Medicare has many gaps and will not pay for all of your health care related claims. For this reason, many Medicare recipients purchase a supplemental plan to fill in all or the most common gaps.
The chart below details ten standardized Medigap plans and explains the different available coverages. It is important to note that private insurance carriers cannot adjust the coverages below in any way. The only difference between carriers is the price for the chosen plan.
|Part A Hospital Coinsurance||Y||Y||Y||Y||Y||Y||Y||Y||Y||Y|
|Lifetime Reserve Days||Y||Y||Y||Y||Y||Y||Y||Y||Y||Y|
|365 More Hospital Days||Y||Y||Y||Y||Y||Y||Y||Y||Y||Y|
|Parts A and B Blood||Y||Y||Y||Y||Y||Y||50%||75%||Y||Y|
|Part B Coinsurance||Y||Y||Y||Y||Y||Y||50%||75%||Y||Y|
|Part A Hospice Coinsurance||Y||Y||Y||Y||Y||Y||50%||75%||Y||Y|
|Skilled Nursing Coinsurance||Y||Y||Y||Y||50%||75%||Y||Y|
|Part A Deductible|
$1,216 in 2014
|Part B Deductible|
$144 in 2014
|Part B Excess||Y||Y|
|Foreign Travel Emergency||Y||Y||Y||Y||Y||Y||Y|
|Preventive Care Coinsurance||Y||Y||Y||Y||Y||Y||Y||Y||Y||Y|
|Out of Pocket Limit||$4,940||$2,470|
Medicare supplements are offered by private insurance companies through independent agents. Traditional Plan F offers the same coverage no matter the company. First year premiums and renewal premium increases are what differ from company to company. Experienced agents like ours can help consumers choose a suitable plan based on these variables.
Basic benefits are covered by all Medicare Plans A-F. After the hospital deductible has been reached, Medicare pays for hospital costs up to 60 days. After 60 days, Plans A-F pay for days 61-90. After 90 days, Plans A-F pay $608 (in 2014). If all 150 days are used, then all Medigap plans pay for 365 more lifetime hospital days.
After the Part B deductible has been reached, all supplemental plans cover 20% of the Medicare approved amount for doctors services, 50% for mental health services, and 100% for some preventive care services. Additionally, Plans A-F cover the first three pints of blood.
Medigap Plans B-F pay the hospital deductible ($1,216 in 2014) for each benefit period.
Original Medicare pays for the first 20 days of skilled nursing care and a portion of days 21-100. Plans C-F cover the remaining portion not covered by Medicare during days 21-100 ($152 per day in 2014). It is important to note that neither Medicare nor supplemental insurance pays for care beyond day 100. Consequently, many seniors purchase a long term care insurance policy.
Plans C and F cover the Part B deductible for doctor and other medical related services.
Plans F and G pay 100% of doctors charges above and beyond the Medicare approved amount. Doctors who do not accept assignment can charge up to 15% more than what is normally approved.
Medicare will not cover health care services received outside of the United States. Plans C, D, F, and G cover emergency care outside of the U.S. once a $250 deductible has been reached by the insured. This benefits pays 80% of the emergency care expenses up to a $50,000 lifetime maximum.
Older plans D, G, I and J cover at-home health care if skilled home health care covered by Medicare has also been received. Plans cover medical assistance for up to eight weeks after skilled care is no longer needed.
Visits up to $40 a day, seven days a week, up to $1,600 a year is the maximum amount covered. Again, long term care insurance is the best hedge against expensive home health care visits that primarily involve custodial, intermediate or skilled care.
Original Medicare covers some preventive care services, but older Plans E and J cover up to $120 a year in additional services not already covered. An example could be a routine physical.
After changes to existing law, Medigap plans no longer cover prescription drugs. Part D prescription drug coverage is now a separate insurance purchased from private health insurance companies.
Not all plans are exactly alike and monthly premiums, drug co-pays, and plan deductibles can very between companies. Typically, private insurers offer three plans to choose from. The federal government offers comparison services at their website www.medicare.gov so consumers can locate a suitable drug plan.
Category: Medicare Supplements