Learn the common terms related to Medicare Supplements and their meanings to understand better the coverage that you will have.
When preparing to enroll in Medicare supplements or are already enrolled – it is essential to have a clear understanding of different terms that you might or usually encounter in the program. By knowing these important terms, you will be able to navigate throughout the different processes and procedures easily and conveniently.
Some of the common words that you will most likely encounter are the following:
Health care providers who accept Medicare patients on assignments cannot charge more than the Medicare approved amount.
The moment when you are admitted to a hospital and ends when you have already stayed out of the hospital or skilled nursing facility or haven’t gotten any inpatient hospital care for 60 days in a row.
Refers to the percentage of the cost that you are required to pay. It is the amount that you share as payment of a medical service or item covered by Medicare. The Medigap policy covers coinsurance only after you’ve paid the deductible (unless the Medigap policy also pays the deductible).
Coordination of Benefits
A system that ensures that your medical bills are sent to the right insurers in case you have more than one. It decides which one of your multiple health coverages (also called as the payers) will pay first. Your “primary payer” pays what it owes on your bills first and then sends the rest of your bills to the secondary payer.
Copayment (or Copay)
It is the specific or set amount in dollars that you will pay to the cost of a medical service or item that Medicare covers.
A health coverage under other source or health benefit plans such as employer sponsored benefits that meet a minimum set of qualifications or at least equal to Medicare.
Any amount of out-of-pocket payment that you are required to give for medical services prior the start of your coverage.
The person who can obtain benefits to both Medicare and Medicaid benefits.
Lifetime Reserve Days
Medicare offers an additional 60 days that you can get or withdraw to get a Medicare coverage beyond the 90 days a hospital per benefit period. These 60 days good for a lifetime but are not necessarily needed to use it all in one hospital stay.
Open Enrollment Period
The first day of the month that you are both 65 years old and are enrolled in Medicare Part B and will last for only six months. This is the time that you can apply for Medigap policies that insurance companies cannot decline your application.
Are medical conditions that you already have before your Medicare supplement started.
The insurance that pays your medical bills first in case you have more than one type of health coverage.
The area, place or location where you need to live to get the benefits of your coverage.
Medicare Supplements Frequently Asked Questions
Here are the quick answers to the most common questions that you might also have in mind:
What is Medigap?
Medigap, also known as Medicare Supplement Plans, are additional insurance that you buy from a private company to pay health care costs not covered by Medicare.
Who is qualified to buy Medigap?
Anyone who is already under Medicare parts A and B.
When Can I Buy Medicare Supplement plans?
You can apply for Medicare Supplements during your Open Enrollment period which includes:
- The six months period from the date you enrolled in Medicare Part B and are already 65 years old.
- Up to 6 months after you turn 65 years old if you became eligible for Part B before you turned 65 years old.
- If you became eligible for Medicare Part B before age 65 because of a disability, you are guaranteed to have Medicare Supplement policy of your choice within the first six months that you are 65 years old and has Medicare Part B.
Can I apply for Medicare Supplements without Medicare Parts A and B?
No. You must have Medicare Part A and are already enrolled in Medicare Part B.
Does everyone need Medicare Supplement Plans?
Not everyone needs Medicare supplements. If you own other health coverage, the gaps in your Medicare might have already been covered. You don’t need Medicare supplement insurance if you:
- Have Medicare Advantage plan.
- Are on Medicaid
- Has Qualified Medicare Beneficiary program that pays your Medicare premiums and out-of-pocket costs.
- Has employer group health plan
Do I need to switch new doctors if I have Medicare Supplement policy?
No. You don’t have to switch doctors if you have a Medicare Supplement policy.
Do I need to have an appointment to visit my specialist to get Medigap benefits?
No. You can visit your specialist whenever you want. Take note that your out of pocket costs will be less if your specialist accepts Medicare assignments.
How much does Medigap plan cost?
Medigap plans are sold by private insurance companies which are free to set prices for the plans they offer. The costs also vary depending on various factors.
Can I be denied of Medicare supplement insurance?
Yes, After your Open Enrollment Period, an insurance company offering Medicare Supplements may not accept your application if you don’t meet the underwriting requirements.
Take note that during your Open Enrollment Period, insurance companies can’t deny you a Medicare supplement policy or charge you a higher premium because of pre-existing conditions.
Will Medicare Supplements cover my pre-existing conditions?
Yes, but it will depend on when you acquired your Medigap policy. There is also a pre-existing condition waiting period which varies according to your guaranteed issue rights, creditable coverage and if you buy your policy during your Open Enrollment period.
Is Medicare Supplement Insurance necessary?
No. Enrolling in Medicare supplement insurance is not mandatory, but please do remember that without it, your Original Medicare will have limited coverage.
What is the best Medicare supplement insurance plan?
Medicare Supplement Plan F offers the most comprehensive benefits, but not everyone needs this much coverage. Therefore, the best Medicare supplement insurance plan will depend on your needs.
How to Choose a Medigap Supplemental Policy
Look at your needs first then check for the various benefits that each Medicare supplement plan offers. Requesting a Medicare Supplement quotes will also help you compare and choose a Medigap policy.
What if I travel or move to another state?
Usually, your Medigap plan will travel with you even if your plan is not offered in that state. To make sure, consult your Medigap plan provider before heading to any location.
Can I have both Medicare Supplement plan and Medicare Advantage plan?
No. If you enroll in Medicare Supplements, while still enrolled in Medicare Advantage, you have to leave the latter before your Medicare Supplements take effect.
Where can I buy Medicare Supplements?
Find out which insurance companies offer Medicare Supplements by getting a Medicare supplement quotes here. Also, don’t forget the prices of Medigap plans that different insurance companies provide.
How can I enroll in Medigap policy?
Contact a licensed agent of your chosen Medigap insurance company.