If you have Medicare Part A and Part B but require medical coverage for some of the things that aren’t covered by standard Medicare, you might want to consider obtaining a Medicare Supplement plan, of which there are several different types to choose from. These plans can provide you with the coverage that you need for such costs as deductibles, copayments, and coinsurance, which are considered to be gaps in standard Medicare coverage. Before you choose a Medicare Supplement policy, you need to be aware of what these plans cover and the costs associated with each Medicare Supplemental insurance plan.
What Are Medicare Supplement Plans?
A Medicare Supplement plan is typically known as a Medigap plan, which is essentially designed to cover the gaps in your standard Medicare plans. In order for you to qualify for a Medicare Supplement policy, it’s essential that you’ve enrolled in both Part A and Part B plans for Medicare. You can also enroll in a Medicare Part D without affecting your ability to enroll in a Medigap plan. While the coverage provided by a Medigap plan can be extensive, there are many expenses that this insurance plan doesn’t cover.
For instance, Medicare Supplement insurance plans won’t cover long-term care in a nursing home, private-duty nursing, dental or vision care, eyeglasses, or hearing aids. Anything that’s covered by Medicare Part C, Medicare Part D, or Medicaid won’t be covered by a Medicare Supplement plan. Part C plans are more commonly referred to as Medicare Advantage plans. Other insurance policies like VA benefits, TRICARE, and union health plans are not considered to be Medigap plans. The main types of costs that are covered by a Medicare Supplement plan include:
What the Standard Federal Medicare Program Covers
Since you must first be enrolled in Medicare Part A and Part B plans, you should better understand what benefits you’ll be provided with when selecting this type of health insurance. When you obtain a Medicare Supplement plan A, the coverage that you receive will include:
- Extensive nursing facility care
- Inpatient care that takes place in a hospital
- Hospice care
- Health care for home settings
- Inpatient care that takes place within a skilled nursing facility, which is a type of facility that isn’t focused on long-term or custodial care
There are two basic types of services that are covered by Medicare Part B, which include preventive services and medically-necessary services. Preventive services include any kind of health care that’s aimed at preventing illnesses or detecting adverse health conditions at an early stage, which is when treatment will be at its most effective. As for medically-necessary services, these types of services include supplies or services that are necessary for the treatment or initial diagnosis of a medical condition. The types of coverage that you can receive with a Part B plan include:
- Ambulance services when you need to be taken to the hospital or an emergency room
- Clinical research
- Durable medical equipment like hospital beds, crutches, canes, oxygen equipment, walkers, and wheelchairs
- Receiving a second opinion before you obtain a vital surgery
- A very limited amount of outpatient prescription drugs
- A variety of mental health services, which extend to outpatient care, inpatient care, and partial hospitalization
If you tend to suffer from illnesses and adverse health conditions, you might also want to think about obtaining a Medicare Part D plan. While this plan isn’t required for you to enroll in before you obtain a Medicare Supplement plan, it will allow you to receive coverage for any prescriptions medications that you require. With this type of plan, you’ll be able to cover at least some of the expenses related to most prescription drugs that you can obtain in the country. Medicare requires that any Part D plan includes the coverage of at least two medications in each therapeutic class, of which there are six. These six categories include antipsychotics, antidepressants, immunosuppressants, anti-convulsants, HIV/AIDS drugs, and anti-cancer medications. The various types of medications that don’t need to be covered in these plans include:
- Cosmetic drugs
- Weight loss medications
- Fertility medications
- Vitamins and minerals
- Cough syrup and similar medications that are solely designed for the treatment of cold symptoms
How do Medicare Supplement Plans Work?
There are a variety of things that you should know before you sign up for a Medicare Supplement plan. For instance, this type of policy is entirely different from a Medicare Advantage plan. While a Medicare Advantage plan allows you to obtain additional Medicare benefits, a Medicare Supplement plan is designed primarily to supplement your initial Medicare benefits. It’s also important to understand that you’ll be required to pay a monthly premium to a private insurance company for the Medigap policy that you choose. This premium must be paid in addition to the Part B premium that’s owed to Medicare.
When you purchase a Medigap insurance policy, this policy will only cover you and not a spouse. If you’re married and your spouse wants to be covered by Medicare Supplemental insurance, they will need to obtain their own policy. When shopping for the right policy, you can purchase a policy from any insurance company in your state that offers such coverage. Among the more notable aspects of a Medicare Supplement plan is that it can automatically be renewed even if you’ve begun to suffer from additional health problems throughout the year. As long as you continue to pay the monthly premium that you owe, your insurance company won’t be able to take the coverage away from you.
While you’re in the midst of shopping for one of these plans, it’s important to remember that it’s illegal for a company to sell you one of these policies if you also have a Medicare Advantage plan. However, it’s possible to obtain a Medicare Supplemental insurance plan if you switch back to your original Medicare. If ever you want to switch over to a Medicare Advantage plan or would like to change to a new Medigap policy, the timing is important for making such a change. A late enrollment penalty for Medicare Advantage or Medicare Part D is applied if you drop the entirety of your Medigap policy or you go at least 63 days or longer without some form of prescription drug coverage.
Do Medicare Supplemental Plans Have Networks?
Likely the most commonly asked question in regards to Medicare Supplement plans is if these plans have networks of doctors and health care providers that are necessary to go to when enrolled into a Medigap plan. Even though some plans will have networks, the majority of Medigap plans don’t. If you don’t want any network restrictions in the future, it’s essential that you understand how to detect these restrictions. Since Medigap is designed to supplement Medicare Part A and Part B plans, the Medicare Supplement plan that you choose will be accepted by all of the health care providers that accept Medicare Parts A and Part B, which applies to almost all providers. Some policies like Plans G, F, and N don’t have any kind of network, which means that you don’t need to worry about a secondary network of providers.
However, there are some plans that will have network restrictions, which are known as “select plans”. These plans aren’t that common and are primarily offered by larger insurance providers like United Healthcare. When you choose a select plan, you’ll need to stay in-network when you receive standard care. However, medical emergencies will always be covered and don’t fall under the same network restrictions. The main benefit of this type of insurance policy is that you’ll be able to pay a lower monthly premium. However, a traditional Medigap plan is likely a better purchase if you don’t want to deal with the frustrations that can occur with network restrictions.
Feel free to give us a call and talk with a licensed insurance agent to learn more about plan limits, plan options, open enrollment periods and calendar year deductibles.