As it was already explained, Medigap plans help paying some of the costs Original Medicare does not cover, such as coinsurances, copayments and deductibles. Previously, we talked about some characteristics of these plans and the definition of the costs they cover, so in this article we will explain the general coverage of Medigap plans and the benefits that are not covered by them.
What do Medicare Supplement Plans cover?
Although each Aetna Medicare supplement Plan G is different, all of them must cover at least a portion of the following benefits: Medicare Part A coinsurance costs up to an additional 365 days after Medicare benefits have run out, Medicare Part A hospice coinsurance or copayment, Medicare Part B coinsurance or copayment and the first three pints of blood used in a medical procedure.
The four benefits mentioned above are the ones covered in Medigap plan A, which is the most basic Medigap because it only covers those. The rest of the plans may have additional benefits and they will depend on the one you choose.
Regarding Medicare Part A, the rest of Medigap plans may cover: coinsurance for hospital stays, copayment or coinsurance for hospice care and Medicare Part A deductible. The coverage will depend on the plan you choose, but they usually go from 50% to 100%.
Regarding Medicare Part B, the rest of Medigap plans may cover: Medicare Part B copayment or coinsurance, Medicare Part B deductible and Medicare Part B excess charges, which happens when a health care provider declines to accept Medicare assignment for a particular procedure or visit. The deductible is only covered by Plan C and F, and the excess charges only by Plan F and G. In these cases, the coverage also goes from 50% to 100%,
Besides Medicare Part A and B, Medicare Supplement Plans have other benefits. First we have Skilled Nursing Facilities whose coverage is limited by Medicare and the majority of Medigap plans cover the coinsurance for this type of care, from 50% to 100%. Then we have the cost of the first three pints of blood you get at a hospital, which is covered from 50% to 100%. In case you need more, Original Medicare will start paying the pints after the third one.
Some Medigap plans also have foreign travel coverage, which cover emergencies you may have outside of the territory of the U.S. They cover health care services or supplies if the emergency begins during the first 60 days of the trip and they usually pay 80% of the billed charges (up to plan’s limits). This is available in Plans C, D, F, G, M, or N.
Lastly, we have the out-of-pocket limit, which is only covered in Plan K and L. When you reach a certain amount of money in expenses for Medicare-covered, the Medigap plan will cover 100% of Medicare-covered costs for the rest of the year.
What benefits Medicare Supplement Plans do not cover?
The following services and supplies are not covered by Medicare Supplement Plans:
- Long-term care (care in a nursing home)
- Routine vision or dental care
- Hearing aids
- Private-duty nursing
In the past, some Medigap plans covered prescription drugs, but since 2006 Medigap plans are not allowed to do so. As they are not included in Original Medicare, you can get prescription coverage through Medicare Prescription Drug Plan (Part D), but do not get confused, this one is not part of Medigap plans.