Know your options

Medicare Supplemental Health Insurance

Medicare supplemental health insurance provides you with additional health insurance benefits that are not available through Medicare Part A or Part B. SomeMedicare supplemental plans, also referred to as Medigap insurance,will provide you with prescription coverage and preventative healthcare. Medicare supplemental health insurance plans can also cover yourMedicare Part A deductible, extra days of hospital care, your Medicareco-payment amounts, skilled nursing and foreign travel emergency care.

Medicare Supplemental Health Insurance Overview

Medicare supplemental health insurance is a plan sold by a private insurance company to those eligible for Medicare as additional coverage for medical needs.These policies can be purchased directly from an insurance provider,which is bound by the federal and state laws governing healthinsurance. Before you sign up for a Medicare plan make sure you get all the Medicare health insurance plan informaiton. You are required to pay a monthly premium directly to theinsurance company, although assistance is available below a certain income level. Medicare supplemental insurance is designed to help cover the "gaps" left by the standard government Medicare plan.

Because Medicare is a compromise between what is needed by the elderlypopulation and what the government can afford to cover, there areobvious gaps in coverage, such as coverage of prescription drugs,extended hospital stays, specialized in-home care, and coverage fortravel abroad.

Before you consider purchasing Medicare supplemental insurance, you should understand the coverage options under Medicare and the rules for joining or switching Medicare policies.You should first maximize your benefits under available Medicareoptions as well as consider the effect of other coverage options suchas group health insurance from your employer or trade union. Analyzing your Medicare costs after accounting for any other health insurance sources may show that you do not need a Medicare supplemental insurance policy.

Thereare 12 standardized policies for Medicare supplemental health insurance andthey are categorized as plans A thru L. This applies to every stateexcept Massachusetts, Minnesota and Wisconsin. Each plan provides adifferent set of benefits. For instance, Plans K and L are new policiesthat will help you limit extensive out of pocket expenses for doctorand hospital service. Plans K and L will have a lower premium than someother Medigap policies, but you will pay a larger amount of Medicare'sdeductibles before the policy pays for any of the medical costs. Withthese new plans you are assuming a greater risk toward your share ofcosts while receiving additional protection over what is provided underoriginal Medicare.

Medicare SELECT policies (Plans F and J)usually cost less but have a high-deductible. You will have to usespecific doctors to get full insurance benefits on these plans. In anemergency you may use any hospital or doctor. The plans are lessexpensive because the physicians that are on the "Select" list agree tosee Medicare patients at a reduced "assignment" fee.

Unlessyou buy a Medicare SELECT policy, you may go to any doctor or hospitalfor treatment. The Medicare supplemental insurance policy pays for itsshare of the expenses and your Medicare policy covers its share. Thelevel of benefits you receive will depend on which plan you choose. Youwill pay for your Medicare supplemental insurance and pay the Medigap insurancecompany on a separate invoice. You will receive a Medicare Summary oncea month by mail and your Medigap insurance company will also send you Medicare health insurance planinformation on what has been paid. A Medicare supplemental health insurance policy doesnot replace your original Medicare coverage. It simply provides additional benefits to help cover themedical expenses that are not paid for by the original Medicare policy.You may also want to join a Medicare Advantage Health Plan that willhelp with drug costs and coinsurance deductibles.

If you haveother insurance, they sometimes pay your bills first and then MedicarePlan pays second. This would mean that your other insurance plan wouldbe the primary payor on your medical expenses. Other insurance that maypay first could be any of the following:

  • Employer sponsored group health coverage
  • No fault Insurance
  • Liability insurance
  • Black lung benefits
  • Workers compensation

Thesetypes of insurance will pay first in most cases. It is important thatyou let your doctor and hospital know if you have other insurance sothey will know how to handle your billing. Medicare may make aconditional payment is some cases. If your insurance that is supposedto pay first does not, this payment must be repaid to Medicare. That iswhy it is called "conditional." If you currently have other insurancethat pays prescription costs and you enroll in a Medicare prescriptiondrug plan, you must let your Medicare know about your other coverage.You should be familiar with all of your rights as a Mediare recipient and how they effect your Medicare supplemental insurance plan.

On January 1, 2006, new Medicare Prescription Drug Plans were made available to everyone on Medicare. Under these new plans,there is a separate co-payment and deductible associated with the costsof your prescription drugs. You must also go to pharmacies that belongto the Medicare Prescription Drug plan. If you choose to go to apharmacy that isn't part of the plan your drugs will not be covered. Inmost, cases only prescription drugs that show onthe MedicarePrescription Drug Plan lists will be covered.

 

 

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Additional Medicare Supplemental Insurance Resources

  • Basic Information About Medicare

    What is Medicare? Are you eligible? This page addresses the basics of Medicare including the different components that make up Medicare and what type of coverage they provide. This is the best place to start if you know nothing about Medicare.

  • Medicare Coverage Options

    There are many plans available to choose from under Medicare including Medicare Advantage Plans, HMOs, PPOs, Medicare Special Needs Plans, Cost Plans and PACE. Each plan options offers distinct benefits that may be best suited for your specific needs, so it is important to explore all of your options for Medicare coverage.

  • Medicare Prescription Drug Coverage

    Medicare prescription drug coverage is an additional insurance benefit that is provided by private companies.

  • The Original Medicare Plan Information

    The original Medicare plan is one of your options for health coverage under Medicare. This page outlines the details of the oldest of the government-sponsored health plans for the elderly including some of the set costs for certain procedures and the original Medicare plan assignment.

  • Analyzing Your Costs With Medicare

    Although it is nearly impossible to estimate your healthcare costs for the coming year, you can gain a better understanding of how your Medicare plan choice affects your out-of-pocket expenses. Without knowing all of your options, you cannot knowingly choose the plan that best minimizes your costs while still providing you with the necessary coverage.

  • Assistance for People With Limited Income

    Learn more about the resources available to those who are on Medicare, but still cannot afford the co-pays, annual premiums or prescription drug coverage.

  • Joining and Switching Medicare Plans

    Like regular health insurance, there are restrictions and guidelines that govern when and if a person can join a particular Medicare plan. The purpose of this is to prevent people from staying on the cheaper, original Medicare plan until a more comprehensive plan is needed to cover illnesses and conditions when they arise later in life.

  • Your Rights Under Medicare

    If you are a recipient of Medicare or Medicare services, learn more about the rights that your granted under the law, such as the right to appeal any denied claim.

  • How do I submit a claim for Medicare Supplemental Insurance?

    Medicare supplemental insurance is designed to be helpful to you, and processing claims for payments via supplemental insurances should be easy and hassle free. In most cases all you will need to do is show your Medicare Supplemental insurance ID card to your healthcare provider at the time of the visit.

  • Understanding Medicare Supplemental Insurance Policy Ratings

    The way heath insurance companies determine premiums are based on "ratings". Although Medicare supplemental insurance is standardized in terms of what gaps any given Lettered Plan must cover, different insurance companies use different "rating" systems - and therefore premium "rates" can vary.

  • Will My Medicare Supplement Pay for Home Healthcare?

    If you are recuperating at home from an illness, injury, or post surgery, and your physician has prescribed home healthcare, Medicare does cover some of the expenses. The key word in that previous sentence is prescribed.

  • Medicare Supplement by the Letters - A look at Plan F

    Medicare Supplement by the Letters - A look at If you had traditional Medicare, Medigap Plan F, and a Medicare Part D plan for prescription drugs, it could be said that just about the only healthcare costs you would have, is your Medicare supplement monthly premiums.