MEDICARE SOLUTIONS
Medigap Outline
Medigap Policies
A Medigap policy is a health insurance policy sold by private insurance companies to fill "gaps" in Original Medicare Plan coverage. Medigap policies must follow federal and state laws. These laws protect you. The front of the Medigap policy must clearly identify it as "Medicare Supplement Insurance."
Each policy has a different set of benefits. Two of the standardized policies may have a high deductible option. In addition, any standardized policy may be sold as a "Medicare SELECT" policy. Medicare SELECT policies usually cost less because you must use specific hospitals and, in some cases, specific doctors to get full insurance benefits from the policy. In an emergency, you may use any doctor or hospital.
Outline of Medicare Supplement Coverage
(Benefit Plans A-N)
This chart shows the benefits included in each plan. Every company must make available Plan “A”. Some plans may not be available in your state as indicated below.
| A | B | C | D | F* | G | K | L | M | N | |
| Medicare Part A Coinsurance hospital costs up to an additional 365 days after Medicare benefits are used up | • | • | • | • | • | • | • | • | • | • |
| Medicare Part B Coinsurance or Copayment | • | • | • | • | • | • | 50% | 75% | • | •*** |
| Blood (First 3 pints) | • | • | • | • | • | • | 50% | 75% | • | • |
| Part A Hospice Care Coinsurance or Copayment | • | • | • | • | • | • | 50% | 75% | • | • |
| Skilled Nursing Facility Care Coinsurance | • | • | • | • | 50% | 75% | • | • | ||
| Medicare Part A Deductible | • | • | • | • | • | 50% | 75% | 50% | • | |
| Medicare Part B Deductible | • | • | ||||||||
| Medicare Part B Excess Charges | • | • | ||||||||
| Foreign Travel Emergency (Up to Plan Limits) | • | • | • | • | • | • | ||||
| Out-of-Pocket Limit** | $4,800 | $2,400 |
*Plan F also offers a high-deductable plan. If you choose this option, this means you must pay for Medicare-covered costs up to the deductable amount of $2,110 in 2013 before your Medigap plan pays anything
**For Plans K and L, after you meet your out-of-pocket yearly limit and your yearly Part B deductable ($147 in 2013), the Medigap plan pays 100% of covered services for the rest of the calendar year.
***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.
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