Basic Benefits (included in
all ten plans)
Medicare Part A: Hospital Services. All plans pay the $192/day
copayment for hospital days 61 through 90 per benefit period; $384/day for days 91 through
150; and 100% of up to 365 additional days per lifetime.
Medicare Part B: Medical Services. All plans cover the 20%
copayment of Medicare's allowed amount for medical expenses.
Blood. AR plans pay for the first three pints of blood yearly.
Medicare Part A: In-Patient Hospital
Deductible (included in plans B through J): This benefit pays the $768 deductible for
hospital stays in each new benefit period. You may need this benefit if it would be
difficult for you to pay the deductible. Remember, this is a deductible you could pay more
than once per year.
Medicare Part A: Skilled Nursing Home Copayment (included in
plans C through J): This benefit pays $96.00 per day for days 21 through 100 of daily
skilled care in a nursing home per benefit period. Only a small portion of Medicare
beneficiaries require daily skilled care in a nursing home. Because Medigap policies only
pay for services covered by Medicare, Medigap coverage is also limited.
Medicare Part B: Deductible (included in plans C, F, and J):
This benefit pays for the first $100 of Medicare covered medical services in each calendar
year. Although this benefit is very popular, it is likely to cost as much or more than the
maximum benefit you can receive.
Foreign Travel Emergency (included in plans C through J): This
benefit covers medically necessary emergency care which begins in the first two months of
each trip outside the USA. After you pay the $250 calendar year deductible, the benefit
covers 80% of emergency care when you are away for less than three months. If you plan to
spend several months abroad each year, this benefit doesn't provide adequate health care
coverage as there is a lifetime maximum of $50,000. |
At-Home
Recovery (included in plans D, G, I, and J): This benefit pays up to $40 per visit for
no more than seven visits per week for personal care services (such as bathing, eating,
and dressing) only when you also require skilled home health care that is covered by
Medicare following an illness, injury, or surgery. The personal care must be ordered by
your doctor and can be used for up to eight weeks after the Medicare visits stop. The
maximum annual benefit is $1,600. For every home health visit that is paid for by Medicare
this benefit will pay for one personal care visit. This benefit does not pay for long-term
care.
Medicare Part B: Excess Doctor Charges (100% coverage in plans
F, I, and J; 80% coverage in plan G): This benefit pays the difference between the
doctor's actual charges and the Medicare approved amount. Under the federal law,
physicians who do not accept assignment (take as full payment the Medicare approved
amount) cannot charge you more than 115% of the Medicare approved amount. This benefit
only pays either 80% or 100% of these excess fees for services approved and paid for by
Medicare. If most or all of your doctors accept Medicare assignment, you probably do not
need this benefit.
Preventive Screening (included in plans E and J): This benefit
pays up to $120 per year for health care screening and other preventive health services not
covered by Medicare, as long as they are ordered by your physician. This benefit
typically adds about $120 to the cost of a policy.
Outpatient Prescription Drugs (basic coverage in plans H and I;
extended coverage in plan J): This benefit provides limited coverage for prescription
drugs. Basic Coverage: after you pay a $250 calendar year deductible, basic coverage pays
50% of outpatient prescription drug charges up to a maximum of $1,250 in each calendar
year. Your prescriptions would have to cost $2,750 per year for you to receive the maximum
benefit. Extended Coverage: after you pay a $250 calendar year deductible, extended
coverage pays 50% of charges up to a maximum of $3,000 in each calendar year. Your
prescription costs would have to exceed $6,250 each year for you to get the maximum
benefit. |