Medicare Supplement Plans - Overview
Medicare Supplement Plans, also known as Medigap Plans, are designed to help cover some of the medical costs that are not covered by Medicare, and are available to anyone enrolled in part A and B of Medicare. There is an open enrollment period for the first six months after you turn age 65, in which you do not need to qualify.
What Medicare Doesn't Cover
Medicare does not cover all health care costs. Medicare coverage consists of Part A (which covers hospital and skilled nursing facility care), and Part B (which covers doctor bills and other medical expenses).
Even with Medicare Part A and Part B coverage, you're responsible for some out-of-pocket expenses including:
- Part A hospital deductible ($1,100)
- Part B deductible ($155)
- Copayments for hospital stays over 60 days
- Care in a skilled nursing facility after 20 days
- Twenty percent coinsurance for doctor bills and other medical expenses
Medicare Supplement Plans are Standardized
By law, Medicare Supplement insurance is standardized into twelve plans (Plans A through L). That means Plan F from one company must include the same benefits as plan F from another company. Since Medicare Supplement insurance plans are standardized and all insurance companies offer the same basic supplemental coverage, your Medicare supplement choice comes down to price and a company's service, reputation and experience with Medicare supplement insurance policies.
In addition to the standard Plan A-L Medicare supplement health care policies, Medicare SELECT is a type of Medicare Supplement health care policy that can cost less than standard Medicare supplemental. However, you can only go to certain doctors and hospitals for your care.
The most popular Medicare Supplement insurance plans in Indiana are offered by Anthem Blue Shield Blue Shield of Indiana. To get a Blue Cross Blue Shield of Illinos Medicare Supplement quote, click on the Medicare Supplement Quote Form.
To qualify for a Medicare Supplement policy, you must be age 65 or older (may vary by state), enrolled in Medicare parts A and B, and you must reside in the state in which you are applying for supplemental coverage.
When to Enroll
Your open enrollment period is the best time to buy a Medicare Supplement policy because companies must sell you any plan they offer regardless of your pre-existing health conditions. Your open enrollment period lasts for 6 months and begins on the first day of the month in which you are age 65 or older and enrolled in Part A and B of Medicare.
To help control rising costs, carriers apply the pre-existing condition clause to newly issued Medicare Supplement plans in most states if you enroll after the open enrollment period. Expenses resulting from a condition existing six months prior to the supplemental policy effective date are not covered unless they are incurred three months after the supplemental policy effective date.
If the supplemental policy replaces another creditable individual or group insurance coverage due to a person's eligibility for Medicare, this Pre-Existing Conditions Limitation will be reduced by the number of months that coverage was in force. If this supplemental policy replaces another Medicare Supplement policy, this Pre-Existing Conditions Limitation will be reduced by the number of months that the coverage was in force.
Medicare Supplement Basic Benefits
Basic benefits included in all plans include:
- Hospitalization - Part A coinsurance plus coverage for 365 additional days after Medicare benefits end.
- Medical Expenses - Part B coinsurance (generally 20% of Medicare-approved expenses), or in the case of hospital outpatient department services under a prospective payment system, applicable copayments.
- Blood - First three pints of blood each year.
Medicare Supplement Benefits by Plan
The chart below shows the standard benefits included in each plan.
|Skilled Nursing Coinsurance||-||-||X||X||X||X||X||X||X||X||50%||75%|
|Part A Deductible||-||-||X||X||X||X||X||-||-||-||50%||75%|
|Part B Deductible||-||-||-||-||-||-||-||X||-||-||-||-|
|Part B Excess||-||-||-||-||-||100%||80%||-||100%||100%||-||-|
|Foreign Travel Emergency||-||-||X||X||X||X||X||X||X||X||-||-|
|At Home Recovery||-||-||-||X||-||-||X||-||X||X||-||-|
*Plan F also has a high deductible option, which some companies may offer. These high deductible plans pay the same benefits as Plan F after one has paid a calendar year $2,000 deductible. Benefits from high deductible Plans F and J will not begin until out-of-pocket expenses exceed $2000.
**Plan K and Plan L provide for different cost-sharing than plans A-F. 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.