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Medicare
Supplements
Medicare Supplemental Insurance (Medigap) is specifically designed to
supplement Medicare's benefits and is regulated by federal and state law, It
must be clearly identified as Medicare supplemental insurance and it must
provide specific benefits that help fill the gaps in your Medicare coverage.
Other kinds of insurance may help you with out-of-pocket health care costs but
they do not qualify as Medigap plans.
Standard Medigap Plans: To make it easier for you to compare Medigap
insurance policies, all states (except Minnesota, Massachusetts and Wisconsin),
U.S. territories and the District of Columbia limit the number of different
Medigap policies that can be sold in any of those jurisdictions to no more than
12 standard Medigap plans. The plans were developed by the National Association
of Insurance Commissioners and incorporated into state and federal law. They
have letter designations ranging from "A" through "L," with Plan A being the
"basic" benefit package. Each of the other 11 plans includes the basic package
plus a different combination of additional benefits.
The 12 Standard Medicare Supplement Plans
The following is a list
of the 12 standard plans and benefits provided by each.
PLAN A
- (the basic policy) consists of these core benefits:
Coverage for the Part A coinsurance amount
($238 per day in 2006) for the 61st
through the 90th
day of hospitalization in each Medicare
period.
Coverage for the Part A lifetime reserve
days coinsurance amount ($476 per day in 2006) for the 91st
through the 150th
day of Medicare's 60 non-renewable lifetime
hospital inpatient reserve days used.
After all Medicare hospital benefits are
exhausted, coverage for 100% of the Medicare Part A eligible hospital
expenses. Coverage is limited to a maximum of 365 days of additional inpatient
hospital care during the policyholder's lifetime. This benefit is paid either
at the rate Medicare pays hospitals under its Prospective Payment System (PPS)
or under another appropriate standard of payment for hospitals not subject to
the PPS. Beneficiaries may be responsible for payment when Medigap hospital
benefits are exhausted.
Coverage under Medicare Parts A & B for the
reasonable cost of the first 3 pints of blood or equivalent quantities of
packed red blood cells per calendar year unless replaced in accordance with
federal regulations.
Coverage for the coinsurance amount for
Part B services (generally 20% of approved amount) after the $124 annual
deductible; 50% coverage of approved charges for outpatient mental health
services after Part B deductible is met.
PLAN B
- includes the core benefits in Plan A PLUS:
Coverage for the Medicare Part A inpatient
hospital deductible ($952 per benefit period in 2006).
PLAN C
- Includes the core benefits in Plan A PLUS:
Coverage for the Medicare Part A deductible
($952).
Coverage for the skilled nursing facility
coinsurance ($119 per day for the 21st
through the 100th
day per benefit period in 2006).
Coverage for the Medicare Part B deductible
($124 per calendar year in 2006).
80% coverage for the medically necessary
emergency care in a foreign country after a $250 deductible.
PLAN D
- includes the core benefits in Plan A PLUS:
Coverage for the Medicare Part A deductible
($952).
Coverage for the skilled nursing facility
care daily coinsurance amount ($119).
Coverage for medically necessary emergency
care in a foreign country (see Plan C for description).
Coverage for at-home recovery. The at-home
recovery benefit pays up to $1600 per year for short-term, at-home assistance
with activities of daily living (bathing, dressing, personal hygiene, etc.)
for those recovering from an illness, injury or surgery.
PLAN E
- includes the core benefits in Plan A PLUS:
Coverage for the Medicare Part A
deductible.
Coverage for the skilled nursing facility
care daily coinsurance amount.
Coverage for medically necessary emergency
care in a foreign country.
Coverage for preventive medical care. The
preventive medical care benefit pays up to $120 per year for such things as
physical exams, serum cholesterol screening, hearing test, diabetes
screenings, and thyroid function test.
PLAN F
- includes the core benefits in Plan A PLUS:
Coverage for the Medicare Part A
deductible.
Coverage for the skilled nursing facility
care daily coinsurance amount.
Coverage for the Medicare Part B
deductible.
Coverage for medically necessary emergency
care in a foreign country.
Coverage for 100% of Medicare Part B excess
charges (see page 11 - Limiting Charge).
PLAN G
- includes the core benefits in Plan A PLUS:
Coverage for the Medicare Part A
deductible.
Coverage for the skilled nursing facility
care daily coinsurance amount.
Coverage for 80% of Medicare Part B excess
charges.
Coverage for medically necessary emergency
care in a foreign country.
Coverage for at-home recovery (see Plan D
for description).
PLAN H
- includes the core benefits in Plan A PLUS:
Coverage for the Medicare Part A
deductible.
Coverage for the skilled nursing facility
care daily coinsurance amount.
Coverage for medically necessary emergency
care in a foreign country.
PLAN I
- includes the core benefits in Plan A PLUS:
Coverage for the Medicare Part A
deductible.
Coverage for the skilled nursing facility
care daily coinsurance amount.
Coverage for 100% of Medicare Part B excess
charges.
Coverage for medically necessary emergency
care in a foreign country.
Coverage for at-home recovery (see Plan D
for description).
PLAN J
- includes the core benefits in Plan A PLUS:
Coverage for the Medicare Part A
deductible.
Coverage for the skilled nursing facility
care daily coinsurance amount.
Coverage for the Medicare Part B
deductible.
Coverage for 100% of Medicare Part B excess
charges.
Coverage for medically necessary emergency
care in a foreign country.
Coverage for preventive medical care (see
Plan E for description).
Coverage for at-home recovery (see Plan D
for description).
PLAN K
- includes the core benefits in Plan A with the following
differences:
Coverage of the $238 coinsurance in 2006
for days 61-90 at 100%.
Coverage of the $476 coinsurance in 2006
for days 91-150 at 100%.
Coverage of the Part B coinsurance paid at
10%.
Coverage of the $952 Part A deductible in
2006 paid at 50%.
Coverage of the $119 skilled nursing
facility daily coinsurance in 2006 paid at 50%.
Annual blood deductible (first 3 pints of
nonreplaced blood in a calendar year) paid at 50%.
Coinsurance for other Medicare Part B
approved expenses paid at 10% of Medicare approved charges.
Coinsurance for certain benefits under
Medicare Hospice benefit paid at 50%.
NOTE:
Plan K limits your annual out-of-pocket payments
for Medicare-approved amounts to $4000 per year. However, this amount does NOT
include charges from your provider that exceed Medicare approved amounts (these
are called “Excess Charges”) and you will be responsible for paying this
difference in the amount charged by your provider and the amount paid by
Medicare for the item or service up to the limiting charge (15% above the
Medicare Approved Amount).
PLAN L
- includes the core benefits in Plan A with the following
differences:
Coverage of the $238 coinsurance in 2006
for days 61-90 at 100%.
Coverage of the $476 coinsurance in 2006
for days 91-150 at 100%.
Coverage of the Part B coinsurance paid at
15%.
Coverage of the $952 Part A deductible in
2006 paid at 75%.
Coverage of the $119 skilled nursing
facility daily coinsurance in 2006 paid at 75%.
Annual blood deductible (first 3 pints of
nonreplaced blood in a calendar year) paid at 75%.
Coinsurance for other Medicare Part B
approved expenses paid at 15% of Medicare approved charges.
Coinsurance for certain benefits under
Medicare Hospice benefit paid at 75%.
NOTE:
Plan L limits your annual out-of- pocket payments
for Medicare-approved amounts to $2000 per year. However, this amount does NOT
include charges from your provider that exceed Medicare approved amounts (these
are called “Excess Charges”) and you will be responsible for paying this
difference in the amount charged by your provider and the amount paid by
Medicare for the item or service up to the limiting charge (15% above the
Medicare Approved Amount).
To learn more about coverage
in your state, or for more information concerning Medicare Supplements, please
call 800-426-2058, or fill out the short form below and an agent will contact
you within 24 hours.
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