original Medicare. This is what is meant by “Supplement” - Medigap plans supplement Original Medicare. When you go to the doctor, stay in the hospital, or otherwise use your Medicare benefits, you’ll present both your Medicare card and your Medigap plan card. Since Original Medicare is the primary coverage, your provider will bill Medicare first; Medicare will pay most of the costs. For Part B services, this means that Medicare pays 80% of the cost, assuming that you’ve met the Part B deductible for the year. Normally, you’re responsible for the remaining 20%. With Medigap coverage, though, your provider will bill your Plan the remaining 20%. Most Medigap plans will pay the entire amount; you’ll owe nothing. The rules and benefits for Medicare Supplement Plans are standardized across 47 of the United States by state and federal legislation. In the standardized states, of which Idaho is one, there are 9 standard Medigap Plans, which are known by letter. The nine plans are Plans A, B, C, D, F, G, K, L, M, and N. There are also high deductible versions of Plans F and G. Each Medigap Plan covers a different number of the Medicare charges you’d normally have to pay. The benefits are spelled out by law, and are the same for each plan in each of the standardized states. This means that Plan A provides the exact same benefits, no matter which insurance company you get it from, and regardless of which state you live in.
While there are 11 choices for Medigap coverage, three of the plans are more popular than the others. The three most popular Medigap plans are F, G, and N.
Plan F covers the most gaps in Medicare of all the Medigap Plans available. In fact, it covers every single one of them, including foreign travel. When you have Plan F, you’re likely to have zero out of pocket costs during the year. This feature also makes it the most expensive option. Plan F is not available for anyone who becomes eligible for Medicare after December 31, 2019. This means that most people entering Medicare today won’t be able to get Plan F.
In some ways Plan G is the replacement for Plan F. Plan G is the most comprehensive plan newly-eligible Beneficiaries can get today. It covers every one of the Medicare costs except for the Part B deductible. For 2022, the Part B deductible is $233. This means that, with Plan G, the most that you’ll pay out of pocket (for Medicare-approved services) is $233. Everything else is covered at 100%. Plan G also provides for emergency coverage outside of the United States.
Plan N is one of the more unique Medigap plans, but still very comprehensive. Plan N is quite similar to Plan G. It covers all of the standard gaps, including foreign travel, in Medicare expect for two:
Excess charges are only imposed by providers who don’t accept Medicare’s pricing. Since Medicare incentives providers to accept their pricing, most do. Therefore, excess charges are relatively rare. The most unique feature of Plan N is that you have to pay small co-payments for certain Part B services:
In return for having to pay these small co-payments, the monthly premiums are notably lower than for Plan G.
Once you’ve decided to get Medigap coverage, you’ll need to figure out which standardized plan to choose. This can be a difficult choice to make. Since this is an important decision, you’ll want to approach your choice in a systematic way. Here are some questions to ask yourself to help make a decision:
The most difficult question is the one related to your estimate of your consumption of medical services. You can’t know this with 100% certainty, of course. However, you can reflect on your personal health history as well as your family’s. If you seem more likely than most people to have health problems, then you might be better served by using one of the more comprehensive Plans like Plan G. On the other hand, if you’re more likely to have good health, especially if you also don’t need international coverage, then a less robust plan, like Plan B or L might be a good fit.
No. With Medicare Supplement Insurance you can see any doctor anywhere in the country that accepts Original Medicare. You also don’t need referrals to see specialists.
No. To get help paying for your medications, you’ll need to also enroll in a Part D drug plan.
Every Medicare Supplement plan with the same plan letter (F, G, etc) offers precisely the same benefits to you, but prices vary widely from one insurer to another. It’s in your best interest to have access to as many plans by as many insurers as possible when you make your Medicare Supplement plan.
That’s where Medicare Consumer comes in. When you speak with our experts you get access to plans from dozens of different insurers. They’ll guide you to the right plan for you at the best possible rate.
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