So, you are about to turn
65 and now you have to select a Medicare Supplement Plan.
You have had insurance all of your life and now the whole thing
is changing from what you have dealt with all of these years!
The standardized plans each cover a different set of
coverages;you find yourself dealing with new terms and language .
This combined with advise from friends and agents that is often
conflicting is just making the process that much more
difficult.
We will attempt to clear all of this up and give you
clear logical focus on which plan is the best value for you.
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In 1992 the Federal Goverment mandated
that Medicare Supplements be
standardized.
There are 10 Standardized
Medicare Supplement plans
called
A through
J
The benefits of each plan are different,
with the exception that all plans cover the Basic
Benefits.
Medicare standardized the plans to limit
the consumers confusion when comparing coverage
offered by different companies. With
standardization, the consumer can easily compare
the benefits and the cost being
offered.
PRESCRIPTION
COVERAGE: Let's deal with this first
of all. Prescription coverage is included only on
plans "H","I",and "J". The extent of that coverage
is explained later within the material ,but right
now let's sum it up by saying that those plan are
very costly and the coverage is very limited. Very
few of these plans are sold as most people
consider them to be too expensive.
A LITTLE
HISTORY: In the past Plan "C"
was the most popular. Plan "C" offered everything
that Plan"F" offered except it did not cover the
"EXCESS CHARGES" (when the provider charges over
the Medicare approved amount). Being that the
Excess Charges are limited by law to 15% ,and the
price differincial between "C" and "F" was
generaly high;most customers bought plan
"C".
In the past couple of years for some
unknown reason this has changed. Even though
Plan "F" offers better coverage than Plan "C";
with many companies Plan "F", is now priced less
than Plan"C". If you are choosing between Plan "C"
and Plan "F"; Plan "F" is now the
better choice.
Because of this odd pricing, Plan"F" is now
the most popular plan.
All companies do not offer all plans. Each
company decides which plans they wish to market.
Most companies only offer four or five plans .
Many companies only offer plans through
"F".
It's time to look at
Plan"G" - - Plans"C" and "F" are not
bad decisions, but Plan "G" may be a better value
once you understand the differences in coverage
and price.
Plan "G" covers
everything that plan "F" covers except the $110
per year Medicare Part B Deductible. You can offten save up to $350
a year by buying plan"G", and the only trade off
is haveing to pay the Part B Deductible; a net
savings of $250 per year. In addition to saving
$250 per year, plan "G covers "At Home Recovery"
(a $1600 per year max benefit) where Plan "F"
does not cover this important benefit.
Do the math; save
$250 net per year on the premiums and get $1600
more in benefits wih Plan "G" instead of Plan
"F".
Medigap
Benefit
A
B
C
D
E
F
G
H
I
J
Medicare Basic
Benefits
Part A Deductible
Part B Deductible
$100 per year
Skilled Nursing
Coinsurance
Foreign Travel
Emergency
Part B Excess - Above Medicare's Approved
Amount
Basic Drug Benefit ($1,250 Limit)
Extended Drug Benefit($3,000 Limit)
At-Home Recovery
$1600 per year
benefit
Preventative Care
365 Extra Days of Hospital
Coverage
3 Pints of Blood
*Plans F and J also have a high
deductible option. If you choose this option,
you must pay $1,730 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.
You may need this benefit
if you have to stay in the hospital. The Part A
deductible for 2005 is $912. This amount can
change every year. You have to pay this
deductible for each benefit period.
Benefit covers: $912 in
2005.This amount can change every year.
You may want to consider
this benefit (which is $110 in 2005) if you have
Medicare Part B. Each year you must pay the Part
B deductible before Medicare starts to pay its
share. If you have this benefit, the Medigap
plan would pay this amount each year.
Benefit covers: The Part A
coinsurance amount for days 61-90 ($228 per day
in 2005) and days 91-150 ($456
per day in 2005) of a hospital stay. The
coinsurance or copayment amount for Part B
services after you meet the $110 yearly
deductible.
Under federal law, doctors
who don't accept "assignment " (take Medicare's
approved amount as payment in full) may charge
up to 15% more than the approved amount. You
might want to think about this benefit if your
doctors don't accept assignment. You may also
want this benefit if you have to stay in the
hospital and can't control whether the doctors
you see accept assignment.
Benefit covers: Plans F, I
and J pay all of the excess charges. Plan G pays
80% of the excess charges.
You may think about this
benefit if you have high prescription drug
costs. Because it covers half your drug costs
after the yearly deductible, to get the full
benefit under Plans H and I, you should have at
least $2,750 in drug costs in a year (you pay
$1,250 plus $250; plan pays $1,250). To get the
full benefit under Plan J, you should have at
least $6,250 in drug costs in a year (you pay
$3,000 plus $250; plan pays $3,000).
Benefit covers: 50% of the
drug costs that Medicare cover (after you pay a
$250 per year deductible). Up to
$1,250 each year under Plans H and I.
Up to $3,000 each year
under Plan J.
You may think about this
benefit if you have high prescription drug
costs. Because it covers half your drug costs
after the yearly deductible, to get the full
benefit under Plans H and I, you should have at
least $2,750 in drug costs in a year (you pay
$1,250 plus $250; plan pays $1,250). To get the
full benefit under Plan J, you should have at
least $6,250 in drug costs in a year (you pay
$3,000 plus $250; plan pays $3,000).
Benefit covers: 50% of the
drug costs that Medicare cover (after you pay a
$250 per year deductible). Up to
$1,250 each year under Plans H and I.
Up to $3,000 each year
under Plan J.
If you travel outside the
United States, this benefit could save you money
for emergency care.
Benefit covers: 80% of the
cost of emergency care during the first 60 days
of each trip (after you pay the
$250 deductible). Up to $50,000 in your
lifetime.
This benefit covers
additional care at home if you are already
getting Medicare-covered home health services.
It pays up to $40 a visit and $1,600 a year.
This benefit may cost a lot and may not be worth
the additional premiums you pay for
it.
Benefit covers: The cost of
at-home help with daily activities like bathing
and dressing if you are already
getting Medicare-covered home health visits. Up to 8
weeks of at-home help after skilled care is no
longer needed. Will pay up
to $40 each visit and $1,600 each year.
You may want to consider
this benefit if you need to go to a Skilled
Nursing Facility (SNF) after a hospital stay and
stay in the SNF longer than 20 days.
Benefit covers: Up to $114
a day for days 21-100 in a Skilled Nursing
Facility
This benefit helps pay for
routine yearly check-ups and tests (such as
routine yearly check-ups, serum cholesterol E
and screening, hearing tests, diabetes
screening, thyroid function test) that may be
important to you to keep you healthy.
Under federal law, doctors
who don't accept "assignment" (take Medicare's
approved amount as payment in full) may charge
up to 15% more than the approved amount. You
might want to think about this benefit if your
doctors don't accept assignment. You may also
want this benefit if you have to stay in the
hospital and can't control whether the doctors
you see accept assignment.
Benefit covers: 100% of the
cost for up to 365 more days of a hospital stay
during your lifetime after you
use up all Medicare hospital benefits.