Medicare Supplemental Health Insurance Plans

   

medicare-health-insuranceMedicare Health Insurance

Medicare is a national social insurance program, currently consists of about 30 insurance companies across the U.S.A and administered by the U.S. federal government itself. Medicare provides health insurance for America’s young people with amyotrophic lateral sclerosis, stage renal disease, and disabilities. It also provides health insurance to older people (aged 65 or older) who have worked and paid into the system.

Medicare health insurance covers about 48% of the charges for those enrolled in Medicare. The enrollees must cover the rest with supplemental insurance or with another form of out-of-pocket coverage. The costs can vary depending on the plans. They might include supplemental insurance and uncovered services, such as long-term, vision, hearing, and dental care.

   

Medicare Insurance Plans

Medicare divided into several parts to cover specific services, including:

1. Medicare Part A (Hospital Insurance)

This part covers hospice care, care in a skilled nursing facility, inpatient hospital stays, and some home health care.

2. Medicare Part B (Medical Insurance)

This part covers preventive services, medical supplies, outpatient care, and certain doctors’ services.

3. Medicare Part C (Medicare Advantage Plans)

This health plan offered by a private company approved by Medicare to provide you with all the benefits of Part A and Part B, including:

Medicare Medical Savings Account Plans, Special Needs Plans, Private Fee-for-Service Plans, Preferred Provider Organizations, and Health Maintenance Organizations.

4. Medicare Part D (prescription drug coverage)

This additional part covers prescription drug to Original Medicare, Medicare Medical Savings Account Plans, some Medicare Private-Fee-for-Service Plans, and some Medicare Cost Plans. You can buy the plan from an insurance company or other private companies approved by Medicare.

Medicare Supplemental Health Insurance (Medigap)

If you have financial issues with the health care costs, then you may interested to buy a Medigap policy to help you pay some of the bills that Original Medicare doesn’t cover, like deductibles, coinsurance, and copayments.

With a Medigap policy and original Medicare, you can still get covered when travel outside the U.S. Medicare will pay its share of the approved amount of health care costs and the Medigap will pay its own share.

There are 9 things that you need to know before buy a Medigap policy, including:

  1. You can not buy a Medigap policy if you already own a Medicare Medical Savings Account (MSA) Plan.
  2. Since January 1, 2006 Medicap policies do not cover prescription drugs.
  3. A Medigap policy is guaranteed renewable, as long as you pay the premium. Even when you have health problems.
  4. You can buy a Medicap policy in your state from any licensed-insurance company.
  5. A Medigap policy only covers one person. You will need two spate policies if your wife want the coverage too.
  6. You need to pay both your Medicare and Medigap policy each month.
  7. You can apply for a Medigap policy even you already have a Medicare Advantage Plan, but your Medigap policy begins, you must leave the Medicare Advantage Plan.
  8. You must have Medicare Part A and Part B.
  9. Medigap policies generally don’t cover long-term care, dental or vision care, private-duty nursing, eyeglasses or hearing aids.

Medicare Supplemental Insurance Plans

All Medigap policies offer the same basic benefits, but some insurance companies may offer you additional benefits, so you must choose clearly which one meets your needs. In Wisconsin, Minnesota, Massachusetts, Medigap policies are standardized in a different way.

The chart below shows basic information about Medigap policies.

N/A = not applicable

% = the plan covers that percentage of this benefit

No = the policy doesn’t cover that benefit

Yes = the plan covers 100% of this benefit

Medigap PlansABCDFGKLMN
Skilled nursing facility care coinsuranceNoNoYesYesYesYes50%75%YesYes
Foreign travel exchangeNoNo80%80%80%80%NoNo80%80%
Part B excess chargesNoNoNoNoYesYesNoNoNoNo
Part B deductibleNoNoYesNoYesNoNoNoNoNo
Part A deductibleNoYesYesYesYesYes50%75%50%Yes
Part A hospice care coinsurance or copaymentYesYesYesYesYesYes50%75%YesYes
Blood (first 3 pints)YesYesYesYesYesYes50%75%YesYes
Part B coinsurance or copaymentYesYesYesYesYesYes50%75%YesYes
Part A hospital and coinsurance costs up to an additional 365 days after Medicare benefits are used upYesYesYesYesYesYesYesYesYesYes
Out-of-pocket limitN/AN/AN/AN/AN/AN/A $4,940 $2,470N/AN/A

Note:

Plan N pays 100% of the Part B coinsurance, except for a copayment of up to a $50 copayment for emergency room visits that don’t result in inpatient admission, and up to a $20 copayment some office visits.

After you meet your yearly Part B deductible and your out-of-pocket yearly limit, the Medigap plan will pay 100% of covered services for the rest of year.

Plan F also offers a high-deductible plan. With this option, you must pay for Medicare-covered costs up to the deductible amount before Medigap pays anything.

Find more information about Medicare and Medicare Supplemental Health Insurance (Medigap) at medicare.gov

Medicare For Dummies (Paperback)


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