Oregon Consumer Guide to Medigap & Medicare Advantage Plans Publications Page This site has a pamphlet comparing Medicare Advantage and Medigap Plans. We carry the majority of these companies and their Products. The Medicare Advantage plans are available in limited areas, while the Medigap plans are available statewide. You can view rates for some Medigap Plans, and also for the Medicare Advantage HMO and PPO plans.
|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 copayments for hospital outpatient services. Plans K, L, and N require insureds to pay a portion of Part B coinsurance or copayments.|
|Blood:||First 3 pints of blood each year.|
|Hospice:||Part A coinsurance.|
Medicare Supplement Benefit Comparison:
|Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up|
|Part B coinsurance or copayment||50%||75%|
|Blood (first 3 pints)||50%||75%|
|Part A hospice care coinsurance or copayment||50%||75%|
|Skilled nursing facility care coinsurance||-||-||50%||75%|
|Part A deductible||-||50%||75%||50%|
|Part B deductible||-||-||-||-||-||-||-||-|
|Part B excess charges||-||-||-||-||-||-||-||-|
|Foreign travel exchange (up to plan limits)||-||-||80%||80%||80%||80%||-||-||80%||80%|
*Plan F also has an option called a high deductible plan F. This high deductible plan pays the same benefits as Plan F after one has paid a calendar year [$2,180] deductible. Benefits from high deductible plan F will not begin until out-of-pocket expenses exceed [$2,180]. 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.
Why were plans E, H, I and J eliminated?
Plan E was eliminated because the new Plan D would contain exactly the same benefits. Plans H, I and J were eliminated because with the other dropped benefits these plans would also duplicate other plans available.
What will happen if the plan that you have is dropped?
Any plan that was purchased prior to June 2010 will remain inforce. Keep in mind these new plans are for new issues with effective dates of June 2010 and beyond. Your clients’ current Medigap plan is guaranteed renewable for life. Even if their health changes, they cannot be terminated or forced to change to one of the new plans.
What is the new hospice benefit?
All plans will now include the Hospice Benefit as part of the “Core Benefits.” Medicare provides coverage for inpatient respite care up to 5 days less a co-payment amount of 5% of the daily benefit. The new Hospice benefit will pick up this 5% co-pay.
Why was the At-Home Recovery benefit dropped?
It was determined that the benefit was confusing and difficult to understand and administer.
Why was Preventive Care dropped from all plans?
Because Medicare Part B has changed to cover many more preventive benefits, effectively rendering this benefit redundant.
|Benefits For Medicare||2016 Out-Of-Pocket Cost|
|Part A Benefits||Part A Cost|
Day 1 Through Day 60
|$1,288 Deductible For First Stay During a Year|
|Day 61 Through Day 90||$322 Per Day 61 Through 90|
|60 Day "Lifetime Reserve"||$644 Per Day|
|Skilled Nursing Facility Day 1 through Day 20||$0 Day 1 Through Day 20|
|Skilled Nursing Facility Day 21 through Day 100||$161.00 Day 21 Through Day 100|
|Hospice Care For Terminally Ill||Nominal Coinsurance For Drugs And Respite Care|
|Benefits For Medicare||2016 Out-Of-Pocket Cost|
|Part B Benefits||Part B Cost|
|Physician And Other Medical Services||20% Of Medicare Approved Amount|
|Outpatient Hospital Care||20% Of Medicare Approved Amount|
|Ambulatory Surgical Services||20% Of Medicare Approved Amount|
|Outpatient Mental Health Services||68.75% Of Medicare Approved Amount|
Additional Medigap Information
- Medigap Plan F offers a high deductible option. You must pay for Medicare-covered costs up to the high-deductible amount ($2,180 in 2016) before your Medigap policy pays anything
- 100% part B coinsurance except up to $20 copayment for office visits and up to $50 copayment for ER.
- You must also pay a separate $250 deductible for foreign travel emergency and there is a $50,000 lifetime maximum benefit.
- After you meet your out-of-pocket yearly limit and your yearly Part B deductible ($166 in 2016) the plan pays 100% of covered services for the rest of the calendar year (This applies only to plans K & L) - [Excess charges do to apply to maximum out of pocket]
- Modified Plan F offers an individual assistance program, as well as coverage for preventive dental care (available in some states)
- 2016 Out of Pocket Limit for Plan K is $4,960.
- 2016 Out of Pocket Limit for Plan L is $2,480.
- You must be enrolled in both Medicare Part A and Medicare Part B and live in the plan's service area to be eligible for these plans.
- You are first eligible during the 7-month Initial Coverage Enrollment Period (ICEP), the 3 months before your 65th birthday, the month of, and 3 months after. CAUTION: You only have one choice so take your time, ask for help and choose wisely.
- You must continue to pay your Medicare Part B premium in addition to any plan premium shown below.
About Information Presented
- This is a web site from CDA Insurance LLC. CDA Insurance LLC is not an insurance carrier, we are an agency that represents many companies offering products to the general public and also to medicare recipients. We do our best to assure that all information presented on our web site is current and accurate.
- CDA Insurance LLC is not associated with Medicare or the Center for Medicare and Medicaid Services. This is not a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE or consult www.medicare.gov.
- A Medicare Supplement plan is a health insurance plan provided by a private company that fills in the “gaps” in original Medicare coverage. CDA Insurance LLC is an agency that sells Medicare Supplement plans to medicare beneficiaries. Submitting our online quote request form does NOT affect your current enrollment, nor will it enroll you in a Medicare Supplement plan or other Medicare plans. To apply for coverage you must submit an application for the company and plan that you want.