Brandon's Posts (8)

Compare Medicare Supplement (Medigap) Plans and Rates from Top Rated Supplemental Insurance Companies

Many Americans that are on Medicare Insurance are finding that with the right Medicare Supplement Insurance Plan from Medigap 360 that you can:

  • Go to any Doctor or Hospital without worrying about “Networks”

  • Provide your Medicare Insurance Coverage and Medicare Supplemental Insurance Plan information 

  • Get all the Treatment that YOUR DOCTOR (not some insurance company) deems necessary and be covered.

That’s peace of mind worth having.

 

Compare Medicare Supplements Online Now
Call Right Now to Speak with a Medicare Supplement Broker
(888) 875-4463

Medicare Supplement Insurance Plans at Lower Rates

Why a Medicare Supplement Insurance Plan from Medigap 360?

If you are on Medicare, you are probably facing tough decisions on choosing the right Medicare SupplementInsurance Plan.  If you are like most of the people we have assisted in the past 26 years, you have found that trying to make the decision on the right Medicare Supplement Insurance Plan (Medigap Plan) can be stressful to say the least. 

The good news is that it doesn’t have to be. 

And you can have the same peace of mind that they have by choosing a Medicare Supplement Insurance Plan from Medigap 360. 

What’s even better is that if you choose the right Medicare Supplement Plan you will never have to pay a penny when receiving treatment in a physician’s office, hospital or specialty treatment center that accepts Medicare Insurance.  

That’s right, whether your doctor or hospital bills are $5 or $5,000,000, if you choose the right Medicare Supplement Plan you will never have to pay anything for doctor or hospital bills as long as Medicare approves a penny of the charges. 

There are:

  • No Deductibles

  • No Co-Pays

  • No Referrals Necessary

  • No Complicated Claims Paperwork to Fill Out

  • No remaining bills to pay if you choose the right Medigap Insurance (Medicare Supplement) Plan

Compare Medicare Supplements Online Now
Call Right Now to Speak with a Medicare Supplement Broker

(888) 875-4463

 

YOUR DOCTOR DECIDES HOW YOU SHOULD BE TREATED… not your Medigap insurance company.

You simply show your Medicare Supplement Insurance Card to the Doctor or Hospital and it will all be taken care of for you.  In fact, Medicare will in most cases send your claim directly to your Medicare Supplement Insurance Company and they will process the claim without you ever having to do anything.  When Medicare is unable to forward your claim, the hospital is required to file with your Medicare Supplement Plan for you.  So you never have to worry about claims paperwork or hassles.  You only need to Compare Medicare Supplements and find the one that is right for you and all is taken care of for you.

And again, if you choose the right Medicare Supplement Insurance Plan from Medigap 360, you will never have to pay a penny. 

We believe that doctors are for deciding on your treatment and Medicare Supplement insurance companies are there to pay your bills if and when health problems occur… and they should stay out of your doctor’s way when he is treating you.

Compare Medicare Supplements Online Now
Call Right Now to Speak with a Medicare Supplement Broker

(888) 875-4463

That is why we at Medigap 360 only work with clients who don’t want an insurance company making important healthcare decisions for them by telling them what doctors or hospitals that they can go to.  We want you and your doctor to have complete freedom to choose the best treatment options possible for you and your family and for you to have a Medicare Supplement Insurance Plan that will pay the bills, wherever you go.   We want you to be able to choose whatever doctor, hospital, or specialized treatment center that you think is best for you and gives you the best chance of recovering and getting back to your life.  

With a Medicare Supplement Insurance Plan, you will have complete freedom to go wherever you want, anywhere in the United States of America as long as they accept Medicare Insurance (which is almost everywhere.)

And another important thing to note is that when you purchase a Medicare Supplement Insurance Plan from Medigap 360 it is YOURS FOR LIFE.   This means that as long as you pay your premiums the insurance company can never take that coverage away from you… EVER!

Compare Medicare Supplements Online Now
Call Right Now to Speak with a Medicare Supplement Broker

(888) 875-4463

 

Don’t pay high rates for a Medicare Supplement Insurance Plan?

Did you know that there are a whole lot of companies offering Medicare Supplements in the United States?  Yet most people on Medicare Insurance can only name one or two of them.  The reason why is that only a few spend big money on advertisements or go to the expense of sending you a pile of information about themselves in the mail.  Most Medicare Supplement Insurance Companies rely on companies like Medigap 360 to educate the public while they concentrate on providing the services of issuing policies and paying claims. 

And since there are many Medicare Supplement Insurance companies offering may Medigap Plans at different rates, you can guess that by shopping around that you will find a company that is offering Medicare Supplements at lower rates than you are currently paying or considering. Most people find that, by letting we at Medigap 360 do the shopping for them, that they can save money on what they are currently paying or considering from the company or companies that they have talked to already.   

And what’s better is that since Medicare Supplement Insurance is standardized from one Medicare Supplement insurance company to the next, you can get the exact same or even better coverage for lower Medigap rates. 

But who has time to shop dozens of Medigap (Medicare Supplement) insurance companies?  Even more, why would you want to deal with the loads of information that they send you (that is more confusing than it is helpful) or with salespeople that want to come to your home and pressure you to buy what their Medigap insurance company is paying them to sell (not what’s necessarily best for you.)  

Well the good news is that you no longer have to.  With one simple phone call to Medigap 360 you will talk to a licensed Medicare Supplement Insurance Specialist.  He or she will be able to help you choose the right Medicare Supplement Plan and ensure that you are saving money and paying fair and lower Medigap Insurance rates.

Compare Medicare Supplements Online Now
Call Right Now to Speak with a Medicare Supplement Broker

(888) 875-4463

 

When I Need Help Choosing a Medicare Supplement Insurance Plan, What Makes Medigap 360 Different?

What makes Medigap 360 different is that WE WORK FOR YOU, not some insurance company.  We shop all the companies that offer Medicare Supplement / Medigap Insurance and find the ones that are reputable and can live up to their promises for many years to come.  (Basically we weed out all the small Medigap companies and the fly by nighters.)  

Then, from the companies that pass our rigorous requirements, we use state of the art technology to compare their Medicare Supplement Insurance rates and plans with you right over the phone (not in your home… we respect your privacy) and find the very best value for your particular situation. 

But that’s not all.  Have you ever applied for an insurance plan such as a Medigap Insurance plan or a Medicare Supplement Policy and been denied or gotten restrictions on your policy that you didn’t see coming… only after you had paid the initial premium.  Remember the hassle it took to get a refund or to find other suitable coverage?  Well, at Medigap 360, we don’t want that to happen to you ever again.

We are also Medicare Supplement Insurance “field underwriters” at Medigap 360.  This means that we will not only find you the best rates for Medicare Supplement Insurance but we will make sure that you will qualify for the coverage before we ask you to apply.  As long as you are honest with us about your health, we will be able to tell you right over the phone if you meet the underwriting standards of the Medicare Supplement or Medigap Insurance Company that is best for you.

This means that you get approved the first time and don’t have to worry about losing coverage. 

 

Compare Medicare Supplements Online Now
Call Right Now to Speak with a Medicare Supplement Broker

(888) 875-4463

 

Then what’s best is that we make arrangements with all of our Medigap and Medicare Supplement insurance companies to be able to enroll you in their plans right over the phone.  We don’t need to come to your house and invade your privacy just to get you the covered for at lower rates. 

How Does Medigap 360 Medicare Supplement Insurance Plans Work with Pre-Existing Conditions?

The simple truth is this.  If you have had another Medicare Supplement Plan for at least 6 months or if you’re new to Medicare Insurance and have been covered under a Group or Individual Major Medical Plan then all pre-existing conditions will be covered immediately by your new Medigap 360 Medicare Supplement Insurance Plan. 

If you haven’t had such Medigap or creditable coverage other than Medicare Supplement Insurance Plans for the past 6 months and you have a pre-existing condition or conditions, then the good news is that you are in exactly the right place.  A simple call to one of our Licensed Medicare Supplement Insurance Specialists at Medigap 360 and you will know your options in a matter of minutes. 

In some cases we can get your pre-existing conditions covered, in others you will only have a short waiting period.  One thing is for sure, you will be advised of the absolute best possible course of action to get the treatment that you need.   And you will always find the Medigap 360 recommendations and options for Medicare Supplement Insurance Plans to be the lowest in the United States.   This is why we are here.  

Call us today for the Medicare Supplement Quotes at the lowest Rates possible and for industry leading advice and counseling.

Compare Medicare Supplements Online Now
Call Right Now to Speak with a Medicare Supplement Broker

(888) 875-4463

 

Read more…

Many Medicare recipients are unwittingly getting trapped in restrictive Medicare Advantage plans without knowing all the facts.  Here are a few solid pointers that will help you and your loved ones know what you're really getting into before you take the plunge.   Be sure to read all the way through to my recommendations on the bottom of this article. 

Brandon

Medicare Advantage Plans vs Medicare Supplement and Medigap Insurance

1) You should not make a decision to buy a Medicare Advantage Plan by comparing the premium of the plan to your Medicare Supplemental Plan

Many Agents will try to compare your Medicare Advantage plan premiums to that of your Medicare Supplemental policy, and they are normally lower.

However, a lower price is no more a reason to buy a Medicare Advantage plan and give up Medicare Parts A and B. than it is to buy a scooter rather than a Mercedes just because it costs less.

To compare prices and come up with a good decision, you must make sure that you are making an apples to apples comparison. This is impossible with Medicare Advantage Plans and Medicare Supplemental Plans as they vary in benefits and structure. Medicare Supplemental Plans along with Medicare Parts A and B normally offer many more benefits and freedoms than Medicare Advantage Plans. In the end, you get what you pay for.

2) To enroll in a Medicare Advantage Plan, you must give up coverage from Medicare Parts A and B

If you choose a Medicare Advantage HMO or PPO Fee For Service Plan, you will be dis-enrolled from Medicare Parts A and B.

Medicare will then pay a monthly premium to the Medicare Advantage plan to provide your health care. The plan may require you to pay an additional premium and may charge you a co-payment each time you go to the doctor or get a prescription.

To join a Medicare Advantage plan, you must have both Medicare Part A and B and not have end-stage renal disease. Also, not all plans are available in all areas of the state that you live in an area that has a plan.

3) You can have increased control over your choice of healthcare providers with Medicare Parts A and B alone rather than a Medicare Advantage Plan, even without a Medicare Supplemental (Medigap) Plan.

Medicare Parts A and B allow you to choose any physician or hospital in the United States. In critical times, this freedom to choose and access the best providers could make a huge difference in treatment, and even save your life.

Medicare Advantage Plans are not so flexible, possibly with severe consequences. Medicare HMOs require you, in most instances, to use only physicians and hospitals in the HMO's network. You can generally go to any doctor or provider you want with a private fee-for-service plan you must find a provider that will treat you and accept the plans terms and conditions.

4) Medicare parts A and B alone (without a Medicare Supplemental) can provide you comparable benefits to Medicare Advantage Plans without restricting your ability to choose your healthcare providers or putting administrative restrictions on your physician for claim payments and referrals

Medicare Advantage Plans must provide, by law, at least the same benefits (or actuarial equivalent) of Medicare. However, this can be deceptive. What this means is that they will offer you benefits based on dollar amounts only that will average what Medicare offers, though they may package the benefits differently. Packaging differences can best be explained by taking a dollar away from you in one place and giving it back in another, which maintains the "actuarial equivalent" requirement. However, though the average payments will be similar after care has been received, Medicare Advantage Plans may restrict or delay you from receiving treatment at that you would choose if your insurance coverage allowed you whatever you wanted.

5) Do not purchase a Medicare Advantage Plan solely to get Prescription Drug Coverage

If you are eligible for Medicare Advantage Plans, you are eligible for Medicare Part D plans that you can keep without giving up Medicare Parts A and B or your Medicare Supplemental (Medigap) Policy.

6) A Medicare Advantage Plan will restrict your right to choose your physicians and hospitals, even with Private Fee for Service Plans, possibly resulting in serious health consequences.

Medicare Advantage Plans only require that they offer you a certain type of healthcare. For instance, if you needed treatment for colon cancer, for instance, they would have to allow you to see physicians and hospitals who treat cancer. However, if you chose to take advantage of the increase in survival rates demonstrated by a hospital or treatment center that specializes in cancer treatments and a physician who specializes or has great experience in colon cancer, you may not be allowed to use them, or you might experience severe delays with your Medicare Advantage Plan. What's worse, if you decide to go to them and pay on your own, you will no longer have Medicare Parts A and B to fall back on. You will be responsible for 100% of all costs.

7) A Medicare Advantage Plan may choose not to renew their contract with Medicare each year in any area. If this happens, you will no longer be allowed to participate in the plan.

Medicare Supplemental Plans and Medicare, however, are guaranteed renewable for life. You can never lose coverage as long as you pay your premiums. What's Important About Making Healthcare Decisions with Health Insurance Remember, the reason that you have health insurance is not solely for the sake of having health insurance. Health insurance for the sake of merely having insurance is boring and expensive. Instead, you purchase insurance to ensure that, if and when health problems occur, that you will be able to recieve the best quality healthcare without regard to the costs involved. Many Seniors make the mistake of simply purchasing insurance based on the monthly cost, possibly exposing themselves to serious health risks caused by reduced access to healthcare.

My reccomendations:

  1. Ultimately it is best to stay enrolled in Medicare Parts A&B and have a comprehensive Medicare Supplemental (Medigap) policy to pay the gaps that Medicare doesn't cover.
  2. If you cannot afford your Medicare Supplemental Policy, first shop around to make sure that you are paying the lowest premium possible. Enter your information above to request a Free Medigap Insurance Quote from Medigap360.
  3. Even if you can afford your current Medicare Supplemental policy, it is best to shop around to make sure that you are not paying more than you have to.
  4. If you still cannot afford Medicare Supplemental Insurance, do not enroll in a Medicare Advantage Plan. Instead, stay with Medicare Parts A&B. This will provide you access to choose any physician or hospital without delay. For the gaps that are left by Medicare coverage, you should be able to work out payment plans with your provider or find charitable programs to assist you . We have never heard of anybody who was not able to get the treatment that they need when they have Medicare Part A and B alone.
  5. Do not take a Medicare Advantage Plan just for Prescription Drug Coverage. Talk with a qualified and licensed Medicare Supplemental Specialists about your prescription drug insurance options including Medicare Part D.

Call for your Free Medigap Insurance Quote

(888) 875-4463

Read more…

  • How do I find the best price for my Medicare Supplemental Insurance Coverage?
  • Which Medicare Supplemental Insurance Policy is the best?
  • What should I consider when choosing a Medicare Supplemental Insurance Company?
  • How can Medigap360 Help Me in choosing and applying for Medigap coverage?
  • How do I change my Medigap Plan in order to save money?
  • If I change my Medigap Coverage will I have a waiting period for pre-existing conditions?
  • When should I make my Medigap Policy effective?
  • What is the fastest way I can get covered and start saving money?



How do I Find the Best Price for My Medicare Supplemental Insurance Coverage?

We make it easy for you at Medigap360. All you have to do is request a multi-company Medicare Supplemental insurance rate analysis from our website.

Which Medicare Supplemental Insurance Policy is the Best?

From our experience we have found plan F and plan G to be the most popular. However, many people have found plan C, D, E and I very economical. It always depends on your particular situation and risk tolerance. If you are having trouble deciding, one of our licensed Medicare Supplemental insurance specialists will be happy to assist you in finding the best plan for you.

What Should I Consider When Choosing a Medicare Supplemental Insurance Company?

Though all companies offer similar standardized plans there can still be some differences. You want to make sure that you are purchasing from a licensed insurance company in your state with an approved Medicare Supplemental insurance policy. Other things you may want to consider is if the company puts a waiting period on pre-existing conditions and if that applies to you. Financial strength is also important. Do not be too concerned if you haven't heard of the company before, there are many insurance companies out there that are very dependable that don't spend tons of money on advertising to make their name known.

How Can Medigap360 Help Me in Choosing and Applying for Medigap Coverage?

We hope, first of all that you find the information on this site to be helpful. We feel that we have put together the most comprehensive website on Medicare Supplemental insurance information in the country. Furthermore, we have taken painstaking measures to present it in a way that is easy to understand and will help you to make the right money saving decisions about your Medicare Supplemental insurance coverage and be able to get back to your life. However, we know that all this information can be overwhelming when you don't do this for a living like we do. We will be happy to help you in any way we can. You can call our toll free number and talk to a licensed Medigap specialist and we will help to educate you in deciding what the very best policy is for you and your family and we can even help you to enroll. You'll find our specialists to be the most knowledgeable in the industry. Since 1984, all we have been doing is helping seniors save money on their Medicare Supplemental insurance while ensuring comprehensive coverage.

How do I Change My Medigap Plan in Order to Save Money?

If you already have a Medicare Supplemental insurance policy you most likely will be able to change to another policy if you find a lower premium. In most cases, you will be able to change without any waiting periods or loss of one day of coverage. However, this must be handled properly with the assistance of a licensed agent. To check your eligibility and save money on your Medigap premiums, simply fill out our rate analysis inquiry or call us toll free at (888) 875-4463. We will be able to determine if changing is right for you. We can guide you through every step of the process to make sure you save the most money if possible, without any gaps in your Medicare Supplemental insurance coverage.

If I Change My Medigap Coverage will I Have a Waiting Period for Pre-Existing Conditions?

In most cases you will not. Medicare Supplemental insurance providers have the option to put up to a 6 month waiting period on pre-existing conditions. If you are subject to this waiting period then previous conditions that you had before applying for coverage may not be covered. However, any new conditions that arise will be covered immediately.

Some companies exercise this option and some don't. However, if you have been covered by a previous Medigap policy or other creditable coverage for the length of the companies waiting period, that waiting period will be deemed as satisfied and you will have coverage from day one. Furthermore, no Medicare Supplemental insurance company is allowed to have any exclusions to their coverage for past medical conditions beyond the pre-existing conditions waiting period. That means, if a company issues you a policy, they cannot exclude certain medical conditions that you have. If they issue you a policy and you are not subject to a waiting period on pre-existing conditions, they will have to cover all conditions old and new.

When Should I Make My Medigap Policy Effective?

If you are just now becoming eligible for Medicare you should make the effective date as soon as possible but no earlier than the effective date of Medicare Parts A and B. If you are replacing coverage, you should apply in time with a future effective date long enough out to receive and review your policy before the effective date of coverage. This will give you time to make sure your transaction was handled properly and that the right policy was issued before cancelling your existing coverage.

What is the Fastest Way I Can Get Covered and Start Saving Money?

The fastest way is to call and speak with one of our licensed Medicare Supplemental insurance specialists at (888) 875-4463. They will be able to evaluate your situation, determine the best plan of action for you and help you get started.

Read more…

Medigap Eligibility

Insurance companies must sell you a Medigap (Medicare Supplement) plan during certain periods of time — one period is called "open enrollment period." The others are called "guaranteed issue periods."

At other times, insurance companies may refuse to sell you a policy. If you have or used to have health problems, you may not be able to buy the Medigap plan of your choice. Most companies will have a few simple health questions that your Medigap360 Medicare Supplement Specialist can ask you to determine your eligibility.

Eligibility: Open Enrollment & Guaranteed Issue Periods

Open Enrollment

Seniors: Medigap companies must sell you a policy - even if you have health problems - if you are at least 65 and apply within six months after enrolling in Medicare Part B. These six months are called your "open enrollment" period. During open enrollment, a company must allow you to buy any of the Medigap plans it offers. You can use your open enrollment rights more than once during this six-month period. For instance, you may change your mind about a policy you bought, cancel it, and still have the right to buy any other Medigap policy, so long as the sale takes place during the six months after you enroll in Medicare Part B.

Although a company must sell you a policy during your open enrollment period, it may require a waiting period of up to six months before covering your pre-existing conditions. Pre-existing conditions are conditions for which you received treatment or medical advice from a physician within the previous six months.

Your right to open enrollment is absolute, even if you wait for several years after you become 65 to enroll in Medicare Part B because of continued employment or other reasons.

People with disabilities: People under age 65 who receive Medicare because of disabilities have a six-month open enrollment period beginning the day they enroll in Medicare Part B. This open enrollment right is only applicable to Medigap Plan A. Companies selling Medicare supplement insurance in Texas may not deny you a Plan A policy because you have pre-existing conditions. Companies are not required to offer the other plans to Texans with disabilities, but they may do so if they wish. During the first six months after you turn 65 and are enrolled in Medicare Part B, you will have a right to buy any of the 12 plans.

Guaranteed Issue

You may have the right to buy a Medigap policy outside of your open enrollment period if you lose certain types of health coverage. For people over age 65, the guaranteed issue right applies to Medigap plans A, B, C, F, K, and L. For people under age 65, this guaranteed issue right applies only to Medigap Plan A. In general, this right is for 63 days from the date coverage ends or from the date of notice that coverage will end. Companies may not place any restrictions, such as pre-existing condition waiting periods or exclusions, on these policies. This is called "guaranteed issue." You must provide proof of the loss of your health care coverage. Texans under age 65 with disabilities who enroll in Medicare Part B also have guaranteed issue rights, but they are only eligible for Medigap coverage under Plan A. This guaranteed issue right is also extended to people on Medicare who lose Medicaid because of a change in their financial situation.

Guaranteed Issue and Medicare Advantage Plan Disenrollment

What often goes unnoticed about Medicare Advantage Plans is that they reserve the right to terminate their contract with Medicare from year to year in any service area that they wish. When this happens, you will no longer be able to continue with your plan and will be placed back on Original Medicare at the beginning of the following year.

If your Medicare Advantage plan terminates its contract in your service area, you have the right to purchase any Medigap plan A, B, C, F, K, or L offered in your state without regard to your medical history or condition. If your Medicare Advantage plan ends services in your area, it must explain to you in writing your options and timeframes to buy a Medigap policy.

Click Here to get a Free Medicare Supplement Insurance Rate Analysis

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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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Medicare Insurance Basics

Medicare Insurance is a Health Insurance Program For:

  • People Age 65 or Older,
  • People under age 65 with certain disabilities, and
  • People of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant.)

Medicare Insurance Benefits Plan Basics:

Medicare Part A (hospital) pays for in-patient hospital services, skilled nursing facility care after a hospital stay, home health care, and hospice care. Medicare Part A also pays for all but the first three pints of blood in a calendar year.

Medicare Part B (medical) pays for medical expenses, clinical laboratory services, and outpatient hospital treatment. In most cases, Medicare Insurance pays 80 percent of the cost of covered services.

Covered medical expenses include physicians´ services and supplies. Some Medicare Part B services are paid as a fixed copayment under the outpatient prospective payment system.

Medicare Part B also pays for some preventive services. Ask your physician about screening tests, flu shots, and vaccines covered by Medicare.

Medicare prescription drug coverage (also called Medicare Part D) pays for prescription drugs, both generic and brand name. You must join a prescription drug plan to have this coverage.

Options for receiving Medicare Insurance benefits

Medicare enters into annual contracts with insurance companies and managed care plans to provide coverage through different types of health plans. The original Medicare plan is available to everyone. Original Medicare is also sometimes called Medicare fee-for-service or traditional Medicare. You can go to any doctor or hospital that accepts Medicare. Original Medicare coordinates with most group retirement plans, Medicaid, Medicare savings programs, and Medigap insurance.

You may have the option to join a Medicare Advantage plan (formerly called Medicare + Choice). Medicare Advantage plans include health maintenance organizations (HMOs), preferred provider plans (PPOs), private fee-for-service plans (PFFS), and medical special needs plans. You can only join a Medicare Advantage plan if a plan is available in your area and you have Medicare Parts A and Part B. Some plans may have additional eligibility requirements. The federal Centers for Medicare and Medicaid Services (CMS) administers Medicare Advantage plans. Plans provide their members with a handbook upon enrollment that outlines the complaints and appeals process for denial of services.

CMS publishes a handbook, called Medicare and You, that describes Medicare coverages and health plan options. The handbook is mailed to every Medicare beneficiary each year.

Services Not Covered by Medicare Insurance Benefits

  • Long-term care services (generally not covered) 
  • Private-duty nursing care
  • Most dental care and dentures.  
  • Healthcare received while traveling outside the United States, except under limited circumstances
  • Custodial care, such as help walking, getting in and out of bed, dressing, bathing, toileting, shopping, eating, and taking medicine (these are commonly referred to as activities of daily living)
  • More than 100 days of skilled nursing facility care during a benefit period following a hospital stay (the Medicare Part A benefit period begins the first day you receive a Medicare-covered service and ends when you have been out of the hospital or a skilled nursing facility for 60 consecutive days)
  • Homemaker services
  • Cosmetic surgery and routine foot care
  • Routine eye care, eyeglasses (except after cataract surgery), and hearing aids.

What You´ll Have to Pay with Medicare

Both Medicare Part A and Part B have costs that you must pay. These include monthly premiums, deductibles, copayments, and coinsurance. You also pay the full cost of services not covered by Medicare.

Premiums are amounts you pay regularly to keep your coverage. Most people do not have to pay a Part A premium, but everyone must pay the Part B premium. The premium amounts may change each year in January. A deductible is the amount you must pay for covered medical expenses before Medicare begins to pay. A copayment is a fixed charge for a medical service. Coinsurance is the percentage of the cost of a covered service that you pay after Medicare pays its portion of the cost.

Health care providers who "accept assignment" agree to limit their fee to the Medicare-approved amount for a service or supply, although you must pay any deductibles, coinsurance, or copayments due. Providers who do not accept assignment may charge as much as 15 percent above the Medicare-approved amount when treating Medicare patients. You must pay the excess amount. The amount you owe is shown on the Medicare Summary Notice that you receive from Medicare. If you were charged more than the 15 percent and paid it, your provider must refund the excess charges to you within 30 days. If you believe a provider has overcharged you, question the bill before you pay it and contact the Medicare carrier that processed your claim.

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