MedSuppInfo.com

About Medicare

Medicare at a glance
Medicare was started in 1965 to help with medical expenses. It's a national health insurance program designed to help people age 65 and over with medical expenses. It also is for people under age 65 with certain disabilities and people of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or kidney transplant).

Medicare has Hospital Insurance (referred to as Part A) and Medical Insurance (referred to as Part B). Part A helps to pay for your in-hospital expenses, care in a skilled nursing facility, and provides limited benefits for home health care and hospice care. Part B helps to pay doctor bills, outpatient hospital care and other medical services not covered by Part A.

The Medicare Modernization Act of 2003 brings a new prescription drug benefit, Part D, to Medicare. This new benefit became available in 2006.

Medicare Advantage is the new name for Medicare + Choice. These plans are managed care and restrict your choice of doctors and facilities for receiving coverage. They generally cover many of the same benefits a Medigap or Medicare supplemental coverage would cover and often include extra benefits like extra days in the hospital. If you decide to join a Medicare Advantage Plan, then you will use the health care card that you get from your Medicare Advantage Plan provider for your health care.

Medicare Supplement insurance plans (often referred to as "Medigap" policies) were developed to help fill the gaps in the Original Medicare. These plans are sold by private insurance companies. Currently, Medicare Supplement is sold in 12 standardized plans. These plans must follow Federal and State laws. Each plan has a different set of benefits. The twelve standard plans, labeled A - L are outlined in the chart below.

Click on the Plan Letter for more details on the benefits in this chart...

Medicare Supplement Benefits By Plan

Plan Letter	Basic Benefits	Part A Deductible	Skilled Nursing Coinsurance	Part B Deductible	Part B Excess<	Foreign Travel Emergency	At Home Recovery	Preventive Care
A
B
C
D
E
F*					100%
G					80%
H
I					100%
J*					100%

Basic Benefits for Plans K and L include similar services as Plans A-J, but cost-sharing for the basic benefits is at different levels.

Plan Letter	Basic Benefits	Part A Deductible	Skilled Nursing Coinsurance	Part B Deductible	Part B Excess<	Foreign Travel Emergency	At Home Recovery	Preventive Care
K**
L**

A-J	K**	L**
Basic Benefits	100% of Part A Hospitalization Coinsurance plus coverage for 365 days after Medicare Benefits End.	100% of Part A Hospitalization Coinsurance plus coverage for 365 days after Medicare Benefits End
	50% Hospice cost-sharing	75% Hospice cost-sharing
	50 % of Medicare-eligible expenses for the first three pints of blood	75% of Medicare-eligible expenses for the first three pints of blood
	50% Part B Coinsurance, except 100% Coinsurance for Part B Preventive Services	75% Part B Coinsurance, except 100% Coinsurance for Part B Preventive Services
Skilled Nursing	50% Skilled Nursing Facility Coinsurance	75% Skilled Nursing Facility Coinsurance
Part A Deductible	50% Part A Deductible	75% Part A Deductible
Part B Deductible
Part B Excess (100%)
Foreign Travel Emergency
At-Home Recovery
Preventive Care NOT covered by Medicare
	$4,620 Out of Pocket Annual Limit***	$2,310 Out of Pocket Annual Limit***

Notes
1. States may allow only some of the ten standard benefit plans.
2. States may approve innovative additional benefit plans under certain circumstances.
3. These standard benefit plans do not apply to policies sold in MA, MN and WI.
4. Availability of plans varies from company to company.

*Plans F and J also have an option called a high deductible Plan F and a high deductible Plan J. These high deductible plans pay the same benefits as Plans F and J after you pay a calendar year $2,000 deductible. Benefits from high deductible Plans F and J will not begin until out-of-pocket expenses total $2,000. Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy. These expenses include the Medicare deductibles for Part A and Part B. They also do not include the $250 foreign travel emergency deductible in Plan F and Plan J.

** Plans K and L provide for different cost-sharing for items and services than Plans A-J.
Once you reach the annual limit, the plans pays 100% of the Medicare co-payments, coinsurance, and deductibles for the rest of the calendar year. The out-of-pocket annual limit does NOT include charges from your provider that exceed Medicare-approved amounts, called "Excess Charges". You will be responsible for paying excess charges.

*** The out-of-pocket annual limit will increase each year for inflation.