Medicare Rights University
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- Edwina Welch
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1 Medicare Rights University Level 2: Medicare Coverage Rules Course 4: Medigap Plans What you will learn: What do Medigap plans cover? What are Medigap plan costs? When can you sign up for a Medigap? A Medigap is a supplemental plan that pays all or part of the remaining costs that Original Medicare does not cover. Medigap plans only work with Original Medicare, not Medicare Advantage plans. + Medigap Plan X
2 Case: Alfred s Medigap Alfred has Original Medicare and a Medigap plan. He goes to a nearby outpatient clinic to get a medically-necessary chest x-ray. Question: How will Original Medicare work with Alfred s Medigap to pay for Alfred s chest x-ray? Answer: Chest x-ray Original Medicare Pays 80% of Medicareapproved cost, first Medigap pays Pays some or a portion of 20% of the Medicare-approved cost, after Medicare pays X There are 10 different types of Medigap plans that private insurance companies can offer: Plans A, B, C, D, F, G, K, L, M, Medigap plans are standardized: Medigaps plans with the same letter must offer the same coverage, even if offered through different companies. Medigap Plan A Medigap Plan B Company 1 Same Plan A coverage Same Plan B coverage Company 2 Company 3 ote: ot all insurance companies offer every plan type. M, MA, and WI have different ways of standardizing Medigap policies.
3 What do Medigaps cover? All Medigaps cover: Part A Hospital Copay Full Cost of Medicare-covered days in a benefit period Full cost of 365 additional lifetime days Part B Medical Coinsurance Part of all of the cost of Part B coinsurances, depending on the Medigap plan type Full cost of Part B coinsurances for Part B-preventive services Cost of Blood Part of all of the cost of the first 3 pints of blood you need each year, depending on the Medigap plan type Hospice Care Coinsurance Full cost of hospice care copays, if the Medigap was purchased on/after June 1, Other Medigap benefits: Coverage: Plans Offering Full Coverage Plans Offering Partial Coverage Part A Hospital Deductible Entire cost each Benefit Period Plans B, C, D, F, G, Plans K, L, M Skilled ursing Facility Copay Days each Benefit Period Plans C, D, F, G, M, Plans K, L Part B Annual Deductible Part B Excess Charges Entire cost each year 100% of Part B excess charges Plans C, F --- Plans F, G --- Emergency Care Outside of the U.S. 80% of emergency care costs during first 60 days of each trip. Plans C, D, F, G, M, --- Medigap Costs Medigap Premium You pay a premium each month to the insurance company to have Medigap coverage. Each lettered plan must offer the same benefits, but premium costs may vary. Medigap Plan A Plan A Coverage Co. 1 Co. 2 Co. 3 Same Plan A Premium $100/month $150/month $125/month Medigap Plan B Plan B Coverage Co. 1 Co. 2 Co. 3 Same Plan B Premium $175/month $300/month $250/month
4 When can you sign up for a Medigap? Federal Law sets minimum enrollment rights: Open Enrollment: Right to buy a Medigap for 6 months beginning the month you are both 65 or older and sign up for Medicare Part B Guaranteed Issue Right: Right to buy a Medigap within 63 days of losing certain types of coverage if you are 65 or older State Law may offer additional rights: Over half the states in the U.S. allow people under 65 the right to enroll in a Medigap. States like ew York also allows people to buy a Medigap at any time during the year. ote: When you have the right to sign up for a Medigap under federal law, insurance companies cannot deny you Medigap coverage or charge you more because of past or present health conditions. Case: Medigap Choices Alfred s friend, Greg, is 62 years old and has Original Medicare due to a disability. Greg lives in upstate ew York. Question: Can Greg sign up for a Medigap? Answer: Yes. ew York State Medigap rules allow Greg to sign up for any Medigap plan at any time during the year, thanks to ew York s open enrollment policy. Medigap rules vary by state, so it s best for people to check with their State Dept. of for more information. What you have learned: What Medigap plans are Medigaps are supplemental insurance plans that pays all or part of the remaining costs that Original Medicare does not cover. Medigap plans only work with Original Medicare. There are 10 different, standardized Medigap plan types. What Medigap plans cover All Medigap plans cover certain benefits at full or partial cost. Some Medigap plans may offer additional coverage, depending on the plan type. Medigap Costs Premium rates vary, depending on which insurance company you buy the Medigap plan from. All Plan As must offer the same benefits, all Plan Bs must offer the same benefits and so on. Medigap Enrollment
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SM MedicareBlue Supplement Plans A, D, F, High Deductible F, and N 2015 Outlines of Coverage Benefit Chart of Medicare Supplement Plans Sold for Effective Dates on or after January 1, 2015 This chart shows
Basic, including 100% Part B Coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER Skilled Nursing.
MUTUAL OF OMAHA INSURANCE COMPANY OUTLINE OF MEDICARE SUPPLEMENT COVERAGE COVER PAGE BENEFIT PLANS A, F, AND G This chart shows the benefits included in each of the standard Medicare supplement plans.