The Medicare Supplement (Medigap) Benefits Comparison Chart, Explained
By the end of this article, you’ll know exactly which Medicare Supplement plans provide the coverage you need, and which don’t. I’ll walk you through the benefits chart row by row, briefly explain each benefit category, and help you decide which benefits are essential to you. Once you’ve made a list of essential benefits, it’s easy to work backwards and find out which plans cover them.
The official Supplement plan comparison chart from Medicare (below) is a lot to take in all at once. Each of the Medicare supplement plans has its own column, with the plan’s letter name at the top. The various benefits offered by the plans each have their own row. Follow a column down, and you’ll see ‘yes’, ‘no’, or a percentage indicating how that plan (column) will cover each benefit (row).
If you’d like to skip to the end and see my list of recommended benefits, or just get a quote, click the one of the buttons below. If you would like to make your own decision about which benefits are important to you, scroll down past the chart to the next section.
Let’s go through that row by row.
Row One: Part A Coinsurance and Hospital Costs
Description: this is an important benefit that is provided by all of the Medicare Supplement plans. After a $1,364 deductible, Medicare Part A pays all costs for inpatient hospital stays up until day 60. If you are unfortunate enough to be in the hospital longer than that, Medicare starts charging you a copay ($341 -$682 dollars per day), and eventually will stop paying your bills altogether. This benefit protects you from that by fully covering an additional 365 days after day 60.
Frequency: it’s hard to find good data on how many people end up staying in the hospital longer than 60 days, but given that the average length of an inpatient hospital stay in the US is 5.5 days, its fair to say that this is a very rare occurrence.
Cost: an endless inpatient hospital stay? The sky’s the limit for cost.
My view: essential coverage. Put this on your list of essential benefits.
Row two: Part B coinsurance or co-payment
Description: This benefit category encompasses the majority or the medical care you will ever receive. The Part B coinsurance applies to all outpatient services, which means it covers everything from lab tests to a doctor’s office visits to complex outpatient surgeries.
Frequency: high.
Cost: the Part B Coinsurance rate is 20%. That means you pay 20% of the Medicare approved amount for any services you receive. There is no maximum amount. You’ll pay 20% no matter how large the bill.
My view: essential coverage! You know how medical bills work. You do not want to be on the hook for 20%.
Row three: blood (first three pints)
Description: this covers you if you receive a blood transfusion.
Frequency: according to a Johns Hopkins study, the percentage of hospital inpatients who receive a blood transfusion has been decreasing, and is down to less that 6% as of 2014.
Cost: Blood generally costs about $200 a pint, and Medicare will fully cover pint number four and beyond. Of course blood prices may vary, but this one is unlikely to bankrupt you.
My view: not essential. This is a rare, relatively low cost service.
Row four: Part A hospice care coinsurance or CO-PAYMENT
Description: Medicare defines hospice care as “a program of care and support for people who are terminally ill (with a life expectancy of 6 months or less, if the illness runs its normal course) and their families.” Hospice care is palliative care, meaning that it is meant to provide comfort, not extend a patient’s life. Medicare only covers in-home hospice care, and will not pay for an inpatient hospice facility.
Frequency: Just under half of all people use hospice care services at the end of their life.
Cost: Medicare will cover most of the costs of in-home hospice care even if you don’t have a supplement plan. The co-payments and coinsurance amounts this benefit would cover are small.
My view: not essential. This is a common but relatively low cost service.
Row five: Skilled nursing facility care coinsurance
Description: skilled nursing facility (SNF) care is generally defined as short-term nursing care your receive at a facility to help you recover from a specific injury or illness. Unfortunately, the Medicare definition of what counts as skilled nursing facility care is very long, and very limited. You can read the whole thing by clicking the link below:
https://www.medicare.gov/coverage/skilled-nursing-facility-snf-care
If you’re lucky enough to have your SNF stay check all the boxes and qualify for Medicare coverage, then Medicare will pay for the first 20 days fully, charge you $170/day for days 21-100, and stop paying after day 100. A supplement plan can cover that $170 co-payment for you from days 21-100. There is no coverage beyond day 100.
Frequency: Current estimates are that 35% of Americans who turned age 65 in 2005 will receive some nursing home care in their lifetime.
Cost: This benefit could save you $13,600 over the course of a 100+ day stay, but you don’t have to imagine a stay that long to start seeing the value here. Given that average stay for a Medicare beneficiary who checks into a SNF is about 25 days, odds are that if you end up in a SNF this benefit will save you thousands.
My view: essential. This covers a relatively common, high cost service.
Row six: Part A deductible
Description: This benefit covers the Part A deductible, which you’ll pay if you get checked into the hospital as an inpatient.
Frequency: It’s hard to give a frequency on this one. An average would be meaningless given that most people check into a hospital just a few times during their lifetimes and a minority of folks with chronic conditions might be checking in multiple times a year. Let’s just say it’s something that’s common enough that most people feel more comfortable if they are insured against it.
Cost: the Part A deductible is $1,364 in 2019. This deductible does not work like most insurance plan deductibles, which are only paid once a year. Once you pay off the Part A deductible, you won’t have to pay it again until you’ve been out of the hospital for 60 days in a row. If you come back after 60 days you’ll pay it again, so a combination of poor health and bad timing could have you paying this a few times in one year.
My view: essential. This may be infrequent, but an inpatient stay in the hospital could happen to any of us. It’s a stressful event that usually marks the beginning of a longer medical rehabilitation process. Spare your future self the stress of an extra $1350 on the bill.
Row seven: Part B deductible
Description: In addition to a 20% coinsurance, Part B (which covers outpatient services) has a $185 deductible.
Frequency: the only way to avoid the Part B deductible is to avoid the medical system entirely. Most people will have to pay this every year.
Cost: the cost is $185.
My view: not essential, not recommended! Here’s a (easy) math problem for you: the only difference between Plan F and Plan G is that Plan F covers the Part B deductible and Plan G does not. These plans are exactly the same otherwise. If the yearly cost of Plan F is $300 more that Plan G, which is a better value? In this hypothetical, and in almost every area where I’ve quoted Medicare Supplement plans, the Plan G comes out ahead.
Row eight: Part B Part B Excess Charge
Description: The Part B excess charge is a surcharge of up to 15% on the Medicare-approved cost for a procedure, paid by the patient in addition to their regular Medicare copayment or coinsurance. Medicare rules are such that a provider can charge up to 15% over the Medicare-approved amount and still receive payment from Medicare. The patient, not Medicare, will pay the entire cost of the extra 15%. The vast majority of providers accept Medicare assignment and will not bill an excess charge for any procedure.
Frequency: Hard to find good data on this but from my experience and by all accounts I’ve read, this is very rare.
Cost: 15% surcharge, which can vary depending on size of the bill.
My view: not essential, but usually worth it. This will come down to how the rates look in your area. If you can save a lot of money by choosing a plan that doesn’t cover this, that might be worth it. Usually there is not much money to be saved, so you might as well get it covered.
Row nine: Foreign Travel Emergency Coverage
Description: Medicare does not pay for care outside of the US, but most Medigap plans do. The foreign travel benefit, which has a $250 deductible and a $50,000 lifetime limit, pays 80% of the costs for foreign travel emergency care during the first 60 days of your trip.
Frequency: Depends
Cost: that depends on where you go, but the good news is that we have the most expensive healthcare system in the world right here in the USA, so no matter where you end up injuring yourself you’ll be getting a smaller bill than you would back home. Wait, is that good news…?
My view: it’s up to you. Some people travel, some don’t.
Row ten:Out of Pocket Limit
Description: this benefit only applies to Plan K and Plan L. The out of pocket limits on these plans ($5,240 for K and $2,620 for L) limit the amount of money you could end up spending out of pocket.
Frequency: rare that you would end up hitting these limits.
Cost: This is a big improvement over Original Medicare coverage, which has no built in out of pocket limit.
My view: if you are looking at Plans K and L because they are the only ones in your price range, make sure you take a look at Medicare Advantage plans in your area. They often offer similar coverage for a lower price. If there are no MA plans in your area then these plans are a good way to add an out of pocket limit to your Medicare coverage.
Plan Recommendations
Now that we’ve decided which benefits are essential and which aren’t, were ready to use that list of benefits to find our plan options. I’ve highlighted my list of essential benefits in green on the chart below.
Now let’s go through and see which plans cover all of the highlighted benefits. My results are in yellow.
Results: your medicare supplement plan options
I have a list of five plans which meet my standards for good coverage: plans C, D, F, G, and N. If you made your own list of essential benefits, you’ll have your own list of acceptable plans.
To make a final decision about which one is best for you, you’ll need to look at prices. As an independent broker, I can take your plan list and get quotes for each from the best companies in your area. To get a quote from me, just fill out the form below. I’m here to help you through every step of the enrollment process, at no cost.