Benefit Chart of Medicare Supplement Plans Sold on or After June 1, 2010
Benefit Plans A, B, C, D, F, F+, G, K, L and N
First, The Different Parts of Medicare (Compliments of www.medicare.gov)
Medicare is health insurance for people age 65 or older, under 65 with certain disabilities, and any age with End-Stage Renal Disease (ESRD). ESRD is permanent kidney failure requiring dialysis or a kidney transplant. The different parts of Medicare help cover specific services if you meet certain conditions.
Medicare Patients receive an EOB (Explanation of Benefits) or MSN (Medicare Summary Notice) from Medicare after going to the doctor or hospital. That is what our company uses to pay claims.
Here are Sample EOB/MSN's and How to Read Them:
Medicare has the following parts:
Medicare Part A
(Hospital Insurance)
- Helps cover inpatient care in hospitals (includes critical access hospitals, inpatient rehabilitation facilities, and long-term care hospitals).
- Helps cover skilled nursing facility (not custodial or long-term care), hospice, and home health care services.
|
Medicare Part B
(Medical Insurance)
- Helps cover doctor services and outpatient care.
- Helps cover some preventive services to help maintain a person’s health and to keep certain illnesses from getting worse.
- Generally pays 80% of the Medicare-approved amount for covered services
|
Medicare Part C
(Medicare Advantage Plans)
- A way to get Medicare benefits through private companies approved by and under contract with Medicare.
- Includes Part A, Part B, and usually other benefits Medicare doesn’t cover. Most plans also provide prescription drug coverage.
|
Medicare Part D
(Prescription Drug Coverage)
- Run by private companies approved by Medicare, which can either be Medicare Advantage Plans or separate Medicare Prescription Drug Plans.
- Helps cover the cost of prescription drugs.
- Each plan can vary in cost and drugs covered.
|
* Denotes plans available by our carrier
BASIC MEDICARE SUPPLEMENT BENEFITS:
- Hospitalization: Part A coinsurance plus coverage for 365 additional days after Medicare benefits end.
- Medical Expenses: Part B coinsurance (generally 20% of Medicare-approved expenses) or copayments for hospital outpatient services. Plans K, L and N require insureds to pay a portion of the Part B coinsurance or copayments.
- Blood: First three pints of blood each year.
- Hospice: Part A coinsurance.
Compare Medigap plans side-by-side
The chart below shows basic information about the different benefits Medigap policies cover.
Yes = the plan covers 100% of this benefit
No = the policy doesn't cover that benefit
% = the plan covers that percentage of this benefit
N/A = not applicable
| Medigap Benefits |
Medigap Plans |
| A |
B |
C |
D |
F* |
G |
K |
L |
M |
N |
| Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
| Part B coinsurance or copayment |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
50% |
75% |
Yes |
Yes*** |
| Blood (first 3 pints) |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
50% |
75% |
Yes |
Yes |
| Part A hospice care coinsurance or copayment |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
50% |
75% |
Yes |
Yes |
| Skilled nursing facility care coinsurance |
No |
No |
Yes |
Yes |
Yes |
Yes |
50% |
75% |
Yes |
Yes |
| Part A deductible |
No |
Yes |
Yes |
Yes |
Yes |
Yes |
50% |
75% |
50% |
Yes |
| Part B deductible |
No |
No |
Yes |
No |
Yes |
No |
No |
No |
No |
No |
| Part B excess charges |
No |
No |
No |
No |
Yes |
Yes |
No |
No |
No |
No |
| Foreign travel exchange (up to plan limits) |
No |
No |
Yes |
Yes |
Yes |
Yes |
No |
No |
Yes |
Yes |
| Out-of-pocket limit** |
N/A |
N/A |
N/A |
N/A |
N/A |
N/A |
$4,940 |
$2,470
|
N/A |
N/A |
* Plan F also offers a high-deductible plan. If you choose this option, this means you must pay for Medicare-covered costs up to the deductible amount of $2,140 in 2014 ($2,180 in 2015) before your Medigap plan pays anything.
** After you meet your out-of-pocket yearly limit and your yearly Part B deductible, 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 inpatient admission.
