Overview of Medicare Supplemental Insurance
By: Source: AARP.org Date Posted: 2006-02-28 09:55:00-05:00
Medicare has several gaps and doesn't pay for all of the health care services you may need. If you are in Original Medicare Plan, you may want to buy Medicare supplemental insurance, also called Medigap insurance. This is health insurance that helps pay for some of your costs in the Original Medicare program and for some care it doesn't cover.
Medigap insurance is sold by private insurance companies. By law, companies can offer only 12 standard Medigap insurance plans — plans named A-L. Each plan has a different set of benefits. (Beginning in 2006, Medigap plans H, I and J cannot be sold with prescription drug benefits, although people who already had those policies can keep them.)
You will want to study all the Medigap plans before deciding which is best for you. No matter which insurance company offers a particular plan, all plans with the same letter cover the same benefits. For instance, all Plan C policies have the same benefits no matter which company sells the plan. However, the premiums can vary.
All 12 Medigap policies cover basic benefits, but each has additional benefits that vary according to the plan. Briefly, Plan A is the most basic plan. Plans B-L offer everything in Plan A and give even more coverage. Plans K-L offer similar services as plans A-J but the cost-sharing for the basic benefits is at different levels.
None of the standard Medigap plans cover:
- long-term care to help you bathe, dress, eat or use the bathroom
- vision or dental care
- hearing aids
- private-duty nursing
- prescription drugs
FYI: If you live in Massachusetts, Minnesota or Wisconsin, you have different standard Medigap plans. Check with your state insurance department or the Guide to Health Insurance for People with Medicare: Choosing a Medigap Policy
FYI: In addition to the standard A-L Medigap policies, Medicare SELECT is a type of Medigap policy that can cost less than standard Medigap plans. However, you can only go to certain doctors and hospitals for your care. Check with your state insurance department to find out if Medicare SELECT policies are available in your state.
Medigap Basic Benefits
Medigap Plan A is the most basic plan. All plans A-J must offer these basic benefits:
Medicare Part A
After you have paid your hospital deductible ($992 in 2007), the Original Medicare Plan pays all your hospital costs for up to 60 days in a benefit period*. If you stay in the hospital more then 60 days, you pay $248 (in 2007) a day for days 61 through 90. Days 91 through 150 cost you $496 (in 2007.)
All 12 Medigap plans cover (pay) your costs for days 61 through 150. In addition, once you use your 150 days of Medicare hospital benefits, all Medigap plans cover the cost of 365 more hospital days in your lifetime. If you have the high-deductible option of plan F or J, you must first pay your annual Medigap deductible before your costs will be covered.
*A benefit period begins the day you go to the hospital and ends when you have been out of the hospital for 60 days in a row. If you go into the hospital again after 60 days have passed, you begin a new benefit period.
Medicare Part B
After you pay your yearly Part B deductible ($131 in 2007), Medicare generally pays 80 percent of doctor and other medical services. It pays 50 percent of mental health services and 100% of some preventive services.
Medigap plans cover all or part of your share of these services—20 percent of the Medicare-approved amount for doctor services and 50 percent for mental health services. (The Medicare approved amount is the amount that Medicare decides is a reasonable payment for a medical service).
Blood
The Original Medicare Plan doesn't cover the first three pints of blood you need each year. Plans A-J pay for these first three pints.
Medigap Extra Benefits
Some people want to have the extra benefits offered by Plans B through J and are willing to pay for more them. Medigap Plans B through J also cover all the basic benefits of Plan A. Plans K and L offer similar services as plans A-J, but the cost-sharing for the benefits is at different levels.
Plans F and J also have a high-deductible option. You will have a lower premium with the high-deductible option, but you will have to pay more out-of-pocket before the policy will begin to pay benefits.
Medicare Part A Hospital Deductible
Medigap Plans B through J cover the hospital deductible ($992 in 2007) for each benefit period. This benefit usually saves you money if you have to stay in the hospital.
Skilled Nursing Home Costs
The Original Medicare Plan pays all of your skilled nursing home costs for the first 20 days of each benefit period. If you are in a nursing home for more than 20 days, you pay part of each day's bill.
Medigap Plans C through J pay your share of the bill ($124 a day in 2007) for days 21 through 100. Neither Medicare nor any Medigap plan pays for any skilled nursing home stay longer than 100 days in a benefit period.
Medicare Part B Deductible
You must pay a deductible each year for doctor and other medical services before Medicare pays.
Medigap Plans C, F, and J pay this deductible. In 2007, the deductible is $131.
Medicare Part B Excess Charges
When you see a doctor who doesn't "accept assignment," he or she doesn't accept Medicare's approved amount as payment in full. The doctor can charge you up to 15 percent more than Medicare's approved amount.
Medigap Plans F, I and J pay 100% of these excess charges. Medigap Plan G pays 80 percent of the excess charges. You might want this benefit if you don't know whether the doctors you see accept assignment, such as when you are in the hospital.
Foreign Travel Emergency
Medicare does not cover any health care you receive outside of the United States. Medigap Plans C through J cover some emergency care outside the United States. After you meet the yearly $250 deductible, this benefit pays 80 percent of the cost of your emergency care during the first 60 days of your trip. There is a $50,000 lifetime maximum.
At-Home Recovery
Medicare covers some skilled home care given by a nurse or a physical, occupational or speech therapist. It does not pay for at-home help for activities of daily living such as bathing and dressing. You pay for this type of care.
Medigap Plans D, G, I, and J cover this type of at-home help if you already are receiving skilled home health care that is covered by Medicare. These plans cover at-home help for up to eight weeks after you no longer need skilled care. However, they will not pay more than $40 per visit, seven visits a week or $1,600 each year.
Preventive Care
Medigap Plans E and J offer this benefit, which is limited to $120 each year. It helps pay for preventive care not covered by Medicare. Since Medicare now covers more preventive care, make sure this benefit is helpful to you.
Prescription Drugs
After January 1, 2006, you can not purchase new Medigap policies covering prescription drugs because private companies approved by Medicare offers this coverage separately. In order to get prescription drug coverage you must enroll in a Medicare Prescription Drug Plan.
Plans K and L
Important: Plans K and L offer similar coverage as plans A-J, but the cost-sharing for the benefits are different levels and have annual limits on how much you pay for services. The out-of-pocket limits are different for plans K and L and will increase each year for inflation. In 2007, the out-of-pocket limit is $4,140 for plan K and $2,070 for Plan L.
Ongoing Coverage
Once you buy a Medigap plan, the insurance company must keep renewing it. The company can't change what the policy covers and can't cancel it unless you don't pay the premium. The company can increase the premium, and should notify you in advance of any increases.
AARP Resources
AARP on Medicare
A series of articles from AARP to help you better understand your Medicare options.
Medigap Listing by Plan
A cross-referenced chart showing the benefits of Medigap policies by type of benefit and by plan.
Additional Resources
Guide to Health Insurance for People with Medicare: Choosing a Medigap Policy
Information about Medigap plans, what they cover and how to choose the best policy.
Medicare Personal Plan Finder
Information on the insurance companies that sell Medigap policies in your area and the range of premiums they charge.
State Health Insurance Assistance Program (SHIP)
How to contact your State Health Insurance Assistance Program (SHIP), an important Medicare partner. Free one-on-one health insurance counseling for people with Medicare.
National Association of Insurance Commissioners (NAIC)
Link to your state insurance department Web site which often lists names and phone numbers of the companies selling Medigap plans in your state.
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