Out of Pocket Expenses Under Medicare Supplement Plan


Medicare Supplement Plans help to meet the expenses not covered by the Original Medicare. These expenses help the customers to reduce their out-of-pocket expenses and safeguard their savings being wiped out in case of prolonged illness and hospitalization. However, even a Medigap policy does not cover all the expenses and the customers may still have to bear some out-of-pocket expenses. If the customers want their Medigap policies to meet most of these out-of-pocket expenses, then they will have to purchase the more comprehensive plans which will have higher monthly premiums. The overview of some of the out-of-pocket expenses are provided below:


Medicare Supplement Plan and Out-of-Pocket Expenses

The out-of-pocket expenses vary with the different Medigap plans. If a customer purchases the high-deductible version of Plan F, then he/she will have to pay an annual deductible of $2,240 before the benefits of the Plan starts. Similarly, the out-of-pocket expenses for the Plan K is $5,240 and for Plan, L is $2,620. Once the customers meet the prescribed deductibles under Plan K and L, the out-of-pocket expenses are covered for the rest of the year by the Medigap plan. Under the Plan N, the customers need to pay a copayment of $20 for visits to doctors and $50 for emergency room visits which do not result in hospitalization. This effectively means that the customers will generally end up paying most of the out-of-pocket expenses before they meet the annual deductible limit and start availing the plan benefits.


Other Out-of-Pocket Expenses

In addition to the copayment, coinsurance, and meeting the deductibles, the customers may also have to incur out-of-pocket expenses for any pre-existing medical condition. If customers have any pre-existing medical condition then the insurance company can make them wait for at least 6-months before their pre-existing condition is covered. The customers will have to pay all the out-of-pocket expenses related to their pre-existing health condition until their prescribed waiting period is over.


Reducing Out-of-Pocket Expenses

The customers should apply for Medicare Supplement plans during their Open Enrollment Period (OEP) as the insurance companies cannot refuse to sell them policies during the OEP, even if they have pre-existing health conditions. They can buy the plans with most comprehensive coverage without any risk of being rejected. If the OEP has lapsed, then the customers should check if they meet the eligibility for guaranteed-issue rights, as they can purchase any plan covering the maximum out-of-pocket expenses if they have the guaranteed-issue rights.