What Is Medigap Plan A?
Key Takeaways
- Medigap Plan A offers some of the lowest monthly premiums among Medigap plans, but also has fewer benefits than other options.
- Medigap Plan A suits those who want to save on premiums and expect limited healthcare usage.
- Medigap Plan A helps with costs that Original Medicare doesn’t cover, such as 100% of Part A and Part B coinsurance, hospice care, and the first three pints of blood needed for transfusions.
- Every insurance company selling Medigap plans is required to offer Plan A, ensuring it is accessible regardless of your location or provider.
Medigap Plan A is one of 10 Medigap plans that private insurance companies offer to people with Original Medicare. It provides basic coverage and often has some of the lowest monthly payments. But, because it doesn’t cover as much as other plans, it might not work for everyone. This article looks at the benefits and drawbacks of Medigap Plan A so you can choose the best Medicare Supplement Insurance plan for your needs.
Medigap At a Glance
Medigap, also called Medicare Supplement Insurance, helps people with Original Medicare pay for costs like coinsurance that Medicare doesn’t cover. Medigap plans do not give you extra health coverage. Instead, they help pay for the part of the bill that’s left after Medicare has paid.
For example, Medicare Part B covers 80% of the cost for things like walkers and crutches. You would have to pay the remaining 20% on your own unless you have a Medigap plan to cover it.
In 2022, about 42% of consumers with Original Medicare also had a Medigap plan to help with their out-of-pocket costs. There are 10 Medigap plans, each labeled with a letter. Not all plans are available in every state, but every company that sells Medigap has to offer Plan A.
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Understanding Medigap Plan A
Medigap Plan A is the most widely available Medigap option offering the most basic level of benefits. Learn more to see if this option could suit your needs.
Key Features of Medigap Plan A
- Widely available. All insurance companies that sell Medigap must offer Medigap Plan A.
- Basic benefits. This Medigap plan has the fewest benefits available.
- Generally lower premiums. Medigap Plan A’s limited coverage means it has one of the lowest premiums of all Medigap options.
What Does Medigap Plan A Cover?
Medigap plans don’t give you extra coverage. Instead, they help pay for costs that Original Medicare doesn’t cover. For example, all Medigap plans, including Plan A, pay for your Part A coinsurance and hospital costs for up to 365 days after Medicare stops paying.
Here’s what Medigap Plan A also covers:
- 100% of your Part B coinsurance
- 100% of hospice care coinsurance under Part A
- 100% of the cost for the first three pints of blood if you need a transfusion
Costs For Medigap Plan A
When picking a Medigap plan, it’s important to think about your current and future health needs. You also need to think about the costs, such as:
- Premiums: This is the amount you pay each month for Medigap Plan A. You will also need to keep paying your Original Medicare premiums.
- Deductibles: Before Medigap Plan A starts helping with your costs, you have to pay your Original Medicare deductibles.
- Copays: Sometimes you have to pay a set fee when you get a service under Medicare. However, Medigap Plan A covers all your Original Medicare copays.
- Coinsurance: Some services require you to pay a percentage of the cost, called coinsurance. For example, without Medigap, you would pay 20% of the cost for services under Part B. With Medigap Plan A, this 20% is fully covered.
See It In Action
Let’s say you break your arm and need surgery to repair the fractured bone. The average cost for this surgery is $4,343 at an ambulatory surgical center. If you’ve already paid your Part B deductible, Medicare will cover 80% of this, leaving you with $868 to pay out of pocket. Medigap Plan A would cover this $868 for you.
Your exact costs can change depending on where you live and what services you need.
How Medigap Plan A Compares With Other Basic Medigap Plans
| Benefits | Plan A | Plan B | Plan K |
|---|---|---|---|
| Part A coinsurance and hospital costs for up to 365 additional days after Medicare benefits are disbursed | Yes | Yes | Yes |
| Part B coinsurance or copayment | Yes | Yes | 50% |
| Part A hospice care coinsurance or copayment | Yes | Yes | 50% |
| Part A deductible | Not covered | Yes | 50% |
| Part B deductible | Not covered | Not covered | Not covered |
| Part B excess charge | Not covered | Not covered | Not covered |
| Out-of-pocket limit | N/A | N/A | $6,620 in 2022 |
| Blood (first three pints) | Yes | Yes | 50% |
| Skilled nursing facility care coinsurance | Not covered | Not covered | 50% |
| Foreign travel exchange up to plan limits | Not covered | Not covered | Not covered |
How to Choose a Medigap Plan
When deciding if Medigap Plan A is right for you, consider your usual health needs. Medigap Plan A has one of the lowest monthly costs, but it also has the fewest benefits. This makes it a good choice for people who want to save money and do not expect to need a lot of medical care, but still want help with hospital and doctor bills.
If you think Medigap Plan A is a good fit, compare options from different insurance companies. Since all Medigap plans with the same letter offer the same benefits, the only things that differ between companies is the price and insurer specifics, like its general reputation and customer service level.
How to Enroll in a Medigap Plan
You can sign up for Medigap any time if you have Original Medicare. However, if you sign up during your Initial Enrollment Period, insurance companies cannot charge you more based on your health, and you’ll have access to all the plan options. If you’re 65 or older, this enrollment period starts when you first join Medicare Part B and lasts for six months. If you wait until after this time, you might have to pay more for your plan, and you could have fewer choices.
Here’s how to sign up for a Medigap plan:
- Find insurance companies in your area. A licensed insurance agent or broker can help you look at different Medigap options.
- Compare prices. The benefits are the same for all Medigap Plan A options, so check prices from different companies to find the best deal.
- Apply. Be honest on your application. If the insurance company finds out you didn’t tell the truth about your health or habits, they might cancel your policy.
- Start your policy. Medigap plans usually begin the first day of the month after you apply and pay your first monthly bill.
If you change your mind, you may be able to switch your Medigap plan later on. However, you might face a waiting period or higher costs.
Putting It All Together
Medigap Plan A helps lower your healthcare costs by covering your coinsurance and copays from Original Medicare. It also covers the first three pints of blood if you need a transfusion. Medigap Plan A has one of the lowest monthly costs, but it also has fewer benefits. This can be helpful for people who do not need a lot of medical care and want to save on hospital and doctor bills. Working with a licensed insurance agent or broker can help you find the best plan for your needs.
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Sources
A Snapshot of Sources of Coverage Among Medicare Beneficiaries. KFF.
Procedure Price Lookup. Medicare.gov