Understanding the Financial Basics of Medicare Supplements
Before you can decide which supplemental insurance is right for you, it’s essential to understand what it’s designed to cover. This starts with a clear picture of what Original Medicare does—and does not—pay for.
What Original Medicare (Parts A & B) Covers
Original Medicare is your primary health insurance from the federal government once you turn 65. It consists of two parts:
- Part A (Hospital Insurance): This helps cover inpatient care in a hospital, skilled nursing facility care (following a hospital stay), hospice care, and home health care.
- Part B (Medical Insurance): This helps cover services from doctors and other healthcare providers, outpatient care, durable medical equipment (like walkers or wheelchairs), and many preventive services.
The Financial “Gaps” in Original Medicare
While this coverage is substantial, it comes with significant out-of-pocket costs, often called “gaps.” These are the expenses you are responsible for paying.
Here’s a simple breakdown using approximate 2024 figures:
- The Part A Deductible: If you are admitted to the hospital, you must first pay the Part A deductible. In 2024, this is over $1,600 for each benefit period. You could potentially pay this deductible multiple times in a single year if you have separate hospital stays.
- Part A Coinsurance: For a long hospital stay, you start paying a daily coinsurance after day 60. This can be over $400 per day.
- The Part B Deductible: Before Part B starts paying, you must meet an annual deductible. In 2024, this is $240.
- Part B Coinsurance: This is the biggest financial risk for most seniors. After your deductible is met, Part B generally only pays for 80% of the Medicare-approved amount for most services. You are responsible for the remaining 20%. There is no annual limit or cap on this 20% coinsurance. A single expensive procedure or treatment for a chronic condition could leave you with a bill for tens of thousands of dollars.
How Medicare Supplements (Medigap) Work
A Medigap plan is private insurance that you purchase to help pay for these gaps. It works alongside your Original Medicare. You show both your Medicare card and your Medigap card at the doctor’s office or hospital. Medicare pays its share first, and then your Medigap plan pays its share, which can be some or all of the remaining costs, depending on the plan you choose.
The most important thing to know about medicare plans of this type is that they are standardized by the federal government. They are labeled with letters (e.g., Plan G, Plan N). This means that a Plan G from one insurance company has the exact same basic medical benefits as a Plan G from any other company. The only differences are the monthly premium you pay and the company’s customer service and reputation.
It is crucial to understand that Medigap is NOT the same as a Medicare Advantage (Part C) plan. A Medigap policy supplements your Original Medicare benefits. A Medicare Advantage plan is an alternative way to get your Medicare benefits, replacing Original Medicare with a private, often network-based plan. This article focuses only on Medigap.
