Insurance Health Insurance

Medigap Benefits & Restrictions

    Types of Plans

    • There are 14 available plans, ranging from Plan "A" to two new Plans, "N" and "M," which become effective in the summer of 2010.

      There are 13 coverage areas and each plan has a different combination of these coverages. The plans that cover fewer areas are generally less expensive, while plans that cover more have a higher premium.

    Example of Benefits

    • The insured receives the least benefits under Plan "A" but it is popular because of its affordability. It covers costs associated with Part A hospital benefits, Part B coinsurance, blood transfusions and preventative medical care.

      In comparison, Plan "F" covers those areas plus the hospital deductible, the skilled nursing facility coinsurance, the Part B deductible, the Part B excess charge benefits and foreign travel emergencies.

      Plan "J" covers everything Plan "F" does and adds at-home recovery costs.

      Plan "D" doe not cover the Part B deductible, the Part B excess charge and the at-home recovery.

    Plans "N" and "M" Benefits

    • The new plan "N" has a reduced premium of approximately 78 percent of what a Plan "D" costs with much the same coverage. The insured, however, is responsible for a greater amount of out-of-pocket co-pays and deductibles.

      Plan "M" also offers comparable coverage to Plan "D" but the percentage of cost that it covers is much less.

    Restrictions

    • Those who take out Medicare Part B when eligible are also eligible to take a Medigap plan within six months with no restrictions on health or coverage.

      If someone chooses to change a Medigap program or insurance company, the new company may restrict the coverage based upon the health and age of the insured. A higher premium may be charged, and preexisting condition coverage may be disallowed for a period of time. This can hamper someone with ill health who is looking to switch to a less expensive plan.

    Cancelation

    • Medigap policies cannot be canceled by an insurance company except on the grounds of non-payment of premiums or a falsified/fraudulent application.

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