Medicare Supplement

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

Consider these facts in deciding if Medicare Supplement insurance for hospital and medical coverage is right for you:

• Medicare Supplement policies may cover all of your co-insurance and deductibles.
• Medicare Supplement policies may cover health care bills not covered by Medicare.

Medicare Facts

• What is Medicare?
• Medicare Eligibility
• Medicare Costs

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Medicare & You

Click here to view the current version of Medicare & You in Adobe .pdf format.

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Medicare.gov

http://www.medicare.gov/

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Medicare Supplement Facts

Medigap Guide

Click here to view the current version of Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare in Adobe .pdf format.

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Standard Plans

Standardized Medicare Supplement Plans for Most States (excluding MA, MN and WI )

Every company offering Medicare Supplement insurance must offer Plan A. In addition, companies may have some, all, or none of the other plans.

Basic Benefits (Included in Plans A - G):

Inpatient Hospital Care: Covers the cost of Part A coinsurance and the cost of 365 extra days of hospital care during your lifetime after Medicare coverage ends.

For medicare supplement plans, Medical Costs: Covers the Part B coinsurance (generally 20% of Medicare-approved payment amount) or copayment amount which may vary according to the service. For hospital outpatient services, the copayment amount will be paid under a prospective payment system. If this system is not used, then 20% of eligible expenses will be paid.

Blood: Covers the first 3 pints of blood each year.

 

Options	A	B	C	D	F*	G
Basic Benefits
Part A: Inpatient Hospital Deductible
Part A: Skilled-Nursing Facility Coinsurance
Part B: Deductible
Foreign Travel Emergency
Part B: Excess Charges					100%	100%

 

* Plan F also has a high deductible option. If you choose this option, in 2017 you must pay $2,180 out-of-pocket per year before the plans pay anything. Insurance policies with a high deductible option generally cost less than those with lower deductibles. Your out-of-pocket costs for services may be higher if you need to see your doctor or go to the hospital.

Basic Benefits (Plans K- N):

Basic Benefits for Plans K, L and N include similar services as Plans A through G and M, but cost sharing for the basic benefits is at different levels.

Options	K**	L**	M	N
Basic Benefits	100% of Part A Hospitalization Coinsurance plus coverage for 365 days after Medicare Benefits end 50% Hospice cost-sharing 50% of Medicare eligible expenses for the first three pints of Blood 50% Part B Coinsurance, except 100% Coinsurance for Part B Preventive Services	100% of Part A Hospitalization Coinsurance plus coverage for 365 days after Medicare Benefits end 75% Hospice cost-sharing 75% of Medicare eligible expenses for the first three pints of Blood 75% Part B Coinsurance, except 100% Coinsurance for Part B Preventive Services		Basic, Including 100% co-insurance, except up to $20 copayment for office visit, and up to $50 copayment for ER
Skilled Nursing Coinsurance	50% Skilled Nursing Facility Coinsurance	75% Skilled Nursing Facility Coinsurance
Part A: Deductible	50% Part A Deductible	75% Part A Deductible	50% Part A Deductible
Part B: Deductible
Part B: Excess (100%)
Foreign Travel Emergency
At-Home Recovery
Preventive Care NOT Covered by Medicare
	$4,960.00 Out of Pocket Annual Limit (2017) ***	$2,480.00 Out of Pocket Annual Limit (2017) ***

**Plans K and L provide for different cost-sharing for items and services than Plans A through G and M. Once you reach the annual limit, the plan pays 100% of the Medicare copayments, coinsurance, and deductibles for the rest of the calendar year. The out-of-pocket annual limit does NOT include charges from your provider that exceed Medicare-approved amounts, called "Excess Charges". You will be responsible for paying excess charges.

***The out-of-pocket annual limit will increase each year for inflation.

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Compare Medicare Supplement Plans

As you approach retirement age, the ever rising cost of health care, makes understanding Medicare, its gaps in coverage and limitations, a very important consideration. Since 1965 Medicare has provided millions of American senior citizens with vital health care services. As good as Medicare is, it may not pay all the cost of being sick. Consequently, what Medicare does not pay becomes your personal financial responsibility.

Choose the Medicare Supplement plan that best meets your needs and your budget. Below lists four of the industry standardized Medicare Supplement plans and the benefits available under each plan. Additional plans may be available.

COVERAGE	WHAT MEDICARE SUPPLEMENT WILL PAY IN 2017	PLAN A	PLAN C	PLAN F	PLAN G
Part A: Medicare Eligible Hospital Expense	$1,316.00 Part A Deductible
	$329.00 per day co-pay for days 61-90
	$658.00 per day co-pay for days 91-150
	100% Medicare - eligible expense after day 150 for an additional 365 days
Skilled Nursing Care	$164.50 per day for days 21 - 100 for medical approved stays in a skilled nursing facility.
Blood	First Three Pints of Blood
COVERAGE	WHAT MEDICARE SUPPLEMENT WILL PAY	PLAN A	PLAN C	PLAN D	PLAN F
Part B: Physician Services and Supplies	$183.00 Part B Deductible
	20% Medicare Eligible Part B Medical Expenses and first three pints of blood
	Eligible Part B charges that exceed Medicare approved amount.
Emergency Care Received Outside the U.S.	After you pay a $250 calendar-year deductible, Insurance Plans pay you 80% of eligible expenses incurred during the first 60 days of a trip up to a lifetime maximum of $50,000. Benefits are payable for health care you need because of a covered injury or illness.

Federal guidelines limit the amount a doctors can charge for benefits covered by Medicare. According to The Centers for Medicare and Medicaid Services (CMS) almost 90% of all doctors accept "assignments". That means they accept the Medicare approved amount as full payment for services rendered. Some plans may not be available in every state.

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Your Right To Buy A Medicare Supplement Policy In Certain Situations

You have the right to buy the Medicare Supplement plan of your choice during your medicare supplement open enrollment period. Your medicare supplement open enrollment period lasts for six months. It starts on the first day of the month in which you are both age 65 or older and enrolled in Medicare Part B. Once you enroll in Medicare Part B, the six months medicare supplement open enrollment period starts and cannot be changed. During this open enrollment period, an insurance company cannot deny you insurance coverage, place conditions on a policy (like making you wait for coverage to start), or change the price of a policy because of past or present health problems.

If you apply for a medicare supplement plan after your medicare supplement open enrollment period has ended, the medicare supplement insurance company is allowed to use medical underwriting to decide whether to accept your application, and how much to charge you for the policy.

There are a few situations involving health care coverage changes where you may have the right to get a medicare supplement policy after your medicare supplement open enrollment period has ended. In these situations, the insurance company cannot deny you insurance coverage, place conditions on the policy (like making you wait for coverage to start), or change the price of a policy because of past or present health problems.

If you lose certain types of health care coverage, you have the right to buy a medicare supplement policy outside of your medicare supplement open enrollment period. These rights are called "Medigap Protections." They are also called "guaranteed issue" rights because the law says that insurance companies must issue you a policy.

Medigap protections are important because without them, if you do not buy a medicare supplement policy during your medicare supplement open enrollment period, an insurance company can refuse to sell you a policy, or you may be charged more for the policy. In addition, if you drop your medicare supplement policy, you may not be able to get it back except in very limited circumstances.

You should not wait until your health coverage has almost ended before you apply for a medicare supplement policy. You can apply for a medicare supplement policy early (while you are still in your health plan) and choose to start your medicare supplement coverage the day after your health plan coverage ends. This will prevent gaps in your health coverage.

Summary of Medigap Protections
There are a few situations involving health coverage changes where you may have a guaranteed issue right to buy a medicare supplement policy.

For example:

1. Your Medicare managed care plan, Private Fee-for-Service plan, PACE provider, or Medicare managed care demonstration project coverage ends because the plan is leaving the Medicare program or stops giving care in your area, or

2. Your health coverage ends because of reasons other than a plan leaving the Medicare program, or

3. You dropped your medicare supplement policy to join a Medicare managed care plan, Private Fee-for-Service plan, or PACE program and then leave the plan within one year after joining. Or you buy a Medicare SELECT policy for the first time and drop the policy within one year after buying, or

4. You joined a Medicare health plan (like a Medicare managed care plan with a Medicare + Choice contract, or Private Fee-for-Service plan) or PACE program when you first became eligible for Medicare at age 65 and you leave the plan within one year of joining, or

5. A change in your circumstances gives you the right to leave (disenroll from) your plan.

In order to get these medicare supplement protections, you must meet certain conditions. All rights to buy medicare supplement policies under the following situations include Medicare SELECT policies since they are a type of medicare supplement policy. For more detailed on your rights and protections, you may want to read Medigap Policies and Procedures.

The medicare supplement protections in this section are from federal law. Many states provide more medicare supplement protections than federal law. Call your State Health Insurance Assistance Program or State Insurance Department for more information.

If you live in Massachusetts, Minnesota, or Wisconsin, you have the right to buy a medicare supplement policy that is similar to the standardized policies you have a right to buy in other states.

Note: There may be times when more than one of these situations applies to you. When this happens, you can choose the protection that gives you the best choice of policies.

For example:

If both situations #1 and #4 apply to you, you may have the right to buy any medicare supplement policy.

• Situation #1 limits your choices to only medicare supplement plans A, B, C, or F that are sold in your state.
• Situation #4 offers you the best choice by allowing you to buy any medicare supplement policy that is sold in your state.

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Massachusetts Standardized Medicare Supplement Plans

Basic Benefits- Included in all plans:

Inpatient Hospital Care: Covers the Part A coinsurance and the cost of 365 extra days of hospital care during your lifetime after Medicare coverage ends.

For medicare supplement plans, Medical Costs: Covers the Part B coinsurance (generally 20% of Medicare-approved payment amount) or copayment amount which may vary according to the service. For hospital outpatient services, the copayment amount will be paid under a prospective payment system. If this system is not used, then 20% of eligible expenses will be paid.

Blood: Covers the first 3 pints of blood each year.

Medicare Supplement Benefits	Core	Supplement 1	Supplement 2
Basic Benefits
Part A: Inpatient Hospital Deductible
Part A: Skilled-Nursing FacilityCoinsurance
Part B: Deductible
Foreign Travel Emergency
Inpatient Days in Mental Health Hospitals	60 days per calendar year	120 days per benefit year	120 days per benefit year
Prescription Drugs ($35 deductible each calendar quarter, then 100% coverage for generic drugs and 80% coverage for brand name drugs)
State-Mandated Benefits: (Annual Pap Smear tests and mammograms. Check your plan for other state-mandated benefits.)

 

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Basic Benefits - Included in all plans:

Inpatient Hospital Care: Covers the Part A coinsurance.

For medicare supplement plans, Medical Costs: Covers the Part B coinsurance (generally 20% of Medicare-approved payment amount) or copayment amount which may vary according to the service. For hospital outpatient services, the copayment amount will be paid under a prospective payment system. If this system is not used, then 20% of eligible expenses will be paid.

Blood: Covers the first 3 pints of blood each year.

Basic Plan	Covers
Basic Benefits
Part A: Skilled-Nursing Facility Coinsurance
Inpatient Mental Health Coverage	175 days per lifetime in addition to Medicare
Home Health Care	40 visits in addition to those paid by Medicare
Part B Coinsurance
Outpatient Mental Health
Prescription Drugs

Optional Riders:

Insurance companies are permitted to offer additional riders to a Medicare Supplement plan.

Optional Riders	Covers
Medicare Part A Deductible Rider
Additional Home Health Care Rider	365 visits including those paid by Medicare
Medicare Part B Deductible Rider
Medicare Part B Excess Charges Rider
Outpatient Prescription Drug Rider
Foreign Travel Rider

Mandated State Benefits under Medicare Supplement Basic Plan:

• Usual and customary expenses for chiropractic services
• Usual and customary expenses for diabetic supplies and equipment
• 30 day skilled nursing home confinement
• Kidney disease treatment for dialysis, transplantation and donor-related services with a $30,000 maximum
• Usual and customary expenses for breast reconstruction following a masectomy
• Usual and customary expenses for hospital and ambulatory surgery center charges and anesthetics for dental care
• Nervous and mental disorder and alcoholism and other drug abuse coverage
• Coverage for at least 80% of the charges for outpatient prescription drugs after a drug deductible of no more than $6,250 per calendar year