Medigap Plan J
| Medigap Plan J Policy Coverage | |
|---|---|
| Basic Benefits |  |
| Part A Deductible | |
| Part B Deductible | |
| Part B Excess | 100% |
| Skilled Nursing Coinsurance | |
| Foreign Travel Emergency | |
| At Home Recovery | |
| Additional Preventative Care | |
Quick Introduction to Medigap Plans
Medigap is a private health insurance policy that is designed to cover medical costs not covered by Medicare programs. It covers many of the costs that people would otherwise have to pay individually such as copayments, coinsurance, and deductibles. There are twelve different Medigap plans ranging from A to L. Any insurance company offering Medigap plans is required to offer Plan A, other plan availability will vary by insurance company and by state. Medigap policies do not cover long-term care such as nursing homes, vision or dental care, hearing aids, eyeglasses or private-duty nursing. This article will deal exclusively with Medigap Plan J policies covering some of the benefits and other considerations.
More on Medigap Plan J
Benefits of Medigap Plan I Policies
Medigap Plan J policies provide Basic coverage in addition to other benefits. Basic coverage of all Medigap plans includes:
- Medicare Part A Coinsurance, and all costs after hospital benefits are exhausted
- Medicare Part B Coinsurance or Copayment for other than preventative services
- Blood (first 3 pints). Medicare typically covers all costs associated with blood after the first 3 pints.
- Medicare Preventative Care Part B Coinsurance
In addition, Medigap Plan J policies provide the following additional benefits:
- Skilled Nursing Facility Coinsurance - For each benefit period, Medicare covers the first 20 days. After day 20 and up through day 100 you normally would pay up to $133.50 per day. Medigap Plan J policies will cover these costs.
- Medicare Part A Deductible - For each benefit period, Medicare typically requires payment of a $1,068.00 deductible for the first 60 days of a hospital stay. Medigap Plan J policies cover these additional costs.
- Medicare Part B Deductibles- Under Medicare you will need to cover the $135 yearly deductible. Medigap Plan J policies will cover these costs.
- Medicare Part B Excess Charges - For doctors and other providers who don't accept assignment under Medicare, you normally must pay for the difference between the Medicare-approved amount and either the provider's fee, or the "limiting charge" (no more than 15% above the Medicare-approved amount) that applies for doctor's fees and many other Part B health care services. Medigap Plan J policies cover these costs.
- Foreign Travel Emergency - Medicare typically does not cover any costs associated with medical care provided outside the United States. Medigap Plan J policies cover many of these costs, up to policy limits.
- At-home Recovery - Medicare-approved home health care to provide treatment ordered by your doctor for an illness or injury. Normally the patient is responsible for payment for services not covered by Medicare. A Medigap Plan J policy will cover these payments up to policy limits.
- Additional Preventative Care Not Covered by Medicare. Some costs associated with these services will be covered by a Medigap Plan J policy.
What Isn't Covered?
Policies that comply with Medigap Plan J do not cover:
- Hospice Care Coinsurance or Copayment - You may be required to pay up to $5 for each drug a hospice provides when you are getting hospice services in your home and 5% of the Medicare-approved amount for each day of inpatient respite care (up to certain limits).
- A Medigap Plan J policy does offer a high-deductible option but you must pay for Medicare-covered costs up to the high-deductible amount of two thousand dollars before your Medigap policy pays anything.
Source: Centers for Medicare & Medicaid Services, Choosing a Medigap Policy: A Guide to Health Insurance for People With Medicare (2009).
These may or may not be important expenses and limitations, depending on your situation. If a Medigap Plan J policy doesn't meet your needs, consider Medigap Plan K policies.