Medigap Plan A, also called Medicare Supplement Plan A, helps cover some of the out-of-pocket healthcare costs from Original Medicare. Medicare Supplement Plans offer varying levels of coverage depending on your needs and budget. The biggest difference between Medigap Plan A and other Medigap plans is that it covers fewer of Original Medicare’s out-of-pocket costs, which also makes it one of the most affordable Medigap options. It may be a good fit if you want to defray some out-of-pocket costs, but do not necessarily need extensive coverage.
How Medigap Plan A Works
Medigap plans cover the “gaps” between Original Medicare (Parts A and B) coverage and the common healthcare costs that you pay out of pocket. Because it is designed to cover the out-of-pocket costs specifically associated with Original Medicare, so it can only be used in conjunction with Original Medicare and not Medicare Advantage.
Medigap also offers out-of-pocket coverage for specific services, depending on the plan. For example, Medicare Supplement Plan A covers Medicare Part A’s hospital coinsurance and costs for up to 365 days.
There are 10 Medigap Plan options available: A, B, C, D, F, G, K, L, M, and N. It should be noted that Plans C and F are not available to anyone who became eligible for Medicare on or after Jan. 1, 2020.
Of all the plan options, Medicare Supplement Plan A covers the fewest additional costs. For example, while the other plans cover at least some of the Part A deductible, Plan A does not. But this more sparse coverage also makes it one of the most affordable Medigap options.
What Does Medicare Supplement Plan A Cover?
|Benefits||Plan A||Plan B||Plan C||Plan D||Plan F||Plan G||Plan|
|Plan M||Plan N|
|Part A coinsurance and hospital costs for up to 365 additional days after Medicare benefits are disbursed||Yes||Yes||Yes||Yes||Yes||Yes||Yes||Yes||Yes||Yes|
|Part B coinsurance or copayment||Yes||Yes||Yes||Yes||Yes||Yes||50%||75%||Yes||100% coinsurance; but copays may still apply|
|Part A hospice care coinsurance or copayment||Yes||Yes||Yes||Yes||Yes||Yes||50%||75%||Yes||Yes|
|Part A deductible||Not covered||Yes||Yes||Yes||Yes||Yes||50%||75%||50%||Yes|
|Part B deductible||Not covered||Not covered||Yes||Not covered||Yes||Not covered||Not covered||Not covered||Not covered||Not covered|
|Part B excess charge||Not covered||Not covered||Not covered||Not covered||Yes||100%||Not covered||Not covered||Not covered||Not covered|
|Out-of-pocket limit||N/A||N/A||N/A||N/A||N/A||N/A||$6,940 in 2023||$3,470 in 2023||N/A||N/A|
|Blood (first three pints)||Yes||Yes||Yes||Yes||Yes||Yes||50%||75%||Yes||Yes|
|Skilled nursing facility care coinsurance||Not covered||Not covered||Yes||Yes||Yes||Yes||50%||75%||Yes||Yes|
|Foreign travel exchange up to plan limits||Not covered||Not covered||80%||80%||80%||80%||Not covered||Not covered||80%||80%|
Medicare Supplement Plan A covers these types of healthcare costs:
- Part A coinsurance and hospital costs for up to 365 days after you use up Medicare benefits: Plan A covers Part A coinsurance for healthcare. For example, if your Medicare Part A insurance pays 80% of the cost for a procedure, you can use Plan A to cover the remaining 20%.
- Part B coinsurance or copayments: If you have a copayment of $50 for a Medicare Part B service, for instance, you can use Plan A to cover the cost.
- The first 3 pints of blood: If you need blood drawn for medical procedures or tests, the first 3 pints are covered by Medicare Supplement Plan A.
- Part A hospice care coinsurance or copayment: Plan A also covers hospice care copayments and coinsurance that you’re responsible for under Medicare Plan A.
If insurers offer any Medigap plans at all, they must offer Plan A, along with Plan C and Plan F. As long as they meet these requirements, they can offer any mix of Medigap plans.
What Does Medicare Supplement Plan A Not Cover?
Medigap Plan A does not cover other healthcare costs, such as:
- Skilled nursing facility coinsurance: Plan A does not cover any skilled nursing facility coinsurance costs. This means that if your Medicare Part A covers 80% of skilled nursing care costs, you pay the other 20% out of pocket.
- Part A and Part B deductibles: You’re still responsible for these costs under Medigap Plan A
- Part B excess charges: In cases where doctors can charge more than the Medicare-allowed amount for services (called the excess charge), Medigap Plan A does not provide coverage.
- Foreign travel exchanges: Medigap Plan A does not provide coverage for any healthcare expenses you incur while traveling abroad.
Medicare Supplement Plan A Eligibility
Once you are enrolled in both Medicare Part A and Medicare Part B, you are eligible to enroll in a Medigap plan. For the first 6 months after you enroll in Medicare Parts A and B, you can enroll in the Medigap plan of your choice and insurers cannot use your medical history to charge you more for coverage. However, after this 6-month period, insurers can use medical underwriting processes to determine plan costs that take your current health status into account.
If you are under 65 and enrolled in Medicare, your state may permit you to enroll in a Medigap plan, but insurers are permitted to charge higher premiums.
Are Medigap Plan A and Medicare Part A the Same?
Medigap Plan A and Medicare Part A are not the same thing. While the terms sound similar, they refer to different products altogether.
Medicare Part A functions as health insurance, helping to cover your care in hospitals, critical access hospitals, and skilled nursing facilities, along with some home health and hospice care. In most cases, patients don’t pay premiums for Part A coverage because they (or their spouse) paid Medicare taxes. If you are 65 or older and didn’t pay Medicare taxes, you can still purchase Part A, but may have a monthly premium.
Medigap Plan A, meanwhile, functions as supplemental insurance that specifically helps with the cost of Original Medicare. It is only available once you have both Medicare Parts A and B, as it is not designed for stand-alone coverage.
Plan A vs. Other Medigap Options
Medigap Plan A offers the fewest coverage types of any Medigap plan. For example, while all 10 plans cover Part A coinsurance and hospital costs, all plans except Plan A also cover at least a portion of the Part A deductible. In addition, Plan A does not cover skilled nursing care or Part B excess charges.
But this spare coverage is not necessarily a drawback. Plan A may be a good choice if your healthcare costs are generally predictable and you do not have any chronic illnesses or other costly health issues. In this case, the lower cost and coverage of Plan A may make sense to provide an additional safety net for unexpected hospital costs or Part B copayments.
Plan A vs. Medicare Advantage
When looking into the best Medicare options for your needs, consider Medicare Advantage, also known as Medicare Part C. Medicare Advantage is sold through private insurers as an alternative way to get Part A and Part B (and sometimes Part D) coverage. Depending on your healthcare needs, either Plan A or Medicare Advantage may be a good fit.
For example, if you’re looking for drug coverage under Medicare Part D, a Medicare Advantage plan may be a good choice because many of these plans include Part D coverage. However, Medicare Advantage plans typically limit beneficiaries to an approved provider network. This means if ease of care access is one of your top priorities, having Medigap Plan A to go with your Original Medicare may be a better option because Medigap can be used with any provider who accepts Medicare at all.
In addition, the specificity of Plan A coverage, such as Part B and Part A coinsurance, may better align with your needs than the broader coverage of Medicare Advantage.
How to Enroll in Medigap Plan A
You can sign up for Medigap coverage at any time throughout the year if you are eligible, but signing up during your initial enrollment period can help you save on costs.
Individual Initial Enrollment Period
- When: 7 months, beginning three months before you turn 65 and ending three months after your 65th birthday
- What You Can Do: Enroll in Medigap for the first time
During this period, you can add any available Medigap plan in your area to your Medicare Part A and Part B coverage. Regardless of your medical history, your Medigap plan costs during the individual enrollment period must be the same as what the insurance company would charge a healthy individual.