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Understanding Medigap Plan J

Understanding Medigap Plan J

For those who have a good understanding of Medigap Plan J, it is likely that you may have greatly reduced your overall out-of-pocket health care costs throughout the years. This is because Medigap Plan J – known for being one of the most comprehensive of the Medicare Supplement insurance policies – provides some benefits for those who are also enrolled in Medicare Part A and Part B.

If you’re enrolled in Original Medicare – which is another name for Medicare Parts A and B – then you are also likely aware of just how much the out-of-pocket expenses can truly add up. But, by having Medicare Supplement coverage such as Plan N, you can keep these costs at bay, and have more control over your financial budget.

What is Covered Under Medicare Supplement Insurance Plan J?

As of June 10, 2010, Medicare Supplement Plan J ceased being available as a new plan option for purchase. However, although there are no new Medigap Plan J’s that are being sold at this time, those who currently have this particular Medicare Supplement insurance plan already will be allowed to keep their coverage, as these plans are “grandfathered” in.

The benefits that are offered in a Medigap Plan J policy include the following:

  • Medicare Part A’s co-insurance and hospitalization costs – up to an additional 365 days after the Original Medicare benefits have been used up;
  • Medicare Part B’s coinsurance or co-payment;
  • First three pints of blood;
  • Medicare Part A coinsurance or co-payment for hospice care;
  • Skilled nursing facility care coinsurance;
  • Medicare Part A’s deductible;
  • Medicare Part B’s deductible;
  • Medicare Part B’s excess charges;
  • Foreign travel emergency – up to the plan’s limits;
  • At-home recovery care – up to the plan’s annual maximum;
  • Preventive care – up to the plan’s maximum.

How Medicare and Its Coverage and Expenses Work

Medicare was initially set up as two primary Parts – Medicare Part A and Part B. Today, however, the program consists of four components. These include the following:

  • Medicare Part A for Hospital Coverage – Medicare Part A is for hospitalization expenses. This can include the care that is received by an enrollee for inpatient hospital care. It can also include various types of home health care services that may be needed after a hospital stay. This part of Medicare can also cover some limited benefits for skilled nursing home stays, as well as for hospice care.
  • Medicare Part B for Doctors and Medical Coverage – Medicare Part B provides coverage for medical care and for doctors’ visits. For example, Part B covers items such as care that is received as a hospital outpatient, as well as for visits to your doctor, and for emergency room visits. Also, Medicare Part B can also provide coverage for certain types of medical equipment that is required such as a wheelchair or a walker and that is ordered by your doctor for your medical needs. Certain types of preventive care is also covered by Medicare Part B such as vaccinations for the flu and pneumonia.
  • Medicare Part C / Medicare Advantage – Medicare Part C is also referred to as Medicare Advantage. This type of Medicare coverage is an alternate way that Medicare enrollees can receive their Medicare Part A and B coverage. Rather than receiving these benefits directly from Medicare, a Medicare Advantage plan can be purchased from a private insurance company. These insurers must offer the same benefits that are offered by Medicare Part A and Part B – however; they can also include additional coverage, such as dental, vision, and wellness benefits. Also, many Medicare Advantage plans will often include prescription drug coverage. If you have a Medicare Advantage plan, it may be set up similar to an HMO (Health Maintenance Organization) or a PPO (Preferred Provider Organization), where there is a list of providers within a network to choose from. You may also be required to have a primary care physician, and to obtain a referral before visiting a medical specialist for various needs.
  • Medicare Part D for Prescription Drug Coverage – Medicare Part D provides coverage for prescription drugs. This is a stand-alone type of coverage that can be purchased by those who are enrolled in Medicare Part A and B (Original Medicare). Medicare Part D plans are also offered through private insurance companies, though, so the benefits can differ from one plan to another, as can the premium that is charged.

If you have Medicare Part A and Part B, then it is likely that you know just how costly the deductibles, coinsurance, and copayments in this program can be. This is especially the case if you require various medical or health related services throughout the year. For 2016, the amount of these out-of-pocket charges for Original Medicare enrollees are as follows:

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 Insurance?

Although the out-of-pocket expenses for Original Medicare enrollees can be high, there is good news in that a Medicare Supplement insurance policy can help to lessen – or in some cases, eliminate – these costs.

Medicare Supplement insurance was designed to help pay for some or all of Medicare’s copayments, coinsurance, and / or deductibles. These types of policies may also pay for additional coverages, as well. Because Medicare Supplement insurance fills in many of the “gaps” in Medicare’s coverage, it is often called “Medigap.”

How Does Medicare Supplement (Medigap) Work?

While Medicare Supplement insurance policies have changed somewhat throughout the years, today there are ten standardized plans that eligible individuals can choose from. Each of these Medigap plans have been named after a letter of the alphabet.

Medigap Plan A is the most basic of these plans, and it offers a core set of benefits. Most of the other Medicare Supplement insurance plans are required to include these core benefits, along with the other benefits that they offer.

Medigap Plan A offers (in 2016) the following coverage:

  • Medicare Part A coinsurance and hospital costs, up to an additional 365 days after Medicare’s benefits have been exhausted;
  • Medicare Part B coinsurance or copayment;
  • First 3 pints of blood per year;
  • Medicare Part A deductible.

All of the insurance companies that offer Medicare Supplement insurance must offer Medigap Plan A – and, all of the Medigap plans of the same corresponding letter are required to provide the same identical benefits. What this means is that all Medigap Plan J policies, regardless of where they were purchased, will have the very same coverage. The amount that is charged for the premium, however, can differ – sometimes substantially – based on the insurer that is offering it. Therefore, it is extremely important to shop and compare before making a Medigap policy purchase.

What You Should Consider When You Own a Medicare Supplement Insurance Policy

If you own a Medicare Supplement Plan J policy, you may have a very comprehensive Medigap plan (even more so than Medigap Plan F). However, because it has been many years since these plans were taken off the market and offered to new policyholders, the insurance companies that still have policyholders in these plans are being left with more and older insureds in Medigap Plan J policies.

What this means is that the likelihood of these insurance companies having to pay out more claims is getting higher – which in turn means that the insurance companies may also be forced to raise their Medigap Plan J premium rates.

With that in mind, for those who are still interested in a comprehensive Medicare Supplement policy, there are several other Medigap plans that provide a wide array of benefits that could be purchased at a lower premium price. Finding a plan can be easy when working with an agency or a company that has access to multiple Medicare Supplement insurance carriers.

Who is Eligible to Purchase Medicare Supplement Insurance Coverage?

Not everyone is automatically eligible to purchase a Medicare Supplement insurance plan. Therefore, it is important to ensure that you are a qualified buyer before shopping for any Medigap policy.

Only those who are an enrollee of Original Medicare (Medicare Part A and Part B) – and who are age 65 or over – will be able to purchase Medigap coverage. This means that someone who is currently enrolled in a Medicare Part C / Medicare Advantage plan is not eligible to have Medicare Supplement.

When is the Best Time to Buy a Medicare Supplement Insurance Plan?

While you may be able to apply for Medicare Supplement insurance at other times, the best time to do so is during a period of time that is known as your “open enrollment” period. This is the time when you turn age 65, and when you are also enrolled in Medicare Part B., Your open enrollment period will last for a period of six months.

During this time, you cannot be turned down for coverage in a Medigap plan – nor can you be charged a higher amount of premium for your policy – even if you have an adverse health condition.

If, however, you wait until after your open enrollment period has expired to apply for Medicare Supplement insurance, then you run the risk of either being charged a higher amount of premium – or even of being turned down.

Where You Can Find the Best Premium Rates on All Medigap Plans

If you are currently enrolled in a Medigap Plan J, and you are considering making a change in your Medicare Supplement insurance coverage, then it will be important that you shop and compare coverage before making your final decision. This is because, even though all Medicare Supplement insurance policies of the same letter are required to offer the very same benefits, the premium price that is charged can differ a great deal from one insurance carrier to another.

When you are ready to move forward with comparing the various Medicare Supplement insurance coverage that may be available to you, we can help. We work with many of the top Medigap insurance carriers in the marketplace today, and we can get you all of the important information that you need for making a well-informed purchase decision. We can do so for you quickly, easily, and conveniently – and without the need to meet in person with an insurance agent. If you are ready to proceed, then all you have to do is just simply fill out the form on this page.

Should you find that you still have any questions regarding Medicare Supplement insurance coverage, then please feel free to contact us directly. We can be reached via phone, toll-free, by dialing 800-376-0824.

We understand that shopping for a new Medicare Supplement insurance plan can be a bit overwhelming. There are so many plans to choose from – and you want to be sure that you will have the proper coverage to meet all of your current – and future – health care needs.

The good news is that we are experts in the Medicare Supplement arena, so we can walk you through all of the important steps to finding a new plan, as well as helping you get a good understanding of your Medigap Plan J benefits. So, contact us today – we’re here to help.

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