How Do Medicare Supplement Insurance Plans Work with Other Medicare Insurance?
Medicare Supplement insurance plans are designed to work with Original Medicare and help pay some of the out-of-pocket costs that Original Medicare (Part A and Part B) doesn’t pay, such as coinsurance, copayments, and deductibles.
How do Medicare Supplement insurance plans work with Medicare Advantage plans and other plans?
Medicare Supplement insurance plans only pay for gaps in coverage in Original Medicare, and not Medicare Advantage plans (like HMOs or PPOs), stand-alone Medicare Prescription Drug Plans, employer/union group health coverage, Medicaid, or TRICARE (military retiree benefits). In fact, it’s illegal for an insurance company to sell you a Medicare Supplement insurance plan if you already have a Medicare Advantage plan or Medicaid (a government program, separate from Medicare, that helps pay health-care costs for those who qualify, generally through low income) unless that coverage is ending.
You can only buy a Medicare Supplement insurance plan when you’re in a Medicare Advantage plan if your coverage under the Medicare Advantage plan will end before the effective date of the Medicare Supplement insurance plan.
How do Medicare Supplement insurance plans work with Medicare Part A and Part B?
If you have Medicare Part A and Part B, there are up to ten standardized Medicare Supplement insurance plans available for you in most states. (Medicare Supplement insurance plans are different in Massachusetts, Minnesota, and Wisconsin.) The plans are labeled A, B, C, D, F, G, K, L, M, and N and may cover between four and nine of the following nine benefits:
- Medicare Part A coinsurance for hospital costs (up to an additional 365 days after Medicare benefits are used)
- Medicare Part B coinsurance or copayment
- The first three pints of blood for a medical procedure
- Part A hospice care coinsurance or copayment
- Skilled nursing facility care coinsurance
- Part A deductible
- Part B deductible
- Part B excess charges
- Foreign travel emergencies
All 10 Medicare Supplement insurance plans cover Medicare Part A coinsurance and hospital costs at 100%. Beyond this one benefit the plans differ in what extent they cover certain benefits and what benefits they cover. For example, only Medicare Supplement insurance plans C and F cover the Part B deductible. All plans cover blood, but Plan K covers it at 50% and Plan L covers it at 75% while the other eight plans cover blood at 100%.
If you’re faced with hospitalization for an extended period, a Medicare Supplement insurance plan could save you money. Hospitalization coinsurance costs for days 61-90 are $335 per day. Days 91 and beyond cost $670 per day until a lifetime reserve is met and you must pay all costs. These dollar amounts are for 2018, and all standardized Medicare Supplement insurance plans generally cover these costs for up to a year after Medicare benefits are exhausted.
However, before receiving benefits under Medicare Part A, you need to pay your Part A deductible (in 2018, $1,340 for each benefit period). Some Medicare Supplement insurance plans cover the Part A deducible.
How do Medicare Supplement insurance plans work with other types of insurance?
Generally Medicare Supplement insurance plans don’t cover routine vision or dental care. They also generally don’t cover hearing aids, eyeglasses, private-duty nursing, or long-term care such as nursing home care. For these categories of care you may be able to buy additional insurance from a private insurance company, or be responsible for the full cost.
How will your coverage costs be divided among the insurance plans?
When you have Medicare and other health insurance, such as a Medicare Supplement insurance plan, each type of coverage is called a “payer.” The primary payer will pay what it owes on your health-care bills first and then send the balance to the secondary payer. Coordination of benefit rules decide who pays first. The secondary payer might not pay all of the uncovered costs and some could be your responsibility. For example, if you have a foreign travel emergency, the five Medicare Supplement insurance plans that cover this only cover it up to 80% up to plan limits. You will then be responsible for paying 20% of the covered costs of your care while traveling, as well as any costs your Medicare Supplement insurance plans doesn’t cover.
Generally, people who use health-care services frequently might save money by purchasing a Medicare Supplement insurance plan. However, if you infrequently need medical benefits, you could pay more for the Medicare Supplement insurance plan premium than you save.
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