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Understanding Medigap Plan D

Understanding Medigap Plan D

Having a good understanding of Medigap Plan D can help you to save a great deal of money each year if you are an enrollee in Original Medicare. This is because each year, those who are enrolled in Medicare Part A and Part B could be paying out thousands of dollars in expenses unnecessarily.

Medicare Part A and B – also known as Original Medicare – is a federal program that is set up to assist those who are age 65 and over, as well as certain disabled individuals, in paying for various health care costs. Unfortunately, because of numerous yearly copayments, coinsurance costs, and deductibles, the individuals who have Medicare are often surprised to find just how much Medicare does not pay for their care.  There are Medigap plans such as Plan N that help fill in the coverage gap. If you already have coverage in place such as with Medicare Plan J and have questions, we can help you find the answers you are searching for.

What is Covered Under Medicare Supplement Insurance Plan D?

Although Medicare Supplement Plan A may be a good option for those who are seeking more basic coverage, there are others who may want more of a comprehensive option. This is where Medigap Plan D shines. This plan provides not only the basic set of “core” benefits that are offered in Medigap Plan A but also several additional coverages.

The full set of benefits that are offered in Medigap Plan D include the following:

  • Part A of Medicare’s co-insurance and hospitalization costs – up to an additional 365 days after Medicare benefits have been used up;
  • Part B of Medicare’s co-insurance or co-payment;
  • First three pints of blood per year;
  • Part A of Medicare’s hospice co-insurance or co-payment;
  • Skilled nursing facility care co-insurance;
  • Part A of Medicare’s deductible;
  • Foreign travel emergency – up to plan limits (80%).

Why Consider Medicare Supplement Plan D Versus Other Medigap Plans?

Although there are some Medicare Supplement insurance purchasers who may wish to keep their premiums low and purchase only the basic set of core benefits that are offered under Plan A, there are others who may wish to provide themselves with additional coverage options – and in turn, more peace of mind.

Medigap Plan D can provide you with the basic benefits – along with additional coverage in the case that you require it. For example, by having the skilled nursing facility coinsurance, that could potentially save thousands of dollars alone.

This is because, provided that you qualify, Medicare Part A only pays for the first 20 days of skilled nursing facility care in full. Then, there is a co-payment required for Days 21 through 100, of $161 (in 2016) for each benefit period.

Therefore, provided that skilled nursing home care was required for that period, you could be required to pay nearly $13,000 out-of-pocket for just that 80 days of care. ($161 co-payment X 80 days = $12,880).

Medigap Plan D also provides additional coverages, too, that are not provided by Original Medicare, such as benefits for a foreign travel emergency. Therefore, this could also provide you with some additional peace of mind.

The only gaps in Medicare not covered by Plan D are the Medicare Part B Deductible and any excess charges above what Medicare Part B covers.  You can eliminate the excess charges gap by going with Medicare supplement plan G and you can purchase Medicare supplement plan F to eliminate all the gaps in Medicare.

How Medicare and Its Expenses Work

When Medicare was initially set up, it consisted of just two parts – A and B. Today, however, there are four components to the Medicare programs. These include:

  • Medicare Part A – Hospital Coverage. Medicare Part A offers hospitalization coverage. This can include the care that you receive as an inpatient in the hospital, as well as certain types of home health care that you may receive following an inpatient hospital stay. Also, Medicare Part A may also cover a limited amount of skilled nursing home services, as well as some services for hospice care.
  • Medicare Part B – Doctor / Medical Services: Part B of Medicare provides coverage for medical / doctors’ services. This can help to cover items like outpatient hospital care, as well as doctor visits and ER care. Also, Medicare Part B can also cover certain medical equipment that is ordered for use by your doctor. Also, Medicare Part B provides coverage for various types of preventive care such as the vaccinations received for the flu and pneumonia. The term “Original Medicare” is often used interchangeably for Medicare Part A and B.
  • Medicare Part C – Medicare Advantage: Medicare Part C is also known as Medicare Advantage. This is another way that you can receive your Medicare Part A and B benefits. Medicare Advantage plans are offered via private insurance companies – so the plans may differ somewhat. However, they must provide all of the benefits that are offered through Original Medicare. They can also provide additional coverage such as dental and vision. In many cases, prescription drug coverage is also included in Medicare Advantage plans. Many Medicare Advantage plans operate in an HMO (Health Maintenance Organization) or a PPO (Preferred Provider Organization) format. This means that you may be required to have a primary care physician and to use providers who are listed within a network in order to get your services – or at least to get your services at a discount. You may also be required to get a referral to see a specialist.
  • Medicare Part D – Prescription Drug Coverage: Medicare Part D offers prescription drug coverage. These plans are also sold through private insurance companies. Therefore, the actual benefits, and the premium cost can differ from one insurance carrier to another. While prescription drug benefits may automatically be offered in many Medicare Advantage plans, this coverage will need to be purchased outright by those who have Medicare Part A and B (Original Medicare).

If you are enrolled in Original Medicare, you may have found that there are certain “gaps” in your coverage and that you are required to pay out various costs when you obtain certain services through Medicare. Depending on the number of services that you receive each year, these expenses can add up. In 2016, the amount of the Medicare Part A and B deductibles, copayments, and coinsurance costs include:

Medicare Part A hospital inpatient deductible and coinsurance:   •   $1,288 deductible for each benefit period

  • Days 1 – 60: $0 coinsurance for each benefit period
  • Days 61 – 90: $322 coinsurance per day of each benefit period
  • Days 91 and beyond: $644 coinsurance per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime)
  • Beyond lifetime reserve days: all costs

Medicare Part B deductible and coinsurance:

  • Deductible of $166
  • After the deductible is met, you typically pay 20% of the Medicare-approved amount for most doctor’s services (including most doctor’s services while you are a hospital inpatient), outpatient therapy, and durable medical equipment.

What is Medicare Supplement (Medigap) Insurance Coverage?

While the out-of-pocket expenses through Medicare can add up, the good news is that there is a way to help curb these costs. That is through the purchase of one of the Medicare Supplement insurance plans.

Medicare Supplement insurance coverage is designed to help in paying for some or all of the deductibles, coinsurance, and / or copayments that are required by Medicare Part A and / or B. These plans may also pay for additional coverage, too. Because this type of insurance essentially fills in many of Medicare’s “gaps,” it is often referred to as “Medigap.”

How Does Medicare Supplement Insurance Work?

There are ten different Medicare Supplement insurance plans to choose from. These are each named after letters of the alphabet, with Plan A being the most basic. All insurance companies that offer Medicare Supplement insurance must provide the same benefits in the Medigap plans of the same letter.

This means that all Medicare Supplement Insurance Plan D’s that are sold – regardless of which insurer they are purchased from – will have the same, identical benefits. The premium prices that are charged, however, can differ substantially from one insurance company to another. Because of that, it is always a good idea to compare several policies before making your plan purchase.

Most of the Medicare Supplement plans that are offered are also required to provide the basic set of core benefits that are provided in Plan A. These benefits include the following (in 2016):

  • Part A of Medicare’s co-insurance and hospitalization costs – up to an additional 365 days after Medicare benefits have been used up;
  • Part B of Medicare’s co-insurance or co-payment;
  • First three pints of blood per year;
  • Part A of Medicare’s deductible.

What to Consider When Choosing a Medicare Supplement Insurance Plan

Before enrolling in any Medicare Supplement insurance plan, it is important to consider certain criteria. This is because you will want to be sure that you are getting the best plan for you and your particular needs.

Therefore, considering the following factors can be helpful when choosing your Medicare Supplement coverage:

  • Your specific health care needs during the year, and the services that are most important to you (as well as to your spouse, if applicable);
  • How much you can afford to pay in Medigap premiums each year, as versus the amount of Medicare Part A and Part B out-of-pocket expenses you may have.

Who is Eligible to Purchase Medicare Supplement Insurance?

You will also want to be sure that you are eligible to purchase a Medicare Supplement Plan D – or any Medigap plan that you are considering. This is because not everyone, even those who are age 65 or older, is eligible to apply for this coverage.

Only those who are enrolled in Original Medicare (Part A and Part B of Medicare), and who are age 65 or over can also have a Medicare Supplement insurance plan. Those who have Medicare Advantage are not eligible to apply for Medicare Supplement.

When is the Best Time to Purchase a Medicare Supplement Insurance Policy?

The best time to apply for this type of coverage will be during your “open enrollment” period. This is the time that is when you turn age 65, and you are also enrolled in Medicare Part B coverage. This period lasts for six months.

It is a good idea to enroll in Medicare Supplement during your open enrollment period because, during this time, you cannot be turned down for a plan – even if you have an adverse health condition. If, however, you wait and apply for Medigap after your open enrollment period has elapsed, you could either be charged a higher amount of premium – or you may even be turned down for a plan.

Where Can You Get the Best Premiums on Medicare Supplement Plan D?

If you are seeking the best premiums on Medigap Plan D, then the way to ensure that you do so is by working with a company or an agency that has access to more than just one Medicare Supplement insurance carrier. That way, you can compare several premiums at one time, and from there, determine which will be the best for you.

We can help you during this process as we work with many of the top carriers in the marketplace, and we can assist you with obtaining all of the important details that you require. If you are ready to move forward, all you need to do is just fill out the form on this page.

We know that Medicare Supplement insurance may seem somewhat confusing. There are many plans to consider – and you want to be sure that you are getting the one that best fits in with your personal needs. That’s why we can walk you through the details that can assist you in narrowing down your options. So, contact us today – we’re here to help.

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