Standard Medigap Policies

Following is a list of the 10 standard plans and the benefits provided by each. A chart comparing the plans follows this section:

PLAN A --BASIC POLICY

Consists of these basic benefits:

  • Coverage for the Part A coinsurance amount ($ 191 per day in 1998) for the 61st through the 90th day of hospitalization in each Medicare benefit period.
  • Coverage for the Part A coinsurance amount ($ 382 per day in 1998) for each of 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 policyholder’s lifetime. This benefit is paid either at the rate Medicare pays hospitals under its Prospective Payment System (PPS) or under another appropriate standard of payment for hospitals not subject to the PPS. Beneficiaries may be responsible for payment when Medigap hospital benefits are exhausted.
  • Coverage under Medicare Parts A and B for the reasonable cost of the first 3 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 outpatient mental health services) after $100 annual deductible is met.

PLAN B

Includes the basic benefit plus:

  • Coverage for the Medicare Part A inpatient hospital deductible ($ 764 per benefit period in 1998).

PLAN C

Includes the basic benefit plus:

  • Coverage for the Medicare Part A inpatient hospital deductible ($ 764 per benefit period in 1998).
  • Coverage for the skilled nursing facility care coinsurance amount ($ 95.50 per day for days 21 through 100 per benefit period in 1998).
  • Coverage for the Medicare Part B deductible ($ 100 per calendar year in 1997).
  • 80% coverage for medically necessary emergency care in a foreign country, after a $250 deductible.

PLAN D

Includes the basic benefit plus:

  • Coverage for the Medicare Part A inpatient hospital deductible ($ 764 per benefit period in 1998).
  • Coverage for the skilled nursing facility care coinsurance amount ($ 95.50 per day for days 21 through 100 per benefit period in 1998).
  • 80% coverage for medically necessary emergency care in a foreign country, after a $250 deductible.
  • Coverage for at home recovery. The at home recovery benefit pays up to $1,600 per year for short-term, at home assistance with activities of daily living (bathing, dressing, personal hygiene, etc.) for those recovering from an illness, injury or surgery.

PLAN E

Includes the basic benefit plus:

  • Coverage for the Medicare Part A inpatient hospital deductible ($ 764 per benefit period in 1998).
  • Coverage for the skilled nursing facility care coinsurance amount ($ 95.50 per day for days 21 through 100 per benefit period in 1998).
  • 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 $1,250 after the policyholder meets a $250 per year deductible (this is called the "basic" prescription drug benefit).
  • 80% coverage for medically necessary emergency care in a foreign country, after a $250 deductible. There is a lifetime maximum for this benefit of $50,000.
  • Coverage for at home recovery. The at home recovery benefit pays up to $1,600 per year for short-term, at home assistance with activities of daily living (bathing, dressing, personal hygiene, etc.) for those recovering from an illness, injury or surgery.

* Plan pays a specified percentage of the difference between Medicare’s approved amount for Part B services and the actual charges (up to the amount of charge limitations set by either Medicare or state law).

PLAN F

Includes the basic benefit plus:

  • Coverage for the Medicare Part A inpatient hospital deductible ($ 764 per benefit period in 1998).
  • Coverage for the skilled nursing facility care coinsurance amount ($ 95.50 per day for days 21 through 100 per benefit period in 1998).
  • Coverage for the Medicare Part B deductible ($ 100 per calendar year in 1998).
  • Coverage for 100% of Medicare Part B excess charges.*
  • 80% coverage for medically necessary emergency care in a foreign country, after a $250 deductible.
  • Coverage for preventive medical care. The preventive medical care benefit pays up to $120 per year for such things as a physical examination, serum cholesterol screening, hearing test, diabetes screenings, and thyroid function test.
  • Coverage for at home recovery. The at home recovery benefit pays up to $1,600 per year for short-term, at home assistance with activities of daily living (bathing, dressing, personal hygiene, etc.) for those recovering from an illness, injury or surgery.
  • Coverage for 50% of the cost of prescription drugs up to a maximum annual benefit of $3,000 after the policyholder meets a $250 per year deductible (this is called the "extended" drug benefit).
  • Future high deductible option.

* Plan pays a specified percentage of the difference between Medicare’s approved amount for Part B services and the actual charges (up to the amount of charge limitations set by either Medicare or state law).

PLAN G

Includes the basic benefit plus:

  • Coverage for the Medicare Part A inpatient hospital deductible ($ 764 per benefit in 1998).
  • Coverage for the skilled nursing facility care coinsurance amount ($ 95.50 per day for days 21 through 100 per benefit period in 1998).
  • Coverage for 80% of Medicare Part B excess charges.*
  • 80% coverage for medically necessary emergency care in a foreign country, after a $250 deductible.
  • Coverage for at home recovery. The at home recovery benefit pays up to $1,600 per year for short-term, at home assistance with activities of daily living (bathing, dressing, personal hygiene, etc.) for those recovering from an illness, injury or surgery.

* Plan pays a specified percentage of the difference between Medicare’s approved amount for Part B services and the actual charges (up to the amount of charge limitations set by either Medicare or state law).

PLAN H

Includes the basic benefit plus:

  • Coverage for the Medicare Part A inpatient hospital deductible ($ 764 per benefit period in 1998).
  • Coverage for the skilled nursing facility care coinsurance amount ($ 95.50 per day for days 21 through 100 per benefit period in 1998).
  • 80% coverage for medically necessary emergency care in a foreign country, after a $250 deductible.
  • Coverage for 50% of the cost of prescription drugs up to a maximum annual benefit of $1,250 after the policyholder meets a $250 per year deductible (this is called the "basic" prescription drug benefit).

PLAN I

Includes the basic benefit plus:

  • Coverage for the Medicare Part A inpatient hospital deductible ($ 764 per benefit period in 1998).
  • Coverage for the skilled nursing facility care coinsurance amount ($ 95.50 per day for days 21 through 100 per benefit period in 1998).
  • 80% coverage for medically necessary emergency care in a foreign country, after a $250 deductible.
  • Coverage for preventive medical care. The preventive medical care benefit pays up to $120 per year for such things as a physical examination, serum cholesterol screening, hearing test, diabetes screenings, and thyroid function test.

PLAN J

Includes the basic benefit plus:

  • Coverage for the Medicare Part A inpatient hospital deductible ($ 764 per benefit period in 1998).
  • Coverage for the skilled nursing facility care coinsurance amount ($ 95.50 per day for days 21 through 100 per benefit period in 1998).
  • Coverage for the Medicare Part B deductible ($ 100 per calendar year in 1998).
  • 80% coverage for medically necessary emergency care in a foreign country, after a $250 deductible.
  • Coverage for 100% of Medicare Part B excess charges.*
  • Future high deductible option.

* Plan pays a specified percentage of the difference between Medicare’s approved amount for Part B services and the actual charges (up to the amount of charge limitations set by either Medicare or state law).

Source: Health Care Financing Administration

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