Medigap policy changes in 2010Article added by Sonya King on March 8, 2010
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Sonya King

Joined: October 01, 2008

Medicare supplement insurance (Medigap) policies are health insurance policies sold by private insurance companies specifically to fill gaps in original Medicare coverage. A Medigap policy typically provides coverage for some or all of the deductible and coinsurance amounts applicable to Medicare-covered services, and sometimes covers items and services that are not covered by Medicare.

Effective June 1, 2010, changes to Medigap policies include: (1) the addition of hospice benefits to the core package (see Policy A, below); (2) the elimination of preventive benefits and at-home recovery benefits as of June 1, 2010; (3) the elimination of Plans E, H, I, and J; and (4) the addition of Plans M and N.

Thus, in 2010 Medigap policies offer the following benefits:

Policy A is the basic core benefit package, which includes: (1) hospital insurance (Part A) coinsurance for the 61st through 90th day of hospitalization in any Medicare benefit period, (2) hospital insurance coinsurance for the 91st through 150th day; (3) hospital insurance expenses for an extra 365 days in the hospital; (4) hospital insurance (Part A) and Medical Insurance (Part B) deductible for the cost of the first three pints of blood; (5) medical insurance (Part B) coinsurance (20 percent of allowable charges); and (6) hospice (Part A) coinsurance.

Policy B includes: (1) the basic core benefit package; and (2) the Hospital Insurance (Part A) deductible ($1,100 in 2010).

Policy C includes: (1) the basic core benefit package; (2) the Hospital Insurance (Part A) deductible ($1,100 in 2010); (3) the coinsurance for care in a skilled nursing home (days 21-100, $137.50 a day in 2010); (4) the Medical Insurance (Part B) deductible ($155 in 2010); and (5) coverage of foreign travel emergencies.

Policy D includes: (1) the basic core benefit package; (2) the Hospital Insurance (Part A) deductible ($1,100 in 2010); (3) the coinsurance for care in a skilled nursing home (days 21-100, $137.50 a day in 2010); (4) coverage of foreign travel emergencies; and (5) at-home recovery assistance (note: the at-home recovery benefit will not be available effective June 1, 2010).

Policy F includes: (1) the basic core benefit package, (2) the Hospital Insurance (Part A) deductible ($1,100 in 2010), (3) the coinsurance for care in a skilled nursing home (days 21-100, $137.50 a day in 2010), (4) the Medical Insurance (Part B) deductible ($155 in 2010), (5) coverage of foreign travel emergencies, and (6) 100 percent coverage of excess doctor charges under Medical Insurance (Part B).

In addition, there is a policy that is the same as Policy F but with a $2,000 deductible (in 2010). This high deductible policy covers 100 percent of covered out-of-pocket expenses once the deductible has been satisfied in a year. It requires the beneficiary of the policy to pay annual out-of-pocket expenses (other than premiums) in the amount of $2,000 before the policy begins payment of benefits. The deductible increases by the percentage increase in the Consumer Price Index for all urban consumers for the 12-month period ending with August of the preceding year.

Policy G includes: (1) the basic core benefit package, (2) the Hospital Insurance (Part A) deductible ($1,100 in 2010), (3) the coinsurance for care in a skilled nursing home (days 21-100, $137.50 a day in 2010), (4) coverage of foreign travel emergencies, (5) at-home recovery assistance (note: the at-home recovery benefit will not be available effective June 1, 2010), and (6) 80 percent of excess doctor charges under Medical Insurance (Part B) (note: the percentage increases to 100 percent effective June 1, 2010).

New Plans - Effective June 1, 2010, two new plans are available (both of which include the basic core benefit package):

Plan M duplicates Plan D (see above), but with a 50 percent coinsurance on the Part A deductible.

Plan N duplicates Plan D (see above) with the Part B coinsurance being paid at 100 percent, less a $20 copayment per physician visit and a $50 copayment per emergency room visit (unless the beneficiary was admitted to the hospital).

Two other standard plans became available in 2006. These two plans do not include the entire core benefit package:

Plan K includes: (1) coverage of 50 percent of the cost-sharing otherwise applicable under Parts A and B, except for the Part B deductible; (2) coverage of 100 percent of hospital inpatient coinsurance and 365 extra lifetime days of coverage of inpatient hospital services; (3) coverage of 100 percent of any cost-sharing otherwise applicable for preventive benefits; and (4) a limit on annual out-of-pocket spending under Part A and Part B to $4,620 (in 2010).

Plan L includes: (1) coverage of 75 percent of the cost-sharing otherwise applicable under Parts A and B, except for the Part B deductible; (2) coverage of 100 percent of hospital inpatient coinsurance and 365 extra lifetime days of coverage of inpatient hospital services; (3) coverage of 100 percent of any cost-sharing otherwise applicable for preventive benefits, and (4) a limit on annual out-of-pocket spending under Part A and Part B to $2,310 (in 2010).

Plans E, H, I, and J will no longer be available for purchase effective June 1, 2010. But if an individual already has or buys one of these plans before June 1, 2010, he or she can keep that plan.

Some plan choices may not be available in Massachusetts, Minnesota, and Wisconsin because these states already required standardized Medigap policies prior to 1992.

Notice, "Medicare Program; Recognition of NAIC Model Standards for Regulation of Medicare Supplement Insurance," 74 Fed. Reg. 18808 (4-24-2009).

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