Ask the Expert

September 2005

Two New Medigap Plans Here’s a guide to what Plans K and L have to offer.

Medicare usually covers only about half of the medical costs of America ’s senior citizens. For most people, that’s just not enough security; they don’t want giant medical bills looming over them. So they look for plans that supplement Medicare coverage. Some can get coverage through their school district, or, if they are married, through their spouse’s employer. But many people buy so-called “Medigap” plans to fill in the holes in Medicare.

Today, there are 10 such plans, Medigap Plans A through J. Starting January 1, there will be two new ones, Medigap K and L. (If you bought your Medigap policy before 1992 or live in Massachusetts, Minnesota, or Wisconsin, your Medigap policy may be called something else.)

The good news: These plans will have lower monthly premiums. The bad news: Some co-payments will be higher. So you need to judge whether the lower premiums are worth the extra risk.

Here’s an overview:

What are the Out-of-Pocket Annual Limits?

Plan K has a $4,000 out-of-pocket annual limit. For Plan L, it’s $2,000.   Once you meet the annual limit, the plan pays 100 percent of the Medicare Part A and Part B co-payments and coinsurance for the rest of the calendar year. 

But those limits don’t apply to any money you spend on the Medicare Part B deductible, which is not covered under either Plan K or L.

In addition, charges from your doctor that exceed Medicare-approved amounts, called “excess charges,” are not covered and do not count toward the out-of-pocket limit—you will have to pay these excess charges. 

What about the NEA Medicare Supplement Insurance Program?

The new Medigap Plans K and L will be available to members through the NEA MemberCare Medicare Supplement Program  beginning January 1, 2006.

—Doug Terwilliger, NEA Member Benefits

More Help

There’s no way to make the new Medigap plans simple, but some Web sites are making an excellent effort to explain your choices clearly. Try these:

• U.S. Department of Health and Human Services,  which runs Medicare.
• The Center for Medicare Advocacy, a non-partisan organization that represents people who are having problems with Medicare and is also involved in efforts to improve Medicarecoverage. This site links to adiscussion group where you can ask a question or post a comment.
• The Medicare Rights Center, which helps people find out what they need to know about this complex system. There’s also a list of hotline phone numbers you can call in each state to learn more.
• The Kaiser Family Foundation offers information about Medigap, Medicare, andprescription drug coverage.