Medicare Supplemental Insurance Plans (Medigaps)

Medicare, the federal health insurance program, is not enough for most Americans. Even with its three parts (A, B, and now D,) some deductibles and coinsurance costs are not covered. Medicare Part-A is hospital coverage, Part-B is medical coverage, and Part-D is prescription drug coverage. Supplementing Medicare with additional insurance is almost necessary these days, with the rising prescription and medical care costs. Here is an overview of how Medicare supplemental plans (called Medigaps) help to ease the burden of what Medicare does not pay.

Medigap policies are designed to "fill in the gaps" in the Original Medicare plan. Sold by private insurance companies, these plans help pay for costs like Medicare deductibles, and must follow state and federal laws. Currently, there are ten standard Medigap plans, labeled "A through J." Plan A offers the most basic coverage, while Plan J offers the most coverage. Plans B through I offer extra benefits. Here are the standardized plans presently available.

Plan A Policy (Basic Coverage)
� Coverage for the Part A coinsurance amount for the 61st through the 90th day of hospitalization in each Medicare benefit period.
� Coverage for the Part A coinsurance amount for each of Medicare's 60 non-renewable lifetime hospital inpatient reserve days used.
� After all Medicare hospital benefits are exhausted, coverage for 100% of the Medicare Part A eligible hospital expenses. Coverage is limited to a maximum of 365 days of additional inpatient hospital care during the policyholder's lifetime. This benefit is paid either at the rate Medicare pays hospitals under its Prospective Payment System (PPS) or under another appropriate standard of payment for hospitals not subject to the PPS. Beneficiaries 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 replaced in accordance with federal regulations.
� Coverage for the coinsurance amount for Part B services (generally 20% of approved amount; 50% of approved charges for outpatient mental health services) after $100 annual deductible is met.

Plan B
Includes the Basic Coverage, plus coverage for the Medicare Part A inpatient hospital deductible�

Plan C
Includes Basic Coverage, plus coverage for the Medicare Part A inpatient hospital deductible, coverage for the skilled nursing facility care coinsurance amount for days 21 through 100 per benefit, coverage for the Medicare Part B deductible, 80% coverage for medically necessary emergency care in a foreign country, after a $250 deductible.�

Plan D
Includes Basic Coverage, plus coverage for the Medicare Part A inpatient hospital, coverage for the skilled nursing facility care coinsurance amount for days 21 through 100 per benefit period, 80% coverage for medically necessary emergency care in a foreign country, after a $250 deductible, coverage for at-home recovery. The at home recovery benefit pays up to $1,600 per year for short-term, at home assistance with activities of daily living (bathing, dressing, personal hygiene, etc.) for those recovering from an illness, injury or surgery.�

Plan E
Includes Basic Coverage, plus coverage for the Medicare Part A inpatient hospital deductible, coverage for the skilled nursing facility care coinsurance amount for days 21 through 100 per benefit period, coverage for 100% of Medicare Part B excess charges*, coverage for 50% of the cost of prescription drugs up to a maximum annual benefit of $1,250 after the policyholder meets a $250 per year deductible (this is called the "basic" prescription drug benefit), 80% coverage for medically necessary emergency care in a foreign country, after a $250 deductible. There is a lifetime maximum for this benefit of $50,000, coverage for at home recovery. The at home recovery benefit pays up to $1,600 per year for short-term, at home assistance with activities of daily living (bathing, dressing, personal hygiene, etc.) for those recovering from an illness, injury or surgery.
* Plan pays a specified percentage of the difference between Medicare's approved amount for Part B services and the actual charges (up to the amount of charge limitations set by either Medicare or state law).�

Plan F
Includes Basic Coverage, plus coverage for the Medicare Part A inpatient hospital deductible, coverage for the skilled nursing facility care coinsurance amount for days 21 through 100 per benefit period, coverage for the Medicare Part B deductible, coverage for 100% of Medicare Part B excess charges*, 80% coverage for medically necessary emergency care in a foreign country, after a $250 deductible, coverage for preventive medical care. The preventive medical care benefit pays up to $120 per year for such things as a physical examination, serum cholesterol screening, hearing test, diabetes screenings, and thyroid function test, coverage for at home recovery. The at home recovery benefit pays up to $1,600 per year for short-term, at home assistance with activities of daily living (bathing, dressing, personal hygiene, etc.) for those recovering from an illness, injury or surgery, coverage for 50% of the cost of prescription drugs up to a maximum annual benefit of $3,000 after the policyholder meets a $250 per year deductible (this is called the "extended" drug benefit), future high deductible option.�

* Plan pays a specified percentage of the difference between Medicare's approved amount for Part B services and the actual charges (up to the amount of charge limitations set by either Medicare or state law).�

Plan G
Includes Basic Coverage, plus coverage for the Medicare Part A inpatient hospital deductible, coverage for the skilled nursing facility care coinsurance amount for days 21 through 100 per benefit period, coverage for 80% of Medicare Part B excess charges*, 80% coverage for medically necessary emergency care in a foreign country, after a $250 deductible, coverage for at home recovery. The at home recovery benefit pays up to $1,600 per year for short-term, at home assistance with activities of daily living (bathing, dressing, personal hygiene, etc.) for those recovering from an illness, injury or surgery.�

* Plan pays a specified percentage of the difference between Medicare's approved amount for Part B services and the actual charges (up to the amount of charge limitations set by either Medicare or state law).�

Plan H
Includes Basic Coverage, plus coverage for the Medicare Part A inpatient hospital deductible, coverage for the skilled nursing facility care coinsurance amount for days 21 through 100 per benefit period, 80% coverage for medically necessary emergency care in a foreign country, after a $250 deductible, coverage for 50% of the cost of prescription drugs up to a maximum annual benefit of $1,250 after the policyholder meets a $250 per year deductible (this is called the "basic" prescription drug benefit).�

Plan I
Includes Basic Coverage, plus Coverage for the Medicare Part A inpatient hospital deductible, coverage for the skilled nursing facility care coinsurance amount for days 21 through 100 per benefit period, 80% coverage for medically necessary emergency care in a foreign country, after a $250 deductible, coverage for preventive medical care. The preventive medical care benefit pays up to $120 per year for such things as a physical examination, serum cholesterol screening, hearing test, diabetes screenings, and thyroid function test.�

Plan J
Includes Basic Coverage, plus Coverage for the Medicare Part A inpatient hospital deductible, coverage for the skilled nursing facility care coinsurance amount for days 21 through 100 per benefit period, coverage for the Medicare Part B deductible, 80% coverage for medically necessary emergency care in a foreign country, after a $250 deductible, coverage for 100% of Medicare Part B excess charges*, future high deductible option.�

* Plan pays a specified percentage of the difference between Medicare's approved amount for Part B services and the actual charges (up to the amount of charge limitations set by either Medicare or state law).�

Keep in mind that the above-mentioned plans will only cover you, not your spouse or partner. Each of you must purchase your own policy. Costs can differ between individual companies, and you must continue to pay your Medicare premiums along with your Medigap premium. The monthly cost of the Medicare Plan B premium is $88.50 (in 2006.) This may be a factor, as two of the Medigap plans may have a high-deductible option.�

Companies that sell Medigap plans are required to offer Plan A, but some do not offer Plans B through J.� Only one plan can be purchased, and each individual insurance company decides which plans to sell.�� Residents in�Minnesota, Massachusetts, and Wisconsin are instructed to�contact their state insurance department to find out what Medigap options are available, as the 10 standard plans do not apply in these states.�

Gather as much�information as you can, �before you buy, �to find the plan which best suits your needs.