Supplemental Medicare insurance helps pay your Medicare Part A and B out-of-pocket costs. Without it, you’ll pay all deductibles, copayments, and coinsurance yourself. This is why you need supplemental insurance with Medicare. It is not a waste of money. It’s solid financial protection.
Do I Really Need Supplemental Insurance with Medicare?
In this article, you’ll discover how Medicare Supplement insurance, also known as Medigap, reduces the risk of large healthcare bills.
- Supplemental Medicare Insurance is a type of insurance policy designed to cover out-of-pocket costs in Original Medicare, including deductibles, coinsurance, and copayments.
- These policies, also known as Medigap, are sold by private insurance companies.
- Medigap plans are standardized by the federal government and are available in 10 different plan types.
Is Supplemental Medicare Insurance a Waste of Money?
Medicare Supplement Insurance is needed to prevent high healthcare bills. Without it, a simple 4 to 5-day stay in the hospital could end up costing you thousands of dollars in out-of-pocket costs.
I recently had a question from a friend on Social Security. She’s had Medicare since she was in her 50s. Now turning age 65 she asked, “Do I really need supplemental insurance with Medicare? I’ve managed with just Parts A, B, and D for all these years.”
If you’re getting your Medicare benefits for the first time, you might be wondering the same thing or have similar questions. Is supplemental insurance necessary with Medicare? Is it a waste of money? Is Medicare Advantage a better option?
I understand why my friend asked the question, and what is the average cost of Medicare Supplement insurance is. She lives in a high-cost area and a basic plan starts at about $100. A more comprehensive plan will start at about $165 per month. That’s a pretty big chunk of her fixed budget.
Thus far, she’s been lucky. She has only needed emergency room care twice and just one stay in the hospital. I reminded her about this and how her former husband absorbed her healthcare costs into his budget. Now she’s on her own and these are her costs. That started a new conversation, including, “Why am I responsible for those payments?”
Let’s start at the beginning and learn why supplemental coverage is so important.
What is Medicare Supplement Insurance?
From the beginning, Medicare was designed to be a shared-cost system. The federal government pays 80% and the Medicare beneficiary pays the remaining 20%.
That’s what Medigap coverage is used for. It helps you pay some of the costs that Medicare does not pay, including deductibles, copayments, and coinsurance. Even one of the 3 cheap Medicare Supplements is better than no coverage.
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What are the Benefits of Supplemental Insurance?
The best way to understand the benefits of Medicare Supplement insurance is to look at your health insurance costs with Medicare.
We all pay monthly premiums for our Medicare coverage. For most of us, Medicare Part A (hospital insurance) is premium-free ($0 per month). We pay for it during the years we work through payroll taxes.
Medicare Part B (medical insurance) is different. It isn’t funded through payroll taxes. We either pay for it directly or it’s taken out of our monthly Social Security benefits. This year the monthly Part B premium is $174.70.
If you are a high-income earner, you will also have an Income Related Monthly Adjustment Amount (IRMAA). These are just the costs to have access to care, not what you pay when you actually use healthcare services.
When you use healthcare services, Medicare has out-of-pocket costs:
- Medicare Part A Deductible: This is a per-benefit period deductible. If you have multiple stays in a hospital, more than 60 days apart, you’ll pay the deductible for each period. The Part A deductible is $1,632.
- Medicare Part A Coinsurance: You pay a daily coinsurance starting on the 61st day of inpatient treatment. It’s $408 per day for days 61 through 90. From the 91st day on it’s $816 per day.
- Medicare Part A Hospice Care: Medicare covers most costs.
- Medicare Part A Blood: Medicare covers the cost of blood transfusions, but you are responsible for the full cost of the first 3 pints covered.
- Medicare Part A Skilled Nursing Facility Coinsurance: Medicare covers up to 100 days of skilled nursing care. But, it only pays 100% for the first 20 days, then you’ll pay $204 per day.
- Medicare Part B Deductible: The Part B deductible is $240 per year. Medicare coverage for your doctor visits, lab work, and other medical services does not start until you have paid this amount.
- Medicare Part B Coinsurance: After you pay your annual deductible, Medicare begins paying 80% of your medical expenses. You pay the remaining 20%.
- Medicare Part B Excess Charges: Some providers add excess charges (up to 15%) on top of the Medicare-approved amount for services. You pay this additional cost.
All of these Medicare Part A and Part B costs are gaps in coverage. That’s why you need Medicare Supplement insurance. Supplements help you pay the out-of-pocket costs in Medicare Part A and Part B.
Is Medigap Insurance Worth It?
Is Medicare supplemental insurance worth it? Yes. It is worth every penny to those who want to know that their healthcare needs are fully taken care of. But, before you buy, explore all of your options.
Do you need supplemental coverage? Do you live in an area with better options? What is your health now and likely to be in the future?
It’s reasonable to look at the average cost of a Medicare Supplement plan and want to know if the extra coverage is really necessary. And more importantly, is it really worth the cost?
If you already have some health issues as you age into Medicare, and you’re likely to have more as you get older, this coverage is priceless because it removes uncertainty. Consider what it will cost to pay your 20% share out-of-pocket without additional coverage. Or, consider the annual limits on a Medicare Advantage plan in your area.
The question of Medigap vs. Medicare Advantage needs to be explored as an option because of the cost difference between Medigap and Medicare Advantage plans. At first glance, it may appear that Medicare Advantage plans cost less. In some cases they do, but you have to look at your potential out-of-pocket costs in both to get to the truth.
Unfortunately, Medicare Advantage plans are not standardized. Every plan is different. This makes it a challenge to compare plans, and it leads to a lot of confusion.
I recently received a mean-spirited email from a woman who wanted to know why I was lying to people about Medicare Advantage plans. She claimed that her girlfriend is getting all of her healthcare through Medicare Advantage for free and that I should be canceled for publishing false information.
As it turns out, her friend has a Medicare Advantage Special Needs Plan for dual-eligible people (D-SNP), which does cover most out-of-pocket costs through Medicaid. The point here is that you can’t make assumptions based on what a friend, neighbor, or family member has.
Everyone’s situation is different. You have to compare your options and balance those options with your health, your budget, and what makes you feel most secure. Only then will you know what is right.
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IMPORTANT NOTE: Medicare Supplement plans only cover the gaps in Original Medicare. So, if Medicare Part A and Medicare Part B do not cover a specific benefit, private insurance companies can’t cover it with a Medigap policy.
This includes a prescription drug plan. Prescription drug coverage is available through stand-alone Medicare Part D plans.
Is it Better to Have Medicare Advantage or Medigap?
Most people looking into Medigap insurance want to know if it is a better option than Medicare Advantage. The answer is different for everyone. To answer this fundamental question for yourself, you need to consider several key factors, including:
- Your health
- Your financial situation
- Your retiree benefits
- Your travel plans
- Where you live
Your health now and in the future is a serious factor in choosing the best Medicare insurance. Sure, both Original Medicare and Medicare Advantage cover the same core major medical benefits. But, did you know that Medicare Advantage plans are not required to cover your Medicare Part A and Medicare Part B benefits in the same way as Original Medicare?
This fact highlights one of the biggest disadvantages of Medicare Advantage. Here’s the difference.
With Original Medicare, a beneficiary’s out-of-pocket expenses are cut and dry. The beneficiary pays approximately 20 percent of all Medicare-covered costs (i.e., deductibles and coinsurance) and Medicare picks up the remaining 80 percent.
Medigap plans are designed to help beneficiaries pay the 20 percent gap by covering the various deductibles and coinsurance costs. Medicare Advantage plans also cover about 80 percent of all major healthcare costs. But, you can’t buy additional coverage for your 20 percent share.
So, if you are not in excellent health, your out-of-pocket costs, through copays, will hit your wallet until you reach your plan’s out-of-pocket maximum (MOOP). And that limit can be as high as $8,550 per year for in-network care.
In other words, if you are not a healthy person, Medicare Advantage can get very expensive. Private insurance companies are in business to make money, and the monthly premiums on their top insurance plans and the copayment they attach to various healthcare services reflect this.
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Your Financial Situation
It may not seem fair, because we all paid into Medicare during our working years, but people with higher incomes and lower incomes get better Medicare insurance. Why is that?
Ask any financial advisor or health insurance expert and they will tell you that Original Medicare, combined with a Medigap Plan F or Plan G policy, is the best health insurance you can get if you have Medicare benefits. The reason this is true is that it completely removes the financial risk of high medical bills.
With Original Medicare plus a Medicare Supplement Plan F or Plan G, the bulk of all healthcare expenses as you age are covered up-front.
For people with low incomes — those who qualify for both Medicare and Medicaid — the Medicare program offers additional assistance to help pay premiums, deductibles, and copayments. For these dual-eligible people, there are a growing number of Medicare Advantage Special Needs Plans (SNPs) that cover all Medicaid, Part A, Part B, and Part D benefits.
NOTE: No matter which Medicare insurance option you choose, you must continue to pay your monthly Medicare Part B premium for outpatient coverage. MA plan premiums and Medigap premiums do not replace what you owe for your Part B coverage. In other words, there’s no such thing as a free Medicare Advantage plan.
Your Retiree Benefits
You may not be wealthy or poor, but if you have retiree benefits that include health insurance, Medicare Advantage might be a good option. Many large companies, governments, and the railroad offer their retirees a Medicare Advantage group health plan and contribute to a portion of the costs. Many of these plans are quite generous, making them an excellent option, particularly for those who can’t afford a Medicare supplement.
Your Travel Plans
One of the big benefits of Original Medicare is that it travels with you anywhere you go in the USA or its territories. It doesn’t cover you when you travel abroad, but most Medigap policies do.
People with Original Medicare coverage and a Medigap Plan C, D, F, G, M, or N are covered at 80 percent when they have a foreign travel emergency. This isn’t the case with Medicare Advantage.
Yes, a Medicare Advantage plan will cover you in the USA if you have a medical emergency that necessitates a hospital stay, but it won’t cover you outside the USA, and you can’t see a doctor outside your coverage area for regular care. All of these costs will come out of your own pocket.
Where You Live
Where you live is a factor because counties with large metro areas generally have better healthcare provider networks and more private insurance health plan options. Also, as of 2021, some health plans are lowering their out-of-pocket limits to be more competitive. San Diego County and Los Angeles County are two good examples.
Both of these large counties have Medicare Advantage plans with a MOOP of less than $1,000. In small, rural counties, private health insurance options may be few or completely non-existent. For example, as of 2023, Alaska still does not have any HMO, PPO, PFFS, or HMO-POS Medicare Advantage plan options.
There are over 200 U.S., counties without private plans, leaving Original Medicare and Medigap the only option. The good news here is that the cost of Medicare Supplement insurance generally tends to cost less in rural areas than it does in big cities. Not always, but generally.
It is also important to note that larger metro areas have more healthcare providers, which means your options for both specialist and primary care doctors are generally excellent with the top Medicare Advantage plan. It also means that many of these same doctors and specialists are difficult to get appointments with if you have Original Medicare.
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Why Do Medicare Advantage Plans Cost Less?
A big difference between Medicare Advantage and supplemental Medicare insurance is when you pay your healthcare costs. With Medicare Advantage, you pay most of the costs when you use services. With a Medigap plan, you pay most costs in advance.
This causes great confusion for many people and it gets them in trouble. Unlike Medicare Advantage, there are no Medicare supplement plans with no premiums. But, there are also no surprises. Here’s why:
- A Medigap plan pays its portion of approved expenses not covered by Medicare, including copayments, coinsurance, and deductibles.
- There is a variety of Medigap plans to meet your needs. Some plans cover all costs allowed by law.
- With a Medigap plan, there’s no network, so you can choose any doctor or hospital that accepts Original Medicare.
- A Medigap policy is guaranteed to renew each year (so long as you don’t commit fraud by lying on your application or failing to pay your premiums).
Why Do People Choose a Medicare Supplement?
There are several key benefits of supplemental plans. They include:
- Freedom to choose healthcare providers without referrals;
- Better coverage on deductibles and coinsurance;
- Coverage while traveling (both in the U.S. and abroad); and
- Coverage that’s easy to understand.
One way to truly understand the incredible value of Original Medicare plus a Medigap policy is to look at hospital insurance (Medicare Part A) coverage. All Medicare supplements cover the Part A hospital coinsurance and most cover all or some of the Part A deductibles, too.
These are, by far, the biggest medical care costs in Original Medicare. A recent Kaiser Family Foundation (KFF) study found that most people in a Medicare Advantage plan would incur higher hospitalization costs for a short inpatient stay than people with Original Medicare alone.
This fact should be a red flag warning to anyone considering Medicare Advantage, particularly people with a chronic health condition that may require inpatient care.
But is a Medicare Supplement Really Necessary?
Health insurance, like auto insurance, is a financial tool. We all buy insurance for different reasons, but most commonly we get it to protect ourselves financially. To answer whether or not the cost is “worth it” depends on your personal financial situation.
In most areas, the average cost of supplemental insurance is less than most people think. Many people look at the best Medigap plans and get turned off by the premiums. But, there are more options than Medicare Plan G (the best you can buy today) if your budget can’t afford it.
If you are in good health and believe you’ll stay that way into your 70s, you might be a good candidate for Medicare Plan N. This policy helps healthy people save money on premiums by charging you a small copay when you see your doctor (up to $20) or use the hospital emergency room (up to $50). With Plan N you’re also responsible for excess charges if your doctor does not accept Medicare’s standard rates for services.
There are other Medigap plans that let you share some of the costs so you can get a lower rate. We suggest that you speak with your insurance agent to get more advice. Call 1-855-728-0510 (TTY 711) and speak with a licensed HealthCompare insurance agent. There’s no obligation, and they offer more plan options than any other national agency. Be sure to ask for a rate increase history for Medigap plans you are considering.
What Are The Disadvantages?
Here are the cons of Original Medicare and a Medigap plan:
- A shrinking pool of doctors who accept patients that are not in a network plan;
- No extras, like prescription drug benefits or routine dental, vision, and hearing care;
- Higher up-front costs; and
- You can be turned down.
The primary disadvantage is that you can be denied Medicare Supplement coverage if your guaranteed issue right has expired and you do not live in a state with enhanced rules.
What are the Benefits of Medicare Advantage?
Most Medicare Advantage plans are a form of managed care, primarily HMO (health maintenance organization) and PPO (preferred provider organization) plans. These types of plans favor healthy people.
In fact, the whole idea behind HMO plans is to keep people healthy to reduce costs. When you are healthy, the other advantage of Medicare’s private health plans really comes into play. That being their extra benefits.
Unlike Original Medicare, with or without Medigap coverage, Medicare Advantage plans can add additional benefits. The most common extra benefit is a prescription drug plan (Medicare Part D plan). But plans also add routine dental, vision, and hearing benefits, too.
Prescription drug coverage can add up quickly. Basic Part D prescription drug coverage, which you’ll need to buy if you keep your Original Medicare, can be as low as $20 but averages about $34 per month. That gives beneficiaries that enroll in a Medicare Part C plan with Part D coverage a $408 benefit (annualized average value).
With basic dental and vision plans costing between $35 and $50 per month, insurance plans with these extra benefits offer healthy people greater cost savings, particularly when you compare the average Medicare Advantage premium with that of a Medicare Supplement plan.
Are Medicare Advantage Plans Bad Like People Say?
Above we talked about the differences between Medicare Supplement Insurance and Medicare Advantage plans, and that may lead you to ask if Medicare Advantage plans are bad. In a word, no, but they are not the right choice for everyone.
Many people aging into their Medicare benefits now are used to employer group health plans that look a lot like Medicare Advantage plans. That’s because group health plans and Medicare Advantage use the familiar HMO (health maintenance organization) and PPO (preferred provider organization) managed healthcare delivery models.
When you and your family were young and healthy, the HMO and PPO style of healthcare delivery saves money. But, as we age, many people discover that their out-of-pocket costs actually go up with an HMO or PPO plan.
That’s because people with one or more chronic health conditions see their doctor and need emergency care more frequently, and they end up paying more copayments. For this very reason, Medicare Advantage has a built-in safety net system, which is a maximum out-of-pocket (MOOP) limit, which is currently $8,550 per year.
It can be lower, however, most plans are at the maximum allowed. But, the MOOP does not include your premiums or your cost of medications. So your actual out-of-pocket costs could be much higher.
You might be wondering if Medigap plans have a MOOP. Some do and some don’t. For example, the high-deductible versions of Plan F and Plan G have an annual deductible that must be met before the policy begins paying. This, plus the Part B deductible for Plan G, becomes the out-of-pocket maximum for these plans. Plans K and L, with their shared costs, are similar. They both have an annual maximum that must be met before the plan covers its share.
In MedicareWire’s opinion, Medicare Advantage plans are only a safe option if you are extremely healthy and have no family history of chronic illnesses later in life, or if you receive assistance paying the out-of-pocket costs. This is the case if your former employer or union offers retiree healthcare benefits, if you are dual-eligible (Medicare and Medicaid), or if you qualify for a Special Needs Plan (SNP).
If none of these situations apply to you, a Medicare supplement plan is the better option.
Medicare Supplement & Medicare Advantage Eligibility
The final discussion about which type of Medicare is best comes down to eligibility and enrollment. Sadly, many people who would be best served by Original Medicare and supplemental insurance go with Medicare Advantage, because they think it costs less.
When people learn their out-of-pocket expenses with a Medicare Advantage plan are unaffordable, it’s often too late to make a switch. But why?
The unavoidable truth is that Medicare Supplement insurance is not health insurance. It is a form of indemnity insurance. As a result, the Affordable Care Act, which regulates medical insurance, does not apply.
The federal Medicare program, and most states, only require insurance companies to issue a Medigap policy, without restrictions, for a very limited time. That time is when you first turn age 65 and have your guaranteed issue right.
Once that right expires, insurance companies can and will turn you down due to preexisting conditions. This fact about Medicare supplement insurance exposes another big advantage of Medicare Advantage plans.
Generally speaking, Medicare does not allow private health insurers to deny enrollees who want to join their Medicare Advantage plans due to a preexisting condition. There are a few exceptions, such as end-stage renal disease (kidney failure). The Centers for Medicare & Medicaid Services cover these medical expenses directly.
And finally, we come to enrollment. With a Medicare Supplement, you can apply for coverage anytime you want. You can also switch plans or carriers or drop coverage anytime you want.
However, you have a one-time Medicare Supplement Open Enrollment Period that gives you a guaranteed issue right (Medigap protections). But, when your guaranteed issue right expires, insurance carriers have the right to ask you health questions and deny coverage if you don’t pass their underwriting process.
With Medicare Advantage plans, you can’t enroll or disenroll whenever you want. Enrollment and dis-enrollment are only available during certain enrollment periods. The most common of these is the Open Enrollment Period, which occurs in the Fall. When you first qualify for your Medicare benefits, you get an Individual Enrollment Period (IEP).
Speak with Your Agent
It’s important to have a candid conversation with your insurance agent about your health and financial situation. Don’t make this important decision alone. Ask your agent if a Medigap policy is right for you. Be specific and ask about hospital stays, long-term care, and other important insurance topics. If you don’t have an agent, or you want a second opinion, Call 1-855-728-0510 (TTY 711) and speak with a licensed HealthCompare insurance agent. There’s no obligation, and they offer more plan options than any other national agency.
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Frequently Asked Questions
Do you know the answer to these popular questions?
Most retirees have a fixed budget and can't afford to pay that much out of pocket. Without a Medicare supplement, you will not be protected from catastrophic medical costs. For more on this subject, see Are Medicare Supplements Worth It or A Waste of Money??
There are three major disadvantages, including monthly premiums, a limited period of guaranteed enrollment, and no additional benefits, such as coverage for prescriptions. When compared with Medicare Advantage plans on the same measures, Medicare Advantage plans appear to be a better option. However, Medigap plans cover more costs. This is what makes a Medicare Supplement plan the best option for anyone concerned about coverage of their major medical costs. Click here to learn more.
In general, AARP / UnitedHealthcare (UHC) has the best rating of all Medicare Supplement insurance carriers. They have an A+ rating with A.M. Best, which rates the financial stability of insurance carriers, and a 3.9 out of 5 stars rating with NCQA, which measures member experiences across all Medigap carriers (they are #1). It's also important to note that AARP / UHC has the most stable rate increase history in the industry. Read Get the Rate Increase History for Medigap Plans Before Buying to learn more.
Citations & References:
- 2023 Medicare Parts A & B Premiums and Deductibles | CMS
- Trump Administration Announces Historically Low Premiums and New Insulin Benefit as Medicare Open Enrollment Begins | CMS
- Institutional Special Needs Plans (I-SNPs) | CMS
- Medicare costs at a glance | Medicare https://www.medicare.gov/your-medicare-costs/medicare-costs-at-a-glance
- How to compare Medigap policies | Medicare https://www.medicare.gov/supplements-other-insurance/how-to-compare-medigap-p…
- What’s Medicare Supplement Insurance (Medigap)? | Medicare
- Medicare Advantage Plans | Medicare
- A Dozen Facts About Medicare Advantage in 2019 | KFF
- Sources of Supplemental Coverage Among Medicare Beneficiaries in 2016 | KFF
- Medicare Advantage | KFF
- Home | State Health Insurance Assistance Programs http://www.shiptacenter.org/
- FastStats – Hospital Utilization http://www.cdc.gov/nchs/fastats/hospital.htm
- NCHS Pressroom – 2008 Press Release – Ambulatory Medical Care Utilization Est… http://www.cdc.gov/nchs/pressroom/08newsreleases/visitstodoctor.htm
- Medicare Supplemental Policies: Do You Need One? | HuffPost Life http://www.huffingtonpost.com/david-belk/medicare-supplemental-policies_b_390…