Medicare Supplement (Medigap) Plan D


Medigap Plan D is a standardized Medicare Supplement insurance plan that helps cover certain out-of-pocket costs not covered by Original Medicare (Part A and Part B). While it offers comprehensive coverage, it does not cover the Medicare Part B deductible.

Medigap Plan D typically provides coverage for Medicare Part A coinsurance and hospital costs, including an additional 365 days of hospital coverage after Original Medicare benefits are exhausted. It also covers Part B coinsurance or copayments, as well as the first three pints of blood needed for a medical procedure. In addition, Medigap Plan D includes coverage for skilled nursing facility coinsurance and provides coverage for emergency medical care during foreign travel, up to plan limits. However, it does not cover the Medicare Part B deductible or excess charges.

Medigap Plan D may be a suitable option for individuals who are willing to pay the Medicare Part B deductible out of pocket. This plan offers a good balance of coverage and cost savings compared to some other Medigap plans. It's crucial to review and compare the available options based on your individual healthcare needs and budget.

Below is a comprehensive list of the covered services provided by Medicare Supplement Plan D, which include benefits under Medicare Part A, Medicare Part B, and other areas:

MEDICARE PART A - HOSPITAL SERVICES - PER BENEFIT PERIOD


HOSPITALIZATION
Semi-private room & board, general nursing and miscellaneous services and supplies

ServiceWho pays what?
First 60 daysMedicare pays: All cost but $1,632
Plan pays: $1,632 (Part A Deductible)
Member pays: Nothing
61st thru 90th dayMedicare pays: All cost but $408/day
Plan pays: $408/day
Member pays: Nothing
91st day and after (While using 60 lifetime reserve days)Medicare pays: All cost but $816/day
Plan pays: $816/day
Member pays: Nothing
Once lifetime reserve days are used; additional 365 daysMedicare pays: Nothing
Plan pays: 100% of Medicare-eligible expenses
Member pays: Nothing
Beyond the additional 365 daysMedicare pays: Nothing
Plan pays: Nothing
Member pays: All cost


SKILLED NURSING FACILITY CARE
You must meet Medicare’s requirements, including having been in a hospital for at least three days, and enter a Medicare approved facility within 30 days after leaving the hospital.

ServiceWho pays what?
First 20 daysMedicare pays: All cost
Plan pays: Nothing
Member pays: Nothing
21st thru 100th dayMedicare pays: All but $204/day
Plan pays: Up to $204/day
Member pays: Nothing
101st day and afterMedicare pays: Nothing
Plan pays: Nothing
Member pays: All cost


BLOOD

ServiceWho pays what?
First three pintsMedicare pays: Nothing
Plan pays: All cost
Member pays: Nothing
Additional amountMedicare pays: All cost
Plan pays: Nothing
Member pays: Nothing


HOSPICE CARE
You must meet Medicare's requirements, including a doctor's certification of terminal illness.

ServiceWho pays what?
Hospice CareMedicare pays: All but very limited
copayment/ coinsurance for outpatient
drugs and inpatient respite care
Plan pays: Medicare copayment and
coinsurance
Member pays: Nothing

MEDICARE PART B - MEDICAL SERVICES - PER CALENDAR YEAR


MEDICAL EXPENSES
In or out of the hospital and outpatient hospital treatment, such as physician's services, inpatient and outpatient medical services and surgical services, physical and speech therapy, diagnostic tests, durable medical equipment.

ServiceWho pays what?
Part B DeductibleMedicare pays: Nothing
Plan pays: Nothing
Member pays: $240 (Part B Deductible)
Part B CoinsuranceMedicare pays: 80%
Plan pays: 20% (Part B Coinsurance)
Member pays: Nothing
Part B Excess Charges
(above Medicare approved
amounts)
Medicare pays: Nothing
Plan pays: All cost
Member pays: Nothing


CLINICAL LABORATORY SERVICES

ServiceWho pays what?
Test for diagnostic lab services  Medicare pays: All cost
Plan pays: Nothing
Member pays: Nothing


BLOOD

ServiceWho pays what?
First three pintsMedicare pays: All cost
Plan pays: Nothing
Member pays: Nothing
Additional amount (First $226 of
Medicare approved amounts)
Medicare pays: Nothing
Plan pays: Nothing
Member pays: $240 (Part B deductible)
Remainder of Medicare approved amountsMedicare pays: 80%
Plan pays: 20% (Part B Coinsurance)
Member pays: Nothing

MEDICARE PARTS A & B - MEDICAL SERVICES - PER CALENDAR YEAR


HOME HEALTH CARE
Medicare approved services

ServiceWho pays what?
Medically necessary skilled care
services and medical supplies/
Durable medical equipment
(First $226 of Medicare approved amounts)
Medicare pays: Nothing
Plan pays: Nothing
Member pays: $240 (Part B deductible)
61st thru 90th dayMedicare pays: 80%
Plan pays: 20% (Part B Coinsurance)
Member pays: Nothing

OTHER BENEFITS


FOREIGN TRAVEL
Medically necessary emergency care services beginning during the first 60 days of each trip outside the United States

ServiceWho pays what?
First $250 each calendar year/Remainder of chargesMedicare pays: Nothing (exccept under limited circumstances)
Plan pays: $0/80% to a lifetime maximum of $50,000
Member pays: $250/20% and amounts over the $50,000 lifetime maximum

Medicare Supplement Plan D and Medicare Part D are NOT the same?

Medicare Part D Prescription Drug Plan (PDP) and Medicare Supplement (Medigap) Plan D are distinct from each other. Medicare Part D is specifically designed to provide coverage for prescription drugs, whereas Medicare Supplement (Medigap) Plan D is an insurance policy that offers a comprehensive range of benefits, including those covered under Original Medicare Parts A and B.

Other Medicare Supplement Plans

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