The ABCs of Medicare coverage options

The ABCs of Medicare coverage options

 

The ABCs of Medicare coverage options

November 8, 2013 by Michael Schroeder

Original Medicare — Part A and B — provides the foundation of coverage for most beneficiaries. Seniors can enroll in the plan about three months before and after they turn 65, and during open enrollment each year between Oct. 15 to Dec. 7, when they can also change or drop plans. But first they must spoon through the governmental insurance alphabet soup.

What are your options for Medigap insurance plans?

Many seniors choose one of these standardized supplemental Medigap plans sold by private insurers to fill in “gaps” left by original Medicare. Insurers can only sell standardized policies identified by letter in most states and these offer the same basic benefits, though some offer additional benefits. Here are some examples of what the plans cover:*

Medigap Plan A
Covers Part A coinsurance; hospital costs up to 365 days after Medicare benefits are exhausted; hospice coinsurance/copay; Part B coinsurance/copayment; and the first 3 pints of blood.

Medigap Plan B
Coverage similar to Plan A, plus it pays the Part A deductible.

Medigap Plan C
Same as Plan B, plus it pays the $147 Part B deductible and provides coverage for emergency care outside the United States.

Medigap Plan D
Plan A-level coverage, plus foreign travel emergency health care coverage.

Medigap Plan F
Similar to Plan D, plus coverage for Part B excess charges from “non-participating” physicians who don’t accept the program’s approved amount for services. A Plan F high-deductible option is also available.

Medigap Plan G
Same as Plan F, except it doesn’t pay the Part B deductible.

Medigap Plan K
Covers 50 percent of most Part A and B coinsurance and copayments, but not Part B deductible, excess physician charges or foreign travel emergency care. Limits yearly out-of-pocket expenses to $4,800.

Medigap Plan L
Coverage similar to Plan K except at 75 percent. Limits yearly out-of-pocket expenses to $2,400.

Medigap Plan M
Covers Part A coinsurance, hospital costs up to 365 days after Medicare benefits are exhausted, hospice coinsurance or copay; Part B coinsurance and copayment; the first 3 pints of blood; skilled nursing facility care coinsurance; 50 percent of the Part A deductible; and foreign travel emergency care.

Medigap Part N
Similar to Plan M, except it fully covers the Part A deductible. It pays Part B coinsurance, minus copays for some office visits and ER visits that don’t result in inpatient admission.

*In Massachusetts, Minnesota and Wisconsin, Medigap policies are standardized in a different way. Medigap Plans E, H, I, and J are no longer for sale. Source: Medicare.gov

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