What’s Covered by Medicare Supplemental Insurance?
We refer to the basic benefits allotted by minimum coverage as “core benefits” or Plan A. This is the least amount of coverage available for purchase. Plan A will offer protection for the 3 core benefits listed below plus an additional one or two benefits.
While Plan A is easy on the wallet and budget on the front end, it is not an especially proper choice for low-income people or other people who cannot afford the deductible under Part A. Should you become hospitalized, you will have to pay the hefty deductible.
(1) Hospitalization: Medicare Part A is only responsible for a portion of the daily costs associated with hospitalization. You are the party responsible for the coinsurance totals. Only after the 60th day and an additional cost of 365 lifetime days does the Medicare Supplement benefit pay the Part A coinsurance amount.
(2) Blood: The first three pints of blood in each calendar year are not covered regardless of their medical necessity. All subsequent blood is covered by Medicare. Supplemental benefits cover those first three pints of blood–or equivalent quantities of packed red blood cells, as defined under Federal regulations–for each procedure performed by your physician. When receiving care from a physician who accepts Medicare assignment, you may only be responsible for the difference between the amount paid by Medicare and the amount approved by Medicare. However, if you are receiving care from a physician who does not accept Medicare assignment, then you will be billed for the total amount not covered by Medicare.
(3) Medical Expenses: Typically Medicare Part B covers 80% of a predetermined amount–which we refer to as the “Medicare approved” amount–of each procedure, service or supply billed by your physician or provider. You are responsible for or the amount leftover (the difference between what Medicare pays and the amount they can legally charge, which we refer to as the “limiting charge.”)
Medicare Supplemental benefit pays the amount not covered under Medicare Part B. Plans B through L are comprised of some combination of these seven additional benefits added to the above basic benefits in various formulations.
- The Part A Deductible: This is deductible you are responsible for paying as a result of your admittance to the hospital. Medicare will pay the eligible charges above that amount. Medicare Part A’s deductible is subject to change annually. Consult your Medicare & You handbook. Medicare Supplement benefit will reimburse you for the amount of this deductible, regardless of the amount. This benefit is included in Plans B through L.
- Skilled Nursing Coinsurance: Under Medicare Part A, the first 20 days (following hospitalization) of care in a skilled nursing facility are covered. However, you are responsible for a coinsurance change starting day 21 and continuing through day 100. Medicare Supplement benefit covers the coinsurance amount beginning on the 21st day. This benefit is included in Plans C through L.
- Part B Deductible: This is amount you are responsible for paying every year prior to eligibility for Medicare coverage. Medicare Part B’s deductible is subject to change annually. Medicare Supplement benefit will reimburse you for the amount of this deductible, regardless of the amount. This benefit is included in Plan C, Plan F, and Plan J.
- Part B Excess Charges: Typically, Medicare Part B covers 80% of a predetermined amount–which we refer to as the “Medicare approved” amount–of each procedure, service or supply billed by your physician or provider. You are responsible for the amount leftover (the difference between what Medicare pays and the amount they can legally charge, which we refer to as the “limiting charge.”) If you have a Medicare Supplement policy with the following: Part B Excess Charges (100%) benefit: Policy will pay the full amount billed by physicians or other providers not accepting Medicare assignment. This is subject to the limiting charge. This benefit is included in Plan F, Plan I, and Plan J. The Part B Excess Charge (80%) benefit: Policy will pay 80% of the amount you are billed by physicians or other providers. This benefit is only in Plan G. In theory, you should save money on premium costs if you select the 80% benefit rather than the 100% benefit. (Keep in mind that this coinsurance amount is paid by the Medical Expenses part of the Basic Benefits, which are contained in every Medicare Supplement insurance policy.)
- Foreign Travel Emergency: Medicare is not responsible for medical care received when you are outside of the United Stated. However, some Medicare Advantage plans and some Medicare Supplement plans will cover those charges. Medicare Supplement benefit will pay 80% of your expenses for most emergency medical care received while traveling in a foreign country, if the need for care occurred during the first 60 days of your trip. However, you must first pay a $250 deductible. There is also a lifetime maximum benefit of ($50,000). This benefit is in Plan C through Plan J.
- At-Home Recovery: Medicare is responsible for infrequent nurse visits or visits from other skilled care providers to your home if you are recovering from an acute illness. Not included in this coverage is custodial care. This would include homemaker services, like assistance dressing, shopping, errands, laundry, or bathing. Medicare Supplement benefit covers the actual charges up to $40 for each visit with an annual maximum of $1,600 each year. This intended to provide short-term, at-home assistance with daily living activities while recovering from an illness, injury, or surgery. The specific insurance company providing the supplemental may have various benefit requirements and limitations. This benefit is in Plan D, Plan G, Plan I, and Plan J.
- Preventive Care: Only some diagnostic testing is covered by Medicare. Medicare Supplement benefit pays up to $120 every year for specific tests performed for screening purposes, as well as routine physical exams, patient education, and other medically appropriate tests or preventive measures not covered by Medicare.
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- New to Medicare in 2012: Accountable Care Organizations
- What Counts Towards the Medicare Part D Coverage Gap?
- The Medicare Part D Coverage Gap Continues
- Long-Term Hospital Care is Covered by Medicare
- Long-Term Care is NOT Covered by Medicare in All Situations