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Who Qualifies for Medigap
Insurance?
The best time to purchase
a Medigap policy is during your open enrollment. This is a period
of six months from the date you turn 65 and enroll in Medicare Part B.
During this window of time, regardless of your health, no company can
deny, put conditions on, or discriminate in the pricing of the policy
you want because of your medical history, health status or claims experience.
However, if you try to get
a Medigap policy after the designated periods for Medicare Part B enrollment,
companies who sell Medigap policies have the right to review your medical
records and deny you coverage if you had a significant amount of medical
treatment or a condition that is likely to require extensive care in the
near future. There are exceptions. For instance, if your Medicare HMO
is going out of business or leaving the area served by your plan, you
may be eligible for guaranteed coverage. If you are not sure, ask us -
1-800-986-4786.
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If
you wait until you are sick to get a Medigap policy, your goose
is cooked!
If
you are going to get a plan do it now. It will never be any cheaper
and there is no such thing as an insurance sale. Think of it as
an early bird special. Click here now for a quote.
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What Does Medigap Cover?
As of June 1992, federal law
mandates that all new Medigap policies must match one of ten standardized
benefit plans which are labeled A through J. No matter what company you
buy from, the coverage each of the ten plans offers is identical from
company to company.
I
don't care if they advertise on television or show you pictures of their
skyscraper headquarters. The "C" plan from one company is EXACTLY
the same the "C" plan of every other company. It is the law.
If
you are not familiar with what Medicare covers then how can you decide
if you need a plan that covers the gaps. You wouldn't know what the gaps
are. Click
here for a complete Medicare Information.
Core Benefits
(Included in All 10 Plans, A - J)
No matter which plan you get, it will have the core benefits. For many
of you that will be enough.
The "A" plans are the least expensive plans.
- Hospitalization.
Covers the $198 Part A per day co-payment for the 61st to 90th days
and the $396 per day co-payment from the 91st to 150th day (reserve
days). All Medigap plans also pay 100 percent of up to 365 additional
days stay in a hospital throughout the rest of the insured's life.
- Medical expenses.
Covers the 20 percent Copayment for the Medicare-allowed-amount for
physician charges.
- Blood. Any Medigap
policy pays for the first three pints of blood for transfusion each
year.
The following additional benefits
are offered by the other plans as indicated.
Additional Medicare Part
A Coinsurance
- Hospital deductible.
Covers $792 for each hospital stay during each new benefit period (offered
by plans B - J).
- Skilled nursing home
Copayment Covers $99 per day for days 21 to 100 of skilled care
in a nursing home per benefit period (offered by plans C - J).
If you do not have a
long term care policy to cover this expense you could get clipped for
over $7800. It depends on how long you are in for. So,
if you are really on the ball you might say to yourself,
"Why don't I take the "A" plan and use the money
I save on a long term care plan?"
Additional Medicare Part
B Coinsurance
- Deductible. Medigap
policies C, F, and J will pay the first $100 of covered physician services
per calendar year. Not
such a big deal.
- Excess doctor charges.
Certain policies will cover the difference between a doctor's charges
and the amount approved by Medicare (plans F, I and J cover 100 percent
while plan G covers 80 percent). A
lot of doctor's will accept the 80% that Medicare pays and you would
not have to pay anything extra. Don't be bashful - ask them.
Additional Coinsurance
- Foreign travel emergency.
Covers 80 percent of emergency care in a foreign country--with a $50,000
lifetime maximum--after a $250 per calendar year deductible (offered
by plans C - J).
For a few dollars you can get an excellent travel health plan for your
trip. It is well worth it. Use the button at the top of this page for
details. If you want the "C" plan that is fine. Don't pay
extra for a "C" supplement just for the foreign travel emergency
coverage.
- At-home recovery.
Pays up to $40 per visit, to a maximum of $1,600 per year, for short
term, at-home assistance with activities of daily living during recovery
from an illness, injury or surgery that qualifies a patient for skilled
home health care under Medicare guidelines (offered by plans D, G, I
and J).
This
is not a home health care plan. I don't care what your friends tell
you. If you can afford it, get Home Health Care and/or Long Term Care
insurance. Again, the money saved by buying a less expensive supplement
is better spent on Home
Health Care and/or Long Term Care insurance
- Preventive screening.
Plans E and J cover $120 per year for health care screenings ordered
by a physician but not covered by Medicare, such as a physical examination,
cholesterol test and diabetes screening.
All Medicare plans will cover ongoing diabetic
testing supplies but not insulin.
- Outpatient prescription
drugs. Some plans cover 50 percent of the cost for drugs prescribed
by a physician After a $250 per year deductible. Plans H and I will
pay up to a maximum annual benefit of $1,250 and Plan J pays up to $3,000.
The H, I and J plans are very expensive. Usually, you will pay more
for the plan than the amount that you get back. Most companies don't
even offer these plans anymore. Furthermore, if you are sick enough
to need that much medication, the only time you will qualify for the
plan is during open enrollment. Click on the Prescription Plan button
at the top for a discount prescription plan.
Florida Medicare
Supplement Coverage:
Comparison of Plans A - J
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