Why You Need a Medicare Supplement Insurance Plan
Medicare is a federal program to help older Americans and some disabled Americans pay for the high cost of health care. However, Medicare was never intended to cover all your health care costs. So even if you’re covered by Medicare, you are still responsible for a large portion of your health care costs.
What Medicare Doesn’t Cover
Medicare does not cover all health care costs. Medicare coverage consists of Part A (which covers hospital and skilled nursing facility care), and Part B (which covers doctor bills and other medical expenses).
Even with Medicare Part A and Part B coverage, you’re responsible for some out-of-pocket expenses including:
(Here are the 2019 deductibles):
- Part A hospital deductible ($1,364)
- Part B deductible ($185)
- Copayments for hospital stays over 60 days
- Care in a skilled nursing facility after 20 days
- Twenty percent coinsurance for doctor bills and other medical expenses
By law, Medicare Supplement insurance plans are standardized into twelve plans. That means Medicare Supplement Insurance Plan F* from one company must include the same benefits as the same plan from another company. While the benefits must be the same, each company’s rates, reputation, membership features and quality of service can vary. With Blue Cross and Blue Shield of New Mexico you don’t have to sacrifice comprehensive benefits or freedom-of-choice for affordability.
All Blue Cross and Blue Shield of New Mexico Medicare Supplement Insurance plans give you:
- Guaranteed Acceptance with no health questions asked
- Freedom to choose any doctors or specialists
- Guaranteed renewability regardless of changes in your health
- Coverage guaranteed to match Medicare’s cost increases year after year
- Blue Extras Member Discount Program that include discounts on wellness products and services including vision, fitness clubs, weight management, complementary alternative medicine, hearing and more
- No claim forms, in most cases
Medicare Supplement Insurance Plan Basic Benefits
Basic benefits included in all plans include:
- Hospitalization – Part A coinsurance plus coverage for 365 additional days after Medicare benefits end.
- Medical Expenses – Part B coinsurance (generally 20% of Medicare-approved expenses), or in the case of hospital outpatient department services under a prospective payment system, applicable copayments.
- Blood – First three pints of blood each year.
- Of all available standardized plans, Medicare Supplement Insurance Plans F and Medicare Supplement Insurance Plan G* offer the most complete protection for uncovered Medicare Part B excess charges. These are the most popular plans because they also pay the Medicare Part A hospital deductible and copayments, skilled nursing facility copayment and foreign travel emergency care.
- Medicare Supplement Insurance Plan F also covers the Medicare Part B deductible.
- Medicare Supplement Insurance High Deductible Plan F* features a $2,300 annual deductible (2019) before plan benefits begin
Part B medical excess: Charges from your provider that exceed Medicare-approved amounts. Only Medicare Supplement Insurance Plan F, Medicare Supplement Insurance High Deductible Plan F cover these charges. For all other plans, you are responsible for paying excess charges. In no case can a provider charge more than 115% of the Medicare approved amount.
Skilled nursing coinsurance: Medicare pays the first 20 days of treatment in a skilled nursing facility, and an annually adjusted per diem for the 21st through 100th day. Plans with this benefit pay an additional annually adjusted per diem for the 21st through 100th day. You are responsible for all charges after the 100th day. In order to receive any Skilled Nursing Facility benefits, you must meet Medicare’s requirements:
- You were admitted to a hospital for at least three days
- You were admitted to a Medicare-approved skilled nursing facility within 30 days of leaving the hospital
Foreign travel emergency: Medically necessary emergency care services beginning during the first 60 days of each trip outside of the United States. All plans offering this benefit require you to pay a foreign travel emergency deductible and a percent of costs after the deductible is met.
Reduced Premium Medicare Select Option
Med-Select options offer you the same solid benefits as the “standard” plans, but cost less. You save on premiums simply by agreeing to use any of the Med-Select participating hospitals for non-emergency elective admissions. If you do not use one of these hospitals for your non-emergency admissions, you pay the $1,364 Part A deductible. Med-Select is not an HMO. With Med-Select, you are fully covered for emergency care at any hospital, and you can choose your own doctors and specialists.
Med-Select is available in specific geographic areas only. You must live within a 30 mile radius of a Med-Select participating hospital.
does not pay in 2019
|Expenses covered by our plans|
|Plan A||Plan B||Plan F||High
|Part A (Hospital Services)**|
|$341 per day
days 61-90 in
|$682 per day
you use your
first three pints
|$170.50 per day
for days 21-100
in a skilled
|Part B (Physician’s Care and Medical Services)|
|$185 Part B
20% for most
except up to $20
copayment for office
visit and up to $50
Medicare Part B
|Additional Expenses Not Covered by Medicare
care received in
* Plan F also has an option called a high-deductible Plan F. This high-deductible plan pays the same or offers the same benefits as Plan F after one has paid a calendar year $2,300 deductible. Benefits from high-deductible Plan F will not begin until out-of-pocket expenses are $2,300.
Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy. These expenses include the Medicare deductibles for Part A and Part B, but do not include the plan’s separate foreign travel emergency deductible.
** Hospital benefits must be provided by facilities participating with Medicare. Payments are limited to the reasonable charge as determined by Medicare.
*** After 90 days of hospitalization, Medicare benefits are paid from a one-time lifetime reserve of 60 additional days (days 91-150) which are not renewable each benefit period. See your Outline of Coverage for details and limitations of these benefits.
† After $185 Part B deductible is met for Plans A, B, F, High Deductible Plan F, and Plan N.
†† Foreign Travel Emergency covered at 80% after first $250 each is paid each calendar year; up to $50,000 lifetime maximum.
*Not connected with or endorsed by the U.S. Government or Federal Medicare Program