Medigap Plan B Benefits
Medicare Supplement Plan B, also known as Medigap Plan B, offers the exact same benefits a Medigap Plan A. It also covers the Medicare Part A hospital deductible in 2018 which is $1340 per each 60-day benefit period.
Medigap Plan B is also “standardized” meaning the same benefits are offered no matter which insurance provider you choose.
Example: A Medigap Plan B with Aetna is exactly the same as a Medigap Plan B with Cigna. The only difference is, different insurance companies can charge different rates for the exact same plan.
So, what benefits does Medigap Plan B cover?
- 100% of the Medicare Part A hospital deductible - which is $1340 per each 60-day benefit period.
- 100% of all Medicare Part A coinsurance and hospital costs - which is the copays for days 61-90 ($335/day) and days 91-150 ($670/day) in hospital; also provides payment in full for 365 additional lifetime days.
- 100% of the Part B Coinsurance - which is the 20% coinsurance for Part B services, such as doctor’s services, laboratory and x-rays, durable medical equipment. Also covers coinsurance for hospital outpatient services.
- 100% of the cost of the first 3 pints of blood.
- 100% of the Medicare Part A hospice care coinsurance for respite care and other Part A-covered services.
So, what benefits doesn’t Medigap Plan B cover?
- Skilled nursing facility care coinsurance - which is $167.50/day from days 21-100 in a skilled nursing facility per each benefit period.
- Medicare Part B excess/limiting charges which can be 15% more than Medicare’s approved charge when a provider does not take assignment.
- Foreign Travel Emergency - which covers 80% of emergency care costs when outside the United States, after annual $250 deductible, up to a maximum lifetime benefit of $50,000.
As you can see, Medigap Plan B does offer some additional benefits that are very significant, like covering the Part A hospital deductible.
But, it still doesn’t cover everything . . .
Here’s an example: Andrew has a condition called neuropathy which caused him to fall in his home and break his foot in early January. He was admitted to the hospital for 3 days and then was transferred to a Skilled Nursing Facility to rehabilitate for a total 92 days.
Subsequently, he was released from the Skilled Nursing Facility and began outpatient physical therapy for 12 weeks.
The good news is, Andrew’s Part A hospital deductible of $1340 was covered because he decided to enroll in a Medigap Plan B. In addition, his 12 weeks of outpatient physical therapy was covered as well.
The bad news is, Medicare Part A only covered the first 20 days of Skilled Nursing Facility Care, and Andrew was responsible for the daily copay of $167.50 from days 21 - 92. That left Andrew on the hook for $11,982.50, which is a pretty nice chunk of change.
For most people, Medigap Plan B may not be a good fit because it is not as comprehensive as a Plan F, Plan G, or Plan N.
Remember, Medigap Plan B is not the same as Medicare Part B. Because these two things sound similar, some people tend to get confused by the terminology. And, it’s very important that you understand the difference BEFORE you choose a plan.
If you’re like most people when it comes to Medicare, you may feel like your “spinning-your-wheels” just trying to figure it all out.
If so, you’re not alone . . .
Fortunately, the Medicare insurance specialists at New Jersey Medicare Plan can help - just give us a call at 1 (844) 280 -0785 and we’ll do the heavy lifting for you!
|Medicare Supplement Insurance Plans (Medigap)|
|Part A coinsurance and
hospital costs (up to an
additiona 365 days after
Medicare benefits are used)
|Part B coinsurance or
|Blood (first 3 pints)||100%||100%||100%||100%||100%||100%||50%||75%||100%||100%|
|Part A hospice care
coinsurance or copayment
|Skilled nursing facility care
|Part A deductible||100%||100%||100%||100%||100%||50%||75%||50%||100%|
|Part B deductible||100%||100%|
|Part B excess charges||100%||100%|
|Foreign travel emergency
(up to plan limits)
* Plan F is also offered as a high-
dedutible plan by some issuers in
some states. If you choose this
option, this means you must pay for
Medicare-covered costs (coinsurance,
copayments, deductibles) up to the
deductible amount of $2340 in 2020
before your policy pays anything. Plan C and plan F are only available to those who are not new to Medicare.
** Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don't result in an inpatient admission.
*** For Plans K and L, after you meet your out-of-pocket yearly limits and your yearly Part B deductible ($198 for 2020), the Medigap plan pays 100% of covered services for the rest of the calendar year.