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Medigap Plan A: What is Covered

What is Covered

Medicare Supplement Insurance Plan A, commonly known as Medigap Plan A, provides basic coverage to help fill the gaps in Original Medicare. While coverage may vary slightly depending on the insurance company, Medigap Plan A typically includes the following benefits:

  1. Medicare Part A Coinsurance and Hospital Costs: Coverage for coinsurance, copayments, and deductibles associated with Medicare Part A, including hospital stays, skilled nursing facility care, hospice care, and some home health care services.

  2. Medicare Part B Coinsurance or Copayments: Payment of the 20% coinsurance or copayments required under Medicare Part B for doctor visits, outpatient services, durable medical equipment, and preventive services.

  3. Blood: Coverage for the first three pints of blood needed for a medical procedure, as Original Medicare typically only covers additional blood beyond this amount.

  4. Part A Hospice Care Coinsurance or Copayments: Payment of coinsurance or copayments for hospice care received under Medicare Part A.

  5. Skilled Nursing Facility Care Coinsurance: Coverage for coinsurance for care received in a skilled nursing facility following a hospital stay, up to the plan limits.

  6. Foreign Travel Emergency: Coverage for emergency medical care received while traveling abroad, up to plan limits.

Medigap Plan Benefits

Medigap Plan A offers basic coverage, including Medicare Part A coinsurance for hospital costs, Medicare Part B coinsurance or copayments for medical services, and coverage for the first three pints of blood needed for a medical procedure. 

Additionally, Plan A provides coverage for hospice care coinsurance under Medicare Part A and coinsurance for skilled nursing facility care following a hospital stay.

What is Not Covered by Medigap Plan A?

While Medigap Plan A provides basic coverage, there are certain services and expenses that are not covered, including:

  1. Medicare Part B Deductible: Plan A does not cover the annual deductible for Medicare Part B, which beneficiaries must pay out of pocket before Medicare coverage begins for Part B services.

  2. Medicare Part B Excess Charges: Plan A does not cover excess charges that may be incurred if a healthcare provider does not accept Medicare assignment and charges more than the Medicare-approved amount for a service.

  3. Prescription Drugs: Medigap Plan A does not cover prescription drugs. Beneficiaries may need to enroll in a standalone Medicare Part D prescription drug plan for drug coverage.

  4. Dental, Vision, and Hearing Services: Plan A does not cover routine dental, vision, or hearing services. Beneficiaries may need to seek alternative coverage options for these services.

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Medigap for Disability Medicare

Medigap plans are available to individuals under age 65 who qualify for Medicare due to disability. 

While not all states require insurance companies to offer Medigap plans to beneficiaries under 65, some states do provide this option. 

Medigap plans for disability Medicare provide the same standardized benefits as plans for individuals aged 65 and older, helping to cover out-of-pocket costs not paid by Original Medicare. 

Eligibility for Medigap plans may vary depending on the state and insurance company, so beneficiaries should check with their state’s insurance department or a licensed insurance agent for more information

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