What Do Medicare Supplement Plans Cover?

January 3, 2019

With so many Medicare plans to keep straight it’s hard to know what is medically covered and what isn’t covered. Medicare supplement plans are available to pay for gaps in your Medicare plan’s coverage. Let’s take a look at what Medicare supplement plans cover.

Doctor and patient

Source: Getty

Medicare does not cover all of the costs associated with health care services and medical supplies. Fortunately, Medicare supplement plans are available from a variety of insurers to help pay for the following medical expenses:

  • Coinsurance and hospital costs for up to one year after Medicare benefits are used up

  • Blood transfusions for up to three pints of blood

  • Hospice care coinsurance or copayment

  • Skilled nursing facility care coinsurance

  • Medicare Part A (hospital insurance) deductible

  • Medicare Part B (medical insurance) deductible

  • Part B excess charge (the difference between the amount a doctor or health care provider can legally charge and the Medicare-approved amount)

  • Medical costs incurred while traveling outside of the U.S.

  • Out-of-pocket limit

Costs Not Covered by Medicare Supplement Plans

A Medicare supplement plan is designed to fill in Medicare coverage gaps, but it does not account for all medical expenses. Typical medical costs not covered by a Medicare supplement plan include:

  • Dental care, unless incurred during hospitalization

  • Eye exams

  • Eyeglasses

  • Hearing aids

  • Prescription drugs (Plans sold after 2006)

Medicare Supplement Plans Coverage Explained

Medigap

Source: Getty

Medicare supplement plan benefits vary, but all provide coverage for coinsurance and hospital costs for up to one year after you’ve exhausted Medicare benefits. There are 10 Medicare supplement plans available in most states. Each plan is designated by a letter and is called, for example, Medicare Supplement Plan A.

  • Plan A: Coverage for Part B coinsurance or copayment, blood transfusions, and hospice care coinsurance or copayment.

  • Plan B: Includes the same coverages as plan A, along with Part A deductible coverage.

  • Plan C: Same coverages as plan B, along with Part B deductible coverage and foreign travel coverage up to 80 percent. Plan C is being discontinued, and after Jan. 1, 2020, you will not be able to enroll in this plan.

  • Plan D: Includes the same coverages as plan C, except Part B deductible coverage.

  • Plan F: Same coverages as plan C, along with Part B excess charge coverage. Plan F is a high-deductible option, and enrollees are required to pay Medicare-covered costs up to $2,240 before their Medicare supplement insurance pays anything. Also, plan F is being discontinued, and after Jan. 1, 2020, you will not be able to sign up for this plan.

  • Plan G: Mirrors plan F coverage, except Part B deductible coverage.

  • Plan K: Covers up to 50 percent of the following costs:

    • Part B coinsurance or copayment, blood transfusions
    • Part A hospice care coinsurance or copayment
    • Skilled nursing facility care coinsurance, and Part A deductibles
    • Plan K does not cover Part B deductibles, excess charges, and foreign travel exchanges, and it has an out-of-pocket limit of $5,240
  • Plan L: Includes coverage for up to 75 percent of the following costs:

    • Part B coinsurance or copayment, blood transfusions
    • Part A hospice care coinsurance or copayment
    • Skilled nursing facility care coinsurance
    • Part A deductibles
    • Plan L does not pay for Part B deductibles or excess charges, or foreign travel medical expenses, and it has an out-of-pocket limit of $2,640
  • Plan M: Includes the same coverages as plan D, but does not cover 50 percent of Part A deductibles.

  • Plan N: Includes the same coverages as plan A, with the exceptions of foreign travel exchange coverage up to 80 percent and full coverage of Part B coinsurance or copayments. Plan N pays 100 percent of Part B coinsurance or copayments, except for copayments of up to $20 for some office visits and up to $50 copayments for emergency room visits which do not result in inpatient admissions.

It’s worth noting that while four older Medicare supplement plans (E, H, I, and J) are no longer available, you can keep this coverage if you purchased one of these plans before June 1, 2010.

Medicare Supplement Plan snapshot

Source: MedicareSupplement.com

Medicare Supplement Plan Coverage Varies in Some States

Medicare supplement plans are available nationwide, but Massachusetts, Minnesota, and Wisconsin offer options differing from those available in other states.

In Massachusetts, core Medicare supplement coverage includes health care items and services under a health insurance plan, up to 60 days of inpatient time at a mental health hospital per calendar year, and various state-mandated benefits. The core Massachusetts Medicare supplement plan does not cover Part A inpatient hospital deductibles or skilled nursing facility coinsurance, Part B deductibles, or foreign travel emergencies. Massachusetts Medicare supplement plan rates run from $1,188 to around $200 per year.

Basic and Extended Basic Medicare supplement plans are available to Minnesota residents. Minnesota’s core Medicare supplement coverage includes inpatient hospital care, medical costs, blood transfusions for up to three pints of blood annually, Part A hospice and respite care cost-sharing, and Parts A and B home health services and supplies cost-sharing. Annual premiums for Medicare supplement insurance in Minnesota average just under $2,000 annually, with a low rate of around $1,500 on up to $3,500.

Core Medicare supplement coverage in Wisconsin consists of health care items and services under a health insurance plan, Part A skilled nursing facility coinsurance, and assorted state-mandated benefits. This coverage also provides up to 175 days per lifetime to supplement Medicare’s inpatient mental health coverage and up to 40 home health care visits in addition to those paid for by Medicare. Wisconsin posts a lengthy document with Medicare supplement insurance annual rates, a sampling of which is $1,800 to $4,500.

The Bottom Line on Medicare Supplement Plans

Medicare supplement plans are ideal for those who are searching for ways to augment their Medicare coverage, but all plans differ quite a bit. It is crucial to examine each Medicare supplement option closely to choose the coverage that can serve you well for years to come.