Tuesday, February 27, 2024

What Does Supplemental Medicare Cover

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What is Medigap? (Medicare Supplement Insurance Explained)

This can be a more complicated situation. If youre on Medicare and Medicaid you can always go to any doctor that accepts Original Medicare. The best practice when dealing with Medicare and Medicaid is to make sure the provider takes both Medicare and Medicaid. This way the Medicaid plan will pay your portion of the bill.

How Do Medicare Supplement Insurance Plans Work With Medicare Advantage Plans And Other Plans

Medicare Supplement insurance plans only pay for gaps in coverage in Original Medicare, and not Medicare Advantage plans , stand-alone Medicare Prescription Drug Plans, employer/union group health coverage, Medicaid, or TRICARE . In fact, itâs illegal for an insurance company to sell you a Medicare Supplement insurance plan if you already have a Medicare Advantage plan or Medicaid unless that coverage is ending.

You can only buy a Medicare Supplement insurance plan when youâre in a Medicare Advantage plan if your coverage under the Medicare Advantage plan will end before the effective date of the Medicare Supplement insurance plan.

What Do These Policies Cover

Heres a link to the benefits each type of supplemental insurance provides. As you can see, most of them only cover Medicare deductibles and co-insurance nothing more. Unless otherwise stated in the policy, it will not cover any service not approved by Medicare. These policies also will not pay any healthcare provider a penny more than the amount Medicare approves for a service. That means that a health care provider who sees a patient who has a supplemental plan gets paid the exact same amount as he would from a patient who only has Medicare.

When you buy insurance, any insurance, its purpose is to cover you for unexpected costs you could never cover yourself. You buy homeowners insurance to cover damage done by a fire or a storm or water damage done by a broken pipe. No one buys a homeowners policy that covers utilities or routine maintenance. Most people who own a house are used to paying for the cost of painting it. Homeowners expect to pay for the cost of replacing their roof every 20 years as well, even though the cost of a new roof on most houses would actually exceed the cost a Medicare patient would pay for the treatment for most cancers.

We also dont use our car insurance to fill our gas tank, change the oil or pay for a transmission overhaul. Again, the cost of overhauling your cars transmission is probably more than what you would pay for a major surgery if you have Medicare.

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What Is Medicare Supplement Open Enrollment

Medicare Supplement open enrollment begins the first month youre insured by Medicare Part B and at least 65 years old. In some cases, younger people may qualify if they have certain disabilities. This open enrollment period lasts six months, during which you may purchase any Medicare Supplement plan available in your state. After this initial Medicare Supplement open enrollment period ends, you may not be able to purchase a Medicare Supplement plan, and if you are, it may be more expensive based on your health status.

Can You Switch Yes But Theres A Catch

Medicare Supplemental Health Insurance

Its logical to consider enjoying the cost savings of a Medicare Advantage plan while youre relatively healthy, and then switching back to regular Medicare if you develop a condition you want to be treated at an out-of-town facility. In fact, switching between the two forms of Medicare is an option for everyone during the open enrollment period. This Annual Election Period runs from October 15 to December 7 each year.

Heres the catch. If you switch back to regular Medicare , you may not be able to sign up for a Medigap insurance policy. When you first sign up for Medicare Part A and Part B, Medigap insurance companies are generally obligated to sell you a policy, regardless of your medical condition. But in subsequent years they may have the right to charge you extra due to your age and preexisting conditions, or not to sell you a policy at all if you have serious medical problems.

Some states have enacted laws to address this. In New York and Connecticut, for example, Medigap insurance plans are guaranteed-issue year-round, while California, Massachusetts, Maine, Missouri, and Oregon have all set aside annual periods in which switching is allowed. If you live in a state that doesn’t have this protection, planning to switch between the systems depending on your health condition is a risky business.

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Doctors Near Me That Accept Medicare

You can easily compare doctors now with the Care Compare Tool. The tool allows you to personalize results for doctors and hospitals in your area. Also, the tool is available on smartphones and tablets. The Care Compare Tool can give you things like contact information, quality ratings, and directions to healthcare facilities. Further, this tool can give you information on nursing homes, hospice, dialysis centers, rehab care, and Long-Term care facilities.

Find Medicare Plans in 3 Easy Steps

We can help find the right Medicare plans for you today

How Do You Enroll In Medicare Supplement

In order to enroll in a Medicare Supplement plan, you must first enroll in Medicare Parts A and B. If you only sign up for Medicare Part A when you turn 65, usually because you or your spouse are still working, then you will need to contact the Social Security Administration to enroll in Part B.

Once you are enrolled in Medicare Parts A and B, you can enroll in a Medicare Supplement plan. Its important to know that in the first six months of Medicare Part B enrollment, you can purchase a Medicare Supplement plan and not have to worry about preexisting conditions or being accepted. This is called the guaranteed issue right period. Any insurance provider must accept your application.

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When To Sign Up For Medicare

As you approach age 65, its important to know which enrollment deadlines apply to your circumstances. Begin by checking on your eligibility. To avoid costly penalties and gaps in coverage, most people should for Medicare Part A and Part B in the seven-month window that starts three months before the month you turn 65 and runs for another three months following your 65th birthday.

If you currently get Social Security, you will be automatically enrolled if not, you need to sign up either online or at your Social Security office.

What Does A Medicare Supplement Policy Cover

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Whenever you purchase your Medicare plan, you hear about many different packages like Medigap, Medicaid, Medicare Advantage plans, etc. Initially, many people may ignore these fancy names and focus on getting the original Medicare. However, these fancy names may act as a Medicare supplement policy that can cover a range of items. WonderingWhat Does a Medicare Supplement Policy Cover? Lets have a look at it.

Medicare supplement policies may fill the gaps between the original Medicare and help you cover the additional cost that Original Medicare doesnt cover. You might say that isnt the original plan? Well, it depends on your preferences. If you have to visit the doctor daily due to a terminal illness, a supplement policy might be vital for you.

Without any further ado, lets see what a Medicare supplement policy is.

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Which Companies Sell Medicare Supplement Insurance In Indiana

Companies must be approved by IDOI in order to sell Medicare Supplement policies. All of the companies listed below have been approved by the state. The plans are labeled with a letter, A through J. Not all companies sell all ten plans. Following each company name and phone number, we have listed the Medicare Supplement plans sold by that company based on the following categories:

  • Medicare Supplements for Persons 65 and Older
  • Medicare Supplements for Persons Under 65 and Disabled
  • Medicare SELECT Insurance Companies

Plan F Coverage Of Medicare Part B Expenses

Plan F also covers the Medicare Part B expenses. Part B covers doctor visits and related charges covered under Medicare for providers. Like Part A, Part B only covers 80% of the Medicare-approved expenses. It leaves the remaining 20% on the Part B participant.

Plan F covers Medicare Part B approved services at the doctors office, such as:

  • Medicare Part B coinsurance and copayment
  • Medicare approved doctors office fees
  • Part B deductible
  • Medicare Part B excess charges
  • Other Medicare-approved expenses associated with Part B coverage

Plan F is one of only two Medicare Supplement plans that cover the Medicare Part B excess charges .

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When Do You Enroll In Medigap

This Medigap Open Enrollment Period is a one-time enrollment opportunity after you are 65 or older and first enroll in Medicare Part B. If you determine that a Medicare Supplement plan is not right for you now and decide to apply later, you could be turned down for coverage. You would go through a process called underwriting to determine if you are acceptable to the insurance company.

Generally, though, you will want to purchase a Medicare Supplement plan during the one-time Medigap Open Enrollment Period to take advantage of the guaranteed issue. You wont have to worry later on about qualifying for coverage.

Your Medicare Supplement plan is also guaranteed renewable which means the insurance company cannot drop your coverage as long as you pay your premium on time. This is a great comfort to have knowledge that youre covered if the worst happens.

What Does Medigap Plan C Cover

Medicare Supplement Plan G

Like all Medigap plans, Plan C basic benefits are the same in most stateshowever, some plans may choose to offer extra benefits at an additional cost. At its most basic level, this plan specifically covers the following costs and benefits:

  • Medicare Part A deductible
  • Part A hospital and coinsurance costs
  • Part A hospice care copayment or coinsurance
  • Skilled Nursing Facility coinsurance

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Medicare Part A: How Much Will A Hospitalization Cost You

Lets say youre hospitalized and all you have is Medicare Part A. How much do you owe the hospital?

If the hospitalization lasts 60 days or less, the answer is $1,556 nothing more. This is an important point: For any hospitalization lasting 60 days or less, you will only owe the hospital $1,556 even if your hospital bill exceeds one million dollars! The doctor who see you in the hospital will bill you separately, but those bills are covered by your Part B benefits .

As an example, below you can see a copy of a bill that a patient of mine gave me a few years ago. This bill is for someone who was hospitalized for about four weeks. As you can see, the total amount billed was over $700 thousand and, yet, the patient still only has to pay $1,260 which was the Medicare Part A deductible in 2015.

Figure 1: Hospital Bill

Should you expect to ever be hospitalized for more than 60 days? No!

The average hospital stay in the US is 5-6 days and that number has been going down each year for more than a decade. Even people who need major surgery like a liver transplant or open heart surgery are usually home in about 7 days. I cant say that 60-day hospitalizations never occur in the U.S., but theyre about as rare as jackpot lottery winners.

Who Should Choose Medigap Plan C

Medigap Plan C can make a substantial difference in out-of-pocket costs and coverage. If any of the following scenarios apply to you, its worth considering Plan C supplemental coverage:

  • Do you travel frequently? Typically, Medicare doesnt cover health care outside of the United States, which means a medical emergency while on vacation can leave you with 100% of the costs incurred. Plan C pays 80%of approved costs up to plan limits in foreign countries.
  • Do you require frequent medical attention? If you suffer from any chronic illnesses or see doctors and specialists on a regular basis, those medical bills can pile up quickly. Plan Cs additional coverage will help manage your out-of-pocket costs.
  • Are you on a fixed budget? When youre on a strict monthly budget, unexpected medical bills can put your finances in jeopardy. Medigap policies help keep your money in your wallet by eliminating costly surprises.

To make the decision thats right for you, consult this supplement plan comparison guide.

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How Does Medicare Supplement Insurance Work

Medicare Supplement insurance plans, also known as Medigap, help supplement Original Medicare. They may help pay some of the healthcare costs that Original Medicare does pay like copayments, coinsurance and deductibles.

A Medigap plan may be purchased from a private insurance company. To be eligible, you must be enrolled in Medicare Parts A and B, you must live in the state where the policy is offered and be age 65 or over. In some states, you can be under age 65 with a disability or end-stage renal disease .

Each standardized Medicare insurance supplement plan covers different types of costs. How much you pay out of pocket will depend on the services covered and the plan you choose.

How And When To Apply For A Medicare Supplement Plan

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The best time to apply for a Medicare Supplement plan is during your six-month open enrollment period. Open enrollment begins during the first month youre 65 and enrolled in Medicare Part B. After this one-time open enrollment, you may not be able to purchase a Medigap plan or you might pay a lot more.

If you or your spouse already have group health care coverage and arent ready to enroll in Part B, you can apply for Part B without penalty during a Special Enrollment Period after your Initial Enrollment Period has ended. Call the Centers for Medicare & Medicaid Services for details if you think you may be eligible.

There are a few steps involved when applying for a Medicare supplement plan.

to see which one meet your needs. Consider your current and future health statusand keep in mind your familys health history, as it may be difficult to switch plans later.

Research which insurance companies in your state sell Medicare Supplement plans and which ones offer the plan you want. Visit Medicare.gov to search by ZIP code to find companies in your area.

Contact that insurance company to request a quote and purchase your Medicare Supplement plan.An agent can assist the process, or a client can deal directly with the carrier. You can typically complete an application via phone, online or on paper, says Corujo.

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Medigap Vs Medicare Advantage Plans

An alternative to Medigap is enrolling in a Medicare Advantage plan, also known as Medicare Part C. When evaluating your options, consider that you cant have a Medigap policy and a Medicare Advantage plan.

Medicare Advantage plans combine your Part A and Part B benefits. They also typically include prescription drug coverage and may cover other services Original Medicare doesnt, like hearing aids or glasses. With Medicare Advantage plans, you may have a monthly premium youll pay in addition to your Medicare Part B premium.

If you decide you want to switch to a Medicare Advantage plan, youll have to cancel your Medigap policy first.

How Much Will Nursing Home Care Cost You

If youre ready to leave the hospital, but not yet well enough to go home, Medicare will allow you to spend some time recovering in a nursing home, often at no extra charge.

If your hospitalization lasts at least three days then Medicare will cover up to 20 days in a skilled nursing facility without charging you a penny more than what you already pay for your hospitalization. That means that your $1,556 Part A deductible will cover up to 60 days in the hospital and up to 20 days in a nursing home if you need it. If you need more time to recover in a Nursing home, it will cost you $194.50 per day for the next 80 days . After that, Medicare wont cover you.

Now here is a very important point that every senior needs to understand: If Medicare doesnt cover a service, in most cases, a supplemental policy wont cover that service either.

Let me make that even more clear: Unless your supplemental policy specifically states otherwise, it wont cover nursing home care beyond 100 days or any nursing home care not covered by Medicare. Most supplemental policies only cover the $194.50 daily charge for a Medicare approved nursing home stay lasting more than 20 days but not more than 100 days Nothing more!

Most supplemental policies also dont cover hospital days that go beyond Medicares lifetime benefit limit either .

Dont let an insurance agent lie to you about that either. If your policy doesnt specifically say a service is covered, its not covered.

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Ways To Find Out If Medicare Covers What You Need

  • Talk to your doctor or other health care provider about why you need certain services or supplies. Ask if Medicare will cover them. You may need something that’s usually covered but your provider thinks that Medicare won’t cover it in your situation. If so, you’ll have to read and sign a notice. The notice says that you may have to pay for the item, service, or supply.
  • What Are The Types Of Medicare Supplement Plans

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    There are a wide range of Medicare Supplement plans. The different types of plans are named alphabetically, Plan A through Plan N.

    Medicare Supplement plans range from those that offer basic coverage, to those offering a much higher level of coverage. Understanding your health care needs, as well as your financial situation, can help when choosing a Medicare Supplement plan.

    Compare Medicare Supplement plans

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