Are All Medigap Plans the Same?
The cost of a Medicare Supplement Insurance plan can vary from one carrier or location to the next.
However, the standardized benefits that each type of Medigap plan covers stays the same, no matter where you live or who your plan carrier may be (except for in Massachusetts, Minnesota and Wisconsin, where Medigap plans have different standards).
That means the benefits of Ohio Medigap Plan A will be exactly the same as Texas Medigap Plan A.
The 9 standardized benefits that may be offered by a Medicare Supplement Insurance plan include the following:
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Medicare Part A coinsurance and hospital costs
Medicare Part A helps cover your hospital costs if you are admitted to a hospital for inpatient treatment (after you reach your Medicare Part A deductible, which is $1,632 per benefit period in 2024).
For the first 60 days of your hospital stay, you aren't required to pay any Part A coinsurance.
But beginning on day 61 of your stay, you're required to pay Medicare Part A coinsurance, which is $408 per day through day 90.
After your 90th day in the hospital, you must pay $816 per day for up to 60 more days. Beyond that, you are responsible for all hospital costs.
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Medicare Part A deductible
Before your Part A coverage kicks in, you are required to pay the Part A deductible. As mentioned above, the Medicare Part A deductible is $1,632 per benefit period in 2024.
The Medicare Part A deductible isn't an annual deductible. This means that you could potentially have to meet the Part A deductible more than once in a given year.
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Medicare Part B deductible
Before Medicare Part B covers any of your costs for things like doctor's appointments or medical devices, you must meet your Part B deductible.
In 2024, the Part B deductible is $240 per year.
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Medicare Part B coinsurance or copayment
After you meet your Part B deductible, you are typically required to pay a coinsurance or copay of 20 percent of the Medicare-approved amount for your covered services.
There is no limit to how much you may be required to pay for this 20 percent copayment or coinsurance in a given year, if you do not have a Medigap plan that provides coverage for this cost.
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Medicare Part A hospice care coinsurance or copayments
If you receive hospice care that is covered by Medicare, you are required to pay a Part A copayment for prescription drugs you use during hospice. You may also be charged 5 percent coinsurance for inpatient respite care costs.
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Coinsurance for skilled nursing facility
There is no coinsurance requirement for the first 20 days of inpatient skilled nursing facility care.
However, a $204 per day coinsurance requirement begins on day 21 of your stay, and you are then responsible for all costs after day 101 of inpatient skilled nursing facility care (in 2024).
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Medicare Part B excess charges
Excess charges can be accrued when you receive Medicare-covered services or items from a provider who does not accept Medicare assignment. This means that they don't accept Medicare reimbursement as payment in full for their services.
In such a case, the provider reserves the right to charge you up to 15 percent more than the Medicare-approved amount.
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First three pints of blood
Original Medicare does not provide coverage for the first three pints of blood that are used in a blood transfusion.
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Foreign travel emergency care
Medicare does not typically provide coverage for emergency care received outside of the U.S. or U.S. territories.
What Happened to Plan C and Plan F in 2020?
Medigap Plan F and Plan C are not available to anyone who became eligible for Medicare on or after January 1, 2020.
If you already had Plan C or Plan F before 2020, you will be able to keep your plan.
If you became eligible for Medicare before 2020, you may still be able to buy either Plan C or Plan F after January 1, 2020, if either is available where you live.
What Are High Deductible Plans F and G?
Plan F and Plan G both offer high deductible options, which carry a deductible of $2,800 in 2024.
You must meet this $2,800 plan deductible before your plan coverage kicks in for the rest of the plan year. One tradeoff for the high deductible is a lower monthly premium.
The average premium for a standard Plan F in 2023 was $202 per month, while the average premium for high-deductible Plan F was $83 per month.1
Medigap Plan K and Plan L Have Annual Out-of-Pocket Spending Limits
Plan K and Plan L each have an annual out-of-pocket spending limit.
Once you reach this limit within a calendar year, the plan will pay 100 percent of the costs for your covered Medicare services for the remainder of the year.
The Plan K out-of-pocket maximum is $7,060 in 2024. The 2024 Plan L out-of-pocket spending limit is $3,530.
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