Managing Costs for Doctor Visits Using a Medicare Supplement Plan
Last Updated : 09/16/20185 min read
If you’re on Medicare and have a lot of doctor visits, Medicare Supplement insurance might be worth considering. Read on to see if Medicare Supplement sounds like it might fit your needs.
What’s Medicare Supplement insurance?
Here’s some quick information in case you’re not familiar with Medicare Supplement (Medigap) insurance. Medicare Supplement plans are sold by private insurance carriers companies.
These plans can work alongside Original Medicare (Part A and Part B) to fill in some of the “gaps” in Medicare coverage. That is, Medicare Supplement plans may cover some of your out-of-pocket expenses under Original Medicare, such as deductibles and coinsurance. This can help lower your doctor visit costs.
In most states, there are up to ten standardized Medicare Supplement plans with lettered names (such as Medicare Supplement Plan A – not to be confused with Medicare Part A). Massachusetts, Minnesota and Wisconsin offer different standardized Medicare Supplement plans.
Does Medicare Supplement insurance pay for doctor visit costs?
All the standardized, lettered Medicare Supplement plans generally pay for at least some of the coinsurance amount from doctor visits covered under Medicare Part B. For example, if a doctor visit is covered under Medicare Part B at a total cost of $100, Part B usually pays $80 and you pay the $20 coinsurance. The standardized Medigap plans usually cover that $20, or a portion of that amount. Different plans cover different amounts of the Part B coinsurance; for example, Plan A usually pays 100%, while Plan K generally pays 50%.
Keeping Medicare doctor visit costs down
Medicare and Medicare Supplement plans generally cover visits to any doctor or other provider who accepts Medicare assignment. A doctor who accepts Medicare assignment is agreeing to charge you no more than the amount that Medicare has approved for a particular service.
In most cases, Medicare Supplement plans don’t restrict you to providers who participate in a health insurance plan network. The exception is a Medicare SELECT plan, which is a special type of Medicare Supplement plan that may require you to use a provider network (or provide more coverage when you do). Medicare SELECT plans might have lower premiums than many other Medicare Supplement plans.
Your cost savings for doctor visits are generally highest when you choose doctors and other health-care professionals who accept Medicare assignment. If you’re not sure if your doctor accepts assignment, you can call his or her office and ask.
Choosing a Medicare Supplement plan that might help you save on doctor visit costs
Medicare Supplement plans labeled A, B, C, D, F, G, K, L, M and N may pay at least part of Part B covered services, which generally includes most doctor’s visits—in the office, in an outpatient center, or in the hospital.
Please note that costs may differ among plans, although the benefits are the same among plans of the same letter name. For example, Medicare Supplement Plan A has the same benefits no matter where you purchase the plan– but what you pay for Plan A (such as the monthly premium) may vary among plans.
How do you know which plan to choose? Only you can decide which plan may be right for you. Here are a few things you may want to consider when looking at Medicare Supplement insurance.
- Your Part B coinsurance/copayment for doctor visits and other services:
- Most Medicare Supplement plans may cover the coinsurance portion (usually 20%) that Medicare does not generally cover for doctor visit costs.
- However, under Medicare Supplement Plan N, you may pay up to $20 for some doctor visits and up to $50 for emergency room visits that don’t result in a hospital admission.
- Medicare Supplement Plans K and L may pay 50% and 75% respectively of your portion not paid by Medicare, but they also limit the amount you pay annually. When you reach this annual cap, the plan may pay 100% of your out-of-pocket Medicare Part A and Part B doctor visit costs for covered services.
- Your Medicare Part B deductible:
- Usually, you must pay this deductible before Medicare will pay its portion of covered medical services (except for certain preventive services Medicare Part B pays in full).
- You may be able to save money on your Medicare Supplement plan premium if you pay your annual Part B deductible. Medicare Supplement plans A, B, D, G, K, L, M and N don’t cover the Part B deductible. Plans C and F generally do.
- Whether your doctor accepts Medicare assignment:
- If your regular doctor doesn’t accept assignment, you might want to take a closer look at Medicare Supplement plans F and G, which may cover your Part B excess charges above the Medicare-approved amount (generally up to 15%).
Feel free to contact me if you would like to learn more about your Medicare Supplement plan options or other Medicare coverage questions you may have. I would like to help you.
- You can use one of the links below to set up a phone call with me or request personalized information from me by email.
- You can also do some research on your own to get familiar with Medicare plan options in your area by clicking on the Compare Plans button on this page.
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