Medicare Parts A and B provide beneficiaries with coverage for the majority of their medical needs, however, they do not pay for all medical costs and were not designed to do so. More detailed coverage information can be found here. What follows is a very basic explanation.

Part A: This covers a stay in a hospital. You are responsible for a $1,132 deductible for each benefit period and per day charges if your hospital stay lasts longer than 60 days.

Benefit Period: A benefit period starts the day you go into a hospital and ends when you haven't received any inpatient hospital (or skilled nursing facility) care for 60 days in a row. If you go into a hospital after one benefit period has ended, a new benefit period begins, and you must pay the inpatient hospital deductible ($1,132) for the new benefit period. There is no limit to the number of benefit periods, except for inpatient mental health care in a psychiatric hospital (190 days per lifetime).

Part B: This covers medical services (doctors, surgeons, labs, etc.). You pay a monthly premium for Part B. The monthly premium is $115.40 for most people. If your income is above $85,000 if single or $170,000 if married, you will pay a higher premium for Part B. Part B also has a $162 yearly deductible. After reaching the deductible you are responsible for generally 20% of the bill for Medicare-approved services. If an expense is not a Medicare-covered expense, you are responsible for 100%.

Excess Charges: Most medical service providers accept the Medicare fee schedule and won't charge more than that. However, some contract with Medicare but can charge up to 15% more than the Medicare fee schedule. That excess will not be paid by Medicare and must be paid by you.

Wellness: Medicare does have a limited amount of preventive benefits. Your Guide to Medicare's Preventive Services from Medicare provides detailed information about these benefits. If you receive preventive services outside the normal Medicare schedule, you will have to pay for those services.

What is Medigap?

As mentioned above, while Original Medicare was designed to pay for most medical costs, it was never intended to pay for all of them. The gaps in coverage leave the beneficiary to pay out of his or her own pocket for costs like the hospital deductible, hospital and service copays and coinsurance, and excess charges. Private companies offer Medicare Supplement insurance to fill in these gaps and lessen or eliminate the out of pocket financial risk to Medicare beneficiaries.

Medicare Supplements are highly regulated insurance products. In most states, including Illinois, Medicare Supplements are standardized and offered by lettered plans A, B, C, D, F, G, K, L, M, and N. There are also Medicare Select plans and a high deductible Plan F. Medicare Select plans are less expensive because they require you to use the network of providers for that specific Medicare Select plan. The regular standardized Medicare Supplements (not Medicare Select) will work with any medical facility that accepts Medicare.

Since the plans are standardized, each company offering a certain lettered plan will include exactly the same benefits in that plan as any other company offering the same plan. For example, a Plan F is a Plan F is a Plan F. The benefits will be no different no matter what company you purchase your Plan F through. Although the benefits are the same, prices do vary from company to company. You can trust BCMIL to explain your options and get you the best price available.

Learn More About Selecting the Right Plan

Check out the Medigap at a Glance chart to compare benefits across all available plans. The Medigap Buyer’s Guide gives you the latest information about plans, benefits, and services available to you through Medicare approved insurance supplements. Check out our frequently asked questions section for answers to the most common questions we get from our clients. Or, simply complete the form below or contact us to get help determining the right plan for you and finding the best rates available in your area. Our services are completely free to our clients and will not increase the cost of your insurance. Medicare can be confusing; let us help.

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