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All Medigap policies issued since 1992 must match one of the following
ten standard benefit plans (labeled A through J)
PLAN A - THE BASIC POLICY CONSISTS OF THESE BASIC BENEFITS:
- Coverage for the Part A coinsurance amount ($203 per
day in 2002) for the 61st through the 90th day of hospitalization in
each Medicare benefit period.
- Coverage for the Part A coinsurance amount ($406 per
day in 2002) for each of the Medicare's 60 non-renewable lifetime hospital
inpatient reserve days used.
- After all Medicare hospital benefits are exhausted, coverage for
100% of the Medicare Part A eligible hospital expenses. Coverage is
limited to a maximum of 365 days of additional inpatient hospital care
during the policy holder's lifetime. This benefit is paid either at
the rate Medicare pays hospitals under its Prospective Payment System
or another appropriate standard of payment.
- Coverage under Medicare Parts A and B for the
reasonable cost of the first three pints of blood or equivalent quantities
of packed red blood cells per calendar year unless replaced in accordance
with federal regulations.
- Coverage for the coinsurance amount for Part
B services (generally 20% of approved amount; 50% of approved charges
for mental health services) after $100 annual deductible is met.
PLAN B - INCLUDES THE BASIC BENEFITS PLUS:
- Coverage for the Medicare Part A hospital deductible
($812 per benefit period in 2002). PLAN C - INCLUDES THE BASIC POLICY
BENEFITS PLUS:
- Coverage for the Medicare Part A deductible.
(See Plan B)
- Coverage for the skilled nursing facility care
coinsurance amount ($101.50 per day for days 21 through 100 per benefit
period in 2002).
- Coverage for the Medicare Part B deductible
($100 per calendar year in 2002.)
- 80% coverage for medically necessary emergency
care in a foreign country, after a $250 deductible.
PLAN D - INCLUDES THE BASIC POLICY BENEFITS PLUS:
- Coverage for the Medicare Part A deductible.
(See Plan B)
- Coverage for the skilled nursing facility care.
(See Plan C)
- Coverage for emergency care in a foreign country.
(See Plan C)
- Coverage for at-home recovery. Pays up to $1600
per year for short-term, at-home help with activities of daily living
(bathing, dressing, personal hygiene, etc.) for those recovering from
an illness, injury, or surgery. There are various benefit requirements
and limitations.
PLAN E - INCLUDES THE BASIC POLICY BENEFITS PLUS:
- Coverage for the Medicare Part A deductible.
(See Plan B)
- Coverage for skilled nursing facility care
(See Plan C)
- Coverage for emergency care in a foreign country.
(See Plan C)
- Coverage for preventive medical care. Pays
up to $120 per year for a physical examination, serum cholesterol screening,
hearing test, diabetes screenings, and thyroid function tests.
- Coverage for the Medicare Part A and B deductible.
(See Plan B and C)
- Coverage for skilled nursing facility care.
(See Plan C)
- Coverage for emergency care in a foreign country
(See Plan C)
- Coverage for 100% of Medicare Part B excess
charges.*
- Coverage for the Medicare Part A deductible.
(See Plan B)
- 80% of Medicare Part B excess charges.
- Coverage for skilled nursing care daily (See
Plan C)
- Coverage for emergency care in a foreign country.
(See Plan C)
PLAN H - INCLUDES THE BASIC POLICY BENEFITS PLUS:
- Coverage for at-home recovery (See Plan D).
- Coverage for the Medicare Part A deductible.
(See Plan B)
- Coverage for skilled nursing facility care.
(See Plan C)
- Coverage for emergency care in a foreign country.
(See Plan C)
- Coverage for 50% of the cost of prescription
drugs up to a maximum annual benefit of $1,250 after the policy holder
meets a $250 per year deductible. (Basic drug benefit).
PLAN I - INCLUDES THE BASIC POLICY BENEFITS PLUS:
- Coverage for the Medicare Part A deductible.
(See Plan B)
- Coverage for skilled nursing facility care
(See Plan C)
- Coverage for 100% of Medicare Part B excess
charges.*
- Basic prescription drug coverage (See Plan H).
- Coverage for emergency care in a foreign country.
(See Plan C)
- Coverage for at-home recovery (See Plan D).
PLAN J - INCLUDES THE BASIC POLICY BENEFITS PLUS:
- Coverage for the Medicare Part A and B deductible.
(See Plan B and C)
- Coverage for skilled nursing facility care.
(See Plan C)
- Coverage for 100% of Medicare Part B excess
charges.*
- Coverage for 50% of the cost of prescription
drugs up to a maximum annual benefit of $3,000 after the policy holder
meets a $250 per year deductible ("extended" drug benefit).
- Coverage for emergency care in a foreign country.
(See Plan C)
- Coverage for preventative medical care (See
Plan E).
- Coverage for at home recovery (See Plan D).
*Excess charges - the difference between a provider's actual charge (up
to the amount of charge limitation set by Medicare or the state) and the
Medicare-approved payment amount. Medicare does not have to approve the
provider charge, even if it does not exceed the full charge limitation.
See LSND Brochure 522.
Disclaimer: This information is not legal advice. If you have a legal problem, you should talk to a lawyer and ask for advice about your options.
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