FAQ

Do You Need Supplemental Insurance with Medicare? – MedicareGuide.com

medicare supplement insurance is intended to limit unpleasant surprises of health care costs. your health at age 65 may not be an indicator of what is to come a few years later. you could get sick and face medical bills that devastate years of planning and preparation. Combine this with the fixed income that so many seniors find themselves on, and you can see why having more security with health bills can make sense.

choosing medicare supplemental insurance can help. may cover up to 100% of out-of-pocket expenses, depending on the plan.

Reading: Who needs medicare supplemental insurance

one in three original medicare beneficiaries (more than 13 million seniors) has chosen to do so.1

choose my type of medicare coverage

your first decision regarding health coverage after age 65 is between original medicare and medicare part c.

Original Medicare covers most medical and hospital expenses. (Does not cover prescription drugs, although you can purchase private drug plans separately.) the balance is left to you, with no limit on out-of-pocket costs.

original medicare lets you see any doctor in the us. uu. who accepts medicare. Provides excellent flexibility – no networking or referral requirements.

medicare part c (or medicare advantage) includes hospital, doctor and drug coverage. covers most of those expenses, but you pay deductibles, copays, and coinsurance. Medicare Advantage plans limit out-of-pocket costs.

medicare advantage is all-encompassing, even offering dental and vision coverage (original medicare doesn’t). but you are limited to your network of doctors and need referrals to see specialists.

what is medicare supplemental insurance?

Original Medicare does not cover all costs. medicare supplemental insurance, or medigap, may cover what medicare doesn’t cover. private insurance companies, vetted by the federal government, offer it to help manage out-of-pocket costs. these policies do not add coverage. Instead, they help pay for what Medicare Parts A and B don’t cover, including copays, coinsurance, and deductibles.2 It doesn’t affect which doctors you can see.

To understand the value of a medicare supplemental plan, you need to understand what original medicare does and doesn’t cover.

Original Medicare is made up of Part A (Hospital Insurance) and Part B (Medical Insurance).

Part A has a deductible that must be paid before hospitalization benefits kick in. Covers the first 60 days of Medicare-eligible hospital care in a benefit period. after that, you pay daily coinsurance amounts, based on the length of your stay.

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Part B also has an annual deductible. Once you reach it, Part B covers 80% of eligible expenses related to the doctor, tests, and medical equipment. you are responsible for the balance (or coinsurance).

in 2021, the part a inpatient hospital deductible is $1,484 per benefit period and the annual part b deductible is $233.3

medicare supplement insurance is designed to help cover these out-of-pocket deductibles and coinsurance.

how does medigap help me?

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Medicare coverage lasts for the rest of your life. As you age, doctor visits and hospital stays can increase. but it is impossible to project your future health care needs.

Medigap policies work hand in hand with Original Medicare to limit your exposure to unexpected out-of-pocket medical expenses. you decide how much you want to be covered and what premium you want to pay.

do i have to get medigap?

are you required to get a medicare supplemental plan? No.

should you? that’s a decision you have to make when considering your medical needs and your budget.

how does medigap work?

To buy a Medigap policy, you must enroll in Medicare Parts A and B.

Medicare coordinates billing and claims between original medicare and your medicare supplemental plan. (rarely files claims).

The provider bills medicare first, then bills your medigap plan. Depending on the plan, the provider then bills you for the remainder, such as the Part B deductible, and your check goes to the provider.

You can renew your medigap policy as long as you pay the premium. the insurer cannot use your health problems to cancel your policy or increase your premium.

there are differences from state to state in some warranties and limitations.

what are my medigap policy options?

the federal government has standardized medicare supplemental plans. you get the same coverage no matter which insurance company sells you the medigap plan. premiums for the same policy may vary between insurance companies. but only the price quoted and the reputation of the insurer will change.

There are ten separate plans, labeled a through n. two plans, c and f, are no longer offered to newly eligible beneficiaries. You can find the specific benefits covered by each plan in this comparison chart.

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once you decide how much coverage you want, you can check online or contact an insurance agent or broker for quotes.

what do medicare supplemental plans cover?

medigap policies cover the following out-of-pocket costs:4

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