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Medigap Plan A

Medicare Supplement plans, also referred to as Medigap insurance, serve as additional coverage to Medicare Part A and Part B. Without being enrolled in Medicare Part A and Part B, you are not eligible for a Medicare Supplement plan. Medigap Plan A provides coverage for certain out-of-pocket expenses that are not covered by Original Medicare. It is the plan with the fewest benefits among all the Medicare supplements, but it has the advantage of lower premiums. Additionally, Medigap Plan A covers a benefit that typically results in the highest out-of-pocket costs.

In addition to hospital stays, Part A also covers critical access hospitals, certain skilled nursing facilities (excluding long-term care), hospice care, and partial home health care. To access these benefits, it’s crucial to meet the eligibility criteria.

Core Policy Benefits in Medigap Plan A

Out of all the Medicare supplements, Plan A provides the least extensive range of benefits. It only covers the core policy benefits that are included in every Medicare supplement plan. This means that Plan A does not offer additional benefits beyond what is required by Original Medicare. Essentially, the plan provides coverage for essential benefits that are common to all Medicare supplement plans.

Therefore, 100% of coverage includes:

  • Part A coinsurance
  • Hospital stays costs up to 365 days after Medicare benefits reach their limit
  • Part B coinsurance or copayment
  • First three blood prints
  • Part A coinsurance and copayment for hospice care

Coverage Not Included in Plan A

Plan A does not offer coverage for the Part A or B deductible, the coinsurance for skilled nursing care, the Part B excess charges, or any coverage for foreign travel emergencies.

Individuals Who Benefit from Plan A

Medigap Plan A is a suitable option for those who prefer a lower monthly premium and are not too worried about incurring out-of-pocket hospital expenses. However, it may not be the best choice for individuals who frequently travel outside the U.S. or require frequent hospitalization. This is because even though the premiums are lower, the out-of-pocket costs can be significantly higher, which could become a financial burden for such individuals.

Medigap Plan A Premiums

The premiums for Medigap Plan A can vary depending on several factors such as the state of residence, the carrier providing the coverage, and individual details like age, gender, and tobacco use. On average, the monthly cost of Plan A falls between $110 and $180. Typically, states with a higher cost of living tend to have higher Plan A premiums.

Plan A for Individuals Younger than 65

Some Medicare supplement plans may not be available to individuals who are under the age of 65 and eligible for Medicare. In such cases, Plan A may be the only available option, but the premium for it is often two to three times higher than what beneficiaries aged 65 and older pay. This is because those who become eligible for Medicare due to a disability often have higher medical costs. However, individuals who receive Social Security disability benefits are eligible for a second open enrollment period without having to undergo medical underwriting. When they turn 65, the second open enrollment window begins, giving them the opportunity to select a different Medicare supplement plan.

How to Compare

Medigap Plan A Versus Medicare Part A

The terminology used in Medicare can be confusing, as “plans” and “parts” have distinct meanings. “Parts” pertain to the benefits of Original Medicare, whereas “plans” refer to Medicare supplements. Medicare Part A covers hospital expenses, including room and board during hospitalization. Medigap Plan A is a supplementary coverage that you can purchase to cover the gaps in coverage between Medicare Parts A and B. Private insurance companies offer Medicare supplement plans, which are intended to assist with some of the out-of-pocket expenses associated with Original Medicare, including coinsurance, copayments, and deductibles.

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