Medicare Supplement Insurance: What is it and What Does it Cover?
Medicare supplement insurance is also known as MediGap, provided by major health insurance providers and private insurance companies.
Basically, supplement insurance is designed to fill "gaps" in original Medicare plans. MediGap policies offer benefits to individuals already covered by a Medicare plan.MediGap offers 12 basic policies, all of which offer similar benefits. Such policies must be identified as a "Medicare supplement insurance", according to Medicare.gov. The plans, designated A through N, offer a variety of basic as well as extra benefits, depending on where you live. The costs of policies vary depending on the benefits as well as the insurance company that sells such policies.
MediGap Insurance or Medicare supplement insurance may help seniors pay co-payments, deductibles and coinsurance costs not covered under Medicare. Supplement insurance policies are specifically designed to supplement Medicare benefits, and don't offer full coverage.
In order to be eligible for Medicare supplement insurance policies, you must already have Medicare Part A and Part B. Medicare Part B policies require monthly installments, such as those offered by private health insurance companies. Supplement insurance also requires a monthly premium to the insurance company offering the policy.
If you and your spouse want Medicare supplemental insurance, you must each obtain separate MediGap policies. Choosing a policy takes a bit of time, research and comparison between plans. Policies and costs offered may differ between states. As of June 1, 2010 some policies cover 100% of benefits.
Others cover a percentage of described benefits. Seniors and family members should know that policies only cover coinsurance after the deductibles have been paid, unless the policy itself stipulates that it will cover deductibles.
Here's a brief rundown of the type of benefits that MediGap plans A through N offer:
Medicare Part A - may include coinsurance on hospital costs up to an additional 365 days following use of Medicare benefits - plans A, B, C, D, F, G, K, L, M, N.
Medicare Part B coinsurance or co-payment - A, B, C, D, F, G, M, N. plan K covers 50% of coinsurance and co-payments, while policy L covers 75%.
Part A hospice care coinsurance or co-payment - plans A, B, C, D, F, G, M, N. Plan K pays 50%, and Plan L pays 75%.
Skilled nursing facility care coinsurance - plans C, D, F, G, M, N. Plan K covers 50%, and Plan L covers 75%.
Medicare Part A deductibles - plans B, C, D, F, G, and N. Plan K pays 50%, Medigap Plan L pays 75%, and Plan M pays 50%.
Medicare Part B deductibles - only policies C and F.
Medicare Part B excess charges - only Plans F and G.
Medicare preventive care Part B coinsurance is covered by all Medigap plans.
Plans K and L offer out-of-pocket limitations. The out-of-pocket limitation for Medigap policy K is $4,620, while the limitations of out-of-pocket expenditures for policy L are $2,310.
Seniors and family members should also known that Plan F offers a high deductible plan, which means that Medicare deductible amounts of $2,000 must be met before Medigap will pay anything.
In addition, after yearly out-of-pocket limits have been met on Medicare Part B deductibles, the plan will pay up to 100% of covered services for the remainder of the calendar year.
Lastly, Plan N will pay 100% of Part B coinsurance except for the $20.00 co-payments for office visits and up to $50.00 for a emergency department visits.
For in-depth information regarding what is covered by Medicare supplemental or MediGap insurance in your state, access Medicare.gov and this link regarding Medigap: