| The
10 Medicare Supplement Plans
and How They Work
Medicare
Supplement insurance can be sold in only ten standard plans: A, B, C, D, F,
G, K, L, M and N. Though the price may vary from one company to another,
the benefits of these plans are the same, regardless of which insurance company
you purchase your coverage through. All
plans offer coverage for “core benefits,” meaning hospitalization,
blood, and your 20% co-insurance for outpatient medical services such as doctor
visits. Other plans also offer coverage to help pay your Part A or B deductible,
Part B “excess” charges (the amount your doctor may charge above the
Medicare approved limits), your portion of the bill for skilled nursing, medical
care while traveling outside of the U.S., at home recovery, and preventative
care. These seven benefits are combined with the core benefits in various
ways to make up the various Medicare Supplement plans. Medicare Supplement
plans do not cover Prescription drugs - that can be covered by adding Part
D. Plan
A: Basic Benefits The
basic benefits (also known as the "core benefits" or
Plan A) are the minimum Medicare Supplement coverage you may buy. These
are the only benefits in Plan A. Every other plan contains these
three Medicare Supplement benefits as the "core" and then adds one
or more additional benefits. -
Hospitalization:
Medicare Part A pays for hospitalizations for the first 60 days, but only
pays a portion of the daily costs from the 61st day through the 150th day.
You must pay the coinsurance amounts for those days. This Medicare Supplement
benefit pays the coinsurance amount for those days, and the total Medicare
reimbursement amount for an additional 365 lifetime days.
-
Blood:
Medicare pays for all blood that is medically necessary except for the first
three pints in each calendar year. This Medicare Supplement benefit
pays for the first three pints of blood not paid for by Medicare.
-
Medical
Expenses: Generally Medicare Part B pays for 80% of a predetermined
amount (called the "Medicare approved" amount) for each procedure,
supply, or service billed by your doctor or other provider that is not a hospital.
This Medicare Supplement benefit pays the coinsurance (generally 20% of the
"Medicare approved" amount) under Medicare Part B.
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Note:
Plan A contains only these 3 core benefits. Although Plan
A is the least expensive policy, it may not be a good choice for low-income
individuals who may not be able to afford the Medicare Part A hospital deductible
when they are hospitalized.
| | Plans
B through N There
are seven additional Medicare Supplement benefits that are combined with the
basic benefits in various ways to make up the nine remaining plans called Medicare
Supplement Plan B through Plan N. Medicare Supplement plans do not cover
Prescription drugs. For Prescription drug coverage, see Medicare
Part D.
-
The Part A Deductible: The Medicare Part A deductible is the
expense for which you are obligated to pay when you are admitted to a hospital
as an inpatient. Medicare pays eligible benefits above that amount.
(The Medicare Part A deductible amount may change yearly, so check the current
Medicare brochure). This
Medicare Supplement benefit reimburses you the deductible amount, no matter
what the amount may be. This supplemental benefit is included in
Plans B through N. Plans K and M cover 50%, Plan L covers 75%.
- Skilled
Nursing Coinsurance: Medicare Part A pays for the first 20 days
of care in a skilled nursing facility following hospitalization, but requires
you to pay a coinsurance beginning on the 21st day through the 100th day.
This Medicare Supplement benefit pays the coinsurance amount beginning on
the 21st day. This supplemental benefit is included in Plans C through
N. Plans K and M cover 50%, Plan L covers 75%.
- Part
B Deductible: The Medicare Part B deductible is the amount you must
pay each year for medical expenses (such as doctor fees) before Medicare begins
paying. (The Part B deductible amount may change per year - $140 in
2012). This Medicare Supplement benefit reimburses you the deductible
amount. This supplemental benefit is included in Plan C and Plan
F.
- Part
B Excess Charges: Medicare Part B pays 80% of a predetermined amount
(called the "Medicare approved" amount) for each procedure performed
by your doctor or other medical care provider. If your doctor accepts
Medicare "assignment," the provider may only bill you for the difference
between the amount paid by Medicare and the amount approved
by Medicare.
If your doctors do not accept Medicare assignment, they may bill you
for the difference between the amount paid by Medicare and the amount they
can legally charge you (called the "limiting charge"). If
you have a Medicare Supplement Plan with the following:
- If
you have a Medicare Supplement Plan with the Part B Excess Charges (100%)
benefit, the supplement plan will pay the full amount billed by your doctors
or other providers who do not take Medicare assignment subject to the limiting
charge. This supplemental benefit is included in Plan F and G.
(Remember
this coinsurance amount is paid by the Medical Expenses part of the
Basic Benefits that are part of every Medicare Supplement insurance
plan).
-
Foreign Travel Emergency: The original Medicare plan does not
pay for medical care outside of the United States, but some Medicare managed
care plans, private Fee-for-Service plans, and some Medicare Supplement plans
do. This Medicare Supplement benefit will pay 80% of your expenses for
most emergency medical care in a foreign country during the first 60 days
of a trip abroad after you pay a $250 deductible. There is a lifetime
maximum benefit, so check the current Medicare
brochure for the dollar amount. This supplemental benefit is
in Plans C, D, F, G, M and N. Check your insurance coverage before
you travel.
The chart below shows
the benefits included in each plan.
|
Features
|
A
|
B
|
C
|
D
|
F*
|
G
|
K**
|
L**
|
M***
|
N***
| |
Basic
Benefits
|
|
|
|
|
|
|
50%
|
75%
|
|
| |
Skilled
Nursing
Coinsurance
|
-
|
-
|
|
|
|
|
50%
|
75%
|
|
| |
Part
A
Deductible
|
-
|
|
|
|
|
|
50%
|
75%
|
|
| |
Part
B
Deductible
|
-
|
-
|
|
-
|
|
-
|
-
|
|
|
| |
Part
B Excess
|
-
|
-
|
-
|
-
|
100%
|
100%
|
-
|
-
|
-
|
-
| |
Foreign
Travel
Emergency
|
-
|
-
|
|
|
|
|
-
|
-
|
|
| |
*
Plan F also has high deductible options, which some companies may offer.
These high deductible plans pay the same benefits as Plan F after one has paid
a calendar year $2000 deductible. Benefits from high deductible Plans
F will not begin until out-of-pocket expenses exceed $2000.
**
Plans K and L provide for different cost-sharing for items and services than
the other Plans. With either of these plans, once you reach your annual
"out-of-pocket limit," the plan will then pay 100% of the Medicare
co-payment, co-insurance and deductibles for the rest of the calendar year.
The out-of-pocket limit does not include charges for any provider that exceeds
Medicare-approved amounts, known as "excess charges." The annual
out-f-pocket limits for these plans in 2012 are $4660 for Plan K, and $2330
for Plan L. ***
Plan M uses cost-sharing feature known as co-insurance (meaning you are paying
part of your bills, in exchange for a lower premium). Plan N uses cost-sharing
as a method to reduce your monthly premiums. However, rather than uses
the deductible-sharing method, like Plan M, it uses co-pays to help reduce the
premium costs. The system of co-pays is set at $20 for doctor's visits
and $50 for emergency room visits. After
you receive your Medicare Supplement policy in the mail, you have a 30-day free
look to examine the plan and to decide if you want to keep it. If you
return the plan within 30 days, all of your money will be refunded.
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