2022 AFBA Financial Planning Guide

of this insurance is to cover all or a part of the deductible and coinsurance payments that you must pay under the Medicare program. The law provides a six month open enrollment period from the date of eligibility for Medicare at age 65. During this open enrollment period, you cannot be denied insurance coverage or charged a higher premium due to poor health conditions. However, policies may not provide coverage during the first six months of the policy for adverse health conditions that existed prior to the start of the policy. Federal law requires that all policies be sold as standardized plans and provide a Basic Benefit package that includes: a. Hospital Care. Covers the Part A coinsurance and 365 extra days of hospital care during your lifetime. b. Medical Costs. Covers the Part B coinsurance (generally 20% of the Medicare approved payment amount). c. Blood. Covers the first 3 pints of blood each year.

If you or your spouse are working and have group health coverage through an employer or union, you may be eligible to delay your enrollment in Part B beyond the normal enrollment period and avoid the subsequent 10% higher premium cost. This is called a Special Enrollment Period. The rules covering special enrollment are very exact. If you believe you are eligible for special enrollment, you should discuss your situation with the Social Security Administration. The medical insurance offered under Medicare Part B will generally cover 80% of approved charges after payment of an annual deductible. Covered services include doctor’s fees, diagnostic fees, and tests including mammography screenings and X–rays. Other items covered include speech and radiation therapy, ambulance service, and certain artificial devices such as pacemakers. Medigap Insurance. Supplemental Medicare insurance is available through private insurance companies. The purpose

COVERAGE OFFERED BY STANDARD TYPES OF MEDIGAP POLICIES

Benefits

A B C*

D F*

G

K

L

M N

Medicare Part A Coinsurance and Hospital Costs (365 extra days of hospital care during your lifetime)

100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

Medicare Part B Coinsurance or Copayment

100% 100% 100% 100% 100% 100% 50% 75% 100% 100%

Blood (first 3 pints each year)

100% 100% 100% 100% 100% 100% 50% 75% 100% 100%

Part A Hospice Care Coinsurance or Copayment

100% 100% 100% 100% 100% 100% 50% 75% 100% 100%

Skilled Nursing Facility Care Coinsurance

0%

0% 100% 100% 100% 100% 50% 75% 100% 100%

Medicare Part A Deductible

0% 100% 100% 100% 100% 100% 50% 75% 50% 100%

Medicare Part B Deductible

0%

0% 100% 0% 100% 0%

0%

0%

0%

0%

Medicare Part B Excess Charges

0%

0%

0%

0% 100% 100% 0%

0%

0%

0%

Foreign Travel Exchange (up to plan limits)

0%

0%

80% 80% 80% 80%

0%

0%

80% 80%

* Plans C and F aren’t available to people who were newly eligible for Medicare on or after January 1, 2020. 2022 Out of Pocket Limit: Plan K pays 100% after out-of-pocket limit of $6,620; Plan L pays 100% after out-of-pocket limit of $3,310. Residents of MA, MN, and WI: Due to differences in state insurance regulations, this chart does not apply. Contact your State Insurance Department for specific guidelines applicable to your state. Prescription Drug Coverage: Medigap policies sold after January 1, 2006 are not allowed to include Prescription Drug Coverage.

CHAPTER 12: SOCIAL SECURITY & MEDICARE

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