Understanding Medicare Supplement (Medigap) Plan A Coverage and Costs
Because of the naming conventions in Medicare, it’s easy to confuse Medicare Part A with Medicare Supplement Plan A. We’ll clear up this common misunderstanding before diving into the specifics of the policy:
Medicare Part A and Medicare Part B make up Original Medicare. Medicare Part A is the inpatient, or hospital, coverage of Original Medicare.
Medicare Supplement Plan A is one type of Medicare Supplement insurance plan. Medicare Supplement insurance is meant to supplement your Original Medicare coverage. All Medicare Supplement plans pay for some out-of-pocket costs leftover by Original Medicare. Compared to other Medicare Supplement plans, Medicare Supplement Plan A provides a little less coverage. Read on to learn more about what Medicare Supplement Plan A covers, and what costs you would be responsible for.
Key takeaways:
Medicare Supplement Plan A is one of ten Medicare Supplement options available to Medicare beneficiaries.
Medicare Supplement Plan A provides less coverage compared to other Medigap plans. The policy covers some out-of-pocket costs leftover by Original Medicare.
Plan G provides the most comprehensive coverage compared to other Medicare Supplement plans and is the most common choice among new Medicare enrollees.
The right Medigap plan for you depends on your unique situation. We recommend speaking with one of our licensed Medicare Advisors to get help choosing the right plan for you.
What are Medicare Supplement plans?
Medicare Supplement (also called Medigap) policies were introduced to fill in the “gaps” left from Original Medicare. Because Original Medicare only pays for 80% of covered services, the program introduced Medicare Supplement (Medigap) to provide additional coverage for the remaining 20% of costs.
There are ten types of Medigap plans, labeled by letters A through N. Each Medigap plan of the same letter type (e.g., every Medigap Plan A) provides identical coverage, regardless of pricing or the insurance provider.
Important note: Massachusetts, Minnesota, and Wisconsin offer a different set of standardized Medicare Supplement plans. These states do not offer a Medigap Plan A.
Benefits of Medicare Supplement plans
For those with Original Medicare, Medigap plans are beneficial because they minimize out-of-pocket costs. They do this by helping to pay for deductibles, copayments, and coinsurance.
Compared to Medicare Advantage, Medicare Supplement plans are more standardized, less restrictive, and don’t require beneficiaries to get prior authorization. Let’s dive into each of these key benefits.
Standardization
You’ll have the same coverage for every Medigap plan of the same type, even if monthly premiums are different. For instance, all Plan As provide identical benefits, even if one plan’s premium is higher than another’s.
No restrictive provider networks
Original Medicare and Medicare Supplement enable you to visit any medical professional who accepts Original Medicare, which is 90% of doctors across the US. This is especially beneficial if you travel often.
No need for prior authorization
Medicare Advantage often requires prior authorization for covered services. If you are denied prior authorization, you must pay the full cost of your treatment. Original Medicare and Medigap don't require prior authorization for any covered service, which makes getting the care you need easier
Eligibility for Medicare Supplement plans
You are eligible for a Medicare Supplement plan if you are enrolled in Original Medicare (Part A and Part B) and not enrolled in Medicare Advantage. The best time to enroll is during your Medigap Open Enrollment period, which lasts for six months after your Medicare Part B coverage starts. We’ll explain more about enrollment later in this piece.
Comparing Medicare Supplement plans
There are ten types of Medicare Supplement plans, and each plan pays for a different set of out-of-pocket costs. Check out this chart to compare plans.
If you need assistance comparing plans and deciding on the right one for you, our licensed Medicare Advisors are here to help! Give us a call at (855)-900-2427 for free advice tailored to your situation.
Medicare Supplement Plan A coverage
Medicare Supplement Plan A isn’t the most popular option for additional coverage. In 2021, 0.7% of beneficiaries enrolled in Medicare Supplement Plan A. This is likely because it doesn’t cover as many out-of-pocket costs and doesn’t provide the same value as more popular plans, like Plan G and Plan N. Currently, Plan G is the most popular Medigap policy for new Medicare enrollees, and it provides the most comprehensive coverage.
What’s covered under Medigap Plan A?
Medigap Plan A covers:
Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up
Part B coinsurance or copayment
Blood transfusion (first 3 pints)
Part A hospice care coinsurance or copayment
What’s not covered?
Medigap Plan A does not cover:
Skilled nursing facility care coinsurance
Part A deductible
Part B deductible
Travel-abroad emergency medical care
In general, Medigap only provides coverage for out-of-pocket costs leftover by Original Medicare. It will not cover additional healthcare services like:
Long-term care and private nurses
Dental care
Routine eye exams and glasses
Medicare Supplement Plan A costs
Medigap Plan A covers a smaller set of out-of-pocket costs than other Medigap plans. With Plan A, your out-of-pocket costs will include:
Original Medicare premiums
Part A deductible
Part B deductible
Medicare Part B excess charges
Skilled nursing facility care coinsurance
Travel-abroad emergency medical care
The cost you may for a Medigap Plan A will depend on personal factors, your location, and the insurance provider you choose.
Medicare Supplement Plan A premiums
Your carrier will determine how much your Medicare Supplement Plan A premium is based on the following factors:
Where you live
Your smoking status
Your age
Your gender
The insurance carrier
Household discounts (offered by some Medigap plans)
Will my Medicare Supplement premium change over time?
Three pricing or “rating” structures affect how your Medicare Supplement premiums could change over time:
Community-rated (aka no-age-rated): The premium you pay is the same as everyone else with the same policy, regardless of age. This ensures that your premium will not increase as you age.
Issue-age-rated (aka entry age-rated): The premium you pay is based on the age you were when you first enrolled in your Medigap plan, meaning your premium cannot increase due to age.
Attained-age-rated: The premium you pay is based on the age you currently are (the age you’ve “attained”). This means your premium can increase as you get older, and you’ll likely start out with a lower premium.
Medicare Plan A deductibles
There is no specific Medigap Plan A deductible, but you’ll have to pay your Original Medicare (Part A and Part B) deductibles since the plan doesn’t cover them.
Medicare Supplement Plan A out-of-pocket costs and maximums
Because Medigap Plan A covers big out-of-pocket costs like your Part A and B coinsurance, it doesn’t have an out-of-pocket limit. You will still be responsible for the following out-of-pocket costs:
Your Part A deductible
Your Part B deductible
Part B excess charges
Travel-abroad emergency medical care
Skilled nursing facility care coinsurance
How to enroll in a Medicare Supplement Plan A
Our Medicare Advisors can help you compare plans and submit your application. Your Medigap Open Enrollment Period is the best time to register for a Medigap plan, which occurs during the first six months that you have Part B coverage. During this time, you have a guaranteed issue right. This means that insurance companies cannot ask you questions about your health history, and you are guaranteed acceptance into any Medigap plan.
It’s more difficult to enroll in a Medigap plan outside of this time and a few other guaranteed issue periods. This is because outside of guaranteed issue periods, insurance companies can ask you questions about your health history and may choose to charge you more or deny your application. Learn more about Medigap Enrollment.
How to choose the right Plan A
If you want more information about your Medigap Plan A options, schedule a free consultation or call us at (855) 900-2427 today!