Medigap Insurance Plans To Help Pay For Medical Expenses That Medicare Does Not Cover

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Medigap Insurance Plans Help Supplement Medicare Part A and Medicare Part B

*While young people are not in the market for Medicare, they have parents and grandparents that are.  So it is important to have an idea of what Medicare involves.

Medicare was designed to help pay for medical costs for people aged 65 older, people of all ages with disabilities, and people with End Stage Renal Disease. However, Original Medicare does not pay for everything and still leaves the member exposed to many out-of-pocket expenses.  Fortunately there are ways to help cover these costs. Private insurers sell Medigap (or Medicare Supplement) plans that fill in the financial gaps that Medicare leaves open.  One thing to note is that all Medigap plans are the same among all insurers. An AARP Plan A is the same as an Aetna Plan A. The difference is how they are priced.

Plan A

Original Medicare typically requires a deductible for inpatient and outpatient services followed by a 20% coinsurance.  Medigap Plan A basically eliminates the coinsurance.

You are still required to pay the deductibles for Part A and Part B, but once the deductible is met, Plan A pays for the rest.  This includes pints of blood.  It pays for the first 3 pints of blood and then picks up the 20% member portion for blood in an outpatient setting.

Medigap Plan A does not pay anything extra for Skilled Nursing Facilities that are not covered by Medicare Part A.

Plan B

Medigap Plan B is very similar to Plan A.  The only addition is that Plan B pays for the patient deductible that the member is responsible for under Medicare Part A.  All other plan provisions are the same for Medigap Plan B as Medigap Plan A.

Plan C

Medigap Plan C has the same provisions as Plan B – which built upon Plan A – but it also pays for two extra things.

  1. Plan C pays for the Medicare Part B deductible.  So with Plan C you will not have a Medicare Part A or Medicare Part B deductible to pay.
  2. Plan C pays for emergency medicare care outside of the United States.  Medicare DOES NOT pay for this emergency service.  You must have a Medigap policy to have emergency insurance coverage outside of the United States.  And then, this only covers the first 60 days of each visit outside of the country.  The medicare care requires a small deductible, and then the Medgap plan pays 80% of charges up to a $50,000 lifetime maximum benefit.

Plan F

Medigap Plan F would be considered the “Cadillac” Medigap plan.  Plan F pays for more services than any other Medigap plan.  It covers everything that Plan C covers, plus the Medicare Part B excess charges that are above the Medicare-approved amounts.

Medigap Plan F still does not cover inpatient hospital stays beyond the additional 365 days after the lifetime reserve days are used.  These extra days are still the responsibility of the member.

Plan F also does not cover more than 100 days of Skilled Nursing Inpatient Care.

If you want to spend the money for the best Medigap insurance plan, Plan F is the way to go.

Plan K

Medigap Plan K is a “50%” plan.  It provides the following coverages for charges under Medicare Part A.

  • 50% of the Medicare Part A deductible, after which it pays for 100% of hospitalization costs.
  • 50% of the Skilled Nursing per day charge for days 21-100.
  • 50% of the first 3 pints of blood in an inpatient setting.
  • 50% of Hospice charges.

Plan K provides the following coverage for charges under Medicare Part B.

  • Portion of preventive benefits not paid for by Medicare Part B.
  • 50% of coinsurance required by the member (10% of charges).
  • 50% of the cost of pints of blood (excluding Part B deductible).
  • 50% of cost of durable medical equipment.

There is also a member out-of-pocket limit.

Plan L

Medigap Plan L is very simple.  You take a look at Plan K and substitute 70% for 50%.  In addition, the member out-of-pocket limit is half of the out-of-pocket limit under Plan K.

Plan N

Medigap Plan N incorporates copays into Medicare Supplement plans. Like Plan F, it pays for virtually all of the Medicare Part A charges. For Medicare Part B charges, it still requires a deductible. However, after the deductible is paid, Plan F pays for the member’s 20% coinsurance, except for a copay charged for office visits and emergency room visits. If the emergency room visit turns into an inpatient stay then the copay is waived.

Medigap Plan N also pays for pints of blood and durable medical equipment after the Medicare Part B deductible is met.

Plan N pays the same foreign travel emergency benefit as the other plans mentioned here.

What is the Cost of Medigap Insurance Plans?

What you pay for a Medigap insurance plan depends on several factors, including your age and zip code.  Contact your Medigap insurance company for more details on the premiums required for each plan.

The amount you pay at the medical service provider depends on if the provider accepts Medicare assignment.  Charges from providers that accept assignment will most likely result in lower costs for the Medicare recipient.

Other Medigap Insurance Information

For more information on Medigap insurance, check out Medicare and AARP.

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Subsidy for Health Insurance – How to Qualify for Assistance

On October 1, 2013, the health insurance marketplaces, also known as exchanges, created by the Patient Protection and Affordable Care Act (Obamacare) will go live for Open Enrollment.  The exchanges will be a great way for individuals and small businesses to find a variety of health plans from a variety of health insurance companies at (hopefully) a competitive cost.

One of the things that helps people, especially young people, afford the premiums on the marketplaces is a tax subsidy for health insurance plans.  Some people will be eligible for this assistance, but not everyone.  Here is how you can have a rough idea if you are eligible for the tax credits.  You must meet all of the following criteria.

No Employer Provided Health Insurance

Obamacare made it mandatory for employers with at least 50 employees to provide all full-time employees with the option of enrolling in their group medical plan.  The plan must pay for at least 60% of allowed charges and no employee may pay more than 9.5% of their salary to purchase the plan.  If an employer offers a plan that fails those two standards, there is a fine they must pay.

The definition of a full-time employee is important in figuring out if you are eligible for a subsidy for health insurance through the exchange.  A full-time employee is defined as someone who average 30 hours per week or more.  There are some calculations that your employer will do to determine hours worked, but in general, 30 hours is a full-time employee.

So, all this to say, that if you are offered coverage at work that meets the two standards above, then you are NOT eligible for a tax subsidy.  If you are not offered coverage, then you still may be eligible for the subsidy.

Annual Earnings

Subsidies are only available to households that earn less than 4 times the federal poverty level. In addition, the amount of the subsidy depends on the household income.  Folks that make less can get a larger subsidy for health insurance in the marketplaces.

Medicaid and Medicare Eligibility

If someone is eligible for Medicaid and Medicare, two government programs that help pay the cost of medical expenses, then that person is not eligible for a subsidy.  A tricky aspect of this rule is that while Obamacare expanded Medicaid coverage, not every state expanded Medicare coverage.  So your eligibility for Medicaid depends on where you live.  You could be eligible in one place, but not eligible in another place.

Medicaid is administered by the states, so check with your local Medicaid office for more information.

How are Subsidies Applied?

For the most part the subsidy for health insurance bought on the exchanges is in the form of tax credits in the following year.  For example, you pay your premium in 2014 and the tax credit is applied on your 2015 tax form.  However, if this arrangement causes a hardship, there are ways to reduce the actual premium.

How to Apply for the Subsidy for Health Insurance

The subsidy for health insurance on the exchanges is designed to be a quick and easy process.  Someone can apply right on the marketplace’s website and find out if they are eligible.  In fact, here is a nifty calculator from Kaiser to help determine if you fit the eligibility requirements.

Find the Best Option for You and Your Family

The marketplaces and the subsidy for health insurance purchased through the marketplaces are designed to make affordable health insurance more available.  However, that does not mean that the exchanges are your best option.  Take a look around to see how you can find the best coverage at a price you can handle.

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