Medicare Supplement Insurance
Medicare Supplemental Insurance Coverage is known as “Medigap” for short. The reason for this is that it’s designed to provide insurance coverage for the “gap” between what Medicare pays and what the costs of a recipient’s actual services are. This difference is created by two factors: First, there are some medical services that Medicare doesn’t pay for at all. Second, there are some medical services that Medicare only pays for in part. So, the Medicare beneficiaries that do not carry any type of Medigap coverage are left responsible for the difference between those two amounts themselves.
Some people do not take advantage of Medicare Supplement insurance coverage simply because they aren’t eligible to do so. There are certain requirements which must be met. For example, in order to enroll in Medigap coverage, a person must be enrolled in either part A or part B of Medicare. In addition, there are also some requirements surrounding the timing of one’s enrollment in a Medicare Supplement insurance plan. There are two open enrollment periods: within six months of turning sixty-five and within six months of enrolling in Medicare part B. During those periods, such a person would be able to enroll in a Medigap plan without a medical screening. Any other time, a medical screening would be required.
There are ten different types of Medicare Supplement Insurance, labeled A through N. Each of them has different specific benefits. In general, the higher the premium for any particular plan, the greater the level of benefits it offers; just as with any other type of insurance. Another thing these plans have in common with other types of insurance is the fact that they change slightly from state to state. Since they are offered by private companies instead of the federal government, different states have different laws to regulate these plans, which accounts for the variances.
Since the inception of Medicare part D, no new Medigap policies sold include any type of prescription drug coverage. So, if you are purchasing a new Medigap policy now, you need to be aware of this. If you purchased your Medigap policy prior to January 1 2006, then you could have a plan which still includes prescription drug coverage. People who have switched to a stand-alone Medicare part D plan had the option to switch to a different Medigap plan altogether if they enrolled in that part D plan prior to May 15th of that year. Now, that freedom is left to the discretion of the issuing company, but you should still be able to drop your prescription coverage.
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Frequently Asked Questions about Medicare Supplement Insurance
Medicare Supplement insurance, often referred to as Medigap insurance, is a private health insurance policy that helps pay some of the costs not covered by Medicare. It can help pay for deductibles and coinsurance when you receive medical care. In addition, with most Medigap policies, you will have part, or all your copayments waived if you receive covered services from a Medicare-participating doctor or other provider. Many Medigap policies also come with free preventive benefits and coverage for some annual screenings, such as mammograms.
Medicare does not pay for all your health care expenses. It helps pay for hospitalization, but it does not pay for most doctor services, surgery, or prescription drugs. Depending on which plan you are enrolled in (Part A and Part B), Medicare will cover either 80% or 100% of the following costs:
- Inpatient hospital care.
- Outpatient treatment.
- Skilled nursing facility care.
- Doctor services (such as the doctor's office visit);
- Prescription drugs.
- Durable medical equipment that is covered under Part B; and
- Preventive health screenings, such as mammograms or colonoscopies, if you are age 65 or over or have been diagnosed with cancer.
- What Medicare does not cover is called "medically necessary care." This means that the health care you receive must be proven to be needed. If it is determined by your doctor or health care provider to be medically unnecessary, Medicare may not pay for it. For example, if a doctor writes a prescription for a drug just because he or she prefers the brand name to generic, Medicare may deny payment for that prescription. In addition, if your doctor gives you a referral for a specialist of the same type as one you already see, even though it is medically necessary, Medicare will not pay for this cost.
Medicare's official website reads as follows: "If you are not yet 65, or have not already enrolled in Part B, you may enroll anytime between the eighth month before your 65th birthday and three months after that birthday by calling 1-800-MEDICARE (1-800-633-4227) or TTY call 1-877-486-2048."
Medicare Advantage plans are an option for people with Medicare. Each plan offers different benefits, so it's important to choose the plan that best fits your health needs and budget. These plans deliver all Part A and Part B benefits — in addition to prescription drug coverage — through private health plans approved by Medicare. Your Part A and B premiums are paid to Medicare, and the plan pays your Part B premium and some or all your Part D premium for you.
Anyone who is:
• Enrolled in Medicare Part A or enrolled in Part B for at least six months. • At least 65 years old and eligible for coverage under Medicare Parts A and B. • Not enrolled in a Medicare Advantage Plan that provides all the services covered by your supplement plan.
There are 10 standard Medigap policies available and a variety of additional options. These are the most common:
- Plan A: pays 100% of Medicare Part A hospitalization costs after you've paid the deductible amount.
- Plan B: pays 100% of Medicare Part A hospitalization costs for 60 days after you've paid the deductible amount.
- Plan C: pays 100% of Medicare Part A hospitalization costs for unlimited time if you do not require skilled nursing care at a rehab facility (if necessary, 24-hour supervision by medically trained personnel);
- Plan D: in addition to paying 100% of Medicare Part A hospitalization costs, it also covers up to 80% of skilled nursing facility care after you've paid the deductible amount.
- Plan F: in addition to paying 100% of Medicare Part A hospitalization costs and up to 80% of skilled nursing facility care after you've paid the deductible amount, it also pays for a variety of other services.
- Plan G: in addition to paying 100% of Medicare Part A hospitalization costs and up to 80% of skilled nursing facility care after you've paid the deductible amount, it also covers outpatient hospital charges for some procedures.
- Plan N: provides extra coverage if you enter a nursing home or other health institution; this policy is designed for those who are not eligible for Medicare's coverage of skilled care
- Plan P: covers up to 80% of the cost of eye exams, eyeglasses, and contact lenses after you've paid the deductible amount; it also helps pay for some other services not covered by Medicare Part B; and
- Plan R: a special Medigap plan available only in Massachusetts, pays 80% of the balance you owe after you've paid your Medicare Part A deductible amount.
Yes, although the earlier you sign up for a policy, the better. That's because if your health status improves during the enrollment period — six months before coverage begins and eight months after it starts — you won't be able to switch plans or get a refund of your premium.