16.1.2 Medigap Plans
Prior to June 1, 2010, there were 12 standardized Medigap plans, now there are 10 (plans A through D, F, G, and K through N). A list of their coverages can be found on page 333 in the Florida study manual, Illustration 21.1.
Basic benefits cover 100% of the Part A hospital coinsurance amount for each day used from the 61st through the 90th day in any Medicare benefit period and also covers:
- 100% of Part A hospital coinsurance amount for each Medicare lifetime inpatient reserve day used from the 91st through the 150th day in any Medicare benefit period;
- 100% of Part A-eligible hospital expenses for 365 additional days after all hospital benefits are exhausted;
- Part B coinsurance amount (generally 20% of Medicare-approved expenses) after the annual deductible is met; and
- the cost of the first three pints of blood each year and Hospice Part A coinsurance.
The basic benefits under Plans K and L provide for different cost sharing for items and services than Plans A through J:
- 100% of Part A hospitalization coinsurance plus coverage for 365 days after Medicare benefits end;
- Hospice cost sharing; (Plan K 50%; Plan L 75%)
- Medicare-eligible expenses for the first three pints of blood; (Plan K 50%, Plan L 75%); and
- Part B coinsurance, except for 100% coinsurance for Part B preventive services. (Plan K 50%, Plan L 75%)
Florida statutes call for all Medicare supplement policies to "contain a prominently displayed no-loss cancelation clause enabling the insured to return the policy within 30 days of the date of receipt of the policy, or the certificate issued thereunder, with return in full of any premium paid."
Florida law requires agents to ask every person solicited whether they are currently covered under any other contracts so they may explain the extent to which the proposed coverage will overlap or duplicate coverage. Before an application is taken, the Department of Financial Services requires that agents obtain a signed form from the applicant acknowledging that this information has been provided.
