Posts Tagged ‘skilled nursing facility’

Medigap Policies

Wednesday, May 26th, 2010

365.118 - family recognitionA Medigap policy is a health insurance policy sold by private insurance companies to fill “gaps” in Original Medicare Plan coverage. Medigap policies must follow federal and state laws. These laws protect you. The front of the Medigap policy must clearly identify it as “Medicare Supplement Insurance.”

In all states, except Massachusetts, Minnesota, and Wisconsin, a Medigap policy must be one of twelve standardized policies so you can compare them easily. Each policy has a different set of benefits. Two of the standardized policies may have a high deductible option. In addition, any standardized policy may be sold as a “Medicare SELECT” policy. Medicare SELECT policies usually cost less because you must use specific hospitals and, in some cases, specific doctors to get full insurance benefits from the policy. In an emergency, you may use any doctor or hospital.

Click image to view guide to Medigap Policies

Outline of Medicare Supplement Coverage

(Benefit Plans A-L)

Medicare Supplement Insurance can be sold in only twelve standard plans. This chart shows the benefits included in each plan. Every company must make available Plan “A”. Some plans may not be available in your state as indicated below.

A B C D E F* G H I J* K L
Medicare Part A Coinsurance & Medigap Coverage for Hospital Benefits
Medicare Part B Coinsurance or Copayment 50%* 75%*
Blood (First 3 pints) 50%* 75%*
Hospice Care Coinsurance or Copayment 50%* 75%*
Medicare Part A Deductible 50%* 75%*
Skilled Nursing Facility Care Coinsurance 50%* 75%*
Medicare Part B Deductible
Medicare Part B Excess Charges 80%
Foreign Travel Emergency (Up to Plan Limits)
At Home Recovery (Up to Plan Limits)
Preventive Care Coinsurance (Included in the Part B Coinsurance)
Preventive Care not Covered by Medicare (up to $120)
**Out-of-Pocket Limit $4,620** $2,310**

Plans A-L are standardized by the federal government. Not all plans may be available in your area. Consider the benefits offered by each plan and look for one that best meets your individual needs.

*Medigap Plans F and J also offer a high-deductible plan. You must pay the high-deductible ($2,000 in 2010) amount before your Medigap-covered costs before pays anything..

**After you meet your out-of-pocket yearly limit and your yearly Part B deductible ($155 in 2010), the plan pays 100% of covered services for the rest of the calendar year. Out-of-pocket limit is the maximum amount you would pay for coinsurance and copayments

Medicare Part A (2010)

Friday, May 21st, 2010

Part A is Hospital Insurance and covers cost associated with confinement in a hospital or skilled nursing facility.

When you are hospitalized for: Medicare Covers You Pay
1-60 Days Most confinement costs after the required Medicare Deductible $1,100 Part A Deductible
61-90 Days All eligible expenses, after the patient pays a per-day copayment. $275/Day
91-150 Days All eligible expenses, after patient pays per-day copayment.


(These Are Liftetime Reserve Days Which may never be used again.)

$550/Day
151 days or more Nothing You Pay All Cost
Skilled Nursing
Confinement:
When you are hospitalized for at least 3 days and enter a Medicare Approved skilled nursing facility within 30 days after a hospital discharge and are receiving skilled nursing care.
All eligible expenses for the first 20 days; then all eligible expenses, (if you qualify), for days 21-100, after patient pays a per day copayment. After 20 days


$137.50/Day

Glossary

Friday, May 21st, 2010

Medicare Terms Defined

For Complete Glossary click here

Lifetime Reserve Days

are limited to 60 days during your life. After these reserve days are used, Medicare provides no hospital coverage after 90 days of a benefit period.

Medicare Eligible Expenses

are expenses which are recognized as reasonable and medically necessary by Medicare. Physicians under Medicare may accept Medicare’s Eligible Expense as their fee amount. Your physician may also charge you more.

Skilled Nursing Facility

provides skilled nursing care and is approved for payment by Medicare or may qualify to receive such approval. Custodial care is not an eligible expense.

Excess Charges

is the difference between the actual charge as billed, and the Medicare approved Part B charge.

Medicare (Part A)

Hospital Services for semiprivate room and board, general nursing and miscellaneous services and supplies. Benefit period applies.

Medicare (Part B)

Medical services in or out of the hospital and outpatient hospital treatment, such as physician services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, and durable medical equipment.

Benefit Period

defines the limit of a stay at a hospital or nursing facility and what benefits you receive for that stay.

Special Notes:

The sale of duplicate Medicare Supplement coverage is prohibited.
Your coverage can never be canceled because of your age, your health, or the number of claims you make as long as you make payments when due.
Consult your local insurance professional for specific information.