Medicare Supplement Plan A
Medicare Plan A is a supplement plan that helps cover a few of the out of pocket costs that Original Medicare doesn’t pay for.
Of all Medigap plans, Medigap Plan A covers the least amount of benefits. However, one of the benefits it does cover is one that could cost you the most out of pocket.
Medicare Plan A Benefits
Medicare Plan A has the least amount of benefits, it only covers what are considered the core policy benefits. Core policy benefits are covered under all Medicare Supplement plans.
Meaning, there are more benefits Plan A doesn’t cover, then there are benefits that it does cover.
Plan A Benefits:
- An additional 365 days of inpatient care
- First 3 pints of blood
- Hospice care coinsurance & copays
- 20% coinsurance for outpatient care
What Medicare Plan A Does NOT Cover
Some benefits it doesn’t cover, that other Medigap plans do, include the Part A deductible, Part B deductible, Skilled Nursing Care coinsurance, excess charges, and foreign travel emergency coverage.
Medicare Supplement Plan A Coverage Chart
Plan A is Ideal For
- Those looking for a lower monthly premium
- People who aren’t concerned about out of pocket hospital costs
- Those who do not travel outside the United States
Important note, Plan A is the ONLY Medigap plan that doesn’t cover the Part A deductible.
How Medigap Plan A Works
Let’s say Julie has Medicare Supplement Plan A. Julie has always been relatively healthy. She didn’t have much time to research all her Medigap options, so she went with the most basic supplement plan she could find.
On a beautiful sunny day, Julie was outside working in her garden. She came across a newer plant that she recently purchased at her local garden center.
Little did she know, she was actually allergic to this specific variety of plant. She had an allergic reaction that put her in the emergency room.
In the emergency room, Julie had multiple tests done to diagnose her condition.
After the hospital got her allergic reaction diagnosed and under control, they sent her home. She then had a few follow-up visits with her primary care physician. At these follow-up visits, they ran a few additional allergy tests to make sure they covered all their bases.
Julie Later Received a $1,600 Bill
Later that month, Julie received a bill from the emergency room and another bill from her doctors’ office. Since she only had coverage for the core policy benefits with Plan A, she was left with hefty medical expenses to pay out of pocket.
The hospital billed her for the inpatient deductible of $1,408. Then, her doctors’ office billed her for the Part B deductible of $198. Her total out of pocket costs was over $1,600.
Julie assumed that she could change plans at a later time if needed. Julie was unaware that she only had a once in a lifetime Medicare Supplement Open Enrollment Period and would have to answer health questions if she were to switch plans outside this open enrollment window.
Now, allergies are not a health condition that would get you declined. However, if Julie happens to be diagnosed with a more severe condition before she switches plans, she could be declined coverage or charged a higher premium.
This is why enrolling in Medicare without a licensed agent is a risk. What you were told by a friendly neighbor, or what you read online from a random source, may not be correct.
It’s our job to make sure we’re aware of any changes so we can provide our clients with the best Medicare education at all times.
Medicare Plan A for Under 65
If you’re on Medicare due to a disability, you may find that Plan A is one of the few Medigap plans available to you in your state.
However, you’ll find that in most cases, the premium for Plan A to those under 65 will be at least double, if not triple, what it would be for someone over 65.
This is due to most beneficiaries on disability having higher medical costs than someone who ages into Medicare at 65.
Medigap premiums do vary by state. If Julie was under 65 and was living in Florida, she would pay somewhere between $400-$590 a month for Plan A. If she was over 65, she would only have to pay between $125-$170 in monthly premiums.
That’s why many individuals who are eligible for Medicare due to a disability choose to enroll in a Medicare Advantage plan. They are more affordable to beneficiaries under 65 than Medigap plans.
Those collecting SSDI benefits are the only individuals who get a 2nd Open Enrollment Period window to enroll without having to answer health questions. When they turn 65, they use this window to then enroll in a Medigap plan at that time.
Pros & Cons of Part A
As with most Medigap plans, they have a few pros and a few cons. For Plan A, the pros include having coverage for the Part B coinsurance and an additional 365 days in the hospital. The cons are the many benefits that it does not include since Plan A only covers core policy benefits.
Plan A & Part A are NOT the Same Things
Plan A & Part A are not the same.
Medicare Part A is your inpatient Medicare coverage, Medigap Plan A is supplemental coverage that will pay for some out of pocket expenses your Part A doesn’t cover.
In which Medicare Supplemental policies are the core benefits found?
All Medicare supplemental policies cover the core policy benefits, including Plan A. In fact, Plan A ONLY covers the core policy benefits.
How many pints of blood will be paid for by Medicare Supplement core benefits?
Medicare Supplement core policy benefits will pay for the first 3 pints of blood.
Could Medicare Be Any More Confusing?
Probably not, but that’s why we’re here! Our team of Medicare agents will explain every detail and prepare you for out of pocket expenses you may encounter.
If Julie had given us a call before she enrolled, we would’ve made sure she understood what Plan A included. We would’ve prepared her for the inpatient and outpatient deductibles she was left responsible for.
The good news is Julie did give us a call after she received the bill for her emergency room visit. We were able to enroll her in a better plan that provided more coverage before anything more serious happened.
Whether you’re 65, under 65, looking for a Medigap plan, or looking for a Medicare Advantage plan, we can help. We can also help you with your prescription drug coverage options.
Give us a call, our services cost you nothing. You’ll also have unlimited support from our Client Care Team when you enroll with us. If you need help with a claim or want to make sure you still have the best price, they are here to assist you.
We also have an online rate form you can fill out to see rates in your area. Please know, our agents still need to collect additional information from you to give you accurate prices. However, our form is a great starting point.