Medigap is a type of health insurance designed to supplement Original Medicare. Medigap plans can help pay some out-of-pocket costs that Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles.
There are 10 different types of Medigap plans standardized by the Centers for Medicare and Medicaid Services (CMS), and each plan offers an extra level of coverage. Plan A is the most basic Medigap plan, and it’s also one of the most popular supplemental insurance plans available in the United States.
Read this article to learn everything you need to know about Medigap Plan A. We’ll explain what this plan covers, who’s eligible for it, how much it costs, and more. Whether you’re already on Medicare or about to turn 65, we’ll give you the information you need to make an educated decision about your health insurance.
What Is Medigap Plan A?
As we mentioned, Medigap Plan A is a supplemental insurance plan that helps cover the gaps in Original Medicare coverage. Like other Medigap plans, Plan A is offered by private insurance companies. Medigap plans were created in 1965, but the federal government standardized the benefits of Plan A in 1992.
Because they’re standardized, all Plan A policies must offer the same basic benefits, regardless of which insurance company provides it. However, there may be some variation in premiums and other features. For many people, Medigap Plan A is an important way to maintain their health and financial security.
What Does Medigap Plan A Cover?
Medigap Plan A is a pretty basic supplemental insurance plan. It covers your share of Part A coinsurance, which is the amount you have to pay for hospital stays after you’ve met your deductible. Medigap Plan A also covers the first 3 pints of blood you need in a year and Part B coinsurance. Part B coinsurance is what you have to pay for outpatient medical care, like doctor’s visits.
In addition, Medigap Plan A covers your share of the hospice care coinsurance or copayment. Hospice care is end-of-life care that helps to make you comfortable and manage your pain. Lastly, Plan A covers Part A’s deductible. The Part A deductible is the amount you have to pay for hospital stays before your Medicare coverage kicks in.
What Does Medigap Plan A Not Cover?
Now that we’ve gone over what Medigap Plan A covers, let’s talk about what it doesn’t. First of all, it doesn’t cover long-term care, dental care, eyeglasses, or hearing aids. It also doesn’t cover private-duty nursing, prescription drugs, or Part B excess charges.
Part B excess charges are the amounts that some doctors charge over and above the standard Medicare-approved quantity. Lastly, Medigap Plan A doesn’t cover preventive care like vaccinations or wellness visits. We’ll give you tips to decide whether or not you need coverage for these services later in the article.
Medigap Plan A Eligibility
To be eligible for Medigap Plan A, you must first be enrolled in Medicare Part A and B. You can enroll in Original Medicare:
- When you’re 65 years old and qualified for Social Security.
- After 24 months of receiving Social Security Disability Insurance (SSDI).
- People with specific disabilities, such as amyotrophic lateral sclerosis (ALS) or permanent renal failure, are automatically eligible.
There are a few exceptions, however. If you have Medicare Advantage, you’re also not eligible for Medigap Plan A. Medicare Advantage plans are another alternative to Original Medicare. You can only have one type of Medicare coverage at a time. If you’re not sure whether or not you have Medicare Advantage, you can check with your insurance company or contact the Social Security Administration.
When Can I Sign Up For Medigap Plan A?
Medigap Open Enrollment Period
You can sign up for Medigap Plan A during your Medigap Open Enrollment Period. Your Medigap Open Enrollment Period starts the first day of the month that you’re 65 years old or older and enrolled in Medicare Part B. After that, you have six months to enroll in a Medigap plan. During this time, you can’t be denied coverage or be charged more because of pre-existing health conditions.
Special Enrollment Period
After your Medigap Open Enrollment Period ends, you may still be able to enroll in Medigap Plan A during a Special Enrollment Period. This is a limited time when you can sign up for Medigap outside of the Regular Open Enrollment Period. You may qualify for it if you move, lose other health coverage, or turn down a Medigap policy during your Open Enrollment Period.
You may be subject to medical underwriting when signing up for Medigap Plan A outside of the Open Enrollment Period. Medical underwriting is the process that insurance companies use to decide whether or not to accept your application and how much to charge you for coverage. People with pre-existing health conditions may be denied coverage or levied more for their Medigap Plan A policy.
How To Enroll In Medigap Plan A?
The process for enrolling in Medigap Plan A is pretty straightforward. You can contact a Medigap plan provider directly and register over the phone or online. You can also work with a qualified insurance advisor who can help you compare plans and find the best option for your needs.
When you’re ready to enroll, you’ll need to provide personal information, like your name, address, date of birth, and Medicare number. You’ll also need to determine how you want to pay your premiums. You can start using your Medigap Plan A coverage as soon as your plan is effective. In most cases, your coverage will start the first day of the month after you enroll.
Medigap Plan A Costs
The cost of Medigap Plan A varies depending on the insurance company, where you live, your age, and if you smoke. The younger you are when you enroll, the lower your premiums will be. If you’re enrolled in Original Medicare, the Standard Medicare Part B monthly premium for Connecticut in 2022 is $170.10 but can be higher for certain individuals with higher income.
You’ll also have to pay a Medigap Plan A premium on top of your Part B premium. The monthly premium for Medigap Plan A in Connecticut in 2022 can range from $131 to $1,381. Some insurance companies offer discounts for couples and people who pay their premiums annually. You may also be able to get a discount if you’re a non-smoker.
Medigap policies can be rated in 3 ways:
- No age-rated (or community-rated): Your premium isn’t determined by your age and may only rise due to inflation or other circumstances. Everyone, despite age, has to pay the same premium.
- Entry age-rated (or issue-age rated): Your premium is determined by your age at the time of purchase and won’t increase as you become older. Inflation or other factors may cause your premium to rise.
- Attained-age-rated: Your premium is determined by your age, and it may rise as you become older as a result of inflation and other circumstances.
How To Pay For Medigap Plan A?
You pay your Medigap Plan A premium directly to the insurance company. In most cases, you can choose to have your premiums deducted directly from your Social Security benefits. You can also typically pay by check or money order.
It’s crucial to keep up with your Medigap Plan A payments. If you miss a payment, your coverage could be suspended. When your coverage is suspended, you may have to pay a late enrollment penalty if you decide to enroll in Medigap Plan A later.
The Pros And Cons Of Medigap Plan A Compared To Other Health Insurance Plans
One of the most significant advantages of Medigap Plan A is that it has low premiums. Medigap Plan A could be a good option if you’re on a tight budget. Another advantage of Medigap Plan A is that it doesn’t have an annual deductible like other health insurance plans.
In contrast, one of the disadvantages of Medigap Plan A is that it doesn’t cover as much as other Medigap policies. Do you feel like you need more comprehensive coverage? Then you may want to consider a different Medigap plan. For instance, Plan A doesn’t cover prescription drugs. If you need help with the cost of your prescriptions, you’ll need to enroll in a separate prescription drug plan.
Is Medigap Plan A The Best Option For You And Your Family?
The best way to answer this question is to sit down and assess your needs. Make a list of the most important things to you in a health insurance plan. Then, compare that list to what Medigap Plan A covers. If Medigap Plan A meets most of your needs, it could be a good option. Every person’s situation is different. There’s no one-size-fits-all answer when choosing a health insurance plan.
Nesso Senior Benefits – Find The Right Health Insurance Plan
At Nesso Senior Benefits, we can help you compare plans and find the best option for your needs. We’re licensed insurance advisors dedicated to helping our clients find the perfect plan for them. We ensure that our clients understand all the information available regarding their Medicare insurance to make educated decisions about their health.
As part of the Nesso Group, we guide individuals and businesses across multi-dimensional areas of expertise. Our services include tax, accounting, wealth, insurance, and more. We aim to provide our clients with the most comprehensive and holistic advice possible to alleviate stress and elevate success.
