Medicare was created because people over 65 found it virtually impossible to get private health insurance coverage. Medicare has made access to health care a universal right for Americans once they reach age 65.
Original Medicare, Parts A & B, pays for many of the basic health-care services and supplies, it does not pay for everything and has substantial deductibles. That’s why you should consider getting a Medicare Supplement insurance policy, also called Medigap. A Medicare Supplement insurance policy is sold by private insurance companies. These plans help pay for specialists, hospital and medical costs that Original Medicare doesn’t cover. Copayments, coinsurance, and yearly deductibles depending on the plan helps pay for these expenses. Some Medicare Supplement insurance policies also help pay for services that Original Medicare doesn’t cover (specialists). That is why it is called a Medigap policy, it fills in the “gaps” of Original Medicare coverage.
How do Medicare Supplement insurance policies work with Medicare?
Medicare Supplement insurance policies supplement your Original Medicare benefits. Your Original Medicare will pay the claims first, as your primary insurance, your Medicare Supplement insurance policy will fill in the cost gaps. For example, suppose you have a $5,000 expense (specialist, ambulance) and have not yet met the yearly Medicare deductible. Medicare will pay 80% of your bill, minus the deductible amount. The Medicare Supplement insurance policy would then pay your remaining 20% coinsurance of your $5,000 bill. Some Medicare Supplement insurance policies also pay the remainder of the Medicare Part B deductibles you still owe.
Plans that don’t supplement Medicare coverage (aren’t Medicare Supplement insurance /Medigap policies)
It’s important to be aware of which plans are not supplements to your Original Medicare:
• Medicare Advantage plans (like an HMO or PPO)
• Medicare prescription drug plans (Part D)
• Employer’s or union’s plans
• Veterans’ benefits
• Long-term care insurance policies
What benefits do Medicare Supplement insurance policies cover?
Currently, there are 10 standardized Medicare Supplement insurance plans, each represented by a letter (A, B, C, D, F, G, K, L, M, N; there’s also a high-deductible Plan F). These are sold in most states (Massachusetts, Minnesota, and Wisconsin each have their own different set of Medicare supplement plans). Coverage levels and premiums vary, but the benefits of each plan within a lettered category remain the same despite the insurance company or location. For example, Plan A benefits are the same in New Jersey as they are in Oregon.
In most cases, Medicare Supplement insurance policies cover the following benefits:
• Medicare Part A coinsurance and hospital costs (up to an additional 365 days after Medicare benefits are used)
• Medicare Part B coinsurance or copayment*
• Blood (first 3 pints)*
• Part A hospice care coinsurance or copayment*
(*Coverage may be partial for some plans.)
Some types of Medicare Supplement insurance policies also cover:
• Skilled nursing facility care coinsurance
• Medicare Part A deductible
• Medicare Part B deductible
• Medicare Part B excess charges
• Foreign travel emergency
For a quick look at the benefits provided by the standardized Medigap policies, please view this Medicare Supplement insurance Plan Benefits A & B Chart.
What benefits are not covered by Medicare Supplement insurance policies?
Medicare Supplement insurance policies don’t cover the following health services and supplies:
• Long-term care (care in a nursing home)
• Vision or dental care
• Hearing aids
• Private-duty nursing
Additional facts about Medicare Supplement insurance policies
• You must have Medicare Part A and Part B to get a Medicare Supplement insurance policy.
• Every Medigap policy must be clearly identified as “Medicare Supplement Insurance.”
• A Medicare Supplement insurance policy can only cover one person, if you are married, you and your spouse would need to buy separate policies.
• Not all types of Medicare Supplement insurance policies may be available in your state.
Now that you know more about the Medicare plans, you may be questioning; which one of these plans is right for you. As a senior with Pre-Existing conditions (50+ years) I always enjoy helping people find the plan that is right for them. If you would like to get more information via this website use the links above. If you prefer to speak with a human; call or email me to schedule a telephone appointment. To take a look at a chart with all available Medicare Supplement insurance plans right (click here).
Call (866) 374-0002 or contact us to schedule an online or in-person consultation.
- Due to many Insurance Companies selling Medigap and Advantage policies we are unable to advise until we are aware of your needs.