Because Medicare does
not pay for all health care services, you have the option of buying
supplemental coverage. Medigap policies are sold by private health insurance companies.
IMedigap
policies can be standardized into 12 plans, lettered A through L,, to
make it easier for consumers to shop for coverage and avoid scams. All
companies that sell Medigap plans must sell at least Plan A, which
offers the "basic benefits." But not all companies offer the full range
of Medigap plans, and some plans might not be available at all in your
state. Insurers in Massachusetts, Minnesota, and Wisconsin are
permitted to sell somewhat different combinations of benefits.
Two of the plans, F and J, have the option of a high deductible and, under federal law, states can allow insurance companies
to add "innovative benefits" to any of the 12 plans. Discounts for
coverage such as eyeglasses or prescription drugs from mail-order
pharmacies are also allowed. In addition, any of the plans can be sold
as a "Medicare SELECT" policy. Those policies generally cost less
because you must use specified hospitals and doctors, except in
emergencies.
Plans H and I offer the basic
prescription-drug benefit. After you pay your $250 per year deductible,
the plan pays 50 percent of the costs of your prescription drugs up to
a maximum of $1,250 per year. Plan J offers the extended
prescription-drug benefit. After you pay your $250 per year deductible,
the plan pays 50 percent of the costs of your prescription drugs up to
a maximum of $3,000 per year.
Medigap plans K and L will
only pay a portion of the cost that Medicare does not cover until you
reach a yearly out-of-pocket limit.
There is one important
consideration to keep in mind: Although the plans themselves are
standardized, the premiums are not. In fact, the costs can vary widely,
even by hundreds of dollars, from one insurer to the next. That means
it is vital to shop around not only for the plan best suited to your
needs but also for cost.
The chart below provides an overview of the benefits offered by each plan.
• Coverage for the Part A co-insurance amount for days 61 through 90 of a hospital stay in each Medicare benefit period
• Coverage for the Part A co-insurance amount for days 91 through
150 of a hospital stay for each of Medicareœs 60 lifetime reserve days,
which may be used only once
• After all Medicare hospital benefits are exhausted, coverage
for 100 percent of the Medicare Part A eligible hospital expenses.
Coverage is limited to a maximum of 365 days of additional inpatient
hospital care during your lifetime. You may be responsible for payment
when Medigap hospital benefits are exhausted
• Coverage under Medicare parts A and B for the reasonable cost
of the first 3 pints of blood or equivalent quantities of packed red
blood cells per calendar year unless this blood is replaced
• Coverage for the co-insurance amount for Part B services
(generally 20 percent of Medicare-approved amount) after annual
deductible is met
• All the basic benefits of Plan A
• Coverage for the Medicare Part A inpatient hospital deductible
• All the basic benefits of Plan A
• Coverage for the Medicare Part A inpatient hospital deductible
• Coverage for the skilled-nursing facility co-insurance amount
• Coverage for the Medicare Part B deductible
• 80 percent coverage for medically necessary emergency care in a foreign country, after a deductible
• All the basic benefits of Plan A
• Coverage for the Medicare Part A inpatient hospital deductible
• Coverage for the skilled-nursing facility co-insurance amount
• 80 percent coverage for medically necessary emergency care in a foreign country, after a deductible
• Coverage for at-home recovery. The at-home recovery benefit
pays an amount per year for short-term, at-home assistance with
activities of daily living (like bathing, dressing, personal hygiene,
etc.) for those recovering from an illness, injury, or surgery
• All the basic benefits of Plan A
• Coverage for the Medicare Part A inpatient hospital deductible
• Coverage for the skilled-nursing facility co-insurance amount
• 80 percent coverage for medically necessary emergency care in a foreign country, after a deductible
• Coverage for preventive medical care. The preventive medical
care benefit pays an amount per year for things like a physical exam,
serum cholesterol screening, hearing test, diabetes screening, and
thyroid function test
• All the basic benefits of Plan A
• Coverage for the Medicare Part A inpatient hospital deductible
• Coverage for the skilled-nursing facility co-insurance amount
• Coverage for the Medicare Part B deductible
• 80 percent coverage for medically necessary emergency care in a foreign country, after a deductible
• Coverage for 100 percent of Medicare Part B excess charges
• All the basic benefits of Plan A
• Coverage for the Medicare Part A inpatient hospital deductible
• Coverage for the skilled-nursing facility co-insurance amount
• 80 percent coverage for medically necessary emergency care in a foreign country, after a deductible
• Coverage for at-home recovery. The at-home recovery benefit pays
an amount per year for short-term, at-home assistance with activities
of daily living (like bathing, dressing, personal hygiene, etc.) for
those recovering from an illness, injury, or surgery
• Coverage for 80 percent of Medicare Part B excess charges
• All the basic benefits of Plan A
• Coverage for the Medicare Part A inpatient hospital deductible
• Coverage for the skilled-nursing facility co-insurance amount
• 80 percent coverage for medically necessary emergency care in a foreign country, after a deductible
• All the basic benefits of Plan A
• Coverage for the Medicare Part A inpatient hospital deductible
• Coverage for the skilled-nursing facility co-insurance amount
• 80 percent coverage for medically necessary emergency care in a foreign country, after a deductible
• Coverage for at-home recovery. The at-home recovery benefit
pays an amount per year for short-term, at-home assistance with
activities of daily living (like bathing, dressing, personal hygiene,
etc.) for those recovering from an illness, injury, or surgery
• Coverage for 100 percent of Medicare Part B excess charges
• All the basic benefits of Plan A
• Coverage for the Medicare Part A inpatient hospital deductible
• Coverage for the skilled-nursing facility co-insurance amount
• Coverage for the Medicare Part B deductible
• 80 percent coverage for medically necessary emergency care in a foreign country, after a deductible
• Coverage for at-home recovery. The at-home recovery benefit
pays up to an amount per year for short-term, at-home assistance with
activities of daily living (like bathing, dressing, personal hygiene,
etc.) for those recovering from an illness, injury, or surgery
• Coverage for 100 percent of Medicare Part B excess charges
• Coverage for preventive medical care. The preventive medical
care benefit pays up to an amount per year for things like a physical
exam, serum cholesterol screening, hearing test, diabetes screening,
and thyroid function test
• All the basic benefits of Plan A
• Coverage for the Medicare Part A inpatient hospital deductible
• 50% coverage for the skilled-nursing facility co-insurance amount
• 50% coverage for Medicare Part B Coinsurance or Copayment
• 50% coverage for Hospice Care Coinsurance or Copayment
• 50% coverage for Skiled Nursing Facility Care Coinsurance
• Preventive Care Coinsurance (Included in Part B Coinsurance)
• 2008 out-of-pocket-limits: $4,440.00
• All the basic benefits of Plan A
• Coverage for the Medicare Part A inpatient hospital deductible
• 75% coverage for the skilled-nursing facility co-insurance amount
• 75% coverage for Medicare Part B Coinsurance or Copayment
• 75% coverage for Hospice Care Coinsurance or Copayment
• 75% coverage for Skiled Nursing Facility Care Coinsurance
• Preventive Care Coinsurance (Included in Part B Coinsurance)
• 2008 out-of-pocket-limits: $2,220.00
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