Medicare Supplement Benefit Guide

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The following Medicare Supplement Benefit Guide will help you compare plans. There are only nine areas of coverage to consider when comparing. All standardized plans cover a portion of these benefits. For example, a Medigap Plan A covers four of them, and a Medigap Plan F covers them all. In this post, we will take a closer look at what the benefits are specifically. All dollar amounts quoted are for 2016.

Medicare Part A Coinsurance (Hospital)

This benefit covers the coinsurance amounts associated with the cost of hospitalization (semi-private room, general nursing, miscellaneous services, and supplies). After paying your Part A Deductible, Medicare pays for the first 60 days of hospitalization. For days 61-90 Medicare pays all except for $322; days 91 and beyond, Medicare pays all except $644 a day, up to the 60 lifetime reserve days. All standardized Medicare Supplements cover Medicare Part A Coinsurance, and this means they will pay the coinsurance amounts for days 61 through your lifetime reserve, $322 and $644 a day respectfully.

Medicare Part B Coinsurance (Medical)

This benefit covers care given in or out of the hospital, including outpatient treatment (doctor services, supplies, speech and physical therapy, diagnostic tests, durable medical equipment). After paying your Part B Deductible, Medicare pays 80% of the cost. All of the standardized Medicare Supplements cover the remaining 20% not paid by Medicare. Medigap Plan N requires a $20 copay for doctor’s office visits before paying the remaining 20%

Blood (first 3 pints)

This benefit applies to both Part A and Part B of Medicare. Under most circumstances blood is supplied free of charge via a blood bank. However, if there is a charge, Medicare only covers the cost after the first 3 pints. All standardized Medicare Supplement plans cover the expense of the first 3 pints if there is a charge.

Part A Hospice Care Coinsurance or Copay

If you require hospice care, Medicare covers all costs except a $5 copay for prescription drugs and a 5% coinsurance for respite care. All standardized Medicare Supplements cover the coinsurance and copays associated with hospice care.

Skilled Nursing Facility Care Coinsurance

For the first 20 days of care, Medicare covers all expenses. Days 21-100 Medicare pays all except $161. Days 101 and beyond, Medicare pays nothing. The plans that offer this benefit will pay all coinsurance amounts up to the 101st-day except Medigap Plan K (50%) and Medigap Plan L (75%).

Plan C, Plan D, Plan F, Plan G, Plan K*, Plan L*, Plan M, Plan N

Not Covered:
Plan A, Plan B

Part A Deductible

Before Medicare pays any benefits under Part A, there is a deductible of $1,288 per benefit period. The plans that offer this benefit will pay the deductible in full except Medigap Plan K (50%), Medigap Plan L (75%), and Medigap Plan M (50%).

Plan B, Plan C, Plan D, Plan F, Plan G, Plan K*, Plan L*, Plan M*, Plan N

Not Covered:
Plan A

Part B Deductible

Before Medicare pays for any Part B benefits, there is a once a year deductible of $166. Both Plans that offer this benefit pay 100%. Due to new legislation taking effect in 2020, this benefit will no longer be provided.

Plan C, Plan F

Not Covered:
Plan A, Plan B, Plan D, Plan G Plan K, Plan L, Plan M, Plan N

Part B Excess Charges

These charges refer to costs under Medicare Part B that are above the Medicare approved amounts. For further information see The Truth About Medicare Part B Excess Charges. Medigap Plan F is the only plan to cover these charges.

Plan F

Not Covered:
Plan A, Plan B, Plan C, Plan D, Plan G, Plan K, Plan L, Plan M, Plan N

Foreign Travel Emergency

Exactly how it sounds, this covers emergency health care coverage when traveling outside the United States. Out of the 10 standardized plans, 6 offer coverage. However, the extent of this coverage will vary by company.

Offers Coverage:
Plan C, Plan D, Plan F, Plan G, Plan M, Plan N

Not Covered:
Plan A, Plan B, Plan K, Plan L

Medicare Supplement Plan Benefit Chart

Medicare Benefit Chart
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