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What is Supplemental Coverage (Medigap)?

Did you know that that there are Out Of Pocket costs associated with Medicare A & B coverage?
Medicare Supplement policies are designed to cover the gaps in Medicare A & B benefits. There are multiple Medicare Supplement plans but each one is defined by Medicare and all Insurance Companies selling these Medicare Supplement policies have to sell identical benefits and cover any hospital or physician covered by Medicare.

Medicare Part A : You normally will not have to pay a premium for Part A (Hospital insurance) if you or your spouse paid Medicare taxes.

Part A pays for Hospital, Skilled Nursing and Nursing home care.

Medicare Part B: The premium is $104.90 per month for most people in 2013. Part B pays for medically necessary services and preventive services.

Both Part A and Part B insurance has coverage limitations, coinsurance and co-pays. In absence of Medicare Supplement plan, these are medical costs that have to be paid out of pocket. ----------- There are a number of Medicare Supplement plans available that can be purchased to pay for out of pocket medical costs. Each of these plans have mandated benefits and all Insurance Companies are required to include the required benefits in the plans offered.

Standard Medicare Supplement Benefits

Medicare Supplement insurance can be sold in only ten standard plans. The chart below shows the benefits included in each plan.  (For more details read Federal Brochure for Choosing a Medigap Policy or click here.) Basic Benefits are included in all plans. They include:

  • Hospitalization, Part A coinsurance plus coverage for 365 additional days during your lifetime after Medicare benefits end.
  • Medical Expenses, Part B coinsurance generally (20% of Medicare approved expenses).
  • Blood, first three pints of blood each year.
  • Hospice Care, Covers Part A Coinsurance year.

* Plan F also has a high deductible options, some companies may offer this option.
** Plans K & L pay 100% of covered services for the rest of the calendar year after you meet your out-of-pocket yearly limit.
*** Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50         copayment for emergency room visits that don't result in an inpatient admission.

Medicare Supplemental Plan F

Medicare Supplement Plan F is also called Medigap Plan F. This plan as shown in the Supplement Plan comparison chart is the most comprehensive of the Supplement Plans. Plan F pays the out of pocket Hospital or Doctor Office deductibles or co-pays that you have to pay if you only have Medicare A & B.

Plan F because of it's comprehensive coverage is the most popular of the Medicare Supplement plans.

Plan F Benefits:

  • Basic Benefits, including 100% Part B coinsurance. Basic Benefits also encompasses Part A coinsurance (the 20% that Medicare doesn't cover), plus coverage for an additional 365 days after Medicare benefits end.
  • Blood - First three pints of blood each calendar year.
  • Hospice - Pays Medicare Part A coinsurance (20% that Medicare doesn't pay) for these services.
  • Skilled nursing facility coinsurance. The plan covers the 20% that Medicare doesn't pay for a skilled nursing facility.
  • The Medicare Part A deductible. Plan F pays this deductible.
  • The Medicare Part B deductible. Plan F pays this deductible.
  • Part B Excess charges. If a doctor does not accept the Medicare approved charges, Medicare Supplement Part F, pays the excess; Doctor's bill minus the Medicare Approved Amount.
  • Foreign Travel Emergency. Plan F covers medically necessary emergency care services beginning during the first 60 days of each trip outside the USA. There is a deductible and lifetime limit on this benefit.

Plan F pays the copays, co-insurance and the unlimited 20% Medicare deductible directly to the providers working with Medicare. There is no need for claim forms or separate bills, Plan F automatically works with Medicare system and Medicare covered services.

With Plan F you have Zero out of pocket charges for Medicare Covered Bills.