Medicare Supplement (Medigap) Plan A


Medigap Plan A is a standardized Medicare Supplement insurance plan that helps fill the gaps in coverage left by Original Medicare (Part A and Part B). It provides a basic set of benefits that are the same across all insurance companies offering Plan A.

Medigap Plan A covers certain costs such as Medicare Part A coinsurance and hospital costs, as well as Part B coinsurance or copayments for medical services. It also covers the first three pints of blood needed for a medical procedure. Medigap Plan A does not cover all the gaps in Original Medicare, such as the Part A and Part B deductibles or excess charges. Additionally, it does not provide coverage for prescription drugs, vision, dental, or other non-Medicare services.

Overall, Medigap Plan A offers basic coverage for essential healthcare expenses, providing individuals with greater financial predictability and peace of mind. It's advisable to compare different Medigap plans to determine which one best meets your specific needs and budget.

Below is a comprehensive list of the covered services provided by Medicare Supplement Plan A, which include benefits under Medicare Part A, Medicare Part B, and other areas:

MEDICARE PART A - HOSPITAL SERVICES - PER BENEFIT PERIOD


HOSPITALIZATION
Semi-private room & board, general nursing and miscellaneous services and supplies

ServiceWho pays what?
First 60 daysMedicare pays: All cost but $1,632
Plan pays: Nothing
Member pays: $1,632 (Part A Deductible)
61st thru 90th dayMedicare pays: All cost but $408/day
Plan pays: $408/day
Member pays: Nothing
91st day and after (While using 60 lifetime reserve days)Medicare pays: All cost but $816/day
Plan pays: $816/day
Member pays: Nothing
Once lifetime reserve days are used; additional 365 daysMedicare pays: Nothing
Plan pays: 100% of Medicare-eligible expenses
Member pays: Nothing
Beyond the additional 365 daysMedicare pays: Nothing
Plan pays: Nothing
Member pays: All cost


SKILLED NURSING FACILITY CARE
You must meet Medicare’s requirements, including having been in a hospital for at least three days, and enter a Medicare approved facility within 30 days after leaving the hospital.

ServiceWho pays what?
First 20 daysMedicare pays: All cost
Plan pays: Nothing
Member pays: Nothing
21st thru 100th dayMedicare pays: All but $204/day
Plan pays: Nothing
Member pays: Up to $204/day
101st day and afterMedicare pays: Nothing
Plan pays: Nothing
Member pays: All cost


BLOOD

ServiceWho pays what?
First three pintsMedicare pays: Nothing
Plan pays: All cost
Member pays: Nothing
Additional amountMedicare pays: All cost
Plan pays: Nothing
Member pays: Nothing


HOSPICE CARE
You must meet Medicare's requirements, including a doctor's certification of terminal illness.

ServiceWho pays what?
Hospice CareMedicare pays: All but very limited
copayment/ coinsurance for outpatient
drugs and inpatient respite care
Plan pays: Medicare copayment and
coinsurance
Member pays: Nothing

MEDICARE PART B - MEDICAL SERVICES - PER CALENDAR YEAR


MEDICAL EXPENSES
In or out of the hospital and outpatient hospital treatment, such as physician's services, inpatient and outpatient medical services and surgical services, physical and speech therapy, diagnostic tests, durable medical equipment.

ServiceWho pays what?
Part B DeductibleMedicare pays: Nothing
Plan pays: $240
Member pays: Nothing
Part B CoinsuranceMedicare pays: 80%
Plan pays: 20% (Part B Coinsurance)
Member pays: Nothing
Part B Excess Charges
(above Medicare approved
amounts)		Medicare pays: Nothing
Plan pays: All cost
Member pays: Nothing


CLINICAL LABORATORY SERVICES

ServiceWho pays what?
Test for diagnostic lab services  Medicare pays: All cost
Plan pays: Nothing
Member pays: Nothing


BLOOD

ServiceWho pays what?
First three pintsMedicare pays: All cost
Plan pays: Nothing
Member pays: Nothing
Additional amount (First $240 of
Medicare approved amounts)		Medicare pays: Nothing
Plan pays: Nothing
Member pays: $240 (Part B deductible)
Remainder of Medicare approved amountsMedicare pays: 80%
Plan pays: 20% (Part B Coinsurance)
Member pays: Nothing

MEDICARE PARTS A & B - MEDICAL SERVICES - PER CALENDAR YEAR


HOME HEALTH CARE
Medicare approved services

ServiceWho pays what?
Medically necessary skilled care
services and medical supplies/
Durable medical equipment
(First $240 of Medicare approved amounts)		Medicare pays: Nothing
Plan pays: Nothing
Member pays: $240 (Part B deductible)
61st thru 90th dayMedicare pays: 80%
Plan pays: 20% (Part B Coinsurance)
Member pays: Nothing

OTHER BENEFITS


FOREIGN TRAVEL
Medically necessary emergency care services beginning during the first 60 days of each trip outside the United States

ServiceWho pays what?
First $250 each calendar
year/Remainder of charges		Medicare pays: Nothing
Plan pays: Nothing
Member pays: All cost

Medigap Plan A and Medicare Part A are not same!

Medicare Part A and Medicare Supplement (Medigap) Plan A should not be confused as they are distinct components. Medicare Part A is a part of Original Medicare that specifically covers hospital and inpatient medical services. On the other hand, Medicare Supplement (Medigap) Plan A is an insurance policy designed to complement Original Medicare by filling in the gaps in coverage.

Medicare Supplement Plan A provides a range of benefits that are included in both Medicare Part A and Medicare Part B. It helps cover expenses such as coinsurance and copayments for hospital stays and outpatient medical services, as well as certain additional benefits like blood transfusions, hospice care coinsurance, and preventive care services.

In summary, while Medicare Part A focuses on hospital and inpatient services under Original Medicare, Medicare Supplement Plan A is a supplementary insurance plan that offers broader coverage for services included in both Medicare Part A and Medicare Part B.


Is Medicare Supplement Plan A available for disabled individuals who are under 65?

Yes, it is possible to enroll in Medicare Supplement (Medigap) Plan A if you became eligible for Medicare due to disability before the age of 65. However, it's important to note that the cost of the plan may be significantly higher for individuals with disabilities compared to those who are 65 years old. This is because people with disabilities often have higher healthcare costs, which can result in higher premiums for Medicare Supplement plans. The specific cost of the plan for individuals with disabilities may be double or even triple that of individuals who are 65.

Other Medicare Supplement Plans

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