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Medicare Supplemental Plans (i.e. Medi-Gap)

Many Medicare beneficiaries choose to purchase private supplemental insurance, known as Medicare Supplemental plans, to help fill the "gap" for benefits not covered under the Medicare program. These Medicare Supplemental plans are commonly referred to as "MediGap" plans1.

For all states except Massachusetts, Minnesota, and Wisconsin2, there are ten standardized MediGap plans (labeled Plan A through J), which private insurance companies may offer. Each plan type offers a varying degree of benefits. Plans H, I, J are the only standardized MediGap plans that offer prescription drug benefits.

       PLAN A (the basic policy) -- consists of these basic benefits:
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  • Coverage for the Part A coinsurance amount for days 61 through 90 of hospital stay in each Medicare benefit period.
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  • Coverage for the Part A coinsurance amount for days 91 through 150 of a hospital stay for each of Medicare's 60 lifetime reserve days that may be used once.
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  • After all Medicare hospital benefits are exhausted, coverage for 100 percent 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. Policyholder 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 three pints of blood or equivalent quantities of packed red blood cells per year unless this blood is replaced.
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  • Coverage for the coinsurance amount for Part B services (generally 20 percent of Medicare-approved amount) after $100 annual deductible is met.

           PLAN B -- includes the basic benefits plus:
  •  
  • Coverage for the Medicare Part A inpatient hospital deductible.

           PLAN C -- includes the basic benefits plus:
  •  
  • Coverage for the Medicare Part A inpatient hospital deductible.
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  • Coverage for the skilled nursing facility coinsurance amount.
  •  
  • Coverage for the Medicare Part B deductible.
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  • 80 percent coverage for medically necessary emergency care in a foreign country, after a $250 deductible.

           PLAN D -- includes the basic benefits plus:
  •  
  • Coverage for the Medicare Part A inpatient hospital deductible.
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  • Coverage for the skilled nursing facility coinsurance amount.
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  • 80 percent coverage for medically necessary emergency care in a foreign country, after a $250 deductible.
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  • Coverage for at-home recovery. The at-home recovery benefit pays up to $40 each visit and $1,600 per year for short-term, at home assistance with activities of daily living (like bathing, dressing, personal hygiene, etc.) for those recovering from an illness, injury or surgery.

           PLAN E -- includes the basic benefits plus:
  •  
  • Coverage for the Medicare Part A inpatient hospital deductible.
  •  
  • Coverage for the skilled nursing facility coinsurance amount.
  •  
  • 80 percent 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 things like a physical examination, serum cholesterol screening, hearing test, diabetes screenings, and thyroid function test.

           PLAN F -- includes the basic benefits plus:
  •  
  • Coverage for the Medicare Part A inpatient hospital deductible.
  •  
  • Coverage for the skilled nursing facility coinsurance amount.
  •  
  • Coverage for the Medicare Part B deductible.
  •  
  • 80 percent coverage for medically necessary emergency care in a foreign country, after a $250 deductible.
  •  
  • Coverage for 100 percent of Medicare Part B excess charges.
    (Excess Charge = The difference between a doctor's or other healthcare provider's actual charge (up to the amount of charge limitation set by Medicare or the state) and the Medicare-approved payment amount).

           PLAN G -- includes the basic benefits plus:
  •  
  • Coverage for the Medicare Part A inpatient hospital deductible.
  •  
  • Coverage for the skilled nursing facility coinsurance amount.
  •  
  • 80 percent coverage for medically necessary emergency care in a foreign country, after a $250 deductible.
  •  
  • Coverage for 80 percent of Medicare Part B excess charges.
  •  
  • Coverage for at-home recovery. The at-home recovery benefit pays up to $40 each visit and $1,600 per year for short-term, at home assistance with activities of daily living (like bathing, dressing, personal hygiene, etc.) for those recovering from an illness, injury, or surgery.

           PLAN H -- includes the basic benefits plus:
  •  
  • Coverage for the Medicare Part A inpatient hospital deductible.
  •  
  • Coverage for the skilled nursing facility coinsurance amount.
  •  
  • 80 percent coverage for medically necessary emergency care in a foreign country, after a $250 deductible.
  •  
  • Coverage for 50 percent of the cost of prescription drugs up to a maximum of $1,250 per year after the policyholder meets a $250 deductible per year (basic prescription drug benefit).

           PLAN I -- includes the basic benefits plus:
  •  
  • Coverage for the Medicare Part A inpatient hospital deductible.
  •  
  • Coverage for the skilled nursing facility coinsurance amount.
  •  
  • 80 percent coverage for medically necessary emergency care in a foreign country, after a $250 deductible.
  •  
  • Coverage for 100 percent of Medicare Part B excess charges.
  •  
  • Coverage for at-home recovery. The at-home recovery benefit pays up to $40 each visit and $1,600 per year for short-term, at home assistance with activities of daily living (like bathing, dressing, personal hygiene, etc.) for those recovering from an illness, injury, or surgery.
  •  
  • Coverage for 50 percent of the cost of prescription drugs up to a maximum of $1,250 per year after you meet a $250 deductible per year (basic prescription drug benefit).

           PLAN J -- includes the basic benefits plus:
  •  
  • Coverage for the Medicare Part A inpatient hospital deductible.
  •  
  • Coverage for the skilled nursing facility coinsurance amount.
  •  
  • Coverage for the Medicare Part B deductible.
  •  
  • 80 percent coverage for medically necessary emergency care in a foreign country, after a $250 deductible.
  •  
  • Coverage for 100 percent of Medicare Part B excess charges.
  •  
  • Coverage for at-home recovery. The at-home recovery benefit pays up to $40 each visit and $1,600 per year for short-term, at home assistance with activities of daily living (like bathing, dressing, personal hygiene, etc.) for those recovering from an illness, injury, or surgery.
  •  
  • Coverage for preventive medical care. The preventive medical care benefit pays up to $120 per year for things like a physical examination, serum cholesterol screening, hearing test, diabetes screening, and thyroid function test.
  •  
  • Coverage for 50 percent of the cost of prescription drugs up to a maximum of $1,250 per year after you meet a $250 deductible per year (basic prescription drug benefit).


    1 MediGap Source: Centers for Medicare and Medicaid Services and the New York State Office for the Aging

    2 MA, MN, and WI had Medigap standardization programs in place before the passage of OBRA '90 and were granted exemptions allowing continued operation of those plans.

     

     

     

     

     

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