General Medicare Info

Benefit Chart of MediGap Plans for Effective Dates on or After January 1, 2017

Basic Benefits:

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 copayments for hospital outpatient services. Plans K, L, and N require insureds to pay a portion of Part B coinsurance or copayments.
Blood: First 3 pints of blood each year.
Hospice: Part A coinsurance.

Medicare Supplement Benefit Comparison:

Medigap Benefits A B C D F/F* G K L M N
Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up
Part B coinsurance or copayment 50% 75%
Blood (first 3 pints) 50% 75%
Part A hospice care coinsurance or copayment 50% 75%
Skilled nursing facility care coinsurance - - 50% 75%
Part A deductible - 50% 75% 50%
Part B deductible - - - - - - - -
Part B excess charges - - - - - - - -
Foreign travel exchange (up to plan limits) - - 80% 80% 80% 80% - - 80% 80%
Out-of-pocket limit N/A N/A N/A N/A N/A N/A  $5,120  $2,560 N/A N/A

*Plan F also has an option called a high deductible plan F. This high deductible plan pays the same benefits as Plan F after one has paid a calendar year [$2,200] deductible. Benefits from high deductible plan F will not begin until out-of-pocket expenses exceed [$2,200]. Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy. These expenses include the Medicare deductibles for Part A and Part B, but do not include the plan's separate foreign travel emergency deductible.

Medigap Frequently Asked Questions

Why were plans E, H, I and J eliminated? 
Plan E was eliminated because the new Plan D would contain exactly the same benefits. Plans H, I and J were eliminated because with the other dropped benefits these plans would also duplicate other plans available.

What will happen if the plan that you have is dropped? 
Any plan that was purchased prior to June 2010 will remain inforce. Keep in mind these new plans are for new issues with effective dates of June 2010 and beyond. Your clients’ current Medigap plan is guaranteed renewable for life. Even if their health changes, they cannot be terminated or forced to change to one of the new plans.

What is the new hospice benefit? 
All plans will now include the Hospice Benefit as part of the “Core Benefits.” Medicare provides coverage for inpatient respite care up to 5 days less a co-payment amount of 5% of the daily benefit. The new Hospice benefit will pick up this 5% co-pay.

Why was the At-Home Recovery benefit dropped? 
It was determined that the benefit was confusing and difficult to understand and administer.

Why was Preventive Care dropped from all plans? 
Because Medicare Part B has changed to cover many more preventive benefits, effectively rendering this benefit redundant.

Medicare Benefits For Part A

Benefits For Medicare 2017 Out-Of-Pocket Cost
Part A Benefits Part A Cost
Inpatient Hospital
Day 1 Through Day 60
$1,316 Deductible For First Stay During a Year
Day 61 Through Day 90 $329 Per Day 61 Through 90
60 Day "Lifetime Reserve" $658 Per Day
Skilled Nursing Facility Day 1 through Day 20 $0 Day 1 Through Day 20
Skilled Nursing Facility Day 21 through Day 100 $164.50 Day 21 Through Day 100
Hospice Care For Terminally Ill Nominal Coinsurance For Drugs And Respite Care

Medicare Benefits Part B

Benefits For Medicare 2017 Out-Of-Pocket Cost
Part B Benefits Part B Cost
Annual Deductible $183
Physician And Other Medical Services 20% Of Medicare Approved Amount
Outpatient Hospital Care 20% Of Medicare Approved Amount
Ambulatory Surgical Services 20% Of Medicare Approved Amount
Laboratory Services $0
Outpatient Mental Health Services 68.75% Of Medicare Approved Amount