Medicare Supplements
Medicare is health insurance for:
People age 65 or order
People under age 65 with certain disabilities
People of any age with End-Stage Renal Disease (ESRD: permanent kidney failure requiring dialysis or a kidney transplant)
Original Medicare:
is run by the federal government.
provides your Medicare Part A and Medicare Part B coverage.
you can join a Medicare prescription drug plan (Medicare Part D) to add drug coverage.
you can buy a Medigap (Medicare Supplement Insurance) policy sold by private insurance companies to help fill the gaps in Medicare Part A and Medicare Part B coverage (such as coinsurance, copayments, and deductibles).
Medicare Part A (Hospital Insurance): Original Medicare helps cover inpatient care in hospitals, skilled nursing facility, hospice, and home health care.
Medicare Part B (Medical Insurance): Original Medicare helps cover doctors' services, outpatient care, and home health care, as well as some preventive services to help maintain your health and to keep certain illnesses from getting worse.
Medicare Part C (Medicare Advantage Plans, like an HMO or PPO): A health coverage option run by private insurance companies approved by and under contact with Medicare.
Medicare Part D (Medicare Prescription Drug Coverage): A prescription drug option run by private insurance companies approved by and under contract with Medicare helps cover the cost of prescription drugs. Many help lower your prescription drug costs and help protect against higher costs in the future.
Original Medicare covers many health care services and supplies, but there are many costs it doesn’t cover. A Medigap policy is health insurance sold by private insurance companies to fill gaps in Original Medicare coverage.
Medigap policies don’t work with any other type of Health Insurance including:
Medicare Advantage Plans
Employer/union group coverage
Veterans Administration benefits
When to Buy a Medicare Supplement Insurance Policy
If you are nearing the age of 65, you can enroll in Medicare during the seven months of the initial enrollment period. The initial enrollment period includes the three months before your 65th birthday, the month of your 65th birthday, and the three months after the month of your 65th birthday. During this period, an insurance company cannot use medical underwriting. This means it cannot:
refuse to sell you any Medicare Supplement Insurance policy it sells.
make you wait for coverage to start (except in limited circumstances).
charge you more for a Medicare Supplement Insurance policy because of any past or present health conditions. If you buy a Medigap policy when you have a guaranteed issue right, the insurance company can’t use a pre-existing condition waiting period at all.
The Benefits of Owning a Medicare Supplement Insurance Policy
With all the choices you have for your healthcare coverage, it’s important to understand how each one works, its benefits, and your share of the costs. Here’s how Medicare Supplement Insurance differs from other coverage, including Medicare Advantage Plans:
Low Out-of Pocket costs
Every year, your Medicare Supplement Insurance policy benefits coordinate with your Medicare benefits to help you meet your eligible healthcare expenses, depending on the plan you choose.
Keep your Doctors and Hospitals
With your Medicare Supplement Insurance policy, you choose your healthcare providers to use whenever and wherever. You don’t have to worry about your doctor or hospital leaving a provider network at any time and you never need a referral to see a specialist.
Other healthcare plans may have local networks that could prevent you from receiving care from the people you’ve grown to know and trust. Read each plan closely. Some let you see anyone as long as the provider accepts the plan’s payment terms. Others let you go outside the network, but you pay for services yourself and usually pay more for them. Providers can leave and join networks.
Coverage is Guaranteed Renewable
Your Medicare Supplement Insurance policy cannot be cancelled. It will be renewed as long as you pay the premiums on time and make no material misrepresentations. Premiums are subject to change. Contracts between the government and some health plans are reviewed annually. As a result, plans may change or not be renewed, forcing members to choose another healthcare option.
Providers Accept Patients with Medicare Supplement Insurance
Your Medicare Supplement policy enables you to see any doctor or provider who accepts Medicare; However, not all providers in a health plan network take new patients or accept its payment terms. Talk with your doctors about their relationship with a health plan before joining.
Your Coverage Goes with You
Just like Medicare, your Medicare Supplement covers your healthcare needs anywhere in the United States. Some Medicare Supplement plans even provide limited medically-necessary emergency care outside the country. That way, you can confidently travel or live part of the year anywhere you choose.
With some other healthcare plans, there may be charges for care no matter where you go. Carefully check all the plan’s travel rules and restrictions.
Guaranteed Issue Coverage
Sometimes when you apply for Medicare Supplement coverage, you don’t answer any questions about your health and your policy is guaranteed issue. One time this happens is during your Medicare open enrollment period. Some other times are when:
you or your Medicare Advantage/Private fee for Service plan move out of the service area.
your employer discontinues its group retiree health coverage.
you leave a Medicare Advantage plan within a year of joining and return to Medicare.
some carriers never ask health questions regardless of age.
Selecting a Medicare Supplement Insurance Policy
Buying a Medicare Supplement Insurance policy is an important decision. All companies offer the same plans, so your choice is primarily based on three factors:
The plan you want at a price you can afford.
The company’s ability to pay its claims.
The company’s service before and after the sale.
Choose the benefits that are important to you. Consider your current healthcare needs, as well as in preparation for future healthcare needs. Medicare Supplements Insurance policies can pay all or part of these expenses.