For more help:
- Long-term care insurance
- Long-term care insurance worksheet
- Government Programs - Eligibility Guidelines
- Medicare Supplement Premium Comparison Guide
- Medicare
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 2007 |
“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. Changes in 2006. |
|
|
|
|
Yes |
|
|
|
|
Yes |
|
|
| Annual Out-of-Pocket Limit 2 |
|
|
|
|
|
|
|
|
|
|
$4,140 |
$2,070 |
1 Plans F & J also offer a “high deductible” option
where you pay the first $1,860 during a 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 HMO’s 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:
- Some LTC policies pay cash once you meet eligibility requirements which can be spent on the care of your choice.
- Other LTC policies only cover care in a specifically defined location.
- Most policies have an “elimination” or “exclusion” period during which the policy doesn’t pay.
- There may be a waiting period between the time you sign-up and when the policy starts.
- Consider a “rider” to protect against inflation if the costs of care should rise.
- An insurance company’s definition of a covered service may not mean what you think. “Skilled”
nursing home care, for example, is not the same as “long-term” or “custodial” nursing home care.
- Finally, some LTC policies require that the patient have a certain number of “limitations”
of everyday activities before it will pay.
Ask your insurance agent about the definition of each covered service, as well as, how much the LTC policy costs.
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