Do I really need supplemental insurance with Medicare?
If you have Original Medicare, a Medicare Supplement plan may help you cover the costs of your healthcare, therefore saving you money. This is because, while offering great coverage, Medicare Part A and Part B will not cover all of your healthcare costs, leaving you with expenses to cover.
Supplemental insurance is advisable for those with Medicare to help cover out-of-pocket costs and gaps in coverage, offering financial protection for deductibles, coinsurance, and other medical expenses not fully covered by Medicare.
As is true for all supplemental policies, these plans are not adequate as stand-alone health coverage, as they can leave you with unlimited out-of-pocket costs in the event of a serious medical condition.
The bottom line
Ultimately, deciding whether Medicare supplemental insurance is worth it comes down to its benefits and costs as it relates to your personal situation. "Seniors should view supplements as a guard for their budget and an open door for their medical needs," says Hill.
Among the 30.6 million Medicare beneficiaries in traditional Medicare in 2021, most (89%) had some type of additional coverage, either through Medigap (41%), employer coverage (32%), Medicaid (16%), or another source (1%).
State | Monthly Cost | Rank from least expensive (1) to most expensive (51) |
---|---|---|
Alaska | $117.64 | 17 |
Arizona | $128.93 | 30 |
Arkansas | $141.51 | 37 |
California | $162.93 | 45 |
About 23% of Medicare's 65.1 million beneficiaries are enrolled in a Medigap plan. While these supplemental insurance policies either partially or fully cover cost-sharing associated with basic Medicare (Part A hospital coverage and Part B outpatient care), the monthly premiums can be pricey.
A Medigap plan (also called a Medicare Supplement), sold by private companies, can help pay some of the health care costs Original Medicare doesn't cover, like copayments, coinsurance and deductibles.
Medicare Plan F (also referred to as Medigap Plan F) is the most comprehensive Medicare supplement plan. This plan covers Medicare deductibles and all copays and coinsurance, which means you pay nothing out of pocket throughout the year.
They have a short guaranteed issue period, which means changing plans after your initial policy is issued may not be possible if your health changes. Plus, Medigap plans do not offer extra benefits, including a prescription drug plan, unlike Medicare Advantage plans.
Why are people leaving Medicare Advantage plans?
Among the most commonly cited reasons are excessive prior authorization denial rates and slow payments from insurers.
Medigap Plan Type | Medigap Cost Range (monthly) |
---|---|
Medicare Supplement Plan G | $237 - $409 |
Medicare Supplement High-Deductible Plan G | $64 - $144 |
Medicare Supplement Plan K | $82 - $162 |
Medicare Supplement Plan L | $182 - $212 |
![Do I really need supplemental insurance with Medicare? (2024)](https://i.ytimg.com/vi/O-WxyTurD3c/hq720.jpg?sqp=-oaymwEcCNAFEJQDSFXyq4qpAw4IARUAAIhCGAFwAcABBg==&rs=AOn4CLAJcAVBInqLKlSUkxUer3JfXkk7HQ)
If you're interested in comprehensive coverage, consider plans from Humana for which you're eligible. The national health care provider serves older adults nationwide and offers plans with monthly premiums, physician copays and specialist copays starting at $0 per month.
Plan F, Plan G and Plan N are the most popular types of Medicare Supplement plans. Medicare Supplement Plan F is the most comprehensive Medigap option available, providing beneficiaries with 100% coverage of Medicare-covered medical expenses after Original Medicare pays its portion.
Increasingly, according to experts who watch insurance markets, hospital and medical groups are bristling at payment rates Medicare Advantage plans impose and at what they say are onerous requirements for preapproval to deliver care and too many after-the-fact denials of claims.
Demographics – Your age, location, and gender can affect your premium rate for a Medicare Supplement plan. Depending on where you live, you may pay more for your coverage. Age and gender can play a part in pricing, too. For example, women typically have longer life expectancies than men.
For most people, the best Medicare Supplement option is Medigap Plan G from AARP/UnitedHealthcare, which costs about $142 per month for a 65-year-old. This plan gives you comprehensive medical coverage from a well-rated company.
The 2024 out-of-pocket (OOP) limits for Medigap plans K & L are $7,060 and $3,530, respectively. These increases in the limits are based on estimates of the United States Per Capita Costs (USPCC) of the Medicare program developed by the Centers for Medicare & Medicaid Services (CMS).
For a qualifying inpatient stay, Medicare Part A covers 100 percent of hospital-specific costs for the first 60 days of the stay — after you pay the deductible for that benefit period. Part A doesn't completely cover Days 61-90 or the 60 “lifetime reserve days” you can use after Day 90.
Medicare Supplement plans help cover some costs that Original Medicare doesn't pay, but they don't include routine dental, vision, hearing or prescription drug benefits. If you're interested in those extra benefits, learn about switching to an all-in-1 Medicare Advantage prescription drug plan .
Which is better a supplement or advantage plan?
While a Medicare Advantage plan is meant to offer you more than Original Medicare alone can, a supplement is designed to simply help with the costs not covered by Medicare Parts A and B.
Basic Medicare Coverage: Is That Enough? Summary: Original Medicare coverage generally has no out-of-pocket maximum and doesn't cover important things like prescription drugs. Additional coverage from private insurance companies can help meet your health-care needs.
Common chronic respiratory diseases include Chronic Obstructive Pulmonary Disorder (COPD), Chronic Bronchitis, Asthma, and pulmonary Hypertension. You may be medically disqualified for Medigap coverage if you have a chronic respiratory disease.
Keep in mind that if you drop your Medigap policy, in most cases you won't be able to get it back, so pay attention to the timing. In general, you can only join a Medicare Advantage Plan during the Medicare Open Enrollment Period between October 15 – December 7 each year.
- Long-term care (also called. custodial care. Custodial care. ...
- Most dental care.
- Eye exams (for prescription glasses)
- Dentures.
- Cosmetic surgery.
- Massage therapy.
- Routine physical exams.
- Hearing aids and exams for fitting them.
References
- https://clearmatchmedicare.com/blog/medicare/do-i-need-health-insurance-if-i-have-medicare
- https://www.kff.org/womens-health-policy/fact-sheet/emergency-contraception/
- https://www.valuepenguin.com/best-medicare-supplement-plans
- https://www.healthline.com/health/healthy-sex/does-plan-b-work-during-ovulation
- https://www.fairhealthconsumer.org/insurance-basics/your-health-plan/having-more-than-one-health-plan
- https://www.uhc.com/news-articles/medicare-articles/should-i-get-part-b-if-im-working-past-65
- https://smartsexresource.com/answered-questions/hi-i-am-15-years-old-and-i-had-sex-without-protection-3/
- https://www.beckershospitalreview.com/finance/hospitals-are-dropping-medicare-advantage-left-and-right.html
- https://www.healthline.com/health/medicare/medicare-and-employer-coverage
- https://www.goodrx.com/conditions/emergency-contraceptive/emergency-contraception-options-how-they-work-ways-to-save
- https://www.verywellhealth.com/how-long-do-plan-b-side-effects-last-7853318
- https://www.medigap.com/faqs/medicare-cost-every-state/
- https://www.forbes.com/health/medicare/best-medicare-supplement-providers/
- https://www.medicare.gov/Pubs/pdf/11546-coordination-of-benefits.pdf
- https://www.medicareresources.org/medicare-benefits/is-original-medicare-coverage-enough/
- https://www.cms.gov/newsroom/fact-sheets/2024-medicare-parts-b-premiums-and-deductibles
- https://www.retiremed.com/library/articles/comparing-employer-coverage-medicare-whats-better-option
- https://www.medigap.com/faqs/medigap-deny-you-coverage/
- https://www.goodrx.com/plan-b/how-effective-is-plan-b
- https://www.cnet.com/personal-finance/insurance/do-you-have-to-enroll-in-medicare-if-youre-65-and-working-everything-you-need-to-know/
- https://fortune.com/well/2023/11/30/medicare-advantage-popular-with-seniors-not-hospitals-doctors/
- https://www.medicare.gov/health-drug-plans/medigap/ready-to-buy/change-policies/switch-drop
- https://www.gohealth.com/medicare/medicare-part-a/coverage/
- https://www.aarp.org/health/medicare-qa-tool/can-you-cancel-part-b.html
- https://www.cms.gov/medicare/health-drug-plans/medigap/k-l-out-of-pocket-limits-announcements
- https://boomerbenefits.com/medicare-supplemental-insurance/medicare-supplement-plans/medicare-plan-f/
- https://yalehealth.yale.edu/topic/emergency-contraception-morning-after-pill
- https://medicarewire.com/article/disadvantages-of-medigap-plans/
- https://www.kff.org/medicare/issue-brief/a-snapshot-of-sources-of-coverage-among-medicare-beneficiaries/
- https://www.medicare.gov/supplements-other-insurance/how-medicare-works-with-other-insurance
- https://www.plannedparenthood.org/planned-parenthood-massachusetts/online-health-center/planned-parenthood-services-birth-control-abortion-std-hiv-pregnancy-health-care/emergency-contraception-plan-b
- https://www.aarp.org/health/medicare-qa-tool/why-do-some-enroll-in-part-b-after-65.html
- https://www.nhs.uk/conditions/contraception/where-can-i-get-emergency-contraception/
- https://www.cnet.com/health/medical/plan-b-emergency-contraception-where-to-get-it-purchase-limits-effectiveness/
- https://www.nerdwallet.com/article/insurance/medicare/what-is-medicare-part-b
- https://www.mutualofomaha.com/advice/know-more-about-my-medicare-options/why-did-my-medicare-supplement-rate-change
- https://networkhealth.com/grow-in-the-know/2022/12/difference-between-medicare-advantage-vs-medicare-supplement
- https://www.insurance.wa.gov/what-medigap-plan-and-why-should-i-buy-it
- https://www.plannedparenthood.org/learn/morning-after-pill-emergency-contraception/whats-plan-b-morning-after-pill
- https://www.drugs.com/medical-answers/signs-plan-work-3573437/
- https://www.forbes.com/health/medicare/best-medicare-advantage-providers/
- https://www.cnbc.com/2023/01/06/key-things-to-know-if-youre-eyeing-medigap-policy-with-basic-medicare.html
- https://www.cms.gov/medicare/enrollment-renewal/health-plans/original-part-a-b
- https://www.cbsnews.com/news/is-medicare-supplemental-insurance-worth-it-what-some-experts-think/
- https://www.theguardian.com/society/2019/nov/27/morning-after-pill-expensive-high-street
- https://www.plannedparenthood.org/blog/i-took-the-morning-after-pill-and-got-my-period-a-week-early-then-i-got-it-again-when-it-was-supposed-to-happen-whats-going-on
- https://healthunit.org/health-information/sexual-health/medication-fact-sheets/emergency-contraceptive-pill-plan-b/
- https://www.forbes.com/advisor/health-insurance/secondary-health-insurance/
- https://www.plannedparenthood.org/blog/my-girlfriend-took-plan-b-three-times-in-one-month-when-will-she-get-her-next-period
- https://www.cms.gov/Outreach-and-Education/Find-Your-Provider-Type/Employers-and-Unions/FS3-Enroll-in-Part-A-and-B.pdf
- https://www.medicalnewstoday.com/articles/signs-that-plan-b-didnt-work
- https://www.sdccd.edu/docs/HumanResources/benefits/forms/active_employee_plans/Dual%20Health%20Insurance%20FAQ's.pdf
- https://www.businessinsider.com/guides/health/reproductive-health/how-effective-is-plan-b
- https://www.westernsouthern.com/retirement/do-i-need-supplemental-insurance-if-i-have-medicare
- https://www.ehealthinsurance.com/medicare/parts/is-basic-medicare-coverage-enough-for-you/
- https://www.goodrx.com/plan-b-one-step/common-interactions
- https://www.medicare.gov/basics/get-started-with-medicare/sign-up/ready-to-sign-up-for-part-a-part-b/how-to-drop-part-a-part-b
- https://www.medicare.gov/what-medicare-covers/what-isnt-covered-by-part-a-part-b
- https://www.plannedparenthood.org/learn/morning-after-pill-emergency-contraception/which-kind-emergency-contraception-should-i-use
- https://thehopeclinic.net/what-do-i-do-when-plan-b-fails/
- https://www.medicare.gov/sites/default/files/2021-10/02179-Medicare-and-other-health-benefits-your-guide-to-who-pays-first.pdf
- https://adyn.com/blog/how-to-know-if-plan-b-worked/
- https://www.ncbi.nlm.nih.gov/books/NBK583410/
- https://www.humana.com/medicare/medicare-resources/medicare-advantage-vs-medicare-supplement
- https://www.humana.com/medicare/medicare-resources/original-medicare-vs-medicare-advantage
- https://www.verywellhealth.com/should-you-buy-supplemental-health-insurance-1738638
- https://www.medicalnewstoday.com/articles/is-medicare-better-than-private-insurance
- https://www.investopedia.com/medicare-supplemental-insurance-cost-7113189
- https://www.commonwealthfund.org/publications/issue-briefs/2016/jan/does-medicare-advantage-cost-less-traditional-medicare
- https://www.lancastergeneralhealth.org/health-hub-home/motherhood/getting-pregnant/implantation-bleeding-or-your-period-how-to-spot-the-difference
- https://bobbybrockinsurance.com/blog/is-it-better-to-have-medicare-as-primary-or-secondary-insurance/