Medicare at a
glance
Medicare was started in 1965 to help with medical expenses. It's a national
health insurance program designed to help people age 65 and over with medical
expenses. It also is for people under age 65 with certain disabilities and
people of all ages with End-Stage Renal Disease (permanent kidney failure
requiring dialysis or kidney transplant).
Medicare has Hospital Insurance (referred to as Part A) and Medical Insurance
(referred to as Part B). Part A helps to pay for your in-hospital expenses,
care in a skilled nursing facility, and provides limited benefits for home
health care and hospice care. Part B helps to pay doctor bills, outpatient
hospital care and other medical services not covered by Part A.
The Medicare Modernization Act of 2003 created a prescription drug benefit,
Part D, to Medicare. The prescription drug benefit became available in 2006
Medicare Advantage plans are managed care (HMO and PPO) and restrict your
choice of doctors and facilities for receiving coverage. They generally cover
many of the same benefits a Medigap or Medicare supplemental coverage would
cover and often include extra benefits like extra days in the hospital. If you
decide to join a Medicare Advantage Plan, then you will use the health care
card that you get from your Medicare Advantage Plan provider for your health
care.
Medicare Supplement insurance plans (often referred to as "Medigap" policies)
were developed to help fill the gaps in the Original Medicare. These plans are
sold by private insurance companies. Effective June 1, 2010, Medicare
Supplement insurance is sold in 10 standardized plans. These plans must follow
Federal and State laws. Each plan has a different set of benefits. The ten
standard plans, labeled A through N are outlined in the chart below.
Click on the Plan Letter for
more details on the benefits in this
chart...
Medicare Supplement Benefits
By Plan
Effective on or after June 1, 2010
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| Basic
Benefits |
| Hospitalization & Preventive
Care |
Other Basic Benefits |
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50% |
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75% |
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$20/$50 Co-Pay |
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Part A
Deductible |
Skilled
Nursing
Coinsurance |
Part B
Deductible |
Part B
Excess |
Foreign
Travel
Emergency |
Out-of-Pocket
Limit |
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| 50% |
50% |
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| 75% |
75% |
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| 50% |
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*Plan F also has an option called a high deductible plan F. This high
deductible plan pays the same benefits as plan F after the insured has paid a
calendar year plan deductible.
| Basic Benefits |
| Hospitalization: |
Part A coinsurance plan coverage for 365 additional days
after Medicare Benefits end. |
| Medical Expenses: |
Part B coinsurance (generally 20% of Medicare approved
expenses) or copayments for hospital outpatient services. Plan N requires
insured to pay up to a $20 copayment per office visit and up to $50 copayment
per emergency room visit (waived if admitted) |
| Blood: |
First three pints of blood each year |
Notes
1. States may allow only some of the twelve standard benefit plans.
2. States may approve innovative additional benefit plans under certain
circumstances.
3. These standard benefit plans do not apply to policies sold in MA, MN and WI.
4. Availability of plans varies from company to company.
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