What Do Supplemental Insurance Plans Provide
Medigap insurance must follow Federal and state laws. Insurers can only sell “standardized” Medigap Plans designated by letters, Plan A through Plan N.
Each standardized Medigap Plan must provide the same basic coverage regardless of which insurer offers the plan. For example, a Plan A purchased from one insurer will offer the same basic coverage as a Plan A from a different insurer. Cost is typically the only difference you’ll find between a Plan A from one insurer versus another insurer. If you live in Massachusetts, Minnesota or Wisconsin, see pages 12 through 15 for those state-specific plans.
The basic or core benefits of Plan A are the minimum Medicare Supplemental coverage you can buy. These core benefits are the only benefits in Plan A. Every other Medigap Plan provides these three Plan A benefits and more.
What Are the Medigap Plan A Benefits?
- Hospitalization: Part A pays for hospitalization for the first 60 days, but only pays for a portion of the daily costs from the 61st through the 150th day of hospitalization. You pay the coinsurance amount after 60 days. Plan A will pay the coinsurance amount for those days, and the total Medicare reimbursement amount for an additional 365 days per lifetime.
- Blood transfusions: Medicare pays for all the blood that is medically necessary except for the first three pints in each calendar year. Plan A pays for the first three pints of blood that are not covered by Medicare.
- Medical Expenses: Part B typically pays for 80 percent of a predetermined amount (the Medicare-approved amount) for each procedure, service or supply from a doctor or other provider that is not a hospital.
What Do Medigap Plans B through N Offer?
These Medigap Plans include the core benefits of Plan A, and offer various combinations of additional benefits.
Although Plan A is the least expensive of the Medigap Plans, it may not be the best choice for people who would not be able to afford the Medicare Part A hospital deductible if they are hospitalized.
Which Medigap Plans Cover the Medicare Part A Deductible?
The Part A deductible is what you are obligated to pay when admitted to a hospital as an inpatient. This deductible may change each year. In 2010, the Part A deductible is $1,100 per illness, and it has increased $32 from 2009.
Medigap Plans B through N reimburse you for this Part A deductible regardless of what that amount may be in a given year.
Which Medigap Plans Cover Skilled Nursing Coinsurance?
Medicare Part A pays for the first 20 days of care in a skilled nursing facility following hospitalization. Medicare requires you to pay a coinsurance amount that starts on the 21st day and continues through the 100th day.
Medigap Plans C through N pay for the coinsurance amount beginning on the 21st day of care in a skilled nursing facility after hospitalization.
Which Medigap Plans Cover the Medicare Part B Deductible?
The Medicare Part B deductible is the amount you must pay each year for medical expenses, such as doctor fees, before Medicare starts to pay. This deductible may change each year, and it is $155 in 2010. That’s $20 more than in 2009.
Medigap Plans C and F reimburse you for this deductible regardless of what that amount may be in a given year.
What Are Part B Excess Charges?
Medicare Part B pays for 80 percent of a predetermined amount (the Medicare approved amount) for procedures performed by a doctor or other medical care provider.
If a provider does not accept the Medicare-approved amount, the provider may bill you for the difference between the amount that Medicare pays, and the amount the provider can legally charge (called the limiting charge).
Which Medigap Plans Can Help with Part B Excess Charges?
Medigap Plan G pays 80 percent of the Part B Excess Charge. This 80-percent benefit should save you money on premium costs compared to the 100-percent benefit of Plan F.
Which Medigap Plans Help with Foreign Travel Emergencies? Medicare does not pay for medical care outside of the United States. Medigap Plans C through N (with the exception of Plan K) pay for 80 percent of emergency medical care in a foreign country during the first 60 days of your trip abroad, once you pay a $250 deductible. These plans may have a lifetime maximum on what they will pay for medical care outside of the U.S.
What Other Benefits Can Medigap Plans Provide?
Certain insurers offer a Medicare Plan F with a $2,000 deductible. These highdeductible plans pay the same benefits as the standard plans after you have met the $2,000 deductible per calendar year.
Medigap Plans K, L and N may offer lower premiums because they require you pay for part of the Part B coinsurance and copayments. After a deductible is met, Plans K and L pay for 100 percent of the Medicare coinsurance, copayments and deductibles for the rest of the calendar year.
What Are the Out-of-pocket Limits?
The out-of-pocket limits do not include charges for any provider that exceeds Medicare-approved amounts, which are known as excess charges. In 2010, the annual out-of-pocket limits are $4,620 for Plan K and $2,310 for Plan L.
With Plan M, you pay for 50 percent of the Part A deductible ($1,100 in 2010), and 100 percent of the Part B deductible ($155 in 2010). Alternatively, Plan N pays 100 percent of the Part A deductible, and you pay 100 percent of the Part B deductible, plus a $20 copayment for office visits and a $50 copayment for emergency room visits.
What Services Are Not Covered by Medigap Plans?
No Medigap Plan covers long-term care, such as nursing home care or privateduty care. None of the Medigap Plans help with the cost of dental care, eyeglasses, hearing aides or vision care.
Which Medigap Plans Are Still Available?
Effective June 1, 2010, legislation changed the choice of Medigap Plans. Only Plans A, B, C, D, F, G, K, L, M and N are available. Although Plans E, H, I and J are no longer available, you can keep any of these that you already have. The Plans D and G that are currently available have different benefits than the Plans D and G that were available before June 1, 2010. Medigap Plan insurers can choose which plans to offer, but they must all provide Plan A and either Plan C or F.