Laying a Solid Foundation | Lesson 3

Medicare Supplement Coverage Options

As we discussed in the last lesson, most states use 10 standardized options for their Medicare Supplements.

And because Medicare loves alphabet soup, I want to mention here, Med Supp Plans include A, B, C, D, F, G, K, L, M, and N.

To dig in a bit more to what these plans cover, we’ll use this helpful chart for reference.

Let’s review plans A through N to get a better overview of what each plan covers.

Plan A offers the most basic coverage and covers the Part A coinsurance and hospital cost for an additional 365 days after a beneficiary’s lifetime reserve days are used up.

Plan A also covers Part B coinsurance or copayment, the first three pints of blood, and Part A hospice coinsurance or copayment.

Plan B covers all the same items as Plan A, and also covers the Medicare Part A Deductible.

In addition to everything covered in Plan B, Plan D also covers the coinsurance for skilled nursing facilities and 80 percent of the costs for medically necessary emergency care outside of the United States.

Next up is plan G.

Plan G covers the Part B excess charge on top of all of the items covered in Plan D.

If you recall from our Original Medicare module, excess charges are an additional charge that a provider can bill a beneficiary if that provider does not accept Medicare Assignment.

Continuing on, coverage looks a little bit different for plans K and L.

Let’s look at plan K first.

Plan K covers the Part A coinsurance as well as those hospital costs for the extra 365 days, just like the other plans we’ve discussed.

However, Plan K uses a cost-sharing method that is a little bit different than the other plans.

For the Part B coinsurance, first 3 pints of blood, Part A hospice coinsurance, skilled nursing coinsurance, and the part A deductible, Plan K will cover 50 percent of that cost and the beneficiary will cover the other 50 percent.

Once the beneficiary hits the out-of-pocket limit, their plan will then cover 100 percent of the costs for those services.

Plan L is similar to Plan K.

The main difference being that Plan L will cover 75 percent of those services mentioned, and the beneficiary will cover the other 25 percent.

Just like Plan K, when a beneficiary reaches their out-of-pocket limit, Plan L will cover 100 percent of those covered services.

Plan M bears more similarity to the other plans we’ve discussed.

Plan M essentially covers the same items as plan D, but only covers 50 percent of the Part A deductible.

Plan N is also similar to Plan D.

However, it differs in the coverage of the part B coinsurance.

Plan N will cover 100 percent of the Part B coinsurance except for a copayment of up to $20 for some office visits and up to $50 for emergency room visits that don’t result in inpatient admission.

So why did we skip over Plans C and F?

We wanted to cover Plans C and F last as these plans are only available to beneficiaries who were first eligible for Medicare before January 1, 2020.

Plan C includes all the same items that are covered in Plan D, and also covers the Part B Deductible.

Similarly, plan F covers all the items included in plan C, while also covering part B excess charges.

I know that is a lot to digest, so let’s break these coverage options to three categories: most coverage, middle-of-the-road coverage, and lower premiums.

Plan C, D, F, and G offer the most coverage, but are also the most expensive options.

Plan M and N offer a little less coverage but usually have lower premiums.

Meanwhile, Plans A, B, K, and L offer more limited coverage generally for the lowest premiums.

Speaking of premiums, our next lesson focuses on the various factors that affect Medicare Supplement premiums.

We’ll see you there!

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