Medicare Tips
When it comes to Medicare, we've been there, done that, now serving 47 tips in 8 categories ranging from Medicare to Medigap Insurance.
Medigap Supplemental Insurance: For Those Times When Medicare Stops
While Medicare is an excellent resource for the millions of Americans currently enrolled in the plans it offers, it simply doesn't cover every medical situation. People who are enrolled in Medicare Part A (which covers hospital services) and Medicare Part B(which covers non-emergency medical care such as doctor visits) plans may still find that they need additional coverage. That is where the Medigap supplemental insurance plans can be a valuable resource: It literally fills the "gaps" that standard Medicare plans do not cover. This may include hospital or doctor copayments, additional hospital benefits and expanded hospice care benefits.
There are 14 different Medigap supplemental insurance plans as of 2010, each with its own benefits and deductibles. Since the Medigap insurance is issued by a private insurer, enrolling in a Medigap plan is purely voluntary and will require a monthly payment. The payment for Medigap plans can vary widely, with the high deductible plans offering the lowest monthly premiums. While completing all the medicare forms can get overwhelming for many people, it is important to remember that enrolling in Medicare Part A and Medicare Part B is essential before you enroll in any of the Medigap supplemental insurance plans. People who are enrolled in the Medicare Advantage plan, also known as Medicare Part C, are not eligible for Medigap supplemental insurance.
Determining Your Medigap Premium
For many, age 65 means taking advantage of Medicare open enrollment. Medicare offers people 65 or older who are U.S. citizens low cost health coverage. In many cases those under 65 who are disabled or have renal failure may also qualify. In addition to Medicare, many people consider additional coverage called Medigap.
Designed by the government as supplemental health insurance that covers the costs that Medicare does not cover, a Medigap premium is payable for each person that is enrolled in Medicare Part A or part B. This type of policy only covers the primary insured person, so spouses or each person must have their own individual Medigap policy.
Medigap insurance is broken down into several categories and the Medigap premium will differ from policy to policy. All policies offer co-insurance for hospital visits and all plans except Medigap Plans K and L will offer co-insurance for Medicare Part B such as doctor's visits and diagnostics. Plans K and L are designed for a lower monthly Medigap premium and coverage for Medicare Part B, blood products, and hospital deductibles are only covered at 50% for K and 75% for L.
Medigap Plans F and J are also policies that may offer lower premiums, but the deductible for these policies may be as much as $2000. All Medigap policies cover preventive care and some even cover care outside the US or include an at home recovery benefit.
All Medigap Plans have been standardized by the federal government. While many companies offer Medigap insurance, these companies can also choose what Medigap Plan they want to or don't want to sell. The Medigap premium will vary depending on the Plan chosen and the geographic region the policy is purchased in.
Medigap Insurance
Many people age 65 or older are eligible for Medicare coverage. Whether they have Medicare Part A or Part B another type of supplemental health insurance they should give consideration to is Medigap insurance coverage.
Medigap insurance is coverage that is defined by the federal government, but sold by third party insurers. Medigap insurance is broken down into several plans labeled Plan A through Plan N. The correct medicare forms to be used for this type of insurance can be found through the Social Security Administration, Medicare, or any approved Medigap insurer.
Of the Medigap insurance plans in place, the cost for each will vary by geographic region and unlike other health insurance policies that cover a spouse or loved one, each insured person must obtain and pay the premiums for a separate Medigap insurance policy. Medigap is supplemental coverage to Medicare, so to qualify to purchase this type of policy, the insured must first be enrolled in Medicare Part A or Part B.
A recent change to Medigap insurance involves prescription drug benefits. If you already have a Medigap policy that covers prescription drugs, you may keep it, but Medicare recommends that all Medigap drug policies be cancelled and switched for a Medicare Part D prescription drug plan. Most Medigap prescription drug plans are not creditable.
All new Medigap plans will no longer offer prescription drug coverage and insured people who have Medigap drug coverage and switch to Medicare Part D will have the Medigap drug coverage discontinued and their premiums adjusted to show that.
Medigap should be considered by all who are eligible because though Medicare offers good coverage for those over 65, it does not cover everything and could leave the patient with substantial bills to pay if an illness strikes.
Purchasing Medigap Supplemental Health Insurance
Medigap supplemental insurance covers out-of-pocket expenses that Medicare does not cover. It is supplemental insurance purchased from private insurance companies.
* The best time to purchase Medigap insurance is during your Medicare open enrollment period, which begins on the first day of the month when you turn 65 years of age.
* Shop around. Because different private insurance companies charge different amount for Medigap insurance policy plans, it is important to compare available plans and coverage before deciding on one that meets your needs. There are ten plans, named A through J -- each plan has different benefits and coverage, so do your homework before or during your Medicare open enrollment period.
* Consider joining Medicare Prescription Plan (Part D). Medigap supplemental insurance does not cover prescription drug coverage, so you'll need to obtain medication coverage elsewhere.
* Medicare Part A and Medicare Part B are required to purchase a Medigap policy.
* Hospice Part A coinsurance is now covered under Medigap supplemental insurance policies.
* Medicap policies only cover one person. If you are married, you and your spouse BOTH have to purchase Medigap policies if you both want supplemental coverage. Medigap policies don't cover nursing home care (long-term care), dental, vision, eyeglasses or hearing aids. Private-duty nursing is also not covered.
* Medicare Advantage Plans (i.e. Part C), Private Fee-for-Service Plan, Medicare Prescription Drug Plans (i.e. Part D), Medicaid, Veterans Benefits, long-term care policies, employer or union plans are not Medigap Plans.
For more information about Medigap supplemental insurance, refer to the 64 page government-sponsored brochure titled Choosing A Medigap Policy: A Guide To Health Insurance For People With Medicare by visiting http://my.medicare.gov or by calling 800-633-4227.
Considering the Need for Medigap Premiums and Policies
Seniors evaluating health insurance coverage options should be sure to consider the addition of Medigap premium costs and coverage policies to their health coverage mix. Medigap policies are sold by private companies and provide coverage to fill the gaps found in traditional Medicare coverage. Medicare policies do not necessarily cover all of one's health care costs, so many seniors opt to pay Medigap premiums to enhance their coverage and reduce unexpected out-of-pocket expenses.
While Medigap policies are sold by private companies, they are standardized with specific benefits, so they should be easy to compare between companies. There are 12 different Medigap coverage policies, named Medigap Plans A through L, which provide slightly different levels of coverage from plan to plan. The Medigap premium for each plan will differ from company to company, so it is important to consider and compare multiple companies to ensure the plan you choose is the best possible fit for your needs.
While a Medigap policy is not required coverage, many seniors feel the cost of a Medigap premium is a minor expense that is worth having in place. Navigating the path of Medicare plans and coverage can be confusing, and there are numerous costs and procedures that are not covered by a basic Medicare plan. This is where the health insurance coverage provided by a Medigap policy can provide both a helpful financial safety net and significant peace of mind.
Medigap Insurance Options Tips for Medicare Patients
The original Medicare plan does not cover all health care services needed by the typical American. While it does pay for many expenses, you are responsible for the unpaid bills for the services that are not covered by Medicare.
This is where a Medigap insurance policy comes in handy. Available for sale by private insurance companies, a Medigap insurance policy can help absorb the expensive health care bills that you are responsible to pay.
The name Medigap derives from the fact that it pays the gap of unpaid costs not covered by the Original Medicare plan, such as co-payments, coinsurance and deductibles.
Each and every Medigap insurance policy is governed by Federal and state laws that must be followed. Each policy must be clearly identified as “Medicare Supplement Insurance.” Medigap insurance companies are further regulated and can sell you only a standardized Medigap policy. The plans vary by benefits and so you are able to choose the Medigap insurance policy that best meets your needs.
In addition, a good Medigap insurance plan to secure is a policy that also offers coverage for services that Original Medicare doesn't cover. Most folks may not be aware that medical care when you travel outside the U.S. is not provided with the Original Medicare plan, so this is an option you would certainly want in a Medigap policy.
One additional note; you are responsible for the premiums for the Medigap insurance policy and no part of these premiums is covered under any Medicare plan.
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| Tammi Reynolds |
