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Overview of Medicare Supplement Plans

Sometimes it’s hard to sort through medical supplement plans. You know you need to fill some of the gaps the Original Medicare leaves to address all your needs, but with what?

Medicare will not pay for all of the health services you might need, and those gaps in health coverage may drive you to find a Medigap plan. Medigap plans help you pay for the services you need that are not provided by Medicare.

To obtain a Medigap policy, you need to speak with a private insurance company. This isn’t as scary as it may sound. Every insurer offers the same standard Medigap insurance plans. There are 11 in all, and they are labeled A-N. Each of the plans offers something different, and most people don’t find it too difficult to find the one that suits their specific concerns. All 11 standard Medigap policies cover basic benefits, but each one has extra benefits that differ depending on the plan and offers variable prices depending on where you purchase your coverage.

Coverage-wise, it does not matter where you buy a Medigap plan, because offerings are uniform nationwide. The only differences you may encounter are premium variables. However, Medigap plans follow different standards for customers in Wisconsin, Massachusetts and Minnesota.

Standard Medigap policies do not cover prescription drugs, glasses, vision care, dental care, private-duty nursing, hearing aids or long-term care to assist with toileting, bathing, eating or dressing.

You may also want to consider Medicare SELECT, if it is available in your state. Medicare SELECT is cheaper than standard Medigap plans but restricts you to certain hospitals and doctors.

Overview of Basic Benefits for Medigap

All Medigap plans offer the following basics. Benefits for plans K-L offer similar services to plans A-G, but cost-sharing levels are different.

Medicare Part A: When your deductible is paid, Medicare pays hospital bills for up to 60 days in a benefit period. If the stay is longer than 60 days, you pay a different price per day, which varies each year. Stays over 90 days in a benefit period are still more expensive. Check your insurance coverage for specific rates.

All 11 Medigap plans cover hospital days you need after Medicare’s 60 have passed (up to 150 total days). Once you pass 150 days of care, the plan will only cover 365 more days in your lifetime. With high-deductible Plan F, the upfront deductible must be paid first. With Plans K,L or M, you pay a portion of the deductible before cost recovery. Medigap also picks up the tab for the 5 percent co-insurance for respite and palliative care under part A.

Medicare Part B: When your deductible is paid, Medicare usually pays 80 percent of medical and doctor care, 50 percent of mental health care and 100 percent of some preventive service costs.
Medigap pays part or all of your share of these services (20 percent of the approved amount for care by a physician and 50 percent for mental health care). All Medigap plans offer preventive care and cover any co-insurance for Part B services.

Medicare does not cover the first three pints of blood you may need each year.
Medigap Plans A-D, F-G and M-N do pay for them. Plan K offers 50 percent coverage, and plan L allows for 75 percent of the expense.

Further benefits are available, and it is best to speak to a qualified insurance agent or broker in order to determine what coverage is best for you and your living circumstances.

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