What is a Medigap in Virginia?

A Medigap Plan is just another name for Medicare Supplement Insurance.

So the question is, “What is a Medicare Supplement in Virginia”?

Medicare Supplement Plans are health insurance that covers the gaps in Medicare. That’s why we call them “Medigap Plans.”

Medicare has gaps, such as copayments, deductibles, and coinsurance. When you get medically-approved services, you must pay the Medicare’s gaps, unless you’ve purchased insurance to cover them.

But if you have a supplement policy in Virginia, Medicare will first pay its share of your medical expenses. Then the Medigap plan will pay its share. Depending on which policy you have, your share could be nothing.

The 10 Standard Medicare Supplements

Medicare standardized all Medigap plans in 1990.  Every Medigap plan has to follow the standardization guidelines.  A letter identifies each standardized plan.

Note:  Don’t confuse the PLANS with the PARTS of Medicare.  There are 10 Medigap Plans and they are Plan A, Plan B, Plan C, D, F, G, K, L, M, and N. Each one of these lettered policies provides the same benefits from company to company.  The Parts of Medicare are Part A (hospitalization), Part B (provider services), Part C (Medicare Advantage which replaces the way you access Medicare), and Part D which is drug coverage.

Plan F is still available to people who had Medicare prior to 01/01/2020, but for those people who didn’t, then Plan G works very similar to Plan F, with the exception of the Part B deductible.  Plan F paid the Part B deductible but Plan G does not.

The monthly premium is the main difference between Medigap Plans with the same letter.  At MedicareQuick, we get the most requests for Medigap Plan F, Plan G, and Plan N so we’ll cover what they are below.

What is a Medigap in Virginia?

What is a Medigap Plan F?

Medicare Supplement Plan F is still one of the most popular Medigap plans in the USA. That’s because if you have a Plan F, you will not pay any deductibles, copays, or coinsurance amounts. Plan F will pay ALL of your shares. Click here to learn more about Medigap Plan F in Virginia.  Just keep in mind that if you did not have Medicare Part A or Part B prior to 01/01/2020 then you are not eligible for Plan F.  But if you had Medicare Part A or Part B before 01/01/2020, then you are eligible for Plan F.

What is a Medicare Supplement Plan G?

Medicare Supplement Plan G is now the most popular plan in our office.  It works exactly like Plan F, except for the Part B deductible.  You’ll pay the Part B deductible every year, and after that, it covers everything else.  The Part B deductible changes each year, but it is generally low.  For example, in 2021 it was $203 for the year.

Click here to learn more about Medigap Plan G in Virginia.

What is Medicare Supplement Plan N?

Medicare Supplement Plan N started in 2010. Plan N normally has lower premiums than Plans F or G. However you will pay more along the way. Every time you see a doctor it will cost $20.  Also, if you visit the Emergency Room, you must pay $50.  There are a lot of insurance agents selling these plans because they try to scare you that Plan G will go up in costs at a faster rate than Plan N.  This is because Plan G is now one of the programs used for “Guaranteed Issue” when someone loses a Medicare Advantage Plan because of a move.

To me, the scariest part of Plan N is excess doctor charges. When doctors bill an extra 15% above it’s called an Excess Charge. If you have Plan N, you must pay this excess charge yourself. Not true with Plans F and G, as they take care of this potential charge.

Excess doctor fees have no cap.  So if you are looking for Medigap Coverage in Virginia, understand that you might not be able to change plans in the future.  If doctors start charging this fee, and you have pre-existing conditions, you might not be able to change plans to one that covers it.  There is no limit to what your costs can be in any given year, so I’d think carefully before purchasing a plan that does not cover these costs.

See more on this in the glossary below. Click here to learn more about Medigap Plan N in Virginia.

What don't Medigap Plans cover in Virginia?

What don’t Medigap Plans cover in Virginia?

If Medicare approves a claim and pays the part that Medicare owes, it will forward the rest of the bill to your Medicare Supplement. Medigap plans only pay after Medicare has first paid its share.  If Medicare won’t cover it, neither will your Medigap plan.

Medicare doesn’t pay for certain things such as

  • Hearing aids
  • Routine dental, vision, and hearing exams
  • Eyeglasses and contacts
  • Retail prescription drugs
  • Long-term care or custodial care

Remember, if Medicare doesn’t pay for it, neither will your Medigap plan.

Glossary of Terms

The terminologies are the most difficult thing about Medicare supplements. Let’s take a look at the benefits as described by Medicare.

Part A coinsurance – all Medigap plans MUST offer this benefit. You’re covered for the daily hospital copays that you accrue starting after your 60th day.

Medicare Part B coinsurance or copayment – every Medigap plan covers this benefit, and it’s one of the most important. Medicare covers 80% of your Part B outpatient expenses. Your Medigap plan covers the other 20% for you. This benefit can be crucial for expensive services such as cancer treatments or dialysis.

Blood) – All Medigap plans include the first three pints of blood.  Medicare will only pay for the 4th pint and above. Blood can be very expensive, and it can be difficult to find out exactly how much it costs because blood banks negotiate with each clinic privately.

Part A Hospice care coinsurance/copayment – Medigap plans pay for the parts of a hospice that Medicare doesn’t.  This means that you usually pay nothing.

Skilled Nursing Facility coinsurance – Medicare pays for the first 20 days of a Skilled Nursing Facility.  It allows for 100 days but you must pay a copay after the first 20 days. A Medigap Plan with Skilled Nursing Facility SNF coverage pays for the other 80 days.

Medicare Part A deductible – the 2019 Part A deductible is $1,364. Keep in mind that it’s not an annual deductible, it’s a per stay deductible.  You might have to pay it multiple times if, for example, you have two inpatient hospital stays over 60 days apart.

Medicare Part B deductible – in 2019, the Part B deductible is $185 per year. This is an annual deductible and applies to doctor’s visits, lab-work, or physical therapy unless your Medicare supplement provides this benefit.

Medicare Part B excess charges –  Providers of Medicare can either accept Medicare’s assigned rates for each service or they can charge you an excess charge. The charge can be up to 15% over the assigned rate. Because the charge can be high for items such as surgery or diagnostic imaging, we recommend that you get a Medigap Plan that covers it.

Foreign travel emergency – Medicare doesn’t cover you outside the USA.  But some Medigap Plans provide some emergency coverage.  They’ll pay 80% of your expenses up to $50,000 after a small deductible.  However, we usually recommend that you get travel insurance when traveling outside the country.

Choosing a Medicare Supplement in VirginiaChoosing a Medicare Supplement in Virginia

Because of the standardization of Medigap plans, it’s easy to compare.  Here’s what you need to look at:

Rates – The Medigap premiums are the monthly rate that you pay to the insurance company that provides your Medigap plan.  You need to find out what premium each insurance carrier will charge you. Is the premium low or is it higher than other plans with the same letter in your area?

  • Rate trend history– Most policies will have an annual or biannual rate increase. What kind of rate increases occurred over the last 3 years? Are these rate increases reasonable or significantly higher than the competitors?   Rates are different depending on where you live.  For example, the rates in Virginia are different than the rates in California.
  • Financial Ratings – Rating companies such as A.M. Best and S&P look at the financial stability of each insurance carrier. These companies give reports, or grades, on the fiscal health of the insurer. Ask your agent what the A.M. Best and S&P Ratings are for each carrier you are considering.

Find out how much plans cost near you. Get a Medigap quote online right now.