Medicare Supplemental

If you're worried about Medicare expenses, a Medigap health insurance policy, also known as Medigap supplemental insurance or a Medicare supplemental plan, assists in covering the "gap" between what Original Medicare (Medicare Parts A and B) covers and your out-of-pocket expenses.

You can obtain a Medicare Supplement insurance policy from private insurance companies, but only if you already have Original Medicare. Medigap provides coverage for Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). However, it doesn't include Medicare Part C (Medicare Advantage plans), Medicare Part D (prescription drug plans), or any other private health insurance, Medicaid, Veterans' Administration benefits, or TRICARE.

As Medigap policies adhere to state and federal regulations, the coverage benefits remain the same regardless of the insurer. Variations lie in the pricing, administration, and the specific options among the 10 offered by the insurer. It's advisable to choose a trusted health insurer and explore various options for the best prices.

Note: All insurance companies selling a particular Medigap plan type in your area must provide identical coverage but may differ in pricing. Therefore, shopping around for the best price is recommended.

Medigap plans cover various healthcare costs that are not covered by Original Medicare. These supplemental insurance policies, offered by private insurance companies, help bridge the financial gap by paying for certain out-of-pocket expenses. Here's an overview of what Medigap plans typically cover:

Covered Services:

• Medicare Part A Coinsurance and Hospital Costs: Helps cover the coinsurance amount for hospital stays beyond what Original Medicare covers.
• Medicare Part B Coinsurance or Copayment: Covers the coinsurance or copayment amount for Medicare Part B services.
• Blood (First 3 Pints): Pays for the first three pints of blood needed for a medical procedure.
• Part A Hospice Care Coinsurance or Copayment: Assists with the coinsurance or copayment for hospice care provided under Medicare Part A.
• Skilled Nursing Facility Care Coinsurance: Helps cover the coinsurance for skilled nursing facility care.
• Part A Deductible: Covers the deductible for Medicare Part A, which applies to hospital stays.
• Part B Deductible: Covers the annual deductible for Medicare Part B services.
• Part B Excess Charges: Pays for charges that exceed the Medicare-approved amount for Part B services.
• Foreign Travel Emergency (Up to Plan Limits): Provides coverage for emergency medical care during foreign travel.

What Medigap Plans Don't Cover:

• Medicare Part D (Prescription Drugs): Medigap plans do not cover prescription drug costs. Beneficiaries need to enroll in a standalone Medicare Part D plan for drug coverage.
• Vision and Dental Care: Routine vision and dental care expenses are not covered by Medigap.
• Hearing Aids: Costs associated with hearing aids are not covered.
• Long-Term Care: Medigap plans do not cover expenses related to long-term care, like nursing home stays.
• Eyeglasses: Routine eyeglasses are not covered by Medigap.
• Private-Duty Nursing: Costs for private-duty nursing are not covered.

Understanding the coverage offered by Medigap plans is crucial for beneficiaries to make informed decisions about their healthcare expenses. It's important to review plan options carefully and choose one that aligns with individual healthcare needs.

Your Medicare Supplement open enrollment period initiates on the first day of the month in which you turn 65 and become covered under Medicare Part B. You have a six-month window to enroll. If you are under 65, inquire with your state's Social Security Administration to determine if additional open enrollment periods are available.

"All insurance companies selling a specific Medigap plan type in your area must provide identical coverage, though prices may vary. Hence, exploring for the best price is advisable."

While Medicare Part A and Part B generally cover pre-existing conditions, Medicare Supplement insurance operates differently. In certain cases, a company may refuse to sell you a Medicare Supplement plan initially. Purchasing a Medicare Supplement plan during the six-month Medicare Supplement Open Enrollment Period ensures that the insurance company cannot deny you coverage.

The insurance company is prohibited from charging you more due to health problems or delaying the commencement of basic benefits. However, there might be a waiting period of up to six months for the inclusion of pre-existing conditions in the Medicare Supplement policy's benefits.

If you apply for a Medicare Supplement insurance plan outside your Medicare Supplement Open Enrollment Period, the private insurance company may subject the plan to "underwriting." This entails a potential physical exam, and the insurance company can either decline to sell you the plan or adjust your premium based on your health status.