New Medicare Supplement Plans and Changes

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Questions and Answers about Medicare Supplement Insurance Plans

June 1st, 2010, Medicare Supplemental Insurance (Medigap) Companies are allowed to sell two new choices for consumers – Medicare Supplement Plan M and Medicare Supplement Plan N.  Also on June 1st, Medigap plans E, H, I, and J were eliminated due to changes in Medicare coverage and simply lack of use of the home recovery benefit,  CMS (Medicare – Centers for Medicare & Medicaid Services) has deemed this benefit unnecessary..CMS removing the “Preventive Care Benefit” and the “At-home-Recovery” benefits make these plans identical to other lettered Medicare Supplement plans.

In addition to these changes, Medicare has added a Hospice Care Respite Benefit and installed a Hospice Prescription co-pay of up to $5 per prescription. (The hospice respite benefit is described below.)  All new Medicare Supplement Plans will cover the $5 co-pay for prescriptions for people on hospice and the 5% co-insurance for qualified hospice respite care. In addition, all plans will have a preventative care coinsurance benefit.

So what changes should concern us:

After 6/1 Medicare will have a Hospice Respite Benefit.  A caregiver for someone on Hospice may be allowed up to a 5 day respite from care.  This may allow the person on hospice to be admitted into a Medicare approved hospital or nursing home for up to 5 days and be covered at 95% when a person meets requirements and  while the caregiver gets a respite.  As long as qualifications are met, there is no limit to the number of times a caregiver can get respite care.  The hospice company used will have more information as to specifics with a loved one on hospice.  (note: the new Medicare plans purchased after 6/1/10 will cover the 5% co-insurance.)

People on hospice will have a $5 co-pay for each qualified prescription drug used for pain relief and symptom control.  New Medicare Plans will cover the new hospice prescription co-insurance ($5)

Plan N may be very attractive to people who now have Medicare Advantage Plans or wish to have some exposure for their own medical costs and wish to cut their premium cost by about 30 – 35%.  Plan N does NOT cover the Part B – $155 deductible.  Plan N does NOT cover excess expenses and has doctor and ER co-pays.  However, Plan N premiums are lower (e.g. using Blue Cross monthly rates):

                                        Plan F       Plan N
Age 65                          $125.00     $  88.00
Age 85                          $241.00     $169.00

IMPORTANTLY – a person does NOT need to change their present Medicare Supplement Plan.  In cases they may wish NOT to do so.  In other cases it is advisable to change to one of the new plans. Specifically, if you have Plan J or another discontinued plan, you may see greater rate increases in the future if you keep the discontinued plan. Look at these differences in plans and how they affect your own situation, talk to a professional agent who specializes in Medicare Plans, and do NOT let anyone tell you that you MUST change your current Medicare Supplement. In addition, always read the outline line of coverage for benefits, limitations and exclusions.

Also remember if you have a Medicare Supplement, you can change plans at any time during the year. If you have a Medicare Advantage Plan (MA), you can only change plans in the annual enrollment period and during a special enrollment period. In 2011, CMS has changed and will no longer have an “open enrollment period” from January 1st – March 31st. Therefore you will not be able to change MAs between 1/1 – 3/31. CMS will allow someone who has a MA to change to original Medicare from January 1st through February 15th.

Also, you can use as resources: www.medicare.gov (Medicare)

Written by

Steven A. Buttice is the president of Medical Reimbursement & Management Services, Inc., a firm specializing in issues affecting seniors, including seminars and consultation on Medicare Plans, Long Term Care and other types of insurance, claims issues, and sales/service of insurance products since 1984.

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