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How Many Medicare Plans Are There? What Do They Cover And How Can You Qualify

To qualify for the different parts of Medicare and Medigap, it is best to enroll during the 7 month enrollment period. During this period you have a guaranteed-issue right to enroll in Medigap plans, regardless of pre-existing issues. Insurance companies cannot reject you during this time. However, after the enrollment period, it may be difficult to qualify for the different Medigap plans due to health status.

There are 2 Medicare health plans offered by private companies who are contracted through Medicare to provide hospital (Medicare Part A) and medical (Medicare Part B) insurance. To qualify for the different parts of Medicare you must be at least 65 years of age. There is an initial enrollment period that lasts 7 months. This enrollment period begins 6 months before a person’s 65th birthday and continues until the month of the person’s birthday. Should enrollment be delayed after the 65th birthday, late enrollment costs may be incurred.

What Happens During Enrollment

During the enrollment period, people decide if they want to receive Part A, Part B, or both Part A and Part B of Medicare. It is also necessary to decide if additional coverage or supplements are desired or if Medicare Advantage Plan is desired. The Medicare Advantage Plan is through private companies and includes both Part A and Part B within the plan. In the majority of companies, it also covers prescription needs.

Qualifying For Medigap

To qualify for the different parts of Medicare Supplemental plans, also known as Medigap, is simply applying for one of the 10 when applying for Medicare Part A and B to cover Medicare out-of-pocket expenses. These costs include Co-insurance, copayments, deductibles, and other medical needs that are not covered or fully covered through the original Medicare Part A or Part B plans. To be able to enroll in the Medigap plans, you must first be enrolled in both Part A and Part B of Medicare. Private insurance companies are not required to offer all the available Medicare Medigap plans. However, they are required to offer Part A. Should a company offers anything above Part A, they must then offer at least Part F of the Medicare Medigap Plans. Due to the popularity of Part F, the majority of private insurance companies do offer the plan to their customers.

Medicare Part FImage result for medicare part f illustration

The Medicare Part F is considered the most comprehensive plan. It includes extensive coverage for those who seek to lower out-of-pocket expenses with the original Medicare Part A and Part B plans. The benefits offered in Medicare Part F are standardized in most states. This means location and insurance companies offer the same basic benefits to all individuals. The costs and benefits covered by Medicare Part F are as follows:

  • Part A hospital and coinsurance costs up to an additional 356 days after Medicare benefits are exhausted
  • Medicare Part A hospice care copayment or coinsurance
  • Medicare Part B coinsurance
  • Medicare Part B excess charges
  • Medicare Part A deductible
  • Medicare Part B deductible
  • First three pints of blood used in an approved medical procedure (annually)
  • Skilled nursing facility coinsurance
  • Foreign travel emergency coverage (80%, up to plan limits)

Though benefits are standardized, the cost of the plans is not. Depending on the county of residence and the private insurance company that sells the plan will decide the cost that must be paid. There is also a Part F option that includes all the same benefits but has a higher upfront out-of-pocket expense. Beneficiaries are expected to pay all out-of-pocket expenses until the $2,240 deductible is met. Once the deductible is met, the plan will pay for all the Medicare-covered costs. This version of the Part F plan allows for lower premiums.

Medicare Part L

The Medicare Part L is another option available by some insurance companies to supplement Part A and Part B with partial coverage of some benefits. Medicare Part L is a budget-friendly plan that does not include the high premium costs associated with other supplement plans, such as Medicare Part F. It offers some assistance and relief with Medicare costs, paying 75% of the cost for most of its covered benefits. It fully covers Medicare Part A coinsurance and hospital costs for up to an additional 365 days after Medicare benefits are exhausted. Medicare Part L covers 75% of the following expenses:Image result for medicare part l illustration

  • Medicare Part A deductible
  • Medicare Part B copayment or coinsurance coverage
  • First three pints of blood for a covered medical procedure
  • Medicare Part A hospice care coinsurance or copayment
  • Skilled nursing facility (SNF) care coinsurance

This plan also includes an out-of-pocket limit benefit which may vary year to year. Should your out-of-pocket expenses reach the yearly limit and your deductible for Part B is met, then 100% of covered services will be paid for the remainder of the calendar year. With the lack of deductible limits on Part A and Part B, this can give peace of mind should a health emergency occur.

Medicare Part M

Medicare Part M covers many different benefits, including foreign travel emergency. It does not cover any deductibles of Part B or any Part B excess charges. An excess charge is the dollar amount doctors may charge above the Medicare-approved amount. This rate could be up to 15% more than the approved amount. Medicare Part M benefits are:

  • Medicare Part A hospital coinsurance and hospital costs up to a year after Original Medicare benefits are used up
  • Part A hospice care coinsurance and copayments
  • Medicare Part B copayments and coinsurance
  • First three pints of blood for a medical procedure
  • Skilled Nursing Facility care coinsurance
  • Medicare Part A deductible (50%)
  • Foreign travel emergency coverage (80% of approved costs up to plan limits)

There are monthly premiums based on one of the following rating systems: community-rated, issue-age-rated, and attained-age rated. Factors such as gender, age, and health status may vary the monthly premium amount. Medicare Part M will not cancel a plan unless it has been proof of false information that was given on application, if the company goes bankrupt, or the monthly premium is not paid. This is also true for other Medicare plans and supplements.

Medicare Part N

The Medicare Part N offers the standardized benefits as the other plans, regardless of location or chosen insurance company. As with other plans, there are some costs that should be expected. The copayment of up to $20 for doctor visits and $50 for emergency room visits that do not lead to hospitalization must be paid. Excess charges for Part B is not included as well. Medicare Part N covers the following benefits:

  • Medicare Part A hospital coinsurance and other costs up to an additional 365 days after Original Medicare benefits are exhausted
  • Medicare Part A hospice care coinsurance or copayment
  • Medicare Part A deductible
  • Medicare Part B coinsurance or copayments (except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that do not result in inpatient admission)
  • First three pints of blood used in a medical procedure (yearly)
  • Skilled nursing facility care coinsurance
  • Foreign travel emergency care (80%, up to plan limits)

Premiums will vary by insurance company and location. The premium will also vary based on the methods the insurance company uses to set rates.

Medicare Part K

Medicare Part K is another plan that will include yearly out-of-pocket spending limit. After you reach the $5,240 spending limit the plan will then cover 100% of covered services for the remainder of the calendar year. Payment of 50% of several cost-sharing expenses in Medicare Part A and Part B. It does not cover any Part B deductibles or excess charges. Medicare Part K covers 50% of the following benefits:

  • Part A deductible
  • Part A hospice care coinsurance or copayment
  • Part B copayment or coinsurance
  • First three pints of blood for a covered medical procedure
  • Skilled nursing facility (SNF) care coinsurance

This plan helps keep you protected if a medical emergency happens. With a set cap on yearly costs, there is no surprise of what will be expected out-of-pocket for the year. Medicare Part K does require a lot of upfront costs. It is important to be prepared to pay that on top of insurance premiums.

Medicare Part G

Individuals who reside in Massachusetts, Minnesota, or Wisconsin are offered a supplemental benefit through the state. This means that Medicare Part G is not an option for those individuals and it is not offered by insurance companies. For the other 47 states, individuals can expect higher premium costs when compared to other Medigap plans due to the comprehensive coverage that is included. Medicare Part G Benefits include:Image result for seniors who travel illustration

  • Medicare Part B coinsurance/copayments
  • Medicare Part A deductible
  • Medicare Part A coinsurance, that is not paid by Medicare Part A for hospital costs
  • Up to 365 additional days of hospital care after exhaustion of Medicare Part A benefits
  • Up to 3 pints of blood
  • Skilled nursing facility coinsurance not paid by Medicare Part A
  • Hospice care coinsurance or copayment not paid by Medicare Part A

Medicare Part G is also a good plan for those who choose to travel outside the United States. It will cover 80% of approved emergency medical care. It also may cover the excess charges that some doctors may bill, as long as the procedure or service is covered by Medicare. Part G also coordinates providers with payments to help reduce the medical claims that are necessary. Out-of-pocket expenses are also significantly reduced. After you have paid the Part B deductible, Medicare Part G will pay all remaining expenses for outpatient diagnostic services and treatments covered by Medicare. The premiums for this plan will vary and are higher than other plans.