| Medigap Plan Benefits |
For more help:
Medigap plans are insurance policies which pay for some of the deducible and/or co-insurance costs that Medicare does not pay. Medigap plans are required to be labeled A through L and must contain the benefits listed below which are indicated with "Yes" regardless of which company sells it. This allows a comparison of premiums between different insurance companies for the same Medigap plan. Insurance companies, however, don't have to sell all twelve of the Medigap plans.
| Updated for 2009 | Yes indicates that the benefit is covered by the Plan | |||||||||||
| Benefits | A | B | C | D | E | F 1 | G | H | I | J 1 | K | L |
| Basic benefits coinsurance for days 61-150 of a hospital stay, all costs of an additional 365 days in a hospital in lifetime, coinsurance for physician and other Part B services after deductible is met, and 1st 3 pints of blood. | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
| Part A - Hospital deductible. | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | 50% | 75% | |
| Skilled nursing facility coinsurance for days 21-100. | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | 50% | 75% | ||
| Part B deductible. | Yes | Yes | Yes | |||||||||
| Part B excess charges 100% of the excess charges of Medicare's approved amount. | Yes | 80% | Yes | Yes | ||||||||
| Emergency care outside the U.S. 80% of cost for medically necessary emergency care, after a $250 deductible. Expenses must occur during 1st 60 days outside U.S. up to a lifetime benefit of $50,000. | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | ||||
| At-home recovery $40 per visit for up to 40 visits annually while receiving Medicare approved Home Health care. | Yes | Yes | Yes | Yes | ||||||||
| Preventive services up to $120 a year if ordered by a doctor. | Yes | Yes | ||||||||||
| Annual Out-of-Pocket Limit 2 | $4,620 2 | $2,310 2 | ||||||||||
1 Plans F & J also offer a high deductible option where you pay the first $2,000 (in 2009) during the calendar year before the plan pays anything.
2 For plans K & L, after you meet your annual out-of-pocket limit (last line above) the plan pays for everything for the remainder of the calendar year.
There is a limited open enrollment period when Medicare eligible beneficiaries can enroll in Medigap plans regardless of preexisting conditions. The initial enrollment period is the first 6 months after you become eligible for Medicare Part B.
Medigap plans and traditional Medicare coverage don't cover eye exams, eyeglasses, hearing aids, or dental care. However, some Medicare approved HMOs may cover some of these.
Medicare and Medigap plans don't cover medical care received outside of the U.S. unless listed above.
Medicare and Medigap plans don't cover long-term custodial care at home or in a nursing home. Medicare fully covers 20 days of short-term skilled care in a skilled nursing facility, after a hospital stay of 3 days or longer, and partially covers days 21 to 100.
There are long-term care (LTC) insurance policies (separate from Medigap polices) which cover care at home or in a nursing home. These policies have different limitations, such as:
Ask your insurance agent about the definition of each covered service, as well as, how much the LTC policy costs.
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