Key Takeaways

• Medicare Supplement plans help cover out-of-pocket costs that Original Medicare doesn’t, such as deductibles, copayments, and coinsurance.

• These plans provide financial predictability and peace of mind, ensuring you don’t face unexpected medical expenses.

The Gaps in Original Medicare

Original Medicare (Parts A and B) offers broad coverage for hospital and medical expenses, but it doesn’t cover everything. You’re responsible for deductibles, copayments, coinsurance, and other costs that can add up quickly. That’s where Medicare Supplement plans (also called Medigap) come in. These plans are designed to fill those gaps and help manage healthcare expenses more effectively.

1. Deductibles for Part A and Part B

Under Original Medicare, you’re responsible for deductibles before your coverage kicks in:

• Medicare Part A (Hospital Insurance): The inpatient hospital deductible is $1,676 per benefit period in 2025. This means if you are hospitalized multiple times in a year, you could face this deductible repeatedly.

• Medicare Part B (Medical Insurance): The annual deductible for Part B is $257 in 2025. After paying this amount, you typically cover 20% of the costs for doctor visits and outpatient services.

Medicare Supplement plans can cover some or all of these deductibles, depending on the plan you choose, reducing your upfront medical expenses.

2. Coinsurance for Hospital Stays

While Medicare Part A covers hospital stays, it doesn’t pay for everything. You must pay coinsurance after a certain number of days:

• Days 1-60: Covered in full after you pay the Part A deductible.

• Days 61-90: You owe $419 per day in coinsurance.

• Days 91 and beyond: You owe $838 per day (using lifetime reserve days).

• After lifetime reserve days are used: You cover all costs.

Medicare Supplement plans help pay for these hospital coinsurance costs, so you’re not stuck with large bills for extended hospital stays.

3. Coinsurance for Skilled Nursing Facility Care

If you need skilled nursing care, Medicare covers some costs, but there’s a coinsurance requirement:

• Days 1-20: Fully covered under Medicare.

• Days 21-100: You pay $209.50 per day in coinsurance.

• After Day 100: You pay the full cost.

A Medicare Supplement plan can cover this daily coinsurance, making extended skilled nursing care more affordable.

4. Part B Coinsurance and Copayments

Under Part B, after you meet the deductible, you typically pay 20% of the Medicare-approved amount for covered services. This includes:

• Doctor visits

• Outpatient procedures

• Lab tests

• Durable medical equipment (like wheelchairs and oxygen)

Some Medicare Supplement plans cover all or part of this 20% coinsurance, helping you avoid unexpected out-of-pocket costs.

5. Emergency Medical Care Abroad

Original Medicare generally does not cover medical care received outside the U.S. If you travel internationally, this can be a significant concern. Some Medicare Supplement plans provide coverage for emergency medical care abroad, typically covering 80% of emergency costs up to plan limits. This benefit ensures you have financial protection when traveling outside the country.

6. Excess Charges from Doctors Who Don’t Accept Medicare Assignment

Not all doctors accept Medicare’s payment as full compensation. Some charge up to 15% more than the Medicare-approved amount. This is called an “excess charge.”

Medicare Supplement plans that include coverage for excess charges pay for these additional costs, so you don’t have to cover them yourself.

7. Extended Hospital Coverage Beyond Medicare Limits

If you require hospital care beyond Medicare’s covered limits, you’re responsible for the full cost of your stay. Some Medicare Supplement plans provide additional coverage beyond Medicare’s limits, ensuring you’re protected if you need long-term hospital care.

Why These Benefits Matter

Medicare Supplement plans exist to provide financial security and eliminate the gaps in Original Medicare. Here’s why these benefits matter:

• Cost Savings: Out-of-pocket expenses like deductibles, coinsurance, and copayments can add up. A Medicare Supplement plan helps manage these costs.

• Predictability: Knowing what you’ll pay for healthcare in advance allows for better budgeting and financial planning.

• Freedom to Choose Providers: Unlike some other plans, Medicare Supplement plans let you see any doctor or specialist who accepts Medicare.

• Peace of Mind When Traveling: If you frequently travel outside the U.S., having emergency coverage can prevent unexpected medical expenses abroad.

Making the Right Choice for Your Needs

Choosing the right Medicare Supplement plan depends on your healthcare needs, budget, and financial goals. Consider:

• How often you visit doctors or specialists

• Whether you travel frequently

• Your ability to pay for unexpected medical expenses

• Your comfort level with out-of-pocket costs

Secure the Coverage You Need

Medicare Supplement plans provide vital coverage that Original Medicare does not, helping you manage out-of-pocket costs, ensuring financial predictability, and offering additional benefits like international emergency coverage. To explore your options and find the best plan for your needs, get in touch with a licensed agent listed on this website for professional advice.