PDF Supplementing Medicare

Consumer Guide to

Medicare

Supplement

Insurance (Medigap)

2023

STATE OF ALASKA

Mike Dunleavy, Governor

Department of Commerce, Community,

and Economic Development

Julie Sande, Commissioner

Division of Insurance

Lori Wing Heier, Director

Life and Health Section

Sharon Comstock, Insurance Specialist

Jeanne Murray, Insurance Specialist

Department of Health

Heidi Hedberg, Commissioner

Senior and Disabilities Services

Anthony Newman, Director

Medicare Information Office

Dana Norwood, Program Coordinator

In This Guide

MEDICARE

Medicare Basics ......................................................................................... 4

Medicare Benefit Chart 2023 ...................................................................... 5

MEDICARE SUPPLEMENT INSURANCE

Ten Standard Supplement Plans ................................................................ 8

Open Enrollment; Pre-Existing Conditions; & Guarantee Issue................... 9

Standard Plan Benefits

Basic Benefits ................................................................................. 10

Part A ¨C Hospital

Part A ¨C Hospice

Part B ¨C Medical Expenses

Part A & B ¨C Blood

Additional Benefits ........................................................................... 12

Skilled Nursing Facility Coinsurance

Part A Deductible

Part B Deductible

Part B Excess Charges

Foreign Travel Emergency

Out-of-Pocket Annual Limit

SHOPPING GUIDE

Price Comparison ............................................................................ 15

Service ............................................................................................ 15

Availability........................................................................................ 16

Important Tips .................................................................................. 16

Shopping Notes Worksheet ............................................................ 18

Alternatives To Medicare Supplement Insurance ...................................... 19

Employer Health Insurance

ACHIA

Medicare Savings Program

Medicaid

Preventing Medicare Fraud ....................................................................... 21

ALASKAN RATE CHARTS

Reading the Charts ................................................................................... 23

Rate Charts ......................................................................................... 25-36

APPENDIX A: Guarantee Issue Without Open Enrollment........................ 37

Additional Help, Complaints, Resources & Information ............................. 39

Page 2

Introduction

Welcome to Alaska¡¯s 2023 Guide to Medicare Supplement Insurance for policies which

were effective June 1, 2010, and later. It was developed collaboratively by the

Department of Health and the Alaska Division of Insurance to assist Medicare

beneficiaries, their caregivers, and families.

Within the Guide you will find:

?

?

?

?

MEDICARE an overview

MEDICARE SUPPLEMENT INSURANCE an overview

SHOPPING GUIDE

ALASKAN RATE CHARTS

The Medicare Information Office provides unbiased

authoritative counseling and outreach on the

Medicare program, Medicare Supplement Plans, and

Prescription Drug Plans and is the State Health

Insurance Program (SHIP). It is located within Senior

and Disabilities Services of the Alaska Department of Health and is available by telephone

and in-person to assist Medicare recipients, family, or providers with questions about

Medicare. The toll-free helpline is 1-800-478-6065 or in Anchorage (907) 269-3680. The

Medicare Information Office also includes the Senior Medicare Patrol (SMP) which

empowers seniors to prevent healthcare fraud.

To obtain a paper copy of this guide contact the Division of Insurance consumer services

section toll free at 1-800-INSUR AK (1-800-467-8725) or in Anchorage at (907) 269-7900.

This guide is intended for use as a reference with, and in addition to, the publication ¡°2023

Guide to Choosing a Medigap Policy¡± which can be found online at

and is available by contacting Medicare at 1-800-MEDICARE

(1-800-633-4227).

The Centers for Medicare and Medicaid Services (CMS) is the federal agency within the

U.S. Department of Health and Human Services which administers Medicare. See

for valuable information on Medicare and the handbook

¡°Medicare & You¡± that gives detailed information on Medicare benefits, rights, and

obligations.¡±

Page 3

MEDICARE

Medicare Basics

Medicare is a federal health insurance program available to the following specific groups:

? People who are age 65 and older

? Those under age 65 who have been on Social Security disability for 24 months (no

wait is required if diagnosed with ALS or Lou Gehrig¡¯s disease).

? Those who have end-stage renal disease (permanent kidney failure).

As shown below, Medicare is made up of Part A and Part B. Most people get Medicare

Part A free. Everyone pays a monthly premium for Medicare Part B (see page 6).

Approval of covered services for Medicare benefits is usually based on what is medically

necessary. The amounts paid for covered services are based on payment schedules

set by Medicare. Under Part A, the health care providers are not allowed to charge more

than what Medicare approves. Part B does allow ¡°excess charges¡± for some services.

The maximum excess charge allowed for most services is 15% more than Medicare's

approved amount.

Medicare pays most of

the health care costs,

but significant gaps can

leave large bills to pay.

The Medicare Benefit Chart on the next page shows Medicare's benefits and the

amounts for which you are responsible.

Page 4

Medicare Benefit Chart 2023

Part A Hospital Insurance - Covered Services

Hospital deductibles and coinsurance amounts change each year.

*Part A Deductible amount is $1,600 for 2023 per benefit period

Hospitalization

First 60 days

Semiprivate room,

61st to 90th day

general nursing,

91st to 150th day

mental health inpatient (Lifetime Reserve Days)

stay, misc. services

Beyond 150 days

All but $1,600*

All but $400 per day

All but $800 per day

You Pay

(Other insurance may

pay all or part)

$1,600*

$400 per day

$800 per day

Nothing

All-charges

Skilled Nursing

Facility Care

First 20 days

21st to 100th day

Beyond 100 days

100% of approved

All but $200 per day

Nothing

Nothing if approved

$200 per day

All costs

Part-time care

100% of approved

Nothing if approved

As long as doctor

certifies need

Blood

All but limited costs for

drugs and respite care

All but first 3 pints

Limited costs for

drugs and respite care

First 3 pints

Services

Home Health Care

Medically necessary

skilled care, therapy

Hospice Care

for the terminally ill

Blood

Benefit

Medicare Pays

Part B - Medical Insurance - Covered Services

**Part B Deductible is $226 for 2023. This single deductible covers all Part B Services.

You Pay

Services

Benefit

Medicare Pays

(Other insurance may

pay all or part)

Medical Expense

Medical services

80% of approved (after 20% of approved

Physician services

in and out of the

$226 deductible**)

(after $226

and medical supplies

hospital

deductible**) plus

excess charges

Outpatient Hospital

Unlimited if

Amount based on a fee Coinsurance or

Treatment

medically

schedule (after $226

copayment amount

necessary

deductible**)

varies according to

the service (after $226

deductible**)

Clinical Laboratory

Diagnostic tests

100% of approved

Nothing if approved

Home Health Care

Part-time care

100% of approved

Nothing if approved

Medically necessary

skilled care, therapy

Durable Medical

Prescribed by Dr. 80% of approved (after 20% of approved

Equipment (DME)

for use in home

$226 deductible**)

(after $226

deductible**) plus

excess charges

Blood

Blood

All but first 3 pints

First 3 pints

Page 5

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