What Does Medicare Supplement Insurance Cover?

A Medicare Supplement (Medigap) policy is private medical insurance that covers some of the gaps in Original Medicare. There are 11 federally standardized plans available. Each Medigap plan is represented by a letter: A, B, C, D, F, G, K, L, M, N, and a high-deductible version of Plan F.

Fast Facts About Medicare Supplement Policies

By federal law, all insurance companies that sell Medicare Supplement policies must offer Plan A (core coverage benefits). Additionally, if a company offers additional plans, it must also offer either Plan C and/or Plan F.

Each of the standardized plans provide the same basic benefits. In this way, a Plan A policy sold by Health Net in San Diego, California will have the same benefits as a Plan A policy from AARP in Tampa, Florida. All Medicare Supplement plans offer the same basic set of coverages, which includes Medicare Parts A and B coinsurance or copayment amounts, blood, and additional hospital benefits not covered by Original Medicare.

In many states, you can purchase a supplement policy called Medicare SELECT. These policies follow the standards of regular Medigap plans. The difference is that the provider requires you to use their network providers, much like a traditional HMO or PPO. The benefit is a significant cost savings on the monthly premium.

Please note that Plans D and G purchased on or after June 1, 2010, have different benefits than the same plans purchased before June 1, 2010. Also, Plans E, H, I, and J were discontinued and can no longer be sold. If you have one of these plans you can keep it or purchase a new policy. The standardized plans do not apply in Massachusetts, Minnesota and Wisconsin.

Part A Expense Covered by Medigap

  • Coinsurance for hospital stays. All Medigap plans cover the coinsurance on hospital costs, up to an additional 365 days after

    your Original Medicare hospital benefits have run out.

  • Copayment or coinsurance for hospice care: Medigap plans cover 50 to 100 percent of your copayments and coinsurance for Part A hospice care expenses, depending on the plan option you choose.
  • Medicare Part A deductible: Although Plan A does not cover the deductible, the remaining plans cover 50 to 100 percent of this cost.

Part B Expenses Covered by Medigap

  • Copayment or coinsurance: Medicare supplements pay for 50 to 100 percent of your Part B copayment and coinsurance amounts (based on the plan).
  • Medicare Part B deductible: Only plans C and F cover the deductible making them the two most popular plans.
  • Part B excess charges: When a healthcare provider declines Medicare’s “assignment” for a particular procedure or visit, Part B excess charges will be incurred. These excess charges are only covered by Medigap plans F and G.

Foreign Travel Coverage

Medicare provides coverage in the United States and its territories only. For this reason some of the Medigap plans cover foreign travel emergencies (up to the plan limits). If you travel you may want to consider Plans C, D, F, G, M, and N.

Blood

Original Medicare only pays for blood after the third pint. Most hospitals receive blood from subsidized blood banks at no cost. However, in the even a hospital must purchase additional blood for you, then you will be charged. All Medicare supplement plans cover up to 100 percent of the cost for the first three pints of blood.

Skilled Nursing

Skilled nursing facilities are healthcare facilities providing short- and long-term care for people with critical medical conditions that can’t be managed at home. While coinsurance for skilled nursing care is not covered by Plans A or B, all other plans cover 50 to 100 percent of these costs.

Source: medicarewire.com

Category: Insurance

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