MEDICARE SUPPLEMENTS

With thousands of people turning 65 and aging into Medicare, having the right product and having access to competitive affordable Medicare Supplement plans is important in providing financial security and peace of mind for the senior population.

Standard Medicare Supplement Benefits
Medicare Supplement insurance can be sold in only ten standard plans. The chart below shows the benefits included in each plan.  (For more details read Federal Brochure for Choosing a Medigap Policy )

Basic Benefits are included in all plans. They include:
  • Hospitalization, Part A coinsurance plus coverage for 365 additional days during your lifetime after Medicare benefits end.
  • Medical Expenses, Part B coinsurance generally (20% of Medicare approved expenses).
  • Blood, first three pints of blood each year.
  • Hospice Care, Covers Part A Coinsurance year.

The basic benefits (also known as the "core benefits" or Plan A) are the minimum coverage you may buy. These are the only benefits in Plan A. Every other plan contains these three benefits as the "core" and then adds one or more additional benefits.
  1. Hospitalization: Medicare Part A pays for hospitalizations for the first 60 days, but only pays a portion of the daily costs from the 61st day through the 150th day. You must pay the coinsurance amounts for those days. This Medicare Supplement benefit pays the coinsurance amount and an additional 365 lifetime days.
  2. Blood: Medicare pays for all blood that is medically necessary except for the first three pints in each calendar year. This Medicare Supplement benefit pays for the first three pints of blood not paid for by Medicare.
  3. Medical Expenses: Generally Medicare Part B pays for 80% of a predetermined amount (called the "Medicare approved" amount) for each procedure, supply, or service billed by your doctor or other provider that is not a hospital. This Medicare Supplement benefit pays the coinsurance generally (20% of the "Medicare approved" amount) under Medicare Part B.

Note: Plan A contains only these 3 core benefits.  Although Plan A is the least expensive policy, it may not be a good choice for low-income individuals who may not be able to afford the Medicare Part A hospital deductible when they are hospitalized.

There are five additional benefits that are combined with the basic benefits in various ways to make up the nine remaining plans called Plan B through Plan N.
  1. The Part A Deductible: The Medicare Part A deductible is the expense for which you are obligated to pay when you are admitted to a hospital as an inpatient. Medicare pays eligible benefits above that amount. (The Medicare Part A deductible amount may change yearly, so check the current handbook). This Medicare Supplement benefit reimburses you the deductible amount, no matter what the amount may be. This benefit is included in Plans B through N.
  2. Skilled Nursing Coinsurance: Medicare Part A pays for the first 20 days of care in a skilled nursing facility following hospitalization, but requires you to pay a coinsurance beginning on the 21st day through the 100th day. This Medicare Supplement benefit pays the coinsurance amount beginning on the 21st day. This benefit is included in Plans C through N.
  3. 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 begins paying. (The Part B deductible amount may change per year). This Medicare Supplement benefit reimburses you the deductible amount. This benefit is included in Plan C and Plan F.
  4. Part B Excess Charges: Medicare Part B pays 80% of a predetermined amount (called the "Medicare approved" amount) for each procedure performed by your doctor or other medical care provider. If your doctor accepts Medicare "assignment", the provider may only bill you for the difference between the amount paid by Medicare and the amount approved by Medicare.

If your doctors do not accept Medicare assignment, they may bill you for the difference between the amount paid by Medicare and the amount they can legally charge you (called the "limiting charge"). If you have a Medicare Supplement Policy with the following:
  • Part B Excess Charges (100%) benefit, the policy will pay the full amount billed by your doctors or other providers who do not take Medicare assignment subject to the limiting charge. This benefit is included in Plan F and Plan G.
 
  1. Foreign Travel Emergency: The original Medicare plan does not pay for medical care outside of the United States, but some Medicare managed care plans, private Fee-for-Service plans, and some Medicare Supplement plans do. This Medicare Supplement benefit will pay 80% of your expenses for most emergency medical care in a foreign country during the first 60 days of a trip abroad after you pay a $250 deductible. There is a lifetime maximum benefit, so check your current handbook for the dollar amount. This benefit is in Plan C, Plan D, Plan F, Plan G, Plan M, and Plan N. Check your insurance coverage before you travel.

Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare 

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