Hay una serie de cuestiones a considerar antes de obtener un seguro médico privado, como seguro complementario / seguro Medigap. ¿Se beneficiaría de un seguro para pagar sus facturas de Medicare (deducibles, copagos, etc.)? O, ¿son sus facturas lo suficientemente bajas que una prima de Medigap sería un gasto innecesario? ¿Qué pasará en el futuro? Usted puede estar sano ahora, pero ¿qué pasará dentro de 6 meses?

Si tiene cobertura de Medicaid o está inscrito en un Plan Medicare Advantage, no necesita un plan Medigap. De hecho, es ilegal que alguien le venda un nuevo plan de Medigap si está inscrito en un Plan Medicare Advantage. Si se inscribe en un plan Medicare Advantage, puede mantener el plan Medigap que ya tiene, pero esto puede no ser una decisión financiera sabia. Considere abandonar cualquier cobertura de Medigap cuando se afilia a un plan de este tipo. Sin embargo, si usted tiene los medios financieros para mantener tal plan todavía podría tener sentido.

Los proveedores de seguros de salud privados pueden aconsejarle con sus opciones de seguro de salud para mayores, pero es una buena idea estar preparado con preguntas para ellos. Asegúrese de que el seguro de Medigap le beneficiará a corto y largo plazo.

Hay 12 planes de Medigap ofrecidos etiquetados del A a la L. Estos no difieren de estado a estado o compañía de seguros a la compañía de seguros. Algunos planes ya no pueden ser vendidos, pero usted puede mantenerlos si compró los planes antes de junio de 2010. Dos nuevos planes (M, N) también se están agregando. El hecho de que estos planes no difieren algo simplifica su decisión. Si vive en Massachusetts, Minnesota o Wisconsin los planes se organizan de manera diferente. Hay actualmente diez planes de Medigap que usted puede comprar actualmente.

¿Qué pasa si ya tengo Medicare original?

Si tiene Medicare Original (Parte A y B), puede haber ventajas en obtener uno de los planes de Medigap. Usted debe estudiar cuidadosamente esto, estudiar los diferentes planes, y luego preparar preguntas para los aseguradores.

Por ejemplo, si usted va a los doctores o los especialistas con cierta frecuencia puede ser sensato conseguir un plan de Medigap. Los planes de Medigap pueden ayudar con copagos y coseguros y si sus copagos cuestan más que la prima para un plan Medigap, tendría sentido comprar ese plan. Los planes de Medigap también pueden cubrir una parte de su deducible de Medicare que podría hacer que Medigap sea una alternativa razonable. No todos los planes de Medigap cubren los deducibles y todo tipo de copagos y coseguro. Algunos planes pagan la cantidad total de copago / coseguro y otros una porción. En algunos casos, algunos tipos de copagos / coseguro no están cubiertos.Los cuidados de hospicios de Medicare Parte A sólo están parcialmente cubiertos por los planes K y L de Medigap. Compare los planes.

¿Qué más cubre Medigap?

Incluso más allá de los copagos, coaseguro y deducibles, los planes de Medigap pueden tener sentido.Medicare Original no cubre todo. Todos los planes de Medigap cubren sus costos de coseguro del hospital de la Parte A hasta 365 días adicionales después de que los beneficios de Medicare se agoten. Los costos de las estancias hospitalarias a largo plazo después de que Medicare se agota pueden ser bastante altos y, por lo tanto, este aspecto de Medigap puede ser muy útil.

Los planes de Medigap también pagan los primeros tres pintas de sangre en un hospital (la cobertura de Medicare comienza después de los primeros tres pintas). Varias fuentes ponen el costo de una pinta de sangre en más de $ 200 – a veces mucho más. Los costos para los pacientes a menudo son mucho más altos que el «costo» que un hospital paga por la sangre.

El coaseguro de atención del centro de enfermería especializada también está cubierto por algunos planes de Medigap. Todos los planes de Medigap, excluyendo los Planes A y B, ofrecen alguna forma de esta cobertura. Los planes K y L ofrecen un 50% y un 75% de cobertura, respectivamente. Si es probable que necesite atención de centro de enfermería especializada, un plan Medigap puede ser beneficioso.

Los planes F y G cubren los cargos por exceso de la Parte B de Medicare. Estos «cargos por exceso» se aplican cuando un médico no acepta la asignación de Medicare («asignación» se refiere a la cantidad que Medicare asigna a un procedimiento específico). En este caso, el médico puede agregar 15 por ciento a la factura y Medicare bajará su contribución de mi 5 por ciento. El paciente pagaría la cantidad pendiente. La frecuencia con que esto será útil es una cuestión de debate.

Viajando al extranjero

Si viaja al extranjero con cualquier frecuencia, una póliza de Medigap también puede ayudar. Varios planes ofrecen cobertura para emergencias de viajes en el extranjero. Los planes C, D, F y G, así como los nuevos planes M y N, ofrecen un cierto nivel de cobertura para las emergencias en el extranjero. Los planes ofrecen diferentes niveles de cobertura, así que asegúrese de encontrar uno que se adapte a sus necesidades.

Cobertura Preventiva

Medicare Parte B Coseguro preventivo también está cubierto por todos los Planes Medigap. Un ejemplo de atención preventiva es el abandono del hábito de fumar. Medicare cubrirá hasta 8 visitas presenciales durante 12 meses. Con Medicare Original pagará el 20 por ciento de la cantidad aprobada por Medicare para el tratamiento (después de que se alcance su deducible).

Otros casos que se consideran preventivos incluyen la medición de masa ósea, cribado cardiovascular, cribado cervical y vaginal, cribado de cáncer colorrectal, cribado de diabetes, vacuna contra la gripe, vacuna contra la hepatitis B, prueba de glaucoma, tiro neumocócico, cribado de cáncer de próstata, mamografías, y una solo vez la examinación de «Bienvenido a Medicare.»

Hay una variedad de razones para investigar la compra de un plan Medigap si tiene Medicare Original. Tan importante como es entender lo que está cubierto por estos planes es también importante entender lo que no cubren. Para algunos beneficiarios de Medicare con Medicare Original, uno de estos planes tendrá sentido. Para otros no lo hará. Las circunstancias médicas individuales y las finanzas son la clave para determinar si un plan Medigap es adecuado para usted.

The Benefit Link Inc | Supplemental Insurance

Medicare Supplement Plan A

Medicare Supplement Plan A is also referred to as Medigap Plan A. This plan is sometimes overlooked because it has fewer benefits than other Medigap insurance plans.

What does Medicare Plan A cover though? It still covers the most important benefit, which is the 20% of outpatient medical care that Medicare doesn’t cover.

Make no mistake. Medicare Plan A pays this, so it is still a very good plan.

Medicare Part A coinsurance and coverage for hospital benefits	✔
Medicare Part B coinsurance or copayment	✔
Blood (first three pints)	✔
Hospice Care coinsurance or copayment	✔
Skilled Nursing Facility Care coinsurance	❌
Medicare Part A deductible	❌
Medicare Part B deductible	❌
Medicare Part B excess charges	❌
Foreign Travel Emergency (up to plan limits)	❌

Medicare Supplement Plan B

Medicare Supplement Plan B, also called Medigap Plan B, offers the same benefits as Plan A. In addition, it will also pay your Part A hospital deductible for you. This is a significant benefit as the deductible in 2017 is $1,316, and tends to go up slightly each year. Having Medigap Plan B means that you will never have to worry about that deductible going up.

Your hospital deductible is a per-incident deductible, not an annual one, so this is an important benefit. Medicare Plan B will pay the deductible even if you incur it more than once in the same year.

Medicare Part A coinsurance and coverage for hospital benefits	✔
Medicare Part B coinsurance or copayment	✔
Blood (first three pints)	✔
Hospice Care coinsurance or copayment	✔
Skilled Nursing Facility Care coinsurance	❌
Medicare Part A deductible	✔
Medicare Part B deductible	❌
Medicare Part B excess charges	❌
Foreign Travel Emergency (up to plan limits)	❌

Medicare Supplement Plan C

Medicare Supplement Plan C is a policy which covers nearly all of the Medicare gaps that you would usually be required to pay. The only exception is the Part B excess charges.

Excess charges are surcharges that your doctor can charge above and beyond what Medicare will reimburse. They are limited to 15% beyond what Medicare pays. Many doctors do not charge excess charges, but occasionally they do. If this concerns you, the Medigap Plan F or G might be a better choice for you than Medicare Plan C. Those two plans cover excess charges, so you won’t have to worry about asking.

Medicare Part A coinsurance and coverage for hospital benefits	✔
Medicare Part B coinsurance or copayment	✔
Blood (first three pints)	✔
Hospice Care coinsurance or copayment	✔
Skilled Nursing Facility Care coinsurance	✔
Medicare Part A deductible	✔
Medicare Part B deductible	✔
Medicare Part B excess charges	❌
Foreign Travel Emergency (up to plan limits)	✔

Medicare Supplement Plan D

Medicare Supplement Plan D is one of the ten Medigap options you can purchase to supplement your Original Medicare benefits. (It is not to be confused with PART D, which is for prescription drugs. You can read about Part D drug policies here.)

A Medigap Plan D policy covers most of the gaps in Medicare for you, with the exception of the Part B deductible and also any excess charges. An excess charge is an additional amount you will pay if a provider charges more than the Medicare allowed amount. You will pay out of pocket for these two minor items if you purchase a Medicare Plan D. However, the policy does cover all of the most important things, like the 20% of outpatient services that you would otherwise owe.

It’s important to compare pricing between Medigap Plan D and Plans F or G, which have richer benefits. This will help you determine if the savings is worth the additional financial exposure to you. Some people would rather pay more for their supplement if they know that all the gaps will be covered. Others don’t mind a little cost-sharing to get lower premiums.

Medicare Part A coinsurance and coverage for hospital benefits	✔
Medicare Part B coinsurance or copayment	✔
Blood (first three pints)	✔
Hospice Care coinsurance or copayment	✔
Skilled Nursing Facility Care coinsurance	✔
Medicare Part A deductible	✔
Medicare Part B deductible	❌
Medicare Part B excess charges	❌
Foreign Travel Emergency (up to plan limits)	✔

Medicare Supplement Plan F

Medicare Supplement Plan F has also been the #1 seller with The Benefit Link for many years. According to a report from America’s Health Insurance professionals, about 57% of all Medigap policies in force were a premium Medicare Plan F policy. (In recent years, Plan G has been the second most popular Medicare supplement plan, and you can read more on that below.)

A Medigap plan, or Medicare Supplement, pays after Medicare to help cover your deductibles, copays, and coinsurance that you would otherwise be responsible for. Medigap plans do not replace your Medicare Part B. You must be enrolled in both Part A and Part B first, then you are eligible to enroll in Medicare supplement Plan F.

When you add a Medicare Supplement Plan F or G to your Original Medicare benefits, your coverage will be quite comprehensive. By definition, Medigap Plan F is the Medicare supplement with the most benefits.

Medicare – Plan F

Medicare Part A coinsurance and coverage for hospital benefits	✔
Medicare Part B coinsurance or copayment	✔
Blood (first three pints)	✔
Hospice Care coinsurance or copayment	✔
Skilled Nursing Facility Care coinsurance	✔
Medicare Part A deductible	✔
Medicare Part B deductible	✔
Medicare Part B excess charges	✔
Foreign Travel Emergency (up to plan limits)	✔

Medicare Supplement Plan G

Did you know that Medicare Supplement Plan G is the second most popular Medicare supplement (next to Plan F) with our Baby Boomer clients? Today we’re going to tell you why. Everyone has heard of Plan F, but what is Medicare Supplement Plan G? What does Plan G cover?

Medicare Plan G coverage is very similar to Plan F. It offers great value for beneficiaries who are willing to pay a small annual deductible. After that, Plan G provides full coverage for all of the gaps in Medicare. It pays for your hospital deductible, copays and coinsurance. It also covers the 20% that Part B does’t cover.

Medicare Part A coinsurance and coverage for hospital benefits	✔
Medicare Part B coinsurance or copayment	✔
Blood (first three pints)	✔
Hospice Care coinsurance or copayment	✔
Skilled Nursing Facility Care coinsurance	✔
Medicare Part A deductible	✔
Medicare Part B deductible	❌
Medicare Part B excess charges	✔
Foreign Travel Emergency (up to plan limits)	✔

Medicare Supplement Plan K

Medicare Supplement Plan K offers you the same basic benefits as other supplements, but with lower premiums. For example, this plan will still cover preventive care services and give you an extra year in the hospital. However, you split the cost-sharing with the insurance carrier on certain items like the Part A deductible. You also agree to pay the Part B deductible and any excess charges.

Medicare Plan K also includes a cap on your spending called an out-of-pocket maximum. For instance, let’s say you have a year with a lot of medical treatments. If your out-of-pocket spending reaches the maximum limit, then your Medigap K policy will kick in to pay all of the rest for that year.

Medicare Part A coinsurance and coverage for hospital benefits	✔
Medicare Part B coinsurance or copayment	50%
Blood (first three pints)	50%
Hospice Care coinsurance or copayment	50%
Skilled Nursing Facility Care coinsurance	50%
Medicare Part A deductible	50%
Medicare Part B deductible	❌
Medicare Part B excess charges	❌
Foreign Travel Emergency (up to plan limits)	❌

Medicare Supplement Plan L

Medicare Supplement Plan L policy also includes a cap on your expenses. This is referred to as your out-of-pocket limit or maximum. Medicare sets this limit annually, and in 2018, the limit for Plan L is $2,620. This means that if in any one calendar year your spending reaches $2,480 in Medicare-approved covered expenses, then the Medigap insurance carrier pays the rest. The cap makes it much easier to agree to share in 25% of the costs on the items listed because you know that even if a year of bad health occurs, you won’t have more exposure than the maximum cap figure.

Medicare Part A coinsurance and coverage for hospital benefits	✔
Medicare Part B coinsurance or copayment	75%
Blood (first three pints)	75%
Hospice Care coinsurance or copayment	75%
Skilled Nursing Facility Care coinsurance	75%
Medicare Part A deductible	75%
Medicare Part B deductible	❌
Medicare Part B excess charges	❌
Foreign Travel Emergency (up to plan limits)	❌

Medicare Supplement Plan M

Medicare Supplement Plan M is one of the new supplements created by the Medicare Modernization Act. It first hit the Medicare insurance market in the summer of 2010. (Sometimes we hear people call it Medicare Part M or Medigap Part M, but the correct term is Plan M.)

Medicare Plan M provides the same basic benefits as other supplements. However, it has a slightly reduced monthly premium in exchange for your willingness to pay half of your hospital deductible and all of your annual outpatient deductible. By sharing in these deductibles as well as excess charges, you get the benefit of reduced premiums.

Plan M could be a good fit for someone who doesn’t expect to visit the hospital often and feels he can afford the occasional cost-sharing. However, it’s important to have a licensed agent who specializes in Medicare supplements to help you. He or she will evaluate the differences in premiums and make sure that the savings are worth the risk of some expenses.

Medicare Part A coinsurance and coverage for hospital benefits	✔
Medicare Part B coinsurance or copayment	✔
Blood (first three pints)	✔
Hospice Care coinsurance or copayment	✔
Skilled Nursing Facility Care coinsurance	✔
Medicare Part A deductible	50%
Medicare Part B deductible	❌
Medicare Part B excess charges	❌
Foreign Travel Emergency (up to plan limits)	✔

Medicare Supplement Plan N

Medicare Supplement Plan N has been popular since it was first introduced in 2010. Also called Medigap Plan N, this option was created for consumers who like the idea of paying a lower premium in exchange for taking on a small annual deductible and some copays.

All Medicare supplement Plan N policies are the same, no matter which insurance company you choose. You can find Plan N available in many states from various well-know insurance companies.

In 2015, AHIP reported that Plan N enrollment grew by 33% between 2013 – 2014.

(You will find that sometimes people refer to Plan N as Part N, but the proper term is Plan N. Medicare itself has Parts, but when you are referring to supplemental insurance, use the word Plans.)

Medicare Part A coinsurance and coverage for hospital benefits	$20 copay for office visits; $50 copay for ER
Medicare Part B coinsurance or copayment	✔
Blood (first three pints)	✔
Hospice Care coinsurance or copayment	✔
Skilled Nursing Facility Care coinsurance	✔
Medicare Part A deductible	✔
Medicare Part B deductible	❌
Medicare Part B excess charges	❌
Foreign Travel Emergency (up to plan limits)	✔

Razones para considerar obtener el seguro de Medigap

¿Qué pasa si ya tengo Medicare original?

¿Qué más cubre Medigap?

Viajando al extranjero

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