Medigap - Medicare Supplement Insurance (Lesson 24.6)
Which Act amended Social Security to make Medicare secondary to group health coverage?
Tax Equity and Fiscal Responsibility Act (TEFRA)
Medicare supplement policies must include a 'free look' period of how many days?
30 days
Plan K covers
50% of the deductible in Medicare Part A, NOT Plan A.
Excluding pre-existing conditions from a Medicare Supplement policy is limited to what period of time after the policy's effective date?
6 months
Types of Standardized Medigap Plans
Each of the 10 standardized plans includes fundamental benefits found in Plan A, with additional benefits attached to the remaining plans: B, C, D, F, G, M and N All plans must supplement both Part A and Part B of Medicare and automatically adjust benefits to reflect statutory changes in Medicare
Plan B Coverage
In addition to the core benefits required in Plan A, Plan B covers the Medicare Part A deductible.
Plan D Coverage
Similar to Plan C, Plan D provides the same coverage amounts, with the exclusion of Medicare Part B's deductible. Plan D also provides 'at-home recovery,' which covers personal care services during recovery from an injury or illness that may be excluded from home health coverage paid under Part A.z
Plan F Coverage
Similar to Plan C, Plan F also covers any 'excess' charges remaining from Medicare Part B.
Plan N Coverage
Similar to Plan D, except that Plan N includes limits on physician visits and ER visits.
Plan G Coverage
Similar to Plan F, Plan G provides the same coverage amounts, with the exclusion of the Medicare Part B deductible. Plan G also provides 'at-home recovery,' which covers personal care services during recovery from an injury or illness that may be excluded from home health coverage paid under Part A.
Medigap Eligibility and Enrollment
All Medigap insurers are required to offer a one-time, 6-month enrollment period after turning age 65 for individuals who have already enrolled in Medicare Part B that guarantees an enrollee the right to purchase any part of a Medicare supplement insurance policy not compatible with Medicare Advantage
Medigap
private Medicare supplement insurance plans to help cover the out-of-pocket costs that remained for Medicare recipients. Commonly referred to as Medigap Plans, these private supplement plans were designed to help cover the costs associated with the 'gaps' in the Original Medicare coverage.
In regards to Medicare supplement policies, Plan A includes all of the following EXCEPT:
20% copayment amount for Part B after payment of the annual deductible
Plan K Coverage
50% of Medicare Part A deductible 50% of Skilled Nursing Facility (SNF) care costs 50% of Part A hospice care costs 50% of Medicare-eligible expenses for the first 3 pints of blood for Medicare Part A and Part B 50% of Part B coinsurance (and 100% of Part B preventive care services
Plan M Coverage
50% of Medicare Part A deductible Skilled Nursing Facility (SNF) care Foreign travel emergency coverage up to Plan M's coverage limits.
Under Medicare Part A, how many days of inpatient hospitalization services are covered after the deductible is satisfied and before a patient has to contribute a copay?
60 days
Plan L Coverage
75% of Medicare Part A deductible 75% of Skilled Nursing Facility (SNF) care costs 75% of Part A hospice care costs 75% of Medicare-eligible expenses for the first 3 pints of blood for Medicare Part A and Part B 75% of Part B coinsurance (and 100% of Part B preventive care services)
Plan C Coverage
Covers the Medicare Part B deductible, as well as Skilled Nursing Facility (SNF) care coinsurance amounts and any foreign travel emergency coverage up to Plan C's coverage limits.
Plan A Coverage The fundamental or 'core' benefits found in Plan A include the following:
Medicare Part A copayments for the 61st through the 90th day of hospitalization in each benefit period Medicare Part A copayments for each of the 60 nonrenewable lifetime impatient hospital reserve days Medicare Part A hospital coinsurance costs up to an additional 365 days after Medicare benefits have been exhausted 100% of Medicare-eligible expenses for the first 3 pints of blood for Medicare Part A and Part B After the annual deductible is met, Medigap plans must provide coverage for the 20% coinsurance required in Medicare Part B, up to a maximum of $5,000 per year; however, Medigap plans may include a deductible before this benefit becomes payable. Medicare Part B coinsurance for preventive care expenses
Federal and State Regulation
Medigap regulation through the Omnibus Budget Reconciliation Act (OBRA) of 1990 and the states began regulating the private Medicare supplement market. National Association of Insurance Commissioners (NAIC) developed a standardized model in which the states regulate the private Medigap market.
After the Initial Enrollment Period (IEP) has ended, individuals who do not elect to enroll into Medicare Parts A and B may do so
during the General Enrollment Period (GEP) from January 1st through March 31st.
