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Medicare Supplement

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

Medicare Facts


Medicare & You

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


Medicare.gov

http://www.medicare.gov/


 

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.


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 Basic Benefits - Plan A - Covered Basic Benefits - Plan B - Covered Basic Benefits - Plan C - Covered Basic Benefits - Plan D - Covered Basic Benefits - Plan F - Covered Basic Benefits - Plan G - Covered
Part A: Inpatient Hospital Deductible Part A: Inpatient Hospital Deductible - Plan A - Not Covered Part A: Inpatient Hospital Deductible - Plan B - Covered Part A: Inpatient Hospital Deductible - Plan C - Covered Part A: Inpatient Hospital Deductible - Plan D - Covered Part A: Inpatient Hospital Deductible - Plan F - Covered Part A: Inpatient Hospital Deductible - Plan G - Covered
Part A: Skilled-Nursing Facility Coinsurance Part A: Skilled-Nursing Facility Coinsurance - Plan A - Not Covered Part A: Skilled-Nursing Facility Coinsurance - Plan B - Not Covered Part A: Skilled-Nursing Facility Coinsurance - Plan C - Covered Part A: Skilled-Nursing Facility Coinsurance - Plan D - Covered Part A: Skilled-Nursing Facility Coinsurance - Plan F - Covered Part A: Skilled-Nursing Facility Coinsurance - Plan G - Covered
Part B: Deductible Part B: Deductible - Plan A - Not Covered Part B: Deductible - Plan B - Not Covered Part B: Deductible - Plan C - Covered Part B: Deductible - Plan D - Not Covered Part B: Deductible - Plan F - Covered Part B: Deductible - Plan G - Not Covered
Foreign Travel Emergency Foreign Travel Emergency - Plan A - Not Covered Foreign Travel Emergency - Plan B - Not Covered Foreign Travel Emergency - Plan C - Covered Foreign Travel Emergency - Plan D - Covered Foreign Travel Emergency - Plan F - Covered Foreign Travel Emergency - Plan G - Covered
Part B: Excess Charges Part B: Excess Charges - Plan A - Not Covered Part B: Excess Charges - Plan B - Not Covered Part B: Excess Charges - Plan C - Not Covered Part B: Excess Charges - Plan D - Not Covered 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 Benefits - Plan M - Covered 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 Skilled Nursing Coinsurance - Plan M - Covered Skilled Nursing Coinsurance - Plan N - Covered
Part A: Deductible 50% Part A Deductible 75% Part A Deductible 50% Part A Deductible Part A: Deductible - Plan N - Covered
Part B: Deductible Part B: Deductible - Plan K - Not Covered Part B: Deductible - Plan L - Not Covered Part B: Deductible - Plan M - Not Covered Part B: Deductible - Plan N - Not Covered
Part B: Excess (100%) Part B: Excess (100%) - Plan K - Not Covered Part B: Excess (100%) - Plan L - Not Covered Part B: Excess (100%) - Plan M - Not Covered Part B: Excess (100%) - Plan N - Not Covered
Foreign Travel Emergency Foreign Travel Emergency - Plan K - Not Covered Foreign Travel Emergency - Plan L - Not Covered Foreign Travel Emergency - Plan M - Covered Foreign Travel Emergency - Plan N - Covered
At-Home Recovery At-Home Recovery - Plan K - Not Covered At-Home Recovery - Plan L - Not Covered At-Home Recovery - Plan M - Not Covered At-Home Recovery - Plan N - Not Covered
Preventive Care NOT Covered by Medicare Preventive Care NOT Covered by Medicare - Plan K - Not Covered Preventive Care NOT Covered by Medicare - Plan L - Not Covered Preventive Care NOT Covered by Medicare - Plan M - Not Covered Preventive Care NOT Covered by Medicare - Plan N - Not Covered
  $4,960.00 Out of Pocket Annual Limit (2017) *** $2,480.00 Out of Pocket Annual Limit (2017) *** Out of Pocket Annual Limit - Plan M - Not Available Out of Pocket Annual Limit - Plan N - Not Available

**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.


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.

CHOOSE THE PLAN THAT'S RIGHT FOR YOU

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.


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.


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.)

 


Minnesota Standardized Medicare Supplement Plans

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.

Medicare Supplement Benefits Basic Extended Basic
Basic Benefits
Part A: Inpatient Hospital Deductible  
Part A: Skilled-Nursing Facility Coinsurance
Part B: Deductible  
Foreign Travel Emergency 80% 80%
Outpatient Mental Health 50% 50%
Usual and Customary Fees   80%
Preventive Care
Prescription Drugs   80%
At-home recovery  
Physical Therapy 20% 20%
Coverage While in a Foreign Country   80%

Optional Riders:

Insurance companies are permitted to offer six additional riders that can be added to a Basic plan. You may choose any one of all of the riders to design a Medicare Supplement plan that meets your needs.

Optional Riders Covers
Part A: Inpatient Hospital Deductible
Part A: Deductible
Usual and Customary Fees
Preventive Care
Prescription Drugs
At-Home Recovery

 


Wisconsin Standardized Medicare Supplement Plans

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: