BENEFITS OF MEDIGAP PLANS

A Medigap policy is private health insurance that helps supplement Original Medicare. This means it helps pay some of the health care costs that Original Medicare doesn’t cover (like copayments, coinsurance, and deductibles).

Basic Benefits of Medigap

Hospitalization
Hospitalization

Part A coinsurance plus coverage for 365 additional days after Medicare benefits end.

Medical Expenses
Medical Expenses

Part B coinsurance (generally 20% of Medicare-approved expenses) or copayments for hospital outpatient services. Plans K, L, and N require insureds to pay a portion of Part B coinsurance or copayments.

Blood
Blood

Medigap covers for the first three pints of blood each year.

Hospice
Hospice

Part A coinsurance.

Medicare Benefits

Hospital Insurance
(Part A)

Inpatient Hospital Day 1 Through Day 60
$1,316 Deductible for first stay during a year

Day 61 Through Day 90
$329 Per Day 61 Through 90

60 Day "Lifetime Reserve"
$658 Per Day

Skilled Nursing Facility Day 1 through Day 20
$0 Day 1 Through Day 20

Day 21 through Day 100
$164.50 Day 21 Through Day 100

Hospice Care For Terminally Ill
Nominal Coinsurance For Drugs And Respite Care

Medical Insurance
(Part B)

Annual Deductible
$183

Physician And Other Medical Services
20% Of Medicare Approved Amount

Outpatient Hospital Care
20% Of Medicare Approved Amount

Ambulatory Surgical Services
20% Of Medicare Approved Amount

Laboratory Services
$0.00

Outpatient Mental Health Services
68.75% Of Medicare Approved Amount

* Part B annual increases are based on Part B medical cost increases and are related to income levels.

Medicare Supplement Benefit Comparison

MEDIGAP BENEFITS A B C D F/F* G K L M N
Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up Check Check Check Check Check Check Check Check Check Check
Part B coinsurance or copayment Check Check Check Check Check Check 50% 75% Check Check
Blood (first 3 pints) Check Check Check Check Check Check 50% 75% Check Check
Part A hospice care coinsurance or copayment Check Check Check Check Check Check 50% 75% Check Check
Skilled nursing facility care coinsurance - - Check Check Check Check 50% 75% Check Check
Part A deductible - Check Check Check Check Check 50% 75% 50% Check
Part B deductible - - Check - Check - - - - -
Part B excess charges - - - - Check Check - - - -
Foreign travel exchange (up to plan limits) - - 80% 80% 80% 80% - - 80% 80%
Out-of-pocket limit N/A N/A N/A N/A N/A N/A $5,120 $2,560 N/A N/A

*Plan F also has an option called a high deductible plan F. This high deductible plan pays the same benefits as Plan F after one has paid a calendar year [$2,200] deductible. Benefits from high deductible plan F will not begin until out-of-pocket expenses exceed [$2,200]. Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy. These expenses include the Medicare deductibles for Part A and Part B, but do not include the plan's separate foreign travel emergency deductible.

Medigap FAQs

Plan E was eliminated because the new Plan D would contain exactly the same benefits. Plans H, I and J were eliminated because with the other dropped benefits these plans would also duplicate other plans available.

Any plan that was purchased prior to June 2010 will remain inforce. Keep in mind these new plans are for new issues with effective dates of June 2010 and beyond. Your clients’ current Medigap plan is guaranteed renewable for life. Even if their health changes, they cannot be terminated or forced to change to one of the new plans.

All plans will now include the Hospice Benefit as part of the “Core Benefits.” Medicare provides coverage for inpatient respite care up to 5 days less a co-payment amount of 5% of the daily benefit. The new Hospice benefit will pick up this 5% co-pay.

It was determined that the benefit was confusing and difficult to understand and administer.

Because Medicare Part B has changed to cover many more preventive benefits, effectively rendering this benefit redundant.