Medigap
Medicare Supplement Plans

Original Medicare is made up of Part A inpatient services and Part B outpatient services. You have a $1,216.00 deductible when you become an inpatient in the hospital under Part A of Medicare. Each time you are admitted into the hospital as an inpatient, with sixty or more days in-between each admission, you will pay the deductible of $1,216.00. Under Medicare Part B, you have an annual deductible of $147.00. After you pay your annual deductible, Medicare will pay 80% of the medical allowable bill for your outpatient services. You will owe the remaining 20%. Paying deductibles for hospital admissions and 20% of outpatient allowable bills will add up. A Medicare Supplement plan can pay your Part A and Part B deductibles as well as your 20% medical allowable balance.

Supplemental Plans (Medigap)

Medicare Supplement Plans give you the most freedom in choosing doctors and facilities for your health care needs.

Part A, is your inpatient services of Medicare. This is where you are being treated as an inpatient. This could be in a hospital, a skilled nursing facility or in hospice.

You have deductibles to contend with. Under Part A of Medicare, you will pay a $1,216.00 deductible when you are admitted to a hospital. After you pay your deductible, Part A will cover the medically needed services while you are admitted to the hospital.

When you are discharged from the hospital your benefit period ends. If you are admitted as an inpatient to the hospital after 60 days from your discharge, you will pay another $1,216.00 deductible for Part A of Medicare. This will continue throughout the calendar year.

Under Part B of Medicare, you currently have an annual deductible of $147.00. Once you pay your deductible, Medicare will pay 80% of the medical allowable bill. You will owe the remaining 20%. Let’s say you have paid your $147.00 deductible on January 15th. You go to a cardiologist on January 31st for shortness of breath.
The Cardiologist’s bill to Medicare is $350.00. Medicare agrees to pay 80% of the $350.00, which is $280.00. You would owe the remaining 20%, which is $70.00.

You will continue to pay out 20% of all the Medicare allowable bills. That can get quite costly.

A Medicare Supplement Plan can pay most your deductibles and cost share (20%) that you owe. Some Medicare Supplement Plans will pay all of the deductibles, cost share, and co-pays. You will pay a premium to the Private Insurance company and they in turn will pay your share of the cost.

Medicare Supplement Plans are standardized. This means whether you reside in California, New York or Oklahoma, your benefits under the Medicare Supplement Plan you choose, is exactly the same in each of those States.

The benefit for visiting the cardiologist under a Medicare Supplement Plan “F” is exactly the same in California, North Dakota, and Florida. The premium you pay for your Medicare Supplement Plan is very different in each State.

Premiums for Medicare Supplement Plans vary from State to State. They may vary from county to county in a State.

Medicare Supplement Plans give you the most freedom in your choices of doctors and facilities. With a Medicare Supplement Plan, you can see any physician, go to any facility, as long as they are contracted with Medicare. You are not required to get referrals to specialists under a Medicare Supplement Plan.
Just pick the specialist you want to see and call them to find out if they are contracted with Medicare. If they are, (most physicians are) make your appointment and you’re done.

The following chart will list all the benefits for Medicare Supplement Plans. These benefits are the same in every State – except Minnesota, Massachusetts and Wisconsin. These three States follow different protocols for Medicare Supplement Plans.

The following chart illustrates the different Medicare Supplement Plans available throughout the United States. Some States do not accept all the Medicare Supplement Plans. You must do your due diligence in the State you reside in, to determine which plans are offered in your State.

The Medicare Survival Guide to – Medicare Supplement Plans

The chart below shows basic information about the different benefits Medicare Supplement policies cover.

  • Yes = the plan covers 100% of this benefit
  • No = the policy doesn’t cover that benefit
  • % = the plan covers that percentage of this benefit
  • N/A = not applicable

medicare-supplement-plans

* Plan F also offers a high-deductible plan. If you choose this option, you must pay for Medicare-covered costs up to the deductible amount ($2,180 in 2015) before your Medicare Supplement plan pays anything.

** After you meet your out-of-pocket yearly limit and your yearly Part B deductible, the Medicare Supplement plan pays 100% of covered services for the rest of the calendar year.

*** Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don’t result in inpatient admission.

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