by Russell Noga | Updated January 7th, 2024
When it comes to planning for the future, there are two factors that should be on the top of your list of priorities: healthcare and finances. Medicare and Medicare Supplement Insurance can help with both.
Medicare is a government-funded health insurance program that is intended for aging individuals (aged 65 and up), as well as individuals who have been diagnosed with qualifying disabilities or illnesses. Given the fact that Medicare provides medical and the high cost of medical care, the program can be an asset for both your health and your finances.
While Medicare does help to cover a lot of the expenses that are related to healthcare, it doesn’t cover everything. You’re responsible for the expenses that Medicare doesn’t cover, and that’s where Medicare Supplement Insurance – or Medigap – can help.
This supplementary insurance is designed to cover the expenses that Medicare doesn’t pay for; copay, coinsurance, and deductibles, for example. If you’re planning on purchasing Medigap, you’re likely wondering about the coverage it provides; more specifically, you might be wondering if it can help to cover the costs that are associated with long-term care.
If you’re ever diagnosed with a chronic condition or develop a disability that requires long-term care in a hospital setting, a hospice, or a skilled nursing facility, will Medigap help to pay for those expenses? To find the answer to this question and other important information related to Medicare Supplement Insurance, keep on reading.
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Medicare Supplement Insurance: An Overview
First, let’s explain what Medicare Supplement Insurance is. This insurance is designed to supplement the coverage that Original Medicare provides. Original Medicare is comprised of two parts: Part A, which covers expenses related to inpatient care, and Part B, which covers expenses related to outpatient care.
Original Medicare doesn’t pay for all of the expenses that are related to inpatient and outpatient care; however, such, as deductibles, copays, and coinsurance. Medicare Supplement Insurance (Medigap) was designed to cover these (and other) expenses that Original Medicare leaves behind.
There are a total of 10 Medicare Supplement Insurance plans: Medigap Plans A, B, C, D, F, G, K, L, M, and N. Plans differ in terms of what benefits they provide, costs, and eligibility.
All plans are sold by private health insurance companies but because they are sold by private insurance companies, all plans that are the same letter must include the same standard benefits. Insurers set their own rates for coverage, and eligibility for certain policies depends on when you became eligible to receive Medicare benefits.
What do Medigap Plans Cover?
As mentioned, the benefits that Medicare Supplement Insurance offers vary from plan to plan; therefore, the specific out-of-pocket expenses that your Medigap policy will cover depend on which plan you purchase. That said, however, all Medicare Supplement plans cover all or a portion of the following expenses that Original Medicare leaves behind:
- Part A coinsurance and hospital expenses
- Part A coinsurance or copayment for hospice care
- Part B coinsurance or copayments
- Blood transfusions for medical procedures (the first three pints)
Additionally, some Medicare Supplement plans also offer the following benefits:
- Part A deductible
- Part B deductible
- Part B excess charges
- Emergency medical care while traveling abroad
It is important to note that as of January 1, 2020, new Medicare enrollees can no longer purchase Medigap plans that cover the Part B deductible, which includes Plan C and Plan F. In other words, if you became eligible for Medicare benefits after January 1, 2020, you cannot purchase Plan C or Plan F; if, however, you had one of these plans before this date, you can hold onto it and if you became eligible for Medicare before this date but have yet to enroll, you can still purchase one of these policies.
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What is Long-Term Care?
Long-term care is defined as coordinated medical care and services over a prolonged period of time. There are various settings in which long-term care can be provided. Examples include:
- Nursing homes or skilled nursing facilities
- Assisted living facilities
- Continuing care retirement communities
- Home health care
Individuals may require long-term care for a variety of reasons; for example, the sudden onset and diagnosis of a severe illness, such as advanced-stage cancer or dementia, or if they are involved in an accident that causes serious and lasting harm.
Does Medigap Cover Long-Term Care?
Original Medicare doesn’t provide coverage for long-term care. It does provide coverage for care and services provided in inpatient settings over short-term periods, such as a hospital or skilled nursing facility care; however, if you require care that exceeds 90 days, you’ll have to cover those expenses out of your own pocket.
Unfortunately, Medicare Supplement Insurance does not provide full coverage for long-term care. While these plans do cover expenses for care and services that are provided in some of the settings outlined above, the coverage is only intended for short-term care and services that are provided on a temporary basis. Some supplement plans can extend the period of coverage for care provided in skilled nursing facilities, and some may help to reduce the costs for hospice care.
How to Get Coverage for Long-Term Care
If you’re concerned that you might require long-term care in the future, the best way to get coverage for long-term care is by purchasing a separate policy that offers this type of coverage. Several private health insurance companies offer policies that are specially designed to help pay for the costs of services and care that are provided over prolonged periods of time.
Like Medigap plans, the benefits that these policies provide, as well as the costs, vary and depend on a variety of factors. For the most part, however, most long-term care plans help to pay for a portion of not all of the expenses that Original Medicare and Medicare Supplement Insurance don’t cover; nursing homes, assisted living facilities, and at-home care, for example.
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Frequently Asked Questions
Does Medigap Cover Long-Term Care?
No, Medigap plans (Medicare Supplement plans) do not cover long-term care, such as stays in nursing homes or assisted living facilities. Medigap plans are designed to help with certain out-of-pocket costs in Original Medicare but do not provide coverage for long-term care services.
Who is eligible for Medigap Plans?
To be eligible for Medigap plans, individuals must be enrolled in Medicare Part A and Part B. The best time to enroll is during the Medigap Open Enrollment Period, which lasts for six months and begins when you are 65 or older and enrolled in Medicare Part B. During this period, you have guaranteed issue rights, meaning insurance companies cannot deny you coverage or charge you more based on pre-existing conditions.
When can you enroll in Medigap Plans?
The Medigap Open Enrollment Period is the ideal time to enroll in a Medigap plan, as you have guaranteed access to coverage without medical underwriting. After this period, you can still enroll in Medigap plans, but insurers may consider your health status, and premiums could be higher.
What are the best Medicare Supplement plans?
The best Medicare Supplement plans for you depend on your individual healthcare needs and budget. Plan G and Plan N are popular choices due to their comprehensive coverage and competitive pricing.
What does Medicare Supplement Plan G cover?
Medicare Supplement Plan G covers most of the gaps in Original Medicare, including Part A and Part B coinsurance, hospice care coinsurance, and the first three pints of blood. It also covers skilled nursing facility care coinsurance, Part A deductible, and 80% of foreign travel emergency costs.
What does Medicare Supplement Plan N cover?
Medicare Supplement Plan N provides similar coverage to Plan G but requires beneficiaries to pay certain cost-sharing amounts, such as a copayment for doctor’s visits and emergency room visits. It does not cover the Part B excess charges.
What is the difference between Medicare Supplement Plans and Medicare Advantage?
Medicare Supplement plans work alongside Original Medicare and help pay for out-of-pocket expenses not covered by Medicare. Beneficiaries can see any healthcare provider that accepts Medicare.
Medicare Advantage plans, also known as Medicare Part C, are private health insurance plans that replace Original Medicare. They often include prescription drug coverage and may offer additional benefits like dental and vision. However, beneficiaries may need to use a network of providers and follow plan rules.
How does Medigap cover long-term care?
Medigap plans do not cover long-term care services, which include assistance with activities of daily living, such as bathing, dressing, and eating. These services are typically not covered by Medicare or Medigap.
How to choose between Medigap Plans and Medicare Advantage?
When choosing between Medigap plans and Medicare Advantage, consider your healthcare needs, budget, preferred providers, and prescription drug coverage requirements. If you want more flexibility in provider choice and additional benefits, a Medicare Advantage plan might be a better fit. If you prefer the freedom to see any provider without referrals and want more predictable out-of-pocket costs, a Medigap plan could be a suitable option.
Can you have both Medigap and Medicare Advantage plans?
No, you cannot have both Medigap and Medicare Advantage plans simultaneously. If you have a Medigap plan, you cannot enroll in a Medicare Advantage plan, and vice versa. You can choose either one based on your preferences and healthcare needs.
Contact Us for a Free Consultation on Medigap Plans
If you have questions about Medicare Supplement plans, call our team at 1-888-891-0229. We offer professional advice on Medigap policies. Our fully licensed agents offer free consultations to give you all the information you need about Medigap. If you want someone to call you back, leave your details on our contact form, and we’ll get a Medigap expert to reach out to you.
Russell Noga is the CEO and Medicare editor of Medisupps.com. His 15 years of experience in the Medicare insurance market includes being a licensed Medicare insurance broker in all 50 states. He is frequently featured as a featured as a keynote Medicare event speaker, has authored hundreds of Medicare content pages, and hosts the very popular Medisupps.com Medicare Youtube channel. His expertise includes Medicare, Medigap insurance, Medicare Advantage plans, and Medicare Part D.