Before we get started on what Medicare Supplement Plan B covers, we’ll clear up a common misunderstanding with Medicare. People often confuse Medicare Part B and Medicare Supplement Plan B. Medicare Part B is one of the parts of Original Medicare, which is what you get when you first enroll in for Medicare coverage.
Medicare Supplement Plan B (also known as Medigap Plan B) is one of ten plan types for Medigap insurance, which helps fill the gaps in coverage left by Original Medicare. Compared to other Medicare Supplement plans, Plan B provides a little less coverage. Read on to learn more about what Medicare Supplement Plan B covers and what costs you’ll owe out of pocket.
Medicare Supplement, also known as Medigap, provides additional insurance plans that complement Original Medicare. Original Medicare pays for 80% of the costs of covered services. To cover the remaining “gaps” left from Original Medicare, Medigap plans pay for some of the remaining 20% of costs.
Every Medigap plan of the same type (e.g. every “Plan B”) has the same coverage, even if the pricing or the insurance carrier is different.
Without Medicare Supplement plans, you would be responsible for covering 20% of services covered by Original Medicare. Depending on the healthcare services you need, this could be a lot of money, especially if you need surgery or regular treatments. Medigap plans pay for out-of-pocket costs like deductibles, copayments, and coinsurance.
In addition to saving you a lot of money on out-of-pocket costs, Medigap plans have three key advantages, listed below.
Every Medigap plan of the same type offers the same coverage, even if the prices vary. For example, all Plan Bs provide identical benefits, regardless of the premiums you pay.
With Original Medicare and Medicare Supplement, you can visit any doctor and facility who accepts Original Medicare, which is 90% of providers all over the country. This is especially helpful if you travel frequently or split time between two states.
A downside of Medicare Advantage is the common need for prior authorization for covered services. If denied prior authorization, you would be responsible for 100% of the cost of the healthcare service. Original Medicare and Medigap don't require prior authorization for any covered services.
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.
There are ten types of Medicare Supplement plans, and each plan covers a different set of out-of-pocket costs. This chart maps out the differences in coverage between each of them.
Medicare Supplement Plan B isn’t the most popular option because it doesn’t provide the same value as Plans G and N. Currently, Plan G is the most popular Medigap plan among new Medicare beneficiaries because it provides the most comprehensive coverage at a great value.
Medigap Plan B covers:
Compared to other Medigap plans, Plan B provides a little less coverage. It doesn’t cover many out-of-pocket costs that other plans do.
Medigap Plan B does not cover:
In general, Medigap only provides coverage for out-of-pocket costs leftover by Original Medicare. It will not cover additional healthcare services like:
Because Medicare Supplement Plan B covers fewer out-of-pocket costs, you may pay more than you would with other Medigap policies. With Plan B, your out-of-pocket costs will include:
How much you pay for your premiums will depend on personal factors, where you live, and your insurance carrier.
Medicare determines your Plan B premium based on the following factors:
There are three pricing or “rating” structures that determine how your Medicare Supplement premiums could change over time depending on your plan.
Community-rated (aka no-age-rated): The premium you pay is the same as everyone else with the same policy, regardless of age. This means 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. Your premium can increase due to inflation and other factors, but not 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.
There is no specific Plan B deductible, but you’ll have to pay your Part B deductible since the plan doesn’t cover it. In 2024, Part B deductible is $240.
Medigap Plan B doesn’t have an out-of-pocket limit because your out-of-pocket costs are limited by your coverage.You will, however, need to pay for the following:
If you need assistance enrolling, our Medicare Advisors are here to help you compare plans and submit your application. Your Medigap Open Enrollment Period is the best time to purchase a Medigap plan.This period lasts for six months after your Part B goes into effect, and during it, 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 because insurance companies can ask you questions about your health history. Insurance companies can then deny your application or charge you more based on this information. Learn more about the specifics of Medigap enrollment in this detailed blog.
Because all Plan Bs have identical coverage, you can focus on choosing the right plan based on premiums and insurance carriers. Our Medicare Advisors can help you understand Plan B and your other Medicare coverage options so you can make the best decision for you.