Medicare and Medigap Blog

Medicare Part D

 

Medicare Supplement Insurance Plan D covers most of the high risk areas not covered by Medicare Insurance. A Medicare Supplemental Plan D can sometimes be less expensive than other more comprehensive plans such as Medigap Plan J or Medigap Plan F but leaves gaps in coverages that these other plans don’t.

Medicare Insurance Recipients who choose Medicare Supplemental Plan D often do so because they don’t feel they need coverage for the Part B Deductible, Preventative Care and Part B Excess Charges and wish to save money on their premium by taking lesser coverage. Before purchasing a Medicare Supplement Plan D, make sure to compare rates on more comprehensive Medicare Supplement Insurance Plans such as Medigap Plan F or J. Often by shopping different Medicare Supplemental Insurance Companies you can find a more comprehensive Medicare Supplement Plan for at lower rates.

Covered by Medicare Supplemental Plan D

Basic Benefits:

* Part B Coinsurance (Generally 20% of outpatient expenses)
* Hospital Coinsurance
* 365 Additional Days Hospitilization Coverage
* Blood Deductible Coverage

Skilled Nursing Coinsurance

Part A Deductible

Foreign Travel

Not Covered by Medicare Supplement Plan D

  • Part B Deductible

  • Part B Excess


Medigap Plan D is only recommended on very rare occasions. For most people, you are better off with a more comprehensive Medicare Supplement Plan such as Medicare Supplemental PlanF or J.

 

Medicare Supplement Plan D


Medigap Plan D
MEDICARE INSURANCE (PART A) - HOSPITAL SERVICES - PER BENEFIT PERIOD


A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row.


Service:


HOSPITALIZATION
Semiprivate room and board, general nursing and miscellaneous services and supplies:


MEDICARE INSURANCE PAYS


PLAN PAYS


YOU PAY


First 60 days


All but $1184


$1184 (Per Benefit Period)


$0


61st through 90th day


All but $296


$296 a day


$0


While using 60 lifetime reserve days


All but $592 a day


$592 a day


$0


Once lifetime reserve days are used:


Additional 365 days


$0


100% of Medicare Eligible Expenses


$0


Beyond the Additional 365 days


$0


$0


All costs




Service:


SKILLED NURSING FACILITY CARE You must meet Medicare's requirements, including having been in a hospital for at least 3 days and entered a Medicare-approved facility within 30 days after leaving the hospital:


First 20 days


All approved amounts


$0


$0


21st through 100th day


All but $148 a day


Up to $148 a day


$0


101st day and after


$0


$0


All cost


Service:


Blood


First 3 pints


$0


3 pints


$0

Additional amounts

100%

$0

$0


Service:


HOSPICE CARE - 
Available as long as your doctor certifies you are terminally ill and you elect to receive these services.




All but very limited coinsurance for outpatient respite care

$0


Balance


NOTICE: When your Medicare Part A hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy's "Core Benefits." During this time the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid



Medigap Plan D
MEDICARE INSURANCE (PART B) - MEDICAL SERVICES - PER CALENDER YEAR


Once you have been billed $147 of Medicare-Approved amounts for covered services (which are noted with an asterisk), your Medicare Part B Deductible will have been met for the calendar year.


Service:


MEDICAL EXPENSES - In or Out of the Hospital and Outpatient Hospital Treatment,

such as Physician's services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment


MEDICARE INSURANCE PAYS


PLAN PAYS


YOU PAY

First $147 of Medicare Approved Amounts

$0

$0

$147 (Part B Deductible)

Remainder of Medicare Approved Amounts

Generally 80%

Generally 20%

$0

Part B Excess Charges (Above Medicare Approved Amounts)

$0

$0

All costs


Service:


BLOOD

First 3 pints

$0

All cost

$0

Next $147 of Medicare Approved Amounts

$0

$0

$147 (Part B Deductible)

Remainder of Medicare Approved Amounts

80%

20%

$0


Service:


CLINICAL LABORATORY SERVICES

Blood tests for Diagnostic Services

100%

$0

$0

 


MEDICARE INSURANCE PARTS  A & B


Service:


HOME HEALTH CARE
Medicare Approved Services:


MEDICARE INSURANCE PAYS


PLAN PAYS


YOU PAY


Medically necessary skilled care services and medical supplies


100%


$0


$0


Durable medical equipment:


First $128 of Medicare Approved Amounts


$0


$0


$147 (Part B Deductible)


Remainder of Medicare Approved Amounts


80%


20%


$0


Services


AT HOME RECOVERY SERVICES
Home care certified by your doctor, for personal care during recovery from an injury or sickness for which Medicare approved a Home Care Treatment Plan


Benefit for each visit


$0


Actual charges up to $40 per visit


Balance


Number of visits covered


$0


Up to the number of Medicare approved visits, not to exceed 7 each week


Balance

Calendar year maximum

$0

$1,600

Balance


OTHER BENEFITS - NOT COVERED BY MEDICARE INSURANCE


Services


FOREIGN TRAVEL

Medically necessary emergency care services beginning during the first 60 days of each trip outside the USA:


First $250 each calendar year


$0


$0


$250


Remainder of charges


$0


80% to a lifetime maximum of $50,000


20% and amounts over the $50,000 lifetime maximum

 

OUTLINE OF MEDICARE COVERAGE

Benefit Chart of Medicare Supplement Plans Sold for Effective Dates as of Jan 1, 2013

Plan A

Plan B

Plan C

Plan D

F

F*

Plan G

Plan K

Plan L

Plan M

Plan n

 

Basic, including 100% Part B co-insurance.



Basic, including 100% Part B co-insurance.



Basic, including 100% Part B co-insurance.



Basic, including 100% Part B co-insurance.



Basic, including 100% Part B co-insurance.



Basic, including 100% Part B co-insurance.


Hospitalization and preventative care paid at 100%; other basic benefits paid at 50%


Hospitalization and preventative care paid at 100%; other basic benefits paid at 75%



Basic, including 100% Part B co-insurance.



Basic, including 100% Part B co-insurance.

 


Skilled Nursing Facility Co-insurance


Skilled Nursing Facility Co-insurance


Skilled Nursing Facility Co-insurance


Skilled Nursing Facility Co-insurance


50% Skilled Nursing Facility Co-insurance


75% Skilled Nursing Facility Co-insurance


Skilled Nursing Facility Co-insurance


Skilled Nursing Facility Co-insurance

 


Part A Deductible


Part A Deductible


Part A Deductible


Part A Deductible


Part A Deductible


50% Part A Deductible


75% Part A Deductible


50% Part A Deductible


Part A Deductible

 


Part B Deductible


Part B Deductible

 


Part B Excess (100%)


Part B Excess (100%)

 


Foreign Travel Emergency


Foreign Travel Emergency


Foreign Travel Emergency


Foreign Travel Emergency


Foreign Travel Emergency


Foreign Travel Emergency

 


Out-of-Pocket limit at $4,620; paid at 100% after limit reached


Out-of-Pocket limit at $2,310; paid at 100% after limit reached

 

*Plan F also has an option called a high deductible Plan F. This high deductible plan pays the same benefits as Plan F after one has paid a calendar year $2,000 deductible. Benefits from high deductible plan F will not begin until out-of-pocket expenses exceed $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, but do not include the plan’s separate foreign travel emergency deductible.

**Plan N includes Basic, including 100% Part B co-insurance, except up to $20 copayment for office visit, and up to $50 copayment for ER.

 

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Brandon Todd is a Patient Advocate, a Licensed Insurance Agent and a Passionate Entrepreneur with a passion for creating unique and abundant win-win relationships.

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