Article from Suddenly Senior on supplemental coverage: Medigap explained

From: Frank Kaiser

Sent: Tuesday, January 17, 2006

Subject: [RxNews] Marci on supplemental coverage - from Suddenly Senior

Dear Marci,

I just began receiving Medicare. Now that I've retired, I don't have any other insurance. While Medicare picks up the cost of certain services, I was recently hospitalized and had a difficult time paying my share of the bill. Is there a secondary policy I can buy to help pay these expenses?

-- Anthony (Cedar Rapids, IA)

Dear Anthony,

Yes. There are insurance companies that sell supplemental coverage to fill certain gaps in Original Medicare. These policies, called Medigaps, help cover Medicare deductibles, coinsurance and some additional benefits.

There are 12 different standardized Medigap plans, labeled A-L (except in Massachusetts, Minnesota and Wisconsin). Not all plans are available in all areas. Medigap plans K and L are new plans that became available in
2006.

Each Medigap plan pays for a particular set of benefits. Plan A offers the fewest benefits and is usually the least expensive. Plans that offer more benefits, like plan J, are more expensive.

The most popular Medigap plans are C and F, because they cover major benefits and are less expensive than other plans.

All Medigap plans (A-L) must include the following basic benefits:

Hospital coinsurance coverage;
365 additional days of full hospital coverage; Full or partial coverage for the 20 percent coinsurance for doctor charges and other Part B services; Full or partial coverage for the first three pints of blood you need each year.

Depending on which Medigap plan you choose, you can get coverage for additional expenses Medicare doesn't cover, including the following:

Hospital deductible (plans B to L)*; Skilled nursing facility coinsurance (plans C to L)*; Part B deductible (plans C, F and J); Excess doctor charges (plans F, G, I and J); Emergency care outside the U.S. (plans C to J); At-home recovery (plans D, G, I and J); Preventive care that Medicare does not cover (plans E and J).

Medigap plans K and L will only pay for a portion of the cost that Medicare does not cover until you reach a yearly out-of-pocket limit.

Notes:

If you are enrolled in a Medicare private health plan, you cannot buy a Medigap policy. If your income is low, you may qualify for government programs that help pay your Medicare costs, so you would not need a Medigap plan.

Stay tuned next week to learn how Medicare works with other types of supplemental plans!

-- Marci