A standard Medigap policy must provide essential coverage to help seniors manage the costs of healthcare that Medicare does not cover. This type of insurance policy is designed to fill in the gaps left by Original Medicare, offering additional benefits and peace of mind for those aged 65 and older.
Medigap policies are sold by private insurance companies and are standardized by the federal government, meaning that each plan must offer the same basic benefits regardless of the insurer. This standardization ensures that seniors can compare policies based on price and additional benefits rather than the specifics of coverage.
A standard Medigap policy must provide coverage for several key areas, including:
1. Part A Deductible: This is the amount you must pay for hospital care before Medicare begins paying its share. A standard Medigap policy must cover the first three pints of blood each year, as well as the Part A deductible.
2. Part B Deductible: Similar to the Part A deductible, this is the amount you must pay for doctor visits and other outpatient services before Medicare starts paying. A standard Medigap policy must cover the Part B deductible.
3. Part B Coinsurance: This is the percentage of the cost of covered services that you must pay after you’ve met your deductible. A standard Medigap policy must cover 80% of the coinsurance for hospital care and skilled nursing facility care.
4. Part A Hospitalization: This benefit helps cover the cost of hospital stays that exceed the 60-day limit covered by Original Medicare. A standard Medigap policy must provide coverage for hospitalization beyond the 60-day limit.
5. Part B Coinsurance: This benefit helps cover the cost of doctor visits, outpatient care, and other services not fully covered by Original Medicare. A standard Medigap policy must cover 80% of the coinsurance for these services.
6. Part B Excess Charges: In some states, Medicare does not cover 100% of the cost of certain services. A standard Medigap policy must cover the 20% coinsurance for these services.
7. Skilled Nursing Facility Care: This benefit helps cover the cost of care in a skilled nursing facility after a hospital stay. A standard Medigap policy must cover the coinsurance for skilled nursing facility care after a hospital stay.
8. Foreign Travel Emergency: This benefit helps cover the cost of emergency care you receive while traveling outside the United States. A standard Medigap policy must cover 80% of the cost of emergency care, up to $50,000 per year.
It’s important to note that while a standard Medigap policy must provide these essential benefits, additional benefits may vary by plan. Some plans may offer coverage for prescription drugs, routine vision and dental care, and other services not covered by Original Medicare.
When selecting a Medigap policy, it’s crucial to compare the benefits and costs of different plans to find the one that best fits your needs. Keep in mind that a standard Medigap policy must provide the same basic benefits, so the primary factors to consider are the cost of the policy and the additional benefits offered. By understanding the requirements of a standard Medigap policy, seniors can make informed decisions about their healthcare coverage and ensure they are adequately protected.
