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Blue Shield Medi Gap

Plans at a Glance
rev 7.2021

Blue Shield Medi Gap Plans at a Glance

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blue shield medi gap enrollment kit

A Medigap policy is private health insurance that helps supplement Original Medicare. This means it helps pay some of the health care costs that Original Medicare doesn’t cover (like copayments, coinsurance, and deductibles). These are “gaps” in Medicare coverage.

If you have Original Medicare and a Medigap policy, Medicare will pay its share of the Medicare-approved amounts for covered health care costs. Then your Medigap policy pays its share.   A Medigap policy is different from a Medicare Advantage Plans – Part C  (like an HMO or PPO) because those plans are ways to get Medicare benefits, (here’s a comparison of the differences) while a Medigap policy only supplements the costs of your Original Medicare benefits. Medicare.Gov Guide to Medigap *

Medicare Part A
(#Hospital Insurance)

Medicare Part A Hospital coverage helps pay for care in hospitals as an inpatient,... skilled nursing facilities, hospice care, and some home health care (see publication # 10969) but not Long Term Care.  

Most people get Part A automatically when they turn age 65 at no charge, since they or a spouse paid Medicare taxes while they were working.  You need to sign up close to your 65th birthday, even if you will not be retired by that time. (If you are getting Social Security benefits when you turn 65, your Medicare Hospital Benefits - Part A - start automatically.) 

Here's a chart it's just a illustration and is NOT official  that shows what Medicare pays, the gaps in Medicare and what you may get when you add a Medi Gap Plan or Medicare Advantage to cover those gaps.

Medi Gap what medicare pays

See 2022 Updates 

Medi Gap – Supplement Plans 

Part B (Medical #Insurance)

Part B - Outpatient helps Pay For Doctors' services, outpatient hospital care, and some other medical services that Part A does not cover, such as the services of physical and occupational therapists, and some home health care see publication 10969, but not Long Term Care. Part B helps pay for these covered services and supplies when they are medically necessary.

The chart below is a very brief summary.  Check the actual Evidence of Coverage for the plan you want to enroll in, Medicare & You or actual Medicare documents.

Part B out of hospital

See 2022 Updates

Our Webpages with more detail:

Medi Gap A - N #Chart
Rev. 7.2021
Click link or image to enlarge

Plan A - N chart a - n chart

 

NAIC Draft Chart for 2020

What is a better choice for Me?

Evidence of Coverage

2022 Open Plans

Plan A (PDF, 231 KB)
Plan F Extra* (PDF, 292 KB)
Plan G (PDF, 237 KB)
Plan G Extra (PDF, 294 KB)
Plan G Inspire (PDF, 287 KB)
Plan N (PDF, 240 KB)

<<<<<<<<<<<<<<<<<Historical>>>>>>>>>>>>>>>>>>>>>>

 

Plan A, Jan. 2018 (PDF)
Plan F Extra, Oct. 2018  (PDF)
Plan G, Jan. 2018 (PDF)

Plan G Extra, Jan. 2020 (PDF)
Plan N, Jan. 2018 (PDF)

(Email us if the links require a password) 

Evidences of Coverage for 2010 Standardized Closed Plans (closed 9/30/2019)

Plan C, Jan. 2018 (PDF)
Plan D, Jan. 2018 (PDF)
Plan F, Jan. 2018  (PDF)
High Deductible Plan F, Jan. 2019 (PDF)
Plan K, Jan. 2019 (PDF)

Evidences of Coverage for Standardized and Pre-Standardized Closed Plans (closed prior to 5/31/2010)

Get complete descriptions of our closed Medicare Supplement plans.

Plan A (pre June 2010) (PDF)
Plan B (pre June 2010) (PDF)
Plan C (pre June 2010) (PDF)
Plan D (pre June 2010) (PDF)
Plan F (pre June 2010)  (PDF)
Plan G (pre June 2010)  (PDF)
Plan J (pre June 2010)  (PDF)
Plan K (pre June 2010)  (PDF)
Plan H Standard  (PDF)
Plan H Plus Rx  (PDF)
Plan I Standard (PDF)
Plan I Plus Rx (PDF)
Coronet Major Medicare (PDF)
Coronet Senior Standard  (PDF)
Coronet Senior Plus Rx  (PDF)
Golden Coronet Senior Standard  (PDF)
Golden Coronet Senior Plus Rx  (PDF)
Preferred Senior  (PDF)

Closed plan rate sheets 

2010 Standardized Closed Plans (closed 5/31/2010) (PDF)
1990 Standardized Closed Plans (closed 5/31/2010) (PDF)
1990 Standardized Closed Plans (closed 12/31/2005) (PDF)

Blue Shield Videos On Medicare 

you tube videos

“Medicare Enlightenment” video series out now!

Child & Related Pages – Site Map 

How does Medi Gap Plan Hi F pay for Hospital Care, Long Term #Acute Hospital, Skilled Nursing, Home Health Care

What happens if you go over 90 days? How do 60 lifetime reserve days work? How do 365 additional from Medi Gap work?

 

 

hi f part a hospital

Email us [email protected] for Source Brochure

skilled nursing hi f

References, Links & Bibliography 

  • Coverage
  • Definitions 
  • Benefit Period
    • CMS on Benefits Periods Official Detailed Manual
    • Medicare Rights.org
    • Medicare Interactive 
      • Benefit periods measure your use of inpatient hospital and skilled nursing facility (SNF) services. A benefit period begins the day you are admitted to a hospital as an inpatient, or to a SNF, and ends the day you have been out of the hospital or SNF for 60 days in a row. After you meet your deductible, Original Medicare pays in full for days 1 to 60 that you are in a hospital. For days 61-90, you pay a daily coinsurance.

        If you have used your 90 days of hospital coverage but need to stay longer, Medicare covers up to 60 additional lifetime reserve days, for which you will pay a daily coinsurance. These days are nonrenewable, meaning you will not get them back when you become eligible for another benefit period.

        Medicare will stop paying for your inpatient-related hospital costs (such as room and board) if you run out of days during your benefit period. To be eligible for a new benefit period, and additional days of inpatient coverage, you must remain out of the hospital or SNF for 60 days in a row. When you start a new benefit period, you will also have a new Part A deductible.

        Note: Medigap policies A through N pay for your hospital coinsurance and provide up to an additional 365 lifetime reserve days. Additionally, Plans B through N pay some or all of your hospital deductible. Medicare Interactive 

  • Skilled Nursing over 100 days
  • Lifetime Reserve Days
    • Medicare Interactive from Medicare
    • Additional 365 from Medi Gap – EOC Page 4 II A 1 c 
      • c) Upon exhaustion of the Medicare hospital inpatient coverage including the sixty (60) lifetime reserve days, coverage for the Medicare Part A Eligible Expenses for hospitalization will be paid at the appropriate standard of payment which has been approved by Medicare, subject to a lifetime maximum benefit of an additional 365 days (except that psychiatric care in a psychiatric hospital participating in the Medicare program is limited to 190 days during the Subscriber’s lifetime);
      • CA Insurance Code (b) With respect to the standards for basic (core) benefits for benefit plans A to J, inclusive, every issuer shall make available a policy or certificate including only the following basic “core” package of benefits to each prospective insured. An issuer may make available to prospective insureds any of the other Medicare supplement insurance benefit plans in addition to the basic core package, but not in lieu of it. However, the benefits described in paragraphs (6) and (7) shall not be offered so long as California is required to disallow these benefits for Medicare beneficiaries by the Centers for Medicare and Medicaid Services or other agent of the federal government under Section 1395ss of Title 42 of the United States Code.

        • (1) Coverage of Part A Medicare eligible expenses for hospitalization to the extent not covered by Medicare from the 61st day to the 90th day, inclusive, in any Medicare benefit period.

          (2) Coverage of Part A Medicare eligible expenses incurred for hospitalization to the extent not covered by Medicare for each Medicare lifetime inpatient reserve day used.

          (3) Upon exhaustion of the Medicare hospital inpatient coverage including the lifetime reserve days, coverage of 100 percent of the Medicare Part A eligible expenses for hospitalization paid at the appropriate Medicare standard of payment, subject to a lifetime maximum benefit of an additional 365 days. The provider shall accept the issuer’s payment as payment in full and may not bill the insured for any balance.

      • (c) The following additional benefits shall be included in Medicare supplement benefit plans B to J, inclusive, only as provided by Section 10192.9.
        • (2) With respect to skilled nursing facility care, coverage for the actual billed charges up to the coinsurance amount from the 21st day to the 100th day, inclusive, in a Medicare benefit period for post hospital skilled nursing facility care eligible under Medicare Part A. CA Insurance Code 10192.8 b 

  • Law & Legal Codes

20 comments on “Blue Shield – Medi-Gap – Any Medicare Provider

  1. 4 comments on “FAQ’s non conical”

    1. Anonymous says:

      I think it’s fairly simple — if you want the most coverage, you get A, B, D + F.. Am I correct?

      • Depends what you mean by “most.” Part A covers hospital. Part B doctor visits. Learn More Part D covers outpatient prescriptions, rx. Plan F pays the co pays and deductibles in A & B. See the comparison below and note that the standard F doesn’t have the $2,240 deductible.

        Some would say “most” might be a Medicare Advantage plan, in that the premiums are usually nil. One downside is the limited HMO doctor list Medicare Advantage MAPD may also cover vision and dental. Check our Medicare Advantage pages to learn more. Here’s our page on comparing Medi Gap vs MAPD. Medi Gap though gives you MUCH more freedom of choice of doctors.

    2. Anonymous says:

      I’m thinking of getting Hi F, with the $2,240 deductible. How do I know if that’s the right plan for me?

      • We’ve discussed similar questions here.

        There is no FREE LUNCH when you buy Insurance. The Insurance Companies are in business to make a profit. Either way, the Insurance Company has calculated that they will pay out 80 cents on each dollar of premium they take in.

        Check out the sample rates below from the Blue Shield Medi Gap Brochure

        Does saving around $120/month or $1,400/year make it worth it to get back $2,200 if you have that many claims? Why not get Long Term Care, where the stakes are higher and there is the potential for real loss and hardship. The difference between F and Hi F is $800. I don’t think that will bankrupt anyone.

        Rate Chart

  2. I have Medi Gap Plan F Extra and Blue Shield Rx Plus for Part D

    I don’t know if I should keep what I have or if there are better options.

  3. I’m having medically necessary treatment for varicose veins.

    How much would Medicare pay?

    How much would a Medi Gap plan pay?

  4. Do you know if there will be any increases on our current Blue Shield supplemental plan [Hi F] next year?

  5. I have Plan N and would like to get an Issue Age plan, rather than having the rates go up every year, based on attained age. Are those plans available in CA?

    • Please review our webpage above and our webpage on Plan F Extra. The main difference in Extra or Innovative is the Hearing Aids, Vision, Teledoc, Over the Counter Medications and Help, I can’t get up. See the link above for the summary of benefits for more detail.

      Right now, Blue Shield is having a “special” and you can get into their Extra Plans, from any other Medi Gap carrier. Email us for details.

      Next year, under the Birthday rule, Extra and Innovative will be considered the same and not better. So, one would be able to switch.

      (M) New or innovative benefits, as described in subdivision (f) of Section 1358.9 and subdivision (f) of Section 1358.91, shall not be included when determining whether benefits are equal to or lesser than those provided by the previous coverage.

      Why are Medi Gap companies offered more benefits?

      One reason is a new buzz word, Social Determinants of Health. Click on the link and check it out.

  6. My wife is disabled with a brain tumor. She has plan High F. She collects SSDI and qualified for Medicare after two years of disability. She is also on Medi Cal.

    We currently pay $412.30 for Part F and the Duo Package (dental and vision), plus $86.40 for the PDP.

    Any suggestions?

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