What is Medigap Plan A
Upon enrolling in Original Medicare, you may find yourself worrying about potential gaps in coverage that could cost you money down the road. Enter Medigap—this supplemental insurance helps provide peace of mind above and beyond what Medicare offers. Medigap plans work in conjunction with your Medicare Parts A and B coverage to pay for additional expenses that don’t fall under Medicare’s purview.
Read on to learn more about Medigap Plan A, including what it does and doesn’t cover, and how it may help you save on out-of-pocket expenses.
What is Medigap Plan A?
Also known as Medigap, Medicare Supplement plans are designed to help pay some of the health care costs that Original Medicare doesn’t cover. There are 10 Medigap plans, including Medigap Plan A.
Medigap Plan A—not to be confused with Medicare Part A—is the most basic plan available, and thus typically the most affordable.
What does Medigap Plan A cover?
As a basic-level plan, Medigap Plan A covers the following costs and benefits:
- Part A coinsurance hospital costs (up to an additional 365 days after Medicare benefits are exhausted)
- Part A hospice care copayment or coinsurance
- Medicare Part B copayments and coinsurance
- First three pints of blood used in an approved medical procedure (annually)
Is Medigap Plan A right for me?
Medigap Plan A is an ideal choice for anyone who wants more coverage than Medicare Parts A and B offer but doesn’t expect to use health care services frequently. That’s because, as the most basic plan on the market, Medigap Plan A doesn’t cover several scenarios that may be important to certain individuals.
Laura is 65, newly eligible for Medicare, and retiring at the end of the year. She's healthy and doesn't expect to spend much time in the hospital, but she's worried about her medical expenses now that she lives on a fixed income. She plans to receive care only from doctors who accept Medicare assignment, but wants to ensure she doesn't see any surprise medical bills in the mail. After comparing plans, Laura thinks Medigap Plan A will best fit both her needs and budget.
To determine if this supplemental insurance plan is right for you, or if you should choose a more comprehensive Medigap plan, take a look at the grid below. It may also be helpful to consult this supplement plan comparison guide.
Covered by Medigap Plan A
Medicare Part A (hospital) deductible
In 2020, your hospital deductible is $1,408 per incident,1 (not annually.) Multiple hospitalizations in a year can become expensive
No(for this benefit, consider plans B, C, D, F, G, K, L, M or N)
Part A hospice care coinsurance or copayment
You may need to pay 5% of the Medicare-approved amount for inpatient respite care, and a copayment of no more than $5 for each prescription drug for pain relief and symptom control while you're at home
Part A hospital costs and coinsurance
Medicare Part A usually pays your hospital costs for stays up to 60 days (minus your deductible). After this time period, you’ll be responsible for a portion of the bill
Medicare Part B coinsurance or copayment
Medicare pays for only 80% of these costs.
First three pints of blood
If your hospital or medical provider has to buy blood for a transfusion, you’ll need to cover the costs of the first three units each calendar year
Part B excess charges
Doctors are legally allowed to charge up to 15% more than what Medicare agrees to pay for Part B services—and you’ll be billed that difference.
No(for this benefit, consider Plans F or G)
Part B deductible
You are responsible for meeting your annual deductible before Medicare pays any claims; in 2020, this deductible is $198.2
No(for this benefit, consider Plans C or F)
Skilled nursing facility (SNF) care coinsurance
Medicare Part A covers skilled nursing care provided in an SNF in certain conditions and for a limited time period; during a stay of 21–100 days, you’ll be responsible for a portion of that bill; starting day 101, you’ll be responsible for 100% of the costs.
No(for this benefit, consider Plans C C, D, F, G, K, L, M or N)
Foreign travel emergency care
Medicare doesn’t cover healthcare outside of the United States, which means a medical emergency while on vacation can leave you with 100% of the costs incurred.
No(for this benefit, consider Plans C, D, F, G, M or N)
Table created using information available at Medicare.gov as of 1/20/2020.
How much does Medigap Plan A cost?
Because each insurance company sets its own monthly premium, you’ll find that pricing varies among carriers. Medigap Plan A offers minimal coverage, which means that its premiums are generally the lowest among the Medigap plan options. Still, it’s a good idea to do your research and compare prices across multiple companies before making a decision.
How to enroll in Medigap Plan A
The ideal time to purchase any Medigap policy is during your Medigap open enrollment period, which is a six-month period that begins the month your Medicare Part B coverage starts. During this time, insurance companies cannot decline coverage, even if you have pre-existing conditions or are in poor health. Once this period has passed, there’s no guarantee you’ll meet the medical underwriting requirements, unless you meet specific criteria to qualify for another Medigap open enrollment period.
The bottom line
Medigap Plan A policies provide additional benefits to help lower your out-of-pocket costs without charging a high premium (compared to other Medicare Supplement plans). If you don’t travel outside of the US often, are in relatively good health with few pre-existing conditions, and aren’t concerned about meeting your Medicare Part A or B deductibles, then this additional coverage may save you money and provide peace of mind.
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