Medicare Supplement Insurance (Medigap)
Medigap (Medicare Supplement Insurance) for Original Medicare
Medicare Supplement Insurance, also known as Medigap plans, provides private health insurance plans that can help cover original Medicare payment “gaps”. Medigap can help pay for co-payments, coinsurance, and deductibles.
What does a Medigap Plan cover?
Medicare Supplement plans are designed to help pay for the costs that you would normally pay out of your own pocket. But the costs and benefits will depend on which plan you select.
The 10 standard Medicare Supplement insurance plans
There are 10 Medicare supplement insurance plans. Each plan is labeled with a letter of the alphabet and has a different combination of benefits. Plan F has a high-deductible option. Plans K, L, M, and N have different cost-sharing components.
Every company must offer Plan A. If they offer other plans, they must offer Plan C or Plan F.
The 10 Medicare supplement plans (plans A, B, C, D, F, G, K, L, M, and N) provide these benefits:
- Pays your daily co-payments for hospitalization expenses from the 61st through the 90th day of the Medicare benefit period.
- Pays the Medicare Part A co-payments for any hospital confinement beyond the 90th day in a benefit period, up to an additional 60 days during your lifetime. (These are your inpatient reserve days. You may use these days when you require more than 90 days in the hospital during a benefit period. When you use a reserve day, it is subtracted from your lifetime total and can’t be used again.)
- Pays the Medicare Part A coinsurance plus coverage for 365 additional days after Medicare benefits end.
- Pays the skilled nursing facility care coinsurance.
Pays the co-payment for outpatient pain medications and the coinsurance for inpatient respite care. Plans K and L pay this cost at a different rate. You must meet Medicare’s requirements, including getting a doctor’s certification of a terminal illness.
After you’ve met your Part B deductible, pays your portion of the 20%Part B coinsurance for doctor bills, hospital or home health care, and some other Medicare-eligible expenses. Plans K, L, and N require you to pay part of the 20% Part B coinsurance.
Pays for the first three pints of blood each year under Medicare parts A and B.
- Plans B, C, D, F, G, and N pay the entire Part A deductible. Plans K, L, and M pay a percentage of the Part A deductible. Out-of-pocket limits apply to plans K and L.
- Plan N requires a $20 co-payment for most office visits and $50 for emergency room visits.
- Plans C and F pay the Part B deductible.
- Plans C, D, F, G, M, and N pay for skilled nursing facility care co-payments from the 21st day through the 100th day in a benefit period for post-hospital skilled nursing facility care eligible under Medicare Part A. This is not custodial care. Plans K and L pay a portion of the cost until you meet the annual out-of-pocket limits. The plan will then pay 100%.
- Plans C, D, F, G, M, and N pay for emergency care while traveling outside the United States. They pay 80% of the charges that Medicare would pay if you were in the United States. Care must begin during your first 60 days outside the United States. The calendar year deductible is $250. The lifetime maximum benefit is $50,000.
- Plans F and G pay Medicare Part B excess doctor charges that Medicare doesn’t pay. They pay 100% of the excess fees, which are limited to 15% above the Medicare-approved amount.
Medicare (Medigap) Supplement Plans
Medicare supplement plans are standardized at both the federal & state level and offer all the same basic benefits but each plan will offer additional benefits, so you can choose a plan best suited to your needs.
Some Medigap plans offer coverage for services not usually part of Original Medicare, like travel outside the U.S. Remember: Medigap policies will not work with Medicare Advantage plans unless an enrollee switches back to the Original Government Medicare plan.
Furthermore, please note that some insurers work for employers or unions that pay for additional insurance that the Government Medicare policy does not cover.
Finally, as you can see, picking the right plan is not an easy task without lots of research and training. Call me to navigate through the many plans and as I can help you make the right choice.