Medicare comes in four parts, but Original Medicare (Parts A and B) offers most of its benefits. Part C, Medicare Advantage, mainly allows users to purchase their A and B benefits from private insurance companies. Part D covers only prescription drugs. Between them, Parts A and B offer coverage for home health services, inpatient and outpatient hospital and mental health care, preventive screenings, exams and hospice care. Medicare supplements, often called Medigap, help beneficiaries pay for Original Medicare's out-of-pocket costs. As of 2011, all Medigap plans have benefits specifically for Part B services.
Part B Copays
The benefits offered by Medicare supplements are standardized. Except for Minnesota, Wisconsin and Massachusetts, which are allowed to sell Medigap differently, as of 2011 all states sell Medigap policies in the same forms. The only differences between them are the prices, which are set by the insurance companies that sell them. All Medigap policies must offer what are called the core or basic benefits. Most of these concern Part A, but one of the core benefits for Medicare supplements is coverage of Part B coinsurance and copayments. This is a major benefit, as most Part B services require a copay or coinsurance amount. Even Medigap Plan A, which has the fewest benefits and is the least expensive, has coverage for Part B coinsurance and copays.
Part B Deductible
Two Medigap plans offer coverage of the Part B deductible. This is an annual amount you are responsible for meeting yourself, after which you only pay 20 percent of the Medicare-approved cost for most services. As of 2011, the deductible is $162 per year. If you purchase Medigap policies C or F, however, they will cover the costs of the annual Part B deductible.
Part B Excess Charges
Health-care providers who participate in Medicare cannot charge more than a maximum amount. However, physicians who do not accept Medicare are allowed to apply a surcharge for treating Medicare patients. As of 2011, this amount is 15 percent. Two Medicare supplements offer coverage of these Part B "excess charges." Plan F, which is available in both a standard and a high-deductible option, is one. Plan G, which has all the same benefits as Plan F minus coverage for the Part B deductible, is the other.
Cost-Sharing Plans
Medigap policies generally cover benefits at 100 percent. There are three cost-sharing plans that cover Part B services at less than 100 percent, which results in lower monthly premiums. Plans K and L cover the Part B coinsurance at 50 and 75 percent, respectively. They do not have a benefit for the Part B deductible or excess charges. Plans K and L also have annual out-of-pocket limits. Plan N, introduced in 2010, has copays for doctor's office visits and emergency room visits that do not result in an inpatient admission. As of 2011, the copay amounts are $20 for office visits and $50 for the emergency room.
Tags: coverage Part, Medicare supplements, Medigap policies, Part deductible, offer coverage, Part coinsurance