Medigap Monday: What is Medicare Supplement Plan D

Medicare Supplement Plan D, is a true Medicare Supplement that works with Medicare to fill in the gaps to Medicare Parts A and B and pay the bills that Medicare does not pay.  It should not be confused with Medicare PART D, which are prescription plans that are specifically designed to cover your medications.

Medicare Supplement Plan D is a very comprehensive plan. If you compare it to Medicare Supplement Plan F, which fills in all the holes to Medicare, there are only two differences to Medicare Supplement Plan D and Medicare Supplement Plan F. The Medicare Supplement Plan D does not cover Medicare’s very small Part B annual deductible of $185.00 for 2019. After you pay that Part B deductible, you’ll have no co-pays or any other out-out-pocket costs for Medicare covered services. Like all Medicare Supplement plans, the Medicare Supplement Plan D does not have any networks. You have the freedom to go to any doctor or any hospital in the country that accepts Original Medicare.

The last difference with Medicare Supplement Plan D from Medicare Supplement Plan F is that it does not cover Medicare Part B excess charges. Some doctors accept what is called the “assigned” rate for their work. Others charge a higher rate, but they cannot charge more than 15 percent more than the assigned rate.

For example, Medicare might decide that the fair “assigned” rate for a specific procedure should be $400. A doctor who accepts the Medicare assignment would bill at or below that rate.

However, your doctor may decide that $400 is not a sufficient reimbursement. Doctors are allowed to charge up to an additional 15% over and above what Medicare has approved. Therefore, in this case, your doctor could charge you $460 and you would be responsible for paying the additional $60 “excess” charge out-of-pocket ($400 X 15% = $60 excess charge) in addition to any deductible and co-pay.

These charges are rare and a good way to avoid them is to ask if your doctor accepts Medicare Assignment. Also, it should be noted that Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island and Vermont do NOT allow Medicare Part B excess charges so the Medicare Supplement Plan D would be a great option in these states because you would be protected from the Medicare Part B excess charges.

If you have any questions regarding Medicare, please give our office a call at 1-855-368-4717 or visit one of our pages:

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