Senior Health Insurance Article

Medicare Supplemental Insurance Plans

Medicare supplemental insurance plans are privately sold insurance policies that have been standardized by the Federal government and designed to fill in the gaps left by standard Medicare coverage.  These policies are commonly called Medigap plans.  There are currently 12 Medigap plans offered for sale and these are named for the letters of the alphabet A through L. 

As you look through the list, it is important to understand that, even though many different companies may sell a Medigap plan D, all Medigap plan Ds offer the exact same set of benefits.  This is true for all A plans, B plans and so on through plan L.  Note that this does not mean that they are all sold at the same price, however!

Basic Benefits Included in All Medigap Plans

$267 per day for coinsurance for your 61st through 90th day in the hospital (2009)

$534 per day for coinsurance for your 91stA>?,??__150th day in the hospital (2009)

Total cost of 365 extra hospital days in your lifetime, after you have used all Medicare hospital benefits

All coinsurance and co-payment costs after you satisfy the $135 yearly deductible for Medicare Part B

Additionally, all Medigap plans must cover the cost of the first three pints of blood under its basic benefits.

While all medicare supplemental plans cover the above basic benefits, all but plan A offer additional benefits as outlined below.

Medigap Plan A

Medigap plan A only covers those basic benefits listed above.

Medigap Plan B

Basic benefits

Medicare Part A hospital deductible: $1,024 (2008) for each benefit period for hospital services

Medigap Plan C

Basic benefits

Medicare Part A hospital deductible

Skilled nursing home costs: your cost ($128 in 2008) for days 21-100 in a skilled nursing home

Medicare Part B deductible: yearly deductible for doctor services ($135 in 2008)

Foreign travel emergency

  o 80% of the cost of emergency care outside the U.S.
  o Up to $50,000 during your lifetime
  o You pay a yearly deductible of $250

Medigap Plan D

Basic benefits

Medicare Part A hospital deductible

Skilled nursing home costs

Foreign travel emergency

  o 80% of the cost of emergency care outside the U.S.
  o Up to $50,000 during your lifetime
  o You pay a yearly deductible of $250

At-home recovery

  o Help for activities of daily living (bathing, dressing) if you are already receiving skilled home care covered by Medicare
  o Help for up to eight weeks after you no longer need skilled care
  o Up to $40 per visit, seven visits per week, or a total of $1,900 per year

Medigap Plan E

Basic benefits

Medicare Part A hospital deductible

Skilled nursing home costs

Foreign travel emergency

  o 80% of the cost of emergency care outside the U.S.
  o Up to $50,000 during your lifetime
  o You pay a yearly deductible of $250

Preventive Care: Up to $120 per year for preventive services not covered by Medicare

Medigap Plan F*

Basic benefits

Medicare Part A hospital deductible

Skilled nursing home costs

Medicare Part B deductible

Medicare Part B excess charges: pays 100% of the difference between your doctor’s charge and the Medicare approved amount, if your doctor does not accept assignment

Foreign travel emergency

  o 80% of the cost of emergency care outside the U.S.
  o Up to $50,000 during your lifetime
  o You pay a yearly deductible of $250

Medigap Plan G

Basic benefits

Medicare Part A hospital deductible

Skilled nursing home costs

Medicare Part B excess charges: pays 80% of the difference between your doctor’s charge and the Medicare approved amount, if your doctor does not accept assignment

Foreign travel emergency

  o 80% of the cost of emergency care outside the U.S.
  o Up to $50,000 during your lifetime
  o You pay a yearly deductible of $250

At-home recovery

  o Help for activities of daily living (bathing, dressing) if you are already receiving skilled home care covered by Medicare
  o Help for up to eight weeks after you no longer need skilled care
  o Up to $40 per visit, seven visits per week, or a total of $1,900 per year

Medigap Plan H

Basic benefits

Medicare Part A hospital deductible

Skilled nursing home costs

Foreign travel emergency

  o 80% of the cost of emergency care outside the U.S.
  o Up to $50,000 during your lifetime
  o You pay a yearly deductible of $250

Medigap Plan I

Basic benefits

Medicare Part A hospital deductible

Skilled nursing home costs

Medicare Part B excess charges: pays 100% of the difference between your doctor’s charge and the Medicare approved amount, if your doctor does not accept assignment

Foreign travel emergency

  o 80% of the cost of emergency care outside the U.S.
  o Up to $50,000 during your lifetime
  o You pay a yearly deductible of $250

At-home recovery

  o Help for activities of daily living (bathing, dressing) if you are already receiving skilled home care covered by Medicare
  o Help for up to eight weeks after you no longer need skilled care
  o Up to $40 per visit, seven visits per week, or a total of $1,900 per year

Medigap Plan J*

Basic benefits

Medicare Part A hospital deductible

Skilled nursing home costs

Medicare Part B deductible

Medicare Part B excess charges: pays 100% of the difference between your doctor’s charge and the Medicare approved amount, if your doctor does not accept assignment

Foreign travel emergency

  o 80% of the cost of emergency care outside the U.S.
  o Up to $50,000 during your lifetime
  o You pay a yearly deductible of $250

At-home recovery

  o Help for activities of daily living (bathing, dressing) if you are already receiving skilled home care covered by Medicare
  o Help for up to eight weeks after you no longer need skilled care
  o Up to $40 per visit, seven visits per week, or a total of $1,900 per year

Preventive care

Medigap Plan K**

Basic benefits

100% of Part A coinsurance plus coverage for 365 days after Medicare benefits end

50% hospice cost-sharing

50% of Medicare-eligible expenses for the first three pints of blood

50% Part B coinsurance after you meet the yearly deductible for Medicare Part B, but 100% coinsurance for Part B preventive services

50% of skilled nursing home coinsurance

50% of Medicare Part A hospital deductible

Annual out of pocket limit of $4,440 (2008).

Medigap Plan L**

Basic benefits

100% of Part A coinsurance plus coverage for 365 days after Medicare benefits end

75% hospice cost-sharing

75% of Medicare-eligible expenses for the first three pints of blood

75% Part B coinsurance after you meet the yearly deductible for Medicare Part B, but 100% coinsurance for Part B preventive services

75% of Skilled nursing home coinsurance

75% of Medicare Part A hospital deductible

Annual out of pocket limit of $2,220 (2008).

*Plans F and J also have a “high deductible option.” If you choose the “high deductible option” on Medigap Plans F and J, you will first have to pay a $1,900 deductible (2008) before the plan pays anything. This amount can go up every year. High deductible policies do have lower premiums, but if you get sick, your costs will be higher.

**The basic benefits for plans K and L include similar services as plans A-J, but the cost-sharing for the basic benefits is at different levels. The annual out-of-pocket limit increases each year for inflation.

In addition to the A-L standard 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. Click here if you want to learn more or to sign up for Medigap Policies.