Medicare Supplemental Insurance (MEDIGAP) is a private form of health insurance that helps cover some Medicare costs such as deductibles, co-payments, and coinsurance. Medigap are regulated by the federal and state governments, but you buy the plans of private insurance companies. You may not be enrolled in a MEDIGAP plan and in a Medicare Advantage plan at a time.
The best time to enroll in a Medigap policy is during the open enrollment period (EPO). This is different from your Medicare open enrollment period. Your Medigap EPO is a 6-month period beginning on the day that you are both 65 years old and enrolled in Original Medicare. During this time, insurance companies cannot deny coverage or increase their premiums due to health problems.
To be eligible for a MEDIGAP plan, you must be enrolled in the Original Medicare (Medicare parts A and B) and be at least 65 years of age or have a qualified disability.
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There are 10 standardized plans to choose from in most states. Minnesota, Massachusetts and Wisconsin have different options. Each plan has the name of a letter and offers a standard set of benefits. For example, Plan A will always cover the same set of benefits, regardless of the company you buy it.
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Medicare: Plans and Coverages
The Medicare Health Program is designed to provide coverage for people in particular circumstances. They qualify for Medicare over 65 years of age, as long as they are U.S. citizens or have lived a minimum of five years as legal and permanent residents in the country.
The program also extends to people who do not meet those requirements, but who can enjoy Medicare if they pay a premium. This way, you will be eligible for a Medicare plan if you are over 65 years old and do not meet the requirement of citizenship or residency, but you or your spouse have paid taxes in the United States at least ten years.
You will also be eligible for Medicare if you are under 65 years of age but have a disability that qualifies you for Social security benefits. Or if you have a terminal-stage kidney disease and need regular dialysis. The last assumption to be eligible for Medicare with less than 65 years is that you suffer from amyotrophic lateral sclerosis, ALS.
If you are in any of these cases, you can apply for your Medicare coverage, which consists of different levels: A, B, C and D. Levels A and B are basic, which is called Original Medicare, while levels C and D provide extra coverage.
Specifically, these plans offer you these services:
- Medicare Part A: The most basic part of Medicare includes key concepts such as hospitalization, home health care, hospice, and medical care that can be received by elderly people living in residences or nursing homes.
- Medicare part B: Level B supplements the previous one with the payment of the expenses derived from the tasks of diagnosis, of the treatments necessary for a disease or ailment and of the preventive treatments, like the early detection of diseases. Plan B includes costs such as hospital transport, medical equipment expenses, ambulatory care or clinical research to be submitted by a patient.
- Medicare Part C: Also known as Medicare Advantage., this level involves the hiring of private insurances accepted by the Medicare program to supplement coverage that does not provide the basic steps. These coverages include, for example, treatments for hearing or vision problems, dental care, health and wellness programs, nursing expenses, and the cost of prescription drugs.
- Medicare Part D: This part of Medicare covers recipes, that is, what the drugs that are prescribed to a sick person cost. With this coverage, the user does not have to pay when he goes to the pharmacy, something that he does have to do in case of having only the basic plans of the program.
If you qualify for the Original Medicare, parts A and B, you will find that the coverages are not complete and that some parts require an economic effort at specific times. I mean, you have to cope with what’s called. Co-payments, coinsurance and deductibles: paying out of your pocket a portion of the cost of treatments, services or benefits. The rest puts Medicare on it.
Because you may not have enough financial resources to cope with those payments when you need a medical service or a particular care. To avoid these problems, you can hire Medicare supplemental insurance, also called Medigap.
Types of medicare supplemental insurance
Original Medicare Supplemental insurance is divided into several types, each offering some benefits or others. Leaving the margins Massachusetts, Minnesota and Wisconsin, which have their own ordination for Medigap, in the rest of the country are offered ten types of insurance Medigap. Each one of them is identified with a letter in this way:
- Type A
It includes the cost of coinsurance in part A of Medicare and an additional hospital year to Medicare coverage. It also includes the cost of part B Coinsurance, the first three pints of blood in transfusion cases, and the co-payment or coinsurance of the terminally ill nursing home that is set forth in Medicare part A.
- Type B:
As covered in type A, it adds Medicare part A deductible expenses.
- Type C
It also includes Medicare part B deductible expenses and coinsurance expenses for a skilled nursing facility.
- Type D
In this case, the coverage of 80 per cent of the exchange costs in foreign travel is added.
- Type F
This modality offers above all the above paying an excess of charges in part B of Medicare.
- Type G
The G type is like the F, but it does not take charge of the deductible expenses in Medicare part B.
- Type K
In this case, the insurance only covers the cost of coinsurance in part A of Medicare and one year of hospital additional to Medicare coverage. It also includes the cost of part B Coinsurance, the first three pints of blood in transfusion cases, and the co-payment or coinsurance of the terminally ill nursing home that is set forth in Medicare part A. From there, the rest of the profits are only covered at 50 percent, leaving the deductibles and excess charges of part B and foreign travel exchange uncovered. It includes as a difference a limit of own pocket expenditures established at 5,240 dollars per year.
- Type L
Like the K, but instead of covering only 50 percent of the cost of the listed services, it raises the payment to 75 percent. Instead, the pocket cap of its own is left at 2,620 dollars.
- Type M
This type of policy involves coverage that leaves out the deductibles and excess charges of Medicare part B. In addition, it only pays 50 percent of part A deductibles and 80 percent of foreign-travel exchanges.
- Type N
The last type of MEDIGAP policy is the same as the M, but in the Medicare part B co-payment or coinsurance concept it establishes franchises: it does not pay costs below $20 in the case of some medical visits, or below 50 dollars in visits to emergencies that do not Include hospitalizations.
For the three states that have their own rules to determine policy types, you should know that, in general, what the different programs include are very similar to the ten general types. However, there are small variations or nuances in the levels of coverage and, above all, varies the nomenclature of the policies and some concepts.
Choose medicare supplemental insurance table
The following table shows the plan options and the costs covered by each plan. If a box contains a percentage, it means that the plan option will pay only the share of the expenses.
|Benefits of Medigap||A||B||C||D||F*||G||K||L||M||N|
|Coinsurance part A and hospital costs up to 365 additional days after Medicare benefits are exhausted||100%||100%||100%||100%||100%||100%||100 %||100 %||100%||100 %|
|Coinsurance or part B co-payment||100%||100%||100%||100%||100%||100%||50%||75%||100%||100%**|
|Blood (first 3 pints)||100%||100%||100%||100%||100%||100%||50%||75%||100%||100%|
|Copayment or co-insurance of residence for terminally ill people A||100%||100%||100%||100%||100%||100%||50%||75%||100%||100%|
|Specialized Nursing Center Coinsurance||100%||100%||100%||100%||50%||75%||100%||100%|
|Deductible part A||100%||100%||100%||100%||100%||50%||75%||50%||100%|
|Deductible part B||100%||100%|
|Excess charge of part B||100%||100%|
|Exchange in travel abroad (to the limits of the plan)||80%||80%||80%||80%||80%||80%|
|Own expenditure limit (2019) * * *||$5,240||$2,620|
|*Plan F also offers a high-deductible plan. If you choose this option, it means you must pay Medicare-covered costs up to a $2.240 deductible at 2018, before your MEDIGAP plan begins to pay.
** Plan N pays 100% of part B coinsurance, except for the co-payment of up to $20 for some visits and up to a co-payment of $50 for emergency room visits that do not generate a patient hospitalization.
*** After it reaches its annual spending limit of its own pocket and its annual part B deductible, the MEDIGAP plan pays 100% of covered services for the remainder of the calendar year.