Even if you currently have Medicare insurance, you need to know that although it will cover most medical expenses, you’ll have to pay for some health care costs. Medicare covers roughly 80% of most approved services, and 20% will be your responsibility. Unfortunately, that 20% can be a huge amount for you to pay. Even when your Medical bills are not very high, that 20% will still add up over time.
That’s why many people on Medicare will pay for Medicare Supplemental insurance plans to pay for the expense that Original Medicare does not cover. Knowing whether you need a Medicare Supplemental plan can be difficult. That’s why The Medicare Family wants you to understand what it is so that you can decide on your own before enrolling.
What Is Medicare Supplemental Insurance (Medigap)?
It’s a medical insurance plan offered by private insurance companies that helps fill the gaps in Original Medicare Parts A and B. As mentioned, Original Medicare pays for roughly 80% of Medicare-approved services, but not all.
A supplemental insurance coverage policy can help pay the remaining healthcare expenses. These policies don’t add coverage for procedures that Medicare won’t cover. Instead, they help pay for what Medicare Parts A and B don’t, including coinsurance, co-pays, and deductibles. It doesn’t matter which doctors you can visit.
Medical Supplement plans are named with letters from A to N. The most popular being Plan F, Plan G, and Plan N.
The benefits you’ll get depend on the letter, but the plans are standardized. This means Plan G from one insurance company will offer the exact same benefits as Plan G provided by any other company. However, it’s important to compare Medigap before choosing one because of the price.
To clearly understand why the Medicare supplemental plan is valuable, you need to know what the original Medicare plan covers and doesn’t cover.
What is Original Medicare?
Original Medicare consists of two parts, A (hospital insurance) and B (medical insurance). Part A requires you to pay a deductible before getting any hospitalization benefits. After that, it covers the first 60 days of a beneficiary’s in-patient hospital stay. After that, you must pay a daily copayment starting on Day 61.
Part B has an annual deductible that resets on January 1st of each year. After that, Part B will cover 80% of approved medical expenses; the remaining is your responsibility. As of 2022, Part A’s deductible is $1,556 per benefit period, while Part B’s annual deductible is $233, which reflects an increase of $30 from the deductible of $203 in 2021.
Original Medicare doesn’t cover things like:
- Prescription Drugs – a beneficiary needs Medicare Part D for drugs unless they have this coverage from their former employer or from the VA.
- Dental care
- Custodial long-term care
- Vision care
So, when you have Original Medicare and have a supplemental insurance policy:
- Medicare will pay the medical expenses it covers first,
- Then your Medigap plan will cover what remains based on the plan letter that you select.
An alternative to Original Medicare with a Medigap plan is to enroll in Medicare Advantage, also known as Part C. It covers hospital, doctor, and drug expenses, but you have to pay for coinsurance, deductibles, and copayments.
It covers even vision and dental coverage. However, there are network restrictions that may only allow you to receive care from certain providers. It is not possible to have a Medigap and a Medicare Advantage plan at the same time. Deciding which of the two is right for you is perhaps the most important choice new enrollees make regarding their Medicare coverage.
Who Qualifies for Supplemental Plans?
You must have Medicare Part A and B to be eligible for both Medicare Advantage and Medicare Supplement plans. All Medicare coverage is individual, so, so your spouse will have to qualify for their own separate policy.
Established Medicare Supplemental Insurance Carriers
Some of them include:
- Anthem Blue Cross Blue Shield
- Mutual of Omaha
- Cigna Supplemental Benefits
- Aetna Senior Supplemental Insurance
- AARP/United Healthcare
- ManhattanLife Assurance Company
- Medico Insurance Company
How to Choose the Best Supplemental Insurance Carriers
Take Into Consideration the Monthly Premium Price
Medigap insurance is federally standardized. This means insurance companies have to offer exactly the same coverage for a given Plan letter (like Plan G or Plan N). While the coverage may be identical, the price you’ll pay is not! A Plan G could range from $100-$250/month for the exact same coverage.
Determine the Total Out-of-Pocket Expenses
When deciding between a Medicare Advantage and Medicare Supplement plan, consider your total out-of-pocket expenses, not just the monthly premiums. Supplements cost more per month, but Advantage plans will cost more if you are going to the doctor frequently due to the copayments per visit.
Consider Customer Service
The availability of good customer service is what differentiates Medicare supplement providers. You can visit the company’s website to see what other people are saying about the company. Also, asking your neighbors and friends who have subscribed to Medigap is an excellent way to learn about a particular company.
Consider How Frequently You Travel
Medicare Advantage plans have networks of hospitals and doctors, so if you frequently travel out of state, you may have to pay more for out-of-network providers. Medicare Supplement plans allow you to see any provider in the entire country who accepts Medicare assignment (95%+ do).
Get Answers to Your Supplemental Insurance Questions
Supplemental health plans may be a valuable addition to original Medicare coverage. Depending on your chosen plan, it can help you pay all the out-of-pocket expenses. Likewise, it can provide coverage for medical services that aren’t covered by primary insurance.
However, supplemental coverage might not be necessary, depending on the scope of your primary coverage and specific circumstances. If you have any questions concerning supplemental coverage, don’t hesitate to contact us and get all answers.