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Medicare Supplement Benefit Explanation
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Standard Medicare Supplement Benefits

Medicare Supplement insurance can be sold in only ten standard plans. The chart below shows the benefits included in each plan.  (For more details read Federal Brochure for Choosing a Medicare Supplement Policy or click here.)

Outline of Medicare Supplement Coverage - Benefit Plans A, F, G, and N

This chart shows the benefits included in each of the standard Medicare Supplement plans. Every company must make Plan A available. Some plans may not be available in your state. Only Applicants first eligible for Medicare before 2020 may purchase Plans C, F, and high-deductible F.

Benefits
Note: A ✔ means 100% of the benefit is paid
Plans available
  Plans available only if first Medicare eligible before 2020
A B D G* HDG* K L M N C F* HDF*
Medicare Part A coinsurance and hospital coverage (up to an additional 365 days after Medicare benefits are used up)
Medicare Part B coinsurance or copayment 50% 75%
copays
apply***
Blood (first three pints) 50% 75%
Part A hospice care coinsurance or copayment 50% 75%
Skilled nursing facility coinsurance     50% 75%
Medicare Part A deductible   50% 75% 50%
Medicare Part B deductible                
Medicare Part B excess charges                
Foreign travel emergency (up to plan limits)        
Out-of-pocket limit in 20202**   $5,880** $2,940**    

* Plans F and G also have a high-deductible option which requires first paying a plan deductible of $2,340 before the plan begins to pay. Once the plan deductible is met, the plan pays 100% of covered services for the rest of the calendar year. High-deductible Plan G does not cover the Medicare Part B deductible. However, high-deductible Plans F and G count your payment of the Medicare Part B deductible toward meeting the plan deductible. These expenses include the Medicare deductibles for Part A and Part B, but do not include the Plan's separate foreign travel emergency deductible.

** Plans K and L pay 100% of covered services for the rest of the calendar year once you meet the out-of-pocket yearly limit.

*** Plan N pays 100% of the Part B coinsurance except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that do not result in an inpatient admission.


The basic benefits (also known as the "core benefits" or Plan A) are the minimum coverage you may buy. These are the only benefits in Plan A. Every other plan contains these three benefits as the "core" and then adds one or more additional benefits.

  1. Hospitalization: Medicare Part A pays for hospitalizations for the first 60 days, but only pays a portion of the daily costs from the 61st day through the 150th day. You must pay the coinsurance amounts for those days. This Medicare Supplement benefit pays the coinsurance amount and an additional 365 lifetime days.
  2. Blood: Medicare pays for all blood that is medically necessary except for the first three pints in each calendar year. This Medicare Supplement benefit pays for the first three pints of blood not paid for by Medicare.
  3. Medical Expenses: Generally Medicare Part B pays for 80% of a predetermined amount (called the "Medicare approved" amount) for each procedure, supply, or service billed by your doctor or other provider that is not a hospital. This Medicare Supplement benefit pays the coinsurance generally (20% of the "Medicare approved" amount) under Medicare Part B.
Note: Plan A contains only these 3 core benefits.  Although Plan A is the least expensive policy, it may not be a good choice for low-income individuals who may not be able to afford the Medicare Part A hospital deductible when they are hospitalized.

There are five additional benefits that are combined with the basic benefits in various ways to make up the nine remaining plans called Plan B through Plan N.

  1. The Part A Deductible: The Medicare Part A deductible is the expense for which you are obligated to pay when you are admitted to a hospital as an inpatient. Medicare pays eligible benefits above that amount. (The Medicare Part A deductible amount may change yearly, so check the current handbook1). This Medicare Supplement benefit reimburses you the deductible amount, no matter what the amount may be. This benefit is included in Plans B through N.
  2. Skilled Nursing Coinsurance: Medicare Part A pays for the first 20 days of care in a skilled nursing facility following hospitalization, but requires you to pay a coinsurance beginning on the 21st day through the 100th day. This Medicare Supplement benefit pays the coinsurance amount beginning on the 21st day. This benefit is included in Plans C through N.
  3. Part B Deductible: The Medicare Part B deductible is the amount you must pay each year for medical expenses (such as doctor fees) before Medicare begins paying. (The Part B deductible amount may change per year). This Medicare Supplement benefit reimburses you the deductible amount. This benefit is included in Plan C and Plan F.
  4. Part B Excess Charges: Medicare Part B pays 80% of a predetermined amount (called the "Medicare approved" amount) for each procedure performed by your doctor or other medical care provider. If your doctor accepts Medicare "assignment", the provider may only bill you for the difference between the amount paid by Medicare and the amount approved by Medicare.

If your doctors do not accept Medicare assignment, they may bill you for the difference between the amount paid by Medicare and the amount they can legally charge you (called the "limiting charge"). If you have a Medicare Supplement Policy with the following:

  • Part B Excess Charges (100%) benefit, the policy will pay the full amount billed by your doctors or other providers who do not take Medicare assignment subject to the limiting charge. This benefit is included in Plan F and Plan G.

(Remember that this coinsurance amount is paid by the Medical Expenses part of the Basic Benefits that are part of every Medicare Supplement insurance policy).

  1. Foreign Travel Emergency: The original Medicare plan does not pay for medical care outside of the United States, but some Medicare managed care plans, private Fee-for-Service plans, and some Medicare Supplement plans do. This Medicare Supplement benefit will pay 80% of your expenses for most emergency medical care in a foreign country during the first 60 days of a trip abroad after you pay a $250 deductible. There is a lifetime maximum benefit, so check your current handbook1 for the dollar amount. This benefit is in Plan C, Plan D, Plan F, Plan G, Plan M, and Plan N. Check your insurance coverage before you travel.

1 Current handbook on Medicare is available from your local Social Security office or by calling the Social Security Administration toll-free at 800-633-4227 or via the website at www.medicare.gov.


Know Your Rights About Purchasing Medicare Supplement Coverage

Agents owe you a duty of honesty, good faith, and fair dealing. Agents are specifically prohibited from doing the following:

  • Using high pressure tactics (selling insurance through threat or undue pressure)
  • Twisting (inducing you to give up or replace an existing policy for a new one)
  • Overloading (selling you more insurance than you need or want)

Agents are required to give you an outline of coverage during the first presentation of an insurance product. The outline must inform you that HICAP is available for insurance counseling free-of-charge and tell you how to reach your local HICAP office.

If you decide to fill out an application, the agent is prohibited from taking more than one month's premium with the application unless the policy is "field-issued". Field-issued means that the agent has the authority to issue the policy to you at the same time you fill out the application. That is the only time the agent may collect more than one month's premium with the application.

After the policy is mailed or delivered, you have a 30-day free look to examine the policy and to decide if you want to keep it. If you return the policy within 30 days, all of your money must be refunded.

Note: If you buy a field-issued policy, your 30-day free look period begins when you receive written notice from the insurance company in the mail.

Always document the date you received the policy and the date you return the policy to the insurance company or the agent.

Buy a comprehensive Medicare Supplement policy that has the most benefits for the amount you can afford. Make sure to consider the following before purchasing insurance:

  • Comparison shop!
  • Call your local Department of Insurance to verify if the agent is properly licensed.
  • Decide what you need and want before you sit down with the agent.
  • Do not be rushed into buying insurance.
  • Set the place, the beginning, and the ending time of your meeting.
  • Get a second opinion before you buy or replace insurance.
  • Do not buy anything you did not intend to purchase or do not want.
  • Do not replace an existing policy unless you can not afford it or the benefits no longer meet your needs.
  • Do not pay more than one month's premium when you apply unless the policy is field-issued.
  • Do not pay cash. (Do not write a check payable to the agent. Write the check payable to the insurance company).
  • Do not be intimidated.
  • If you feel unsure or uncomfortable DON'T DO IT!

NOTICE! Final rates and benefits are based on actual plan selection (including plan riders you may request) and the assignment of any rate adjustment factors due to the medicare supplement plan's underwriting guidelines.

IMPORTANT NOTICE: Coinsurance amounts represented with a "%" are payable after the plan deductibles are reached; Co-pay amounts represented with a "$" are not subject to plan deductibles (except where noted). Refer to contract for a detailed explanation of plan benefits, features, exclusions and limitations. Out of pocket maximum shown includes the plan deductible unless otherwise noted. Co-pays, Deductibles, and Coinsurance amounts listed above are your share of the costs for covered benefits.

Do Not Cancel your current coverage until a new policy is approved and you have received written confirmation of the policy's rates and benefits from the insurance company. Rate and Benefit Disclaimer Notification!

Additionally, information contained in this website is limited in scope, subject to change without notice, and does not contain all the terms, conditions, limitations, or exclusions of the referenced benefit plans. Only the insurance company Plan Documents and Policy's contain the exact terms and conditions of coverage. Your grant of access to the rate and benefit summaries contained herein may not be relied upon as a guarantee of your eligibility or coverage under these benefit plans.