Medicare Supplement Insurance -- Part 3

Welcome back to the final post of this series on Medicare Supplements or Medigap Policies. In Part 1 we reviewed original Medicare, and in Part 2 we examined some of the general features of Medicare Supplements and the companies that offer them. Now let us turn to the plans themselves.

As we noted previously, there are currently 15 different plans to choose from; and they are designated with the letters A through L. The availability of these plans will vary from state to state and from company to company. However, all companies carrying any Medicare Supplements must carry Medicare Supplement A.

Medicare Supplement A is the basic supplement. It contains the core benefits that are also part of nearly all the other supplements, so it is worth taking a closer look at Supplement A in order to identify these core benefits. Medicare Supplement A pays for the following gaps in original Medicare:

1. Your first 3 pints of blood. Under original Medicare you pay 100% for these out of your own pocket.
2. Your co-pays for hospitalization between 60 days and 90 days. Under original Medicare you pay these co-pays each day you are in the hospital. Currently, the rate is $267 per day or more than $8,000 for the period; but the rate usually increases annually.
3. Your co-pays for hospitalization between 90 days and 150 days. Under original Medicare you pay these co-pays each day you are in the hospital. Currently, the rate is $534 per day or more than $32,000 for the period; but the rate usually increases annually. Also, please note that these are original Medicare's Lifetime Reserve Days, which means that you only get to use them once in your lifetime.
4. Your Part B co-insurance of 20% of Medicare's approved charges. Under original Medicare you pay this 20% of approved charges for any covered medical services received including outpatient treatment such as visiting your doctor.
5. 100% of your Part A hospitalization costs for an additional 365 Lifetime Reserve Days. Under original Medicare you pay 100% of these costs.

As you proceed further through the alphabet of Medicare Supplements, you will add to the benefits detailed above. For example, by the time you reach Medicare Supplement C you would have the following benefits in addition the the ones mentioned above:

1. Payment of the inpatient skilled nursing co-pays for days 21 through 100. Under original Medicare you pay these co-pays each day you are in a skilled nursing facility. Currently, the rate is $133.50 per day or more than $10,000 for the period; but the rate usually increases annually.
2. Payment of the Part A deductible. Under original Medicare you pay this deductible for any hospital stay between 1 and 60 days. Currently, the deductible is $1,068; but it usually increases annually. Additionally, due to Medicare's flexible benefit period you could pay this deductible up to 5 times per year. It is not an annual deductible.
3. Payment of the Part B deductible. Under original Medicare you pay this annual deductible for any covered medical services received including outpatient treatment such as visiting your doctor. Currently, the deductible is $135; but it usually increases annually.
4. Payment for foreign travel emergency. Under original Medicare you pay 100% of the costs for any emergency medical treatment that you may receive outside the United States of America. This Medicare Supplement C benefit will pay 80% up to 60 days of care after you pay a $250 deductible. However, there is a $50,000 lifetime limit to this benefit.

The next high-water mark is Medicare Supplement F. It covers all the core benefits of Supplement A and the additional benefits of Supplement C. To these it adds one more benefit -- 100% payment of Part B excess charges. At a glance this may seem a rather nominal difference from Supplement C. However, it carries more weight than it might appear because if you are billed excess charges; then under original Medicare you pay 100% of them. Please see Part 1 of this series for a more complete description and example of excess charges.

For a number of reasons, which no doubt include its excellent coverage (100% of Medicare approved charges plus 100% of excess charges plus foreign travel emergency), Medicare Supplement F has been popular. In fact, Supplement F has been so popular that there are currently 3 versions of it. The first is the standard version outlined above. The second is a high deductible version (Supplement J has a high deductible version as well.) that begins to cover expenses as outlined above only after you incur $2,000 in covered services. However, the third one is da bomb!

Medicare Supplement Innovative F is perhaps the most appropriately named of the supplements. In addition to providing the excellent coverage of the standard F, Medicare Supplement Innovative F pays 100% up to $800 per year for the following preventive benefits:

1. 100% up to $500 per year for preventive dental including oral exams once per 6 months, bite wing radiographs annually, complete series of panorex radiographs once per 3 years, dental prophylaxis once per 6 months, diagnostic casts once per 2 years, and extraoral radiographs twice per year.
2. 100% up to $100 for an annual physical exam.
3. 100% up to $100 for an annual vision exam.
4. 100% up to $100 for an annual hearing exam.
5. Free telephone access 24 hours per day and 7 days per week to a registered nurse by way of a nurse advice hot-line.

Of course, under original Medicare you pay 100% of the costs for any of the above services. There are only 2 disadvantages to Supplement Innovative F. The first is that in some states you may be required to pay a $5 co-pay for an office visit to a doctor. The second is that it can be hard to find an agent offering a Supplement Innovative F. Probably because it is one of the newer Medicare Supplements, it is not yet widely carried. However, I know of at least one nation-wide company that does carry it. If you would like more information, then please contact me. Although this blog is not for plugging insurance companies, I am always happy to provide whatever assistance I can to those searching for more information.

After Medicare Supplement Innovative F the benefits do not necessarily get more complete but rather emphasize particular areas. For instance, Supplement G offers less coverage than Supplement F (although the coverage is still very good) but has the advantage of $1,600 per year for at home recovery benefits. Medicare Supplement K, for another example, offers a significantly lower premium in exchange for increased cost-sharing in the skilled nursing, Part A deductible, and other co-insurances.

Hopefully, this post (as well as the series) will be helpful to you if you are trying to navigate the Medicare maze for yourself or for a loved-one. Please feel free to contact me if I may be of service to you. Unfortunately, it is difficult if not impossible to anticipate every question about Medicare Supplement Insurance, and post it in this blog; but I am available to answer more specific questions as they arise.