Benefits of A Medicare supplement plan

Introduction

This page lists the benefits of a Medicare supplement plan.

Basic Benefits

1) Part A coinsurance. The Medicare supplement will pay the $371 per day coinsurance for days 61-90 of a hospital stay. The Medicare supplement will pay the $742 per day coinsurance for the 60 lifetime reserve days. The Medicare supplement will pay for 365 additional days of hospitalization after Medicare hospitalization benefits are exhausted.

2) Medical expenses Part B: The Part B coinsurance is generally 20% of Medicare approved expenses. This includes the coinsurance for outpatient services and surgery. Plans K, L, and N require the Medicare beneficiary to pay a portion for the Part B coinsurance. ***Details below.

3) Blood: The first three pints of blood.

4) Hospice: The Medicare supplement pays the hospice coinsurance and the copay for hospice drugs.

Skilled Nursing Facility coinsurance

1) Medicare pays 100% for the first 20 days for an approved stay for skilled nursing facility care.

2) For days 21-100 Medicare will pay for an approved stay. There is a $185.50 per day coinsurance that the Medicare supplement pays. ***See below for Plans K and L.

Part “A” Deductible

1) For 2021, the Medicare Part “A” deductible is $1,484 per hospital benefit period. The benefit period is for 60 days and begins after one’s discharge. The Medicare supplement could pay this benefit more than one time per year. ***See below for Plans K and L

Part “B” Deductible

1) The Medicare Part “B” deductible is an annual $203 in 2021.

Part “B” Excess (100%)

1) In general, if a Medicare Part “B” provider charges an excess above the Medicare approved amount, this benefit will pay that amount. Physicians may charge a maximum of 115% of the Medicare approved amount. These are known as non-participating physicians or physicians that do not accept Medicare assignment or assigned rates.

2) There could potentially be excess charges for an ambulance or durable medical equipment.

Foreign Travel Emergency

1) In general, Medicare does not pay in foreign countries. One will pay the first $250 for Medical services. After that, the Medicare supplement will pay 80%, and the insured will have a 20% coinsurance. Usually one must pay his/her bill upfront and then bring the bills back to submit a claim.

Out-of-pocket limit

1) For Plan K there is a maximum annual out-of-pocket limit of $6,220. Plan K will pay 100% after that limit is reached.

2) For Plan L there is a maximum annual out-of-pocket limit of $3,110. Plan L will pay 100% after that limit is reached.

High-deductible Plan F and G

1) High-deductible Plan F or G pays the same benefits as Plan F or G after one has paid a calendar year deductible of $2,370. This deductible is for what the Medicare supplement would have paid. Medicare still pays its part when one has high-deductible Plan F or G. After one has met the deductible, then the plan pays just like a regular Plan F or G.

***Details for Plans K, L, and N

1) Plan K pays 50% of the Part A deductible and skilled nursing coinsurance. It pays 10% for most Medicare approved Part B expenses.

2) Plan L pays 75% of the Part A deductible and skilled nursing coinsurance. It pays 15% for most Medicare approved Part B expenses.

3) Plan N: The insured pays a maximum $20 copay for a doctor’s office visit and a maximum $50 copay for an emergency room visit.