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What Medigap Policies Cover

medicare supplements
Medigap coverage is Medicare supplements designed to cover expenses not covered by Original Medicare. There are currently ten Medigap policies you can purchase. There are others that you can continue using if you purchased them before June 1, 2010. Medigap policies are supplemental medical insurance that covers the gaps in Original Medicare. It can be useful health insurance coverage for those with Original Medicare. But whether or not buying a policy makes sense depends on your personal medical circumstances. It can also depend on the plan.

Deductibles, Copayments, Coinsurance

Medigap policy can be used to pay your Original Medicare Part B deductibles, copayments, and coinsurance. The deductible is the amount you pay to Medicare for Part B coverage on a monthly basis. Your copayments are what you pay, over and above Part B coverage, for doctor’s visits and other similar services. Coinsurance is the percentage you pay (after your deductible) of your medical bills. Medigap can pay some or all of all three of these expenses. It depends on what plan you choose to purchase.

Your Medicare Part A deductible is not covered by Medigap Plan A. Plans B through G and N cover this deductible at 100 percent. Plans K and L cover at their customary rates of 50 and 75%. In this case Plan M also covers at 50%.

Fewer plans help with paying for your Medicare Part B deductible. Only Plans C and F cover this deductible, both at 100%. This might be why these are two of the more popular plans.

Hospital Costs

All Medigap plans cover Part A hospital costs up to an additional 365 days after your Medicare coverage for hospital costs are used. All of the Medigap policies also cover Medicare Part B coinsurance or copayments. They do, however, cover these at differing rates. Plans A through G and M cover 100% of this cost. Plan K covers 50% and Plan L 75%. Plan N covers all except $20 for office visits and $50 for emergency room visits.

Blood Donation

All the Medigap Medicare supplements plans provide some coverage for the first three pints of blood you need in the hospital. Original Medicare does not start paying until after the third pint. Plans A through G and M, again, cover 100 percent. Plans K and L cover 50% and 75% respectively. Plan N covers 100%.

Hospice Care

All the current plans cover Medicare Part A Hospice care coinsurance or copayments. Plans A through G, M and N cover at 100% Plans K and L, again, cover at 50% and 75% respectively. Hospice care is one type of care for those in the latter stages of a terminal illness.

Skilled Nursing Facilities

Skilled Nursing Facility Care Coinsurance is not covered by Plans A or B. It is 100% covered by Plans C through G, M and N. As is the norm plans K and L cover at 50 and 75% respectively. Skilled Nursing Facilities are health care facilities licensed and inspected by your state. They offer short and long term care for those with serious medical needs that cannot be treated at home. In some cases, patients have temporary health issues. But these facilities also often care for those with permanent health issues. These facilities may also provide rehabilitation.

Excess Charges

Medicare Part B Excess Charges are covered by two of the Medigap Plans; F and G. Medicare Excess Charges occur when a health care provider declines to accept Medicare’s “assignment” for a particular procedure or visit. The assignment is the amount Medicare agrees to pay for that particular service. In cases where a doctor declines to accept the assignment the doctor can then charge you 15% more than the assigned amount. Medicare will also lower the amount they pay for this service or visit by 5%. You have to pay the difference in this case, unless you have Medigap coverage that will cover it. How much you save with coverage for excess charges depends on the amount of a given assignment.

Foreign Travel

A number of Medigap plans also have coverage for Foreign Travel Emergencies. Plans A, B, K and L offer no such coverage. Plans C, D, F, G, M and N all offer full coverage up to the limits of the plan. If you travel with some regularity it might be worthwhile to look into these plans. Medicare generally only covers U.S. States and possessions.

Preventive Care

All Medigap plans cover Medicare Preventive Care Part B Coinsurance at a 100% rate. Preventive care is, obviously important. Few would disagree that it is better to prevent an illness than to treat it after you have it. Medicare covers a wide variety of preventive services. These services include shots for flu, Hepatitis B, and pneumonia. These include screenings and tests for; Breast Cancer (mammograms), Diabetes, Colon Cancer, Abdominal Aortic Aneurisms, cardiovascular health, Glaucoma, HIV, and Prostate care. Preventive care also covers Bone Mass Measurements, Pap Tests & Pelvic Exams, Medical Nutrition Therapy Services, Diabetes Self-Management Training, a one-time “Welcome to Medicare” exam, a yearly wellness exam, smoking cessation, and more. You would need to see if the costs of the preventive services listed would be cost effective for a Medigap plan.

Medigap exists to cover services that Original Medicare does not. In that they can help Medicare recipients with their health care costs. It is also possibly worth checking into Medicare Advantage Plans and comparing their costs with the costs of Original Medicare and a given Medigap plan.

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