What do Supplemental Insurance Policies for Medicare Cover?

Supplemental Insurance Policies for Medicare, otherwise called as Medigap, are crucial tools to help a baby boomer secure the retirement years.

And this is why we’d like to discuss more on what these policies cover. Doing so will help you and our other readers choose a Medigap Plan that will best for your needs or preferences. After all, knowledge is power when it comes to planning for your future – and we’re aiming to be your definite resource on Medicare Supplements!

Let’s Focus on the Gaps

Medicare Supplements are designed to help policyholders pay for the “gaps” found in Original Medicare Plans.

Now, for you to understand the importance of these insurance plans, let’s discuss what these “gaps” are and what Original Medicare Plans cover.

What are Original Medicare Plans?

Original Medicare Policies offer coverage managed by the federal government. Made up of both Medicare Part A and Part B, Original Medicare Plans are considered to be a stable and trusted source of health insurance for seniors in the country.

Part A, hospital insurance, covers the following:

  • Hospital care
  • Skilled-nursing facility care
  • Nursing home care (this is not long term care – Medicare will only cover services beyond custodial care)
  • Hospice care
  • Home health services

Meanwhile, Part B is medical insurance and covers the following:

  • Ambulance services
  • Durable medical equipment (DME)
  • Clinical research
  • Mental Health treatment (inpatient, outpatient, partial hospitalization services)
  • Outpatient prescription drugs (limited)

Original Medicare Plans are fee-for-service policies. Part A is typically automatically enrolled once an individual turns 65 (premiums have been paid as part of tax deductions during that individual’s work years). Part B, depending on one’s circumstances, needs to be applied once a person is first eligible for it (late fees are applied otherwise). Monthly premiums are applied for Medicare Part B coverage.

Original Medicare Plans do not cover cosmetic surgery, long term care, health coverage outside the country, hearing care, dental care, and vision care.

What are the Gaps?

Gaps are out-of-pocket health care costs, such as coinsurance fees, copayments, and deductibles. These aren’t covered by Original Medicare Policies.

The gaps, often overlooked, can prove to be expensive during the twilight years. As seen in a recent Commonwealth Fund report, 15 million Medicare beneficiaries spent, more or less, 20% of their household income on insurance premiums and out-of-pocket health care costs last year.

The gaps, alone, cost at an average of $3,024 per year.

To give you an idea of what these gaps here, please refer to the table below:

 

Examples of Original Medicare Gaps

Part A Gaps Part B Gaps
  • Inpatient Hospital Care
  • Hospital admission (deductible; first admission in a benefit period)
  • Daily coinsurance charges (days 61 through 90)
  • Coverage charges after 90 days in any benefit period (unless a beneficiary has and uses lifetime reserve days)
  • Daily coinsurance charges for each lifetime reserve day used
  • Fees for private hospital room use and private duty nurse services
  • Nonemergency care in a hospital not part of the Medicare program
  •  Care received outside the United States and its territories, except under limited circumstance in Canada and Mexico
  • Annual deductibles
  • Coinsurance and permissible charges in excess of Medicare-approved amount
  • Charges for most services unnecessary (or unreasonable) for the diagnosis or treatment of all illness or injury
  • Charges for most self-administered prescription drugs and immunizations
Psychiatric Hospital Coverage
  • Costs for care received after 190 days of specialized treatment in a psychiatric hospital during a recipient’s lifetime
  • General hospital fees
  • Skilled-nursing facility charges
  • Daily coinsurance (days 21 through 100 in a benefit period)
  • Costs for care after 100 days in a benefit period
  • Costs if a beneficiary wasn’t transferred to the skilled-nursing facility in a timely manner (after a qualifying hospital stay)
  • Costs for care in a skilled-nursing facility not approved by Medicare
  • Custodial care costs in a Medicare-approved skilled-nursing facility
  • Costs for care in a general nursing home
Home Health Coverage
  • Costs for full-time nursing care
  • Costs for meals delivered to a beneficiary’s home
  • Costs for prescription drugs (limited)
  • Costs for Medicare-approved amount for durable medical equipment (20% coverage for DMEs)
  • Charges in excess of the Medicare-approved amount on unassigned claims
  • Homemaker services that primarily assist a beneficiary in personal care or housekeeping needs
Hospice Coverage
  •  Inpatient respite care and outpatient drugs charges or fees
  • Deductibles and coinsurance charges for usage of regular Medicare benefits on treatment of a condition (terminal illness isn’t covered)

 

Tackling the gaps, as seen above, can prove to be a worthwhile and practical way to enter the retirement phase of one’s life.

Take Advantage of Different Solutions

Aside from helping policyholders pay for the various gaps in Original Medicare Plans, Medigap coverage can also offer individuals a wide variety of retirement solutions.

With ten standardized Medicare Supplement Insurance Plans to choose from, applicants are given the assurance that there is a policy available to address one’s unique needs or preferences. Some solutions presented by these standardized plans are foreign travel coverage and cost-sharing options.

Also, the opportunity to choose a plan offers individuals the control and power they deserve to feel, especially during the golden years. Flexible and practical, and going beyond with the primary design of covering the gaps, Medigap Plans truly provide a solution for retirement’s most crucial needs.

For more information, the FreeMedSuppQuotes Medicare Supplement Plans Comparison Chart will help interested individuals to learn more on what each Medigap Plan has to offer. Please make sure to check this handy resource out.

Make Sure to Get a Plan During the Medicare Supplement Insurance Open Enrollment Period

Seeing how crucial Medicare Supplements are, make sure to get one during the Medigap Open Enrollment Period (OEP). Enrolling for coverage during this period will only ensure one of gaining the coverage he or she wants – financial savings are secured as well.

The Medicare Supplement Insurance OEP lasts for six months, which typically begins when you turn 65 and are enrolled in Medicare Part B as well. During this period, private insurance companies cannot use a medical underwriting process for applicants.

This means that applicants will enjoy these benefits:

  • A private insurance company cannot refuse to sell an applicant any Medigap policies it offers.
  • A private insurance company cannot charge an applicant a higher premium than it charge others who are 65 and older or have health conditions.
  • A private insurance company cannot delay the start of an applicant’s Medigap coverage.

Also, applicants can switch to other Medigap policies during the OEP. This allows an individual to test the waters and see which standardized Medigap plan will best address his or her retirement needs.

Please take note that the Medicare Supplement Insurance OEP is different from the Medicare OEP. Similarly named, these are two different events that cater to different needs.

Here are the key differences that you should have in mind:

  • A Medigap OEP happens only once (a better term to use is that this OEP is the initial enrollment period of a Medigap applicant, or the period when he or she is first qualified to purchase a Supplemental Insurance Plan for Medicare)
  • The Medicare OEP happens annually (which would mean a better term to use is the annual enrollment period, which happens every October 15 to December 7 of each year).
  • The Medigap OEP addresses Medicare Supplement enrollments and policy switches.
  • The Medicare OEP address enrollment in other Medicare coverage products, such as Medicare Advantage and Medicare Part D (drug prescriptions).

Knowing the difference as early as now will help you face stressful and frustrating future enrollment issues.

Request a Medicare Supplement Insurance Quote Now

Lastly, to assure yourself that you’re getting the right plan and to find out more details on coverage and such, make sure to request for a Medicare Supplement Insurance quote. Doing so will allow you to connect with an agent who’ll be able to discuss in detail the best way to approach the retirement years.

Additionally, consider as well requesting for Medigap quotes from several private insurance companies in your area. Medigap policies, as mentioned, offer flexible solutions. And this can also be seen even during the enrollment phase, wherein applicants have the advantage to shop around the market for supplements.

We’re stressing this – you have the power to choose, so maximize it with a Medigap Plan!

We hope the information posted above will help you in both choosing and enrolling for a Medigap policy. Supplemental Insurance Policies for Medicare are definitely a solution you should take advantage of – inquire more about these plans as early as today!

Also, please let us know what you think with the information found in this article. We need your feedback for us to write content that will help you and others out. We need your input for us to stay as one of the top resources in Medicare Supplement Insurance information. Please leave us a comment below – we are more than happy to hear from you!

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