Gaps in Medicare insurance
Gaps in Medicare Part A
Part A coverage is very basic, with coverage limited inpatient hospital stays, skilled nursing, home health, and hospice services. For most individuals, Medicare Part A does not provide all the services required in order to fulfill their medical needs. Some of the common gaps in coverage include:
- Hospital coinsurance – $267 per day for days 61 to 90 and $534 for days 91 to 150
- Skilled nursing facility coinsurance – $133.50 per day for days 21 to 100
- Skilled nursing facility services beyond 100 days per spell of illness.
- The first three pints of required blood per year
- The Part A annual deductible – $1,068
- All preventive health care
Gaps in Medicare Part B
Part B offers additional benefits excluded in Medicare Part A, such as chemotherapy, renal dialysis, influenza and pneumonia vaccinations, durable medical equipment and outpatient hospital procedures. Some of the common gaps in Medicare Part B that are available through a Medicare Supplemental insurance plan include:
- 20% coinsurance payment – Medicare only covers 80% of the approved rate for all services and items included in Part B.
- Medicare Part B annual deductible – $135
- Medicare Part B Excess charges – the amount charged by physicians in excess of the Medicare approved amount
- Benefits offered in the twelve standardized Medicare advantage plans
There are several additional covered benefits in a Medicare supplement insurance plan. Medigap plan options are identified by a letter ranging from A thru L, with A being the most basic and L being the most comprehensive. Even the most basic Plan A supplemental plan will provide you additional coverage for:
Medicare Part A coinsurance
Medicare Part B coinsurance
The first 3 pints of blood per year
Medicare Part B preventive health care coinsurance
All Medigap plans offer the additional benefits included in Plan A, with additional benefits being added to the policy as the plan level increases.
Plan B adds the Medicare Part A Deductible
Plan C adds the skilled nursing facility care coinsurance, the Medicare Part B deductible and coverage for foreign travel emergencies
Plan D adds home care recovery benefits, but excludes the Medicare Part B Deductible
Plan E adds preventive care not covered in Part B
Plan F covers the Medicare Part B excess charges
Plan G pays 80% of the Medicare Part B excess charges, but adds back the at-home recovery benefits excluded from Plan F
Plan H is the exception to the hierarchy, as it does not include coverage for the Medicare Part B excess or at-home recovery
Plan I puts these benefits back, but removes the Part B deductible benefit
Plan J is the most comprehensive of all Medigap plans and covers all of the combined benefits of all other Medigap plans.
Plan K and Plan L pay a 50% and 75% of these additional benefits respectively
Keep in mind that policies B through L can have important variations but all of them should have the same basic coverage including one or several benefits from the list mentioned above. You will need to compare premium costs and place them in context with the additional benefits offered under each of these plans.
What to consider when shopping for Medicare supplement insurance?
As always, the most important thing is to understand and know your options. Depending on the state in which you reside, there are several companies that offer Medigap insurance on the private market.
With Medicare Supplement Insurance, there can be a substantial difference in premium from company to company. Although the same Plan has the same benefits, regardless of carrier, the difference in price is due to the market demands, claims history and negotiated rates with contracted physicians and hospitals.
Be aware of your necessities
Being fully conscious of your necessities or anticipated medical requirements that might be covered under a Medigap plan is helpful. We always recommend seeking for an agent or broker, that way you will have professional help with your specific case.
Know when to buy
When you first become eligible for Medicare, you will be provided with a six month open enrollment period that guarantees you acceptance from any insurance company for any of the Medicare Supplemental plans you choose to purchase. If you do not purchase a supplemental plan during this open period, you may be subject to medical eligibility review and the insurance company may have the right to deny your enrollment.