Health plans for Individuals, Families and Groups in California

 

What Medicare does not pay

 

Have you been looking forward to Medicare to get off of your expensive individual health plan and on to less expensive Medicare coverage? Well there certainly may be some savings when you reach 65, however you must be aware of the things that Medicare does not pay.

That's what Supplemental Medicare plans or "Medigap" policies are for... to pick up the difference.

Medigap polices will help you pay for the following costs that are NOT covered by Medicare Part A or Part B

Medicare Part A and Part B deductibles

If you need to stay in the hospital, you will pay the following amounts based on how long you need to stay in the hospital:

  • $840 total for days 1 through 60
  • $210 per day for days 61 through 90
  • $420 per day for days 91 through 150
  • All costs for each day beyond 150 days

For other non-hospital services you will pay $100

Additionally you will pay:

  • 20% of the Medicare-approved amount for most covered services
  • 50% of outpatient mental health treatments and the co-payment for outpatient hospital services
  • 5% of the Medicare-approved amount for inpatient respite care

Part B Excess - Above Medicare's Approved Amount

Under federal law, doctors who don't accept "assignment" (take Medicare's approved amount as payment in full) may charge up to 15% more than the approved amount. You will pay this excess amount.

Outpatient Prescription Drugs

You will pay the entire cost of prescription drugs.

Foreign Travel Emergency

You will pay the entire cost of emergency care while traveling in a foreign country.

Skilled Nursing Coinsurance

You will pay $105 per day for days 21 through 100 per stay in a Skilled Nursing Facility plus all costs beyond the 100th day.

Preventative Care

You will pay the entire cost of routine yearly check-ups and tests (such as routine yearly check-ups, serum cholesterol E and screening, hearing tests, diabetes screening, thyroid function test).

Blood

You will pay for the first 3 pints of blood.

 

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