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

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

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

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

Hospice

Hospice benefit, or Part A, covers the coinsurance for hospice services required by the patient.

Medicare Benefits

Hospital Insurance
(Part A)

Inpatient Hospital Day 1 Through Day 60
$1,632 Deductible for first stay during a year

Day 61 Through Day 90
$408 Per Day 61 Through 90

60 Day "Lifetime Reserve"
$816 Per Day

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

Day 21 through Day 100
$204 Day 21 Through Day 100

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

Medical Insurance
(Part B)

Annual Deductible
$240

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	G/G*	K	L	M	N
Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up
Part B coinsurance or copayment						50%	75%
Blood (first 3 pints)						50%	75%
Part A hospice care coinsurance or copayment						50%	75%
Skilled nursing facility care coinsurance	-	-				50%	75%
Part A deductible	-					50%	75%	50%
Part B deductible	-	-		-	$240	-	-	-	-
Part B excess charges	-	-	-	-		-	-	-	-
Foreign travel exchange (up to plan limits)	-	-	80%	80%	80%	-	-	80%	80%
Out-of-pocket limit	N/A	N/A	N/A	N/A	N/A	$7,060	$3,530	N/A	N/A

*Plan G also has an option called a high deductible plan G. This high deductible plan pays the same benefits as Plan G after one has paid a calendar year [$2,800] deductible. Benefits from high deductible plan G will not begin until out-of-pocket expenses exceed [$2,800]. 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

Why were plans E, H, I and J eliminated?

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.

What will happen if the plan that you have is dropped?

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.

What is the new hospice benefit for Medigap?

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.

Why was the At-Home Recovery benefit dropped?

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

Why was Preventive Care dropped from all plans?

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