MediGap Plan Information

MediGap Plans

MediGap Plans are a form of “Supplemental” Coverage for Medicare. They are offered by Private Insurance Companies that cover the “Gaps” that are in Original Medicare.

What are those gaps?

Some examples are:

Coverage for Blood; Medicare only covers the first 3 pints of blood but in most hospitalizations without “bleeding or lacerations” that should be sufficient. For those needing emergency care from an accident or wound well 3 pints is considered a taste.

Hospital stays; Medicare covers the first 60 days of any stay in a hospital due to any one incident after a deductible of $1,100.

• Between days 61 – 90 there is a co pay of $275 per day per stay while Medicare covers all other costs.
• 91-150, the co insurance is $550 per day per stay; Medicare picks up the rest
• All costs for each day beyond 150 days are covered by the beneficiary.

Co-pays & Deductibles; As stated above Part A & Part B both have either a deductible, co pay or premium. For more information please see Medicare Costs Breakdown

Foreign Travel; Original Medicare will not cover any health costs while incurred out of the country.

With a MediGap plan these costs or gaps will be covered depending on the plan that is selected by the beneficiary.

For most beneficiaries on Medicare, there are 10 Plans (A-N with nothing for E & I) to choose from and each have certain aspects that they cover or don’t cover. 3 states Massachusetts, Minnesota, and Wisconsin have a different set up

Examples of the Plans:

Plan A; the most basic and the building block of all other Plans, covers an additional 365 days of hospitalization, any coinsurance (not except on skilled nursing) and Blood.

Plan F; (the most robust) covers everything in Plan A and all deductibles, excess charges & foreign travel emergency care.

*Some of the 10 standard plans pay for services not covered by Medicare such as outpatient prescription drugs, preventive screening, and emergency medical care while traveling outside the United States. Coverage is also provided in some plans for health care provider charges in excess of Medicare’s approved amount and for some care in your home, but these are all based on the Plan chosen* - www.ec-online.net

Unfortunately, Medicare also has many other “Gap’s” that are not covered like coverage for Dental, Vision, Hearing and Podiatry. In order to insure against these possible costs a beneficiary needs to look into a Medicare Advantage Plan - see our article on MA Plans.

Note; that it is against the rules to own both a MediGap Plan and a Medicare Advantage Plan.

Premiums; Even though benefits are identical for all Medigap plans, premiums vary from one company to another and then depending on what area too.

There are 3 ways to calculate premiums;

Issue age; If the plan is purchased at age 65, you will always pay the same premium the company charges people who are 65 regardless of your age.

Attained age; the premium is based on your current age and will increase as your grow older.

No age rating; everyone pays the same premium regardless of age and the state must approve the rates

Enrollment; As long as the beneficiary has been enrolled in Medicare A & B during the 6 month Initial Enrollment Period the beneficiary can choose a MediGap Policy from a private company in the state of residence that has been approved by Medicare.

*The company cannot deny or condition the issuance or effectiveness, or discriminate in the pricing of a policy because of medical history, health status or claims experience. The company can, however, impose the same preexisting condition restrictions that apply to Medigap policies sold outside the open enrollment period.*

After the IEP the enrollment period is then October 15 to December 7 with an effective date being January 1 of the next year.

Please note that the beneficiary is now subject to the terms and conditions of the Private Insurance Company offering these plans. The beneficiary can be charged more, have their coverage delayed or be flat out rejected all based on health conditions.

There are also other conditions to; If the beneficiary has moved from one state to another, enrollment is allowed or the beneficiary has been employed and just newly retired.

For more information on MediGap Plans please see;

www.goodcare.com; www.medicare.gov; www.ec-online.net