Medicare can be confusing. You’re turning 65 and have no idea what to do next. You know you want the best health insurance coverage but don’t want to break the bank. This is where a Medigap Plan D can help.
This Medicare plan, also called Medicare Supplement Plan D, is designed to work with Original Medicare, providing extra coverage for expenses not fully paid for by Medicare Part A and Part B. Let’s examine what it’s all about.
Understanding Medigap Plan D
First things first – what does a Medicare Supplement do? Original Medicare has gaps in coverage. You end up paying a portion of many medical costs, such as copays, coinsurance, and deductibles. A Medicare Supplement Insurance plan swoops in and helps cover these out-of-pocket expenses, leaving you with more predictable healthcare costs.
What Does Medigap Plan D Cover?
So, what exactly does a Plan D offer? The specifics of Medicare Supplement plans are standardized, meaning they provide the same core benefits across all insurance companies. Let’s look at the specific areas a Medigap Plan D helps with:
- Part A Coinsurance and Hospital Costs: Medigap Plan D covers your Part A coinsurance for hospital stays, including additional days after your original Medicare benefits run out. That’s extra peace of mind right there.
- Part B Coinsurance or Copayments: This coverage helps cover your Part B coinsurance (or copayments) when you see your doctor or receive outpatient treatment.
- Blood: Need a transfusion? No problem. A Plan D helps you with the cost of the first three pints of blood.
- Part A Hospice Care: Should you ever need hospice care, Plan D assists with the related coinsurance or copayment.
- Skilled Nursing Facility Care Coinsurance: After a hospital stay, you may need time at a skilled nursing facility (SNF) for rehab or other care. Plan D chips in for the SNF care coinsurance.
- Part A Deductible: You won’t have to pay your Part A deductible out of pocket because Plan D covers it. And it’s no small amount. In 2024 it’s $1,632 per benefit period.
- Foreign Travel Emergency: This one is for the globetrotter. Plan D can cover up to 80% of foreign travel emergency costs within certain limits, which can be a real lifesaver abroad.
But remember, there’s no free lunch. While Plan D gives you comprehensive coverage, you pay a monthly premium for these benefits. Remembering what a Medigap Plan D does not cover is crucial. For example, this plan does not include prescription drug coverage. You must get a Medicare Part D prescription drug plan for drug coverage.
Is Medigap Plan D Worth It?
Knowing what Plan D covers will help you manage your out-of-pocket costs. This plan might sound fantastic on paper, but is Plan D the right fit for you? That depends on your situation. Here’s a deeper look at when Plan D could work for you and when it might not be a good fit:
When It’s a Great Choice:
- You Value Predictability: Do you hate surprises? Plan D shields you from unexpected out-of-pocket expenses. Knowing your costs are capped, you can plan your budget with peace of mind.
- Frequent Doctor Visits: If you frequently visit doctors or use medical services, this plan’s robust coverage can help you save a lot over time.
- Travel Overseas: Planning adventures abroad? Plan D provides coverage for unexpected medical hiccups that could happen while you’re traveling.
When to Reconsider:
- Limited Budget: Medigap Plan D isn’t the cheapest Medigap plan because it offers more comprehensive coverage. So, while it helps control out-of-pocket costs during the year, this plan may not be ideal if monthly premiums are challenging for your budget. You may want to look into Plan A, Plan N, or Plan K and Plan L, which tend to be more budget-friendly.
- Part B Excess Charges: Sometimes, healthcare providers might bill above what Medicare approves for their services, also called Part B excess charges. Plan D does not cover these extra costs. Other Medigap Plans do, though – Medigap Plan F (if you were eligible before January 1, 2020) and Medigap Plan G include this protection.
- Need Prescription Drug Coverage: Since Plan D does not include a drug plan to cover your prescriptions, if this is important for you, you would have to look into Medicare Part D or find a Medicare Advantage Plan with prescription coverage. Just ensure it doesn’t have the primary disadvantage of Medicare Supplement insurance. You can learn more about prescription coverage for Medigap plans here: Paying for Drugs When You Have a Medigap Plan.
Exploring Medigap Options: A, B, C, D, F, G, K, L, M and N
While Plan D offers adequate coverage for some people, exploring all the options is crucial to ensure you have a complete picture before selecting one. There are ten Medigap Plans in total: A, B, C, D, F, G, K, L, M, and N, each offering a different level of coverage. We can help you compare Medigap plans in your area and get current rates.
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Medicare Supplement Insurance Plans C and F are no longer available for people who turned 65 on or after January 1st, 2020, as changes went into effect according to the 2009 Medigap Federal Register Notice and outlined by the Medicare Access and CHIP Reauthorization Act.
Medicare.gov is an official website that shares helpful information about the Medicare system. There, you can also learn the difference between Medicare supplement insurance and a Medigap policy.
A handy chart summarizes what each Medicare Supplement insurance plan offers to help you quickly grasp the main distinctions. This gives a good bird’s eye view so you can figure out which supplement insurance plan sounds right up your alley before diving into the specifics.
| Medicare Supplement Plan | Key Features |
|---|---|
| Medigap Plan A | It offers primary core benefits like Part A coinsurance, hospice care, and the first three pints of blood but does not cover Part B deductible or Part B excess charges. It tends to be more affordable. |
| Medigap Plan B | Offers the same basic coverage as Plan A but with added Part A deductible coverage. Still omits coverage for Part B excess charges and generally has a slightly higher monthly premium. |
| Medigap Plan C | Medigap Plan C provides a broad spectrum of coverage. It covers Part A and B coinsurance and deductibles, the first three pints of blood for medical procedures, and skilled nursing facility care coinsurance. Plus, it covers foreign travel emergencies. However, it is no longer available to people newly eligible for Medicare after January 1, 2020. |
| Medigap Plan D | Comprehensive plan covering many out-of-pocket expenses: Part A coinsurance, hospital costs beyond original Medicare benefits, Part B coinsurance or copayments, first three pints of blood, Part A hospice care coinsurance or copayments, skilled nursing facility care coinsurance, Part A deductible, and foreign travel emergencies. Does not cover Part B deductible. This popular and robust alternative to Plan C offers many of the same advantages. |
| Medigap Plan F | Widely known as the most comprehensive choice until changes took effect on January 1st, 2020. This plan is similar to Medigap Plan D plus coverage for the Part B deductible and Part B excess charges. The drawback? Typically, it has the highest premiums. Plan F is no longer available to those newly eligible for Medicare on or after January 1st, 2020. |
| Medigap Plan G | It closely resembles Plan F in coverage, protecting nearly all out-of-pocket Medicare costs except the Part B deductible. Many choose this plan due to its lower premium cost despite not having Part B deductible coverage. This plan offers broad protection without the sky-high cost. If you’re concerned about Part B excess charges, it’s a real winner. |
| Medigap Plan K | This plan provides partial coverage. Think of it as a cost-sharing approach, where the plan covers 50% of your Medicare coinsurance, copays, and deductibles until you meet an annual out-of-pocket limit. While your monthly premiums might be less, you take on more financial risk if you need lots of care. Plan K can work for people who expect lower healthcare needs but still desire protection for emergencies or high medical bills. |
| Medigap Plan L | Shares a similar cost-sharing structure with Plan K but ups the coverage. Plan L pays for 75% of your Medicare expenses. Similar to Plan K, this could be attractive if you value affordability and aren’t worried about many high medical bills. |
| Medigap Plan M | This option delivers mid-range coverage. It covers many costs, like Part A and B coinsurance, but has copayments for some services, such as doctor visits. This plan can work for people seeking decent coverage without top-tier premiums. |
| Medigap Plan N | Also, offering mid-level coverage. Similar to Plan D, it excludes coverage for Part B excess charges. However, Medigap Plan N includes small copays for office and emergency room visits, which may appeal to folks willing to trade lower premiums for copays. This plan’s structure aims to control your upfront premium costs while balancing some modest copayments for specific medical services. |
FAQS about Medigap Plan D
What is a Part D Medigap plan?
This is tricky because “Part D” sounds like Medigap Plan D. However, Part D is prescription drug coverage, whereas Plan D helps with Original Medicare’s costs. And Medicare Supplements sold after 2005 no longer cover prescription drugs, even Plan D.
On the other hand, Medicare Part D, available through standalone plans or included within Medicare Advantage, specifically addresses prescription drug costs. You might need a Medigap and a Medicare Part D plan to cover both gaps. The difference between Original Medicare, Medicare Supplement Insurance, and Medicare Advantage confuses people new to Medicare. Just remember this. The Medicare program organizes coverage in “Parts,” whereas private insurance companies sell “plans.”
What is the difference between Medigap G and D?
Both Plan D and Plan G provide substantial coverage, but significant distinctions exist. Medigap Plan G covers something that Plan D does not – Plan G covers those Part B excess charges. You’re responsible for any Part B excess charges with Plan D, although Medicare Supplement Plan D is often the cheaper option.
Who is eligible for Medigap Plan D?
Good news – if you’re enrolled in both Medicare Part A and Part B, you’re eligible for Medigap Plan D. It doesn’t matter how you qualify for Medicare, be it by turning 65 or by being disabled; you are free to apply for Medigap plans. However, the best time to apply is during your Medicare supplement open enrollment, which lasts six months and kicks off when you turn 65 and are enrolled in Part B. You may have difficulty getting a Medigap policy if you miss this enrollment period. You may also encounter higher premium costs or possible denials. You can learn more about situations where you can be denied Medicare supplement insurance here.
What is the difference between Medigap F and G?
Before January 1, 2020, Medigap Plan F had the bragging rights for the complete coverage, including coverage for those tricky Part B excess charges, and the Medigap policy was popular for that reason. It also covered everything Medigap Plan G covers. The difference? Plan G does not include coverage for the Part B deductible. However, Plan G’s monthly premium often ends up being less, which has made it an increasingly popular plan.
When Can I Enroll in a Plan D Medicare Supplement?
You might ask, “When is the best time to get a Medigap plan?” The answer is simple: during your Medigap Open Enrollment Period. This period starts the month you turn 65 and are enrolled in Medicare Part B. It lasts for six months. During this time, you have a guaranteed issue right. This means insurance companies can’t deny coverage or charge you more based on your health.
But what if you missed your Medigap Open Enrollment Period? Don’t worry. You still have health plan options, but they might be trickier. Outside of this period, you can apply for Medigap Plan D anytime. However, you might have to go through medical underwriting. This means the insurance company will look at your health history. They could deny coverage or charge you a higher premium based on your health.
Conclusion
Navigating Medicare supplement insurance options can be a headache, especially with all the jargon. But by carefully understanding Medigap Plan D, you can decide if it’s right for you. It provides broad protection, but it has some downsides.
Take the time to carefully assess your situation and healthcare requirements, compare the different Medigap plan options, consider your budget constraints, and weigh your need for coverage with potential copayments. You can always get expert assistance or additional help.
Finding the plan that perfectly complements your needs is essential. And that is the key to navigating Medicare successfully.