Medigap Coverage Is Changing

Between copayments, deductibles, and coverage exclusions Medicare does not cover all medical expenses. To supplement Medicare coverage, you may purchase a Medigap policy from a private insurer. There are currently 12 Medigap plans that are identified by letters A through L. Each plan package offers a different combination of benefits, allowing purchasers to choose the combination that is right for them.

In July 2008 the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) was approved by Congress. Part of the act covered Medigap and introduced some changes effective June 1, 2010. Four current Medigap standard coverage levels or plans will be dropped and two new plans will be added, bringing the total number of available Medigap plans to 10. Plans E, H, I, and J will no longer be sold. Existing holders of a policy with these plans will be able to renew the same policy when it falls due, but only if the provider continues to offer the plan. If the provider decides not to continue to offer the plan members will not be able to obtain that plan nor any of the other discontinue plans.

The changes will only affect existing policyholders at the point of their annual renewal. At the same time, two new plans -- M and N -- will be added. Plan M will pay 50 percent of the Part A deductible and some of the cost of foreign travel emergencies. It will not cover the Part B deductible. Plan N will pay the full Part A deductible, but it will require a $20 copayment for Part B office visits and up to a $50 copayment for emergency room visits. Plan N will also cover foreign travel emergencies.

There will also be some changes to the benefits offered by plans. The home health recovery benefit and preventive care benefit offered by some plans will be dropped. The preventive care benefit is duplicative of services that regular Medicare offers. The home health recovery benefit covered some personal services for individuals receiving skilled care through Medicare, but was underused.

One change affecting everyone is an additional benefit included with the basic coverage offered under all Medigap plans. If you take out a Medigap policy on or after June 1, 2010, coverage will include the amount of cost sharing for all Part A Medicare eligible hospice care and respite care expenses. You will not gain this benefit if you choose to retain your current plan with the existing benefits. Prior to the implementation of the new coverage, only those with the high deductable plans K and L received any benefit for this expense, with 50% and 75% coverage of the cost sharing amount respectively. The benefit for plans K and L will remain at the levels before June 1, 2010.

Previously, Plan G offered coverage of 80% of the Part B excess. Beginning June 1, 2010, the coverage is increased to 100% of the Part B excess. If you currently hold a Plan G policy you will not be able to obtain the benefit of this change on renewal unless you give up the at-home recovery portion of your existing plan. Essentially you can either retain the benefits of the existing plan or you can accept the changes and have the benefits of the new Plan G.

Two new plans, M and N are to be introduced on June 1, 2010.

Plan M is similar to Plan D except that only 50% of the Medicare Part A deductible is covered. In addition to 100% coverage of the Part B co-insurance, skilled nursing facility care and medically necessary emergency care in a foreign country are covered.

Plan N is also similar to Plan D, except that it requires co-payments of up to $20 for each covered health care provider office visit (including visits to medical specialists); and up to $50 for each covered emergency room visit. The ER co-payment is waived if you are admitted to the hospital.

If you are thinking about changing your plan you should consider doing it very carefully. Once you change your plan you cannot go back to your previous plan if it is not available to new policyholders.

-Above from: “Medigap Coverage Is Changing” ElderLaw News from ElderLawAnswers, March 10, 2010 2:08 PM http://www.elderlawanswers.com/resources/article.asp?id=8081&Section=4&state= retrieved 3/10/10; and “ Medigap Changes That Could Affect You” by Gavin Magor , TheStreet, http://www.mainstreet.com/article/family/family-health/medigap-changes-could-affect-you retrieved 3/10/10.

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