California Medicare Supplement Plans (Medigap)

While Medicare pays for a lot of health care services, there are still many it does not cover. The traditional Medicare Plan does not provide 100% coverage for medical expenses such as deductibles, co-payments, and co-insurance. Therefore Medigap was designed to help pay the costs that Medicare does not cover. Medigap in California is also referred to as ‘California Medicare Supplement Plans’.

California Medicare Supplement Plans

As of June 1, 2010, the types of Medicare Supplement Plans that you can buy have changed. There are now 10 plans available. The benefits of each plan are different, with the exception that all plans are required to cover the ‘Basic Benefits’. Two new Medigap Plans are offered – Plans M and N, and the Plans E, H, I, and J are no longer available.

Medicare Supplement Plans since June, 2010

	A	B	C	D	F	F	G	K	L	M	N
Medicare Part A Coinsurance and Hospital Benefits
MedicarePart A Deductible	-							50%	75%	50%
Medicare Part B Coinsurance or Co-payment								50%	75%		Copay*
Medicare Part B Deductible	-	-		-				-	-	-	-
Medicare Part B Excess Charges	-	-	-	-				-	-<	-	-
Blood (First Three Pints)								50%	75%
Foreign Travel Emergency (Up to Plan Limits)**	-	-						-	-
Hospice Care Coinsurance or Co-payment								50%	75%
Preventive Care Coinsurance
Skilled Nursing Coinsurance	-	-						50%	75%
Out-of-Pocket Limit						(1)		(2)	(2)
* Plan N pays Part B coinsurance or co-payment except for an insured copay of up to $20 for each doctor’s office visit and up to $50 for each emergency room visit (emergency room copay waived if admitted as an inpatient). ** You must also pay a separate deductible for foreign travel emergency care ($250 per year). The plan pays 80% after the $250 deductible up to the plans lifetime limit of $ 50,000 (1) 2010 High Deductible Plan F pays NO Benefits until a $2000 deductible is met. Medicare Supplement Plan F also has a high deductible option. If you select the high deductible plan F you have to pay the first $2,000 (deductible in 2010) in MediGap-covered costs before the MediGap policy pays anything. In some areas some companies will offer a Select Plan C and Select Plan F. The plans are the same as Plan C and Plan F except they will have network hospitals to use. Select Plan C and Select Plan F will have lower premiums. (2) On plans K & L Only. After you meet your out-of-pocket yearly limit of $4620 on plan K and $2310 on plan L and your $155 yearly Part B deductible, the plan pays 100% of covered services for the rest of the calendar year.

What is Medigap and how do California Medicare Supplement Plans work?

Medigap is additional health care insurance provided by private insurance companies to cover the gaps in the Medicare Plan. Medigap policies are regulated by Federal and State Laws in order to protect you as a beneficiary. Medigap policies have to be clearly labeled as “Medicare Supplement Insurance”, and the policies are standardized for each State.

Medigap Eligibility Requirements

Medigap coverage works only in conjunction with the Medicare Plan. Typically, you must have Medicare Part A and Part B in order to be eligible for Medigap. Acceptance of your application is guaranteed if you are 65 or older and apply within six (6) months of your initial enrollment in Plan B of Medicare. Under certain circumstances pre-existing conditions might be waived. Please ask us for specific details. As Medigap policies only cover one person per policy you and your spouse must each purchase separate policies.

Prescription Drug Coverage

Medigap policies no longer cover prescription drugs. You cannot have both Medicare Part D and Medigap drug coverage at the same time. If you have a Medicare Prescription Drug Plan (Part D) and a Medigap policy that covers drugs, then you need to tell your Medigap insurance provider to remove the drug coverage from your policy. While Medicare Part D coverage is more beneficial than Medigap drug coverage, you can also decide to keep your Medigap policy with prescription drug coverage instead.

Does Medigap work with an Advantage Plan?

No. If you enroll in a California Medicare Advantage Plan, your Medigap coverage will not work. You may wish to (although legally you don’t have to) cancel your Medigap policy if you choose a plan aside from the Original Medicare Plan.

If you have any questions about California Medicare Supplement Plans (Medigap), please feel free to give us a call at 1-800-266-3618 or click here to email us.