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Medicare Supplement Policies


A Medicare Supplement Policy (MSP), sometimes referred to as “Medigap”, is a health insurance policy issued by a private insurance company and is designed to fill in some of the gaps in Medicare, gaps attributable to deductibles, co-payment requirements and benefit periods. They are not provided or administered by the federal government, but federal regulations do require the plans to meet certain requirements which eliminate questionable marketing practices and provide a degree of consumer protection. The protections assure that the private insurance companies may not discriminate in pricing or availability of coverage based on health status, claims experience, receipt of health care or medical condition.

It is important to understand that all MSP benefits are the same regardless of which insurance company coverage is placed with.

An open enrollment period is a 6-month period that guarantees the right to buy Medigap coverage once a senior first signs up for Medicare Part B. If a person is eligible for Medicare Supplement plans, coverage is offered on a guaranteed issue basis with no pre-existing conditions exclusion.

Medigap Plans Effective on of after June 1, 2010

With a Medicare Supplement policy, benefits are standardized based on plans identified with the letters A, B, C, D, F, G, K, L, M and N.. Plan A offers only the core benefits (also known as “basic”), which include:

  • Approved hospital costs for the co-payments for days 61 through 90 in any Medicare benefit period. Approved hospital costs for the co-payments for lifetime reserve days 91 through 150.
  • Approved hospital costs for an additional 365 days after all Medicare benefits are used.
  • Hospice Care Coinsurance or co-payment
  • Blood (except for the first 3 pints; must be paid for by the insured or donated).
  • Part B coinsurance or co-payment and Preventative Care Part B coinsurance or co-payment

 

Note: The Medigap policy covers coinsurance only after you have paid the deductible (unless the Medigap policy also covers the deductible).

Additional plans are available with standardized benefits as follows:

Plan B – Core benefits plus Medicare Part A deductible.

Plan C – Core benefits, Medicare Part A deductible, skilled nursing facility coinsurance, Medicare Part B deductible and the foreign travel benefit.

Plan D – Core benefits, Medicare Part A deductible, skilled nursing facility coinsurance, and the foreign travel benefit.

Plan F – Core benefits, Medicare Part A deductible, skilled nursing facility coinsurance, Medicare Part B deductible, 100% of Medicare Part B excess charges, and the foreign travel benefit. Plan F offers a high-deductible plan. This means you must pay for Medicare-covered costs up to the deductible amount of $2,000 in 2010 before your Medigap plan pays anything.

Plan G – Core benefits, Medicare Part A deductible, skilled nursing facility coinsurance, Medicare Part B excess charges, and the foreign travel benefit. This plan must pay for services of activities of daily living (ADL) that Medicare doesn’t cover.

Medicare Supplements K and L are lower premium plans with higher out-of-pocket costs. The core benefits are different in these two plans as well:

Plan K - includes 50% of the Medicare Part A deductible and 50% of skilled nursing facility coinsurance. Reductions in core benefits include 50% of charges for the first 3 pints of blood, 50% of Part B coinsurance, and 50% of hospice cost-sharing and respite care expenses for Part A. Out of Pocket Limit: $4,620. After you meet your out-of-pocket yearly limit and your yearly Part B deductible ($155 in 2010), the Medigap plan pays 100% of covered services for the rest of the calendar year. Out-of-pocket limit is the maximum amount you would pay for coinsurance and co-payments.

Plan L - includes 75% of the Medicare Part A deductible and 75% of skilled nursing facility coinsurance. Reductions in core benefits include 75% of charges for the first 3 pints of blood, 75% of Part B coinsurance, and 75% of hospice cost-sharing and respite care expenses for Part A. Out of Pocket Limit: $2,310. After you meet your out-of-pocket yearly limit and your yearly Part B deductible ($155 in 2010), the Medigap plan pays 100% of covered services for the rest of the calendar year. Out-of-pocket limit is the maximum amount you would pay for coinsurance and co-payments.

Plan M - Core benefits, 50% of the Medicare Part A deductible, skilled nursing facility coinsurance, the foreign travel benefit.

Plan N - Core benefits, 100% of the Part B coinsurance except up to $20 co-payment for office visits and up to $50 for emergency department visits, Medicare Part A deductible, skilled nursing facility coinsurance, the foreign travel benefit.

For more information, contact www.medicare.gov, which can provide basic consumer information.

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