What Is Medigap Plan A? What You Need to Know

Medigap Plan A is a Medicare Supplement Insurance plan that covers some of the out-of-pocket expenses associated with Medicare Part A and Part B coverage.

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Medigap Plan A includes all of the “basics” for Medigap plans — the benefits that every Medigap plan covers. Plan A has lower premiums than some other Medigap options because it doesn’t include the extras that some other plans provide.

How it works

Original Medicare beneficiaries can buy a Medigap plan to help pay for out-of-pocket costs like deductibles, copays and coinsurance. These plans aren’t available for Medicare Advantage members.

There are 10 standardized Medigap plans available in most states (except Massachusetts, Minnesota and Wisconsin, which use different standards). The plans differ in terms of coverage for services, out-of-pocket limits and premium costs.

What Medigap Plan A covers

Here’s what Medigap Plan A covers, according to Medicare.gov:

• Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up.
• Part A hospice care coinsurance or copayment.
• Part B coinsurance or copayment.
• Blood transfusion (first three pints).

What Medigap Plan A doesn’t cover

Here are the benefits Medigap Plan A doesn’t cover that are included in some other plans:

• Part A deductible.
• Part B excess charges (when a provider charges you more than Medicare’s approved amount).
• Skilled nursing facility care coinsurance.
• Emergency care during travel outside the U.S.

Additionally, all Medigap plans, including Plan A, sold to new Medicare members don’t cover the following:

• Part B deductible. (Since 2020, new Medicare members can’t buy any plan that covers the Part B deductible, although existing members may own older plans that do.)
• Prescription drugs.
• Long-term care.
• Dental care.
• Vision care.
• Private-duty nursing.

How much does Medigap Plan A cost?

Medigap Plan A is regulated by the government, but premiums are set by the private insurers that sell the plan. Prices vary as a result of factors, including age, location and tobacco use. In a representative California ZIP code (92589) in 2022, monthly premiums for a 65-year-old nonsmoker range from $94 to $232.

To find out what Medigap Plan A would cost you, visit Medicare.gov.

The easiest and least expensive time to enroll in a Medigap policy is during your Medigap open enrollment period. This period happens only once. It starts when you turn 65 and enroll in Medicare Part B, and lasts for six months.

During the Medigap open enrollment period, providers can’t consider your health or medical history when setting your premiums. At any other time outside of that period, providers can charge more or deny coverage because of your health status or medical history.

If you have questions about Medicare, visit Medicare.gov or call 800-633-4227 (TTY: 877-486-2048).

The article What Is Medigap Plan A? What You Need to Know originally appeared on NerdWallet.

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