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Important Things to Know About Your Medicare Coverage

Important Things to Know About Your Medicare Coverage

November 11, 2021
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Rising health care costs have made health insurance a much-needed product offering to mitigate the financial blow that could derail your finances. However, it’s important to know that over the years the health insurance space has moved away from simple, on size fits all medical insurance.

If you’re on Medicare coverage, chances are you’ve already noticed that it has some gaps that need to be supplemented by some other additional health policies.

Supplementing Your Medicare Insurance through Medigap  

While Medicare is a comprehensive federal health care administration program, not all services will be covered. In order to help consumers, meet their health care needs, the federal government has worked with private insurance plan providers to create Medigap policies.

Medigap plans are additional insurance policies that are made to work with Medicare. These are private health plans that help pay for some of the costs that traditional Medicare doesn’t’ cover.

If you use medical services when you have Medicare supplement insurance, Medicare pays its portion first, then your Medicare supplement plan will pay for any remaining covered costs.

Registration Timelines

There is a limited time for Medigap registration, in which you’re guaranteed the right to purchase a Medigap under federal laws without Medigap denying you coverage or delaying coverage of pre-existing conditions, known as the "guaranteed right issue."

When the consumer is 65 or more, they’re guaranteed the right for six months after their 65th birthday or the month they register first in Part B during their initial registration period. Consumers over 65 can also be guaranteed the right to enroll in a Medigap if they lose qualified health coverage. In this case, they have 63 days to sign you up for a Medigap. Those under the age of 65 are not guaranteed the right to purchase a Medigap under federal law. Different states have different laws on Medigap purchase rights.

Medigap policies cover some of your personal health care expenses after Medicare Part A or Medicare Part B has paid its share. Medigap policies can help cover:

  • Part A and Part B co-insurance.
  • Co-payments of Parts A and B.

As well as:

Part A deductible - All but one standardized plan provides all or part of the Part A deductible for inpatient hospitalization ($1,408 for each 60-day benefit period).

Part B Deductible -As of January 1, 2020, Medigap plans sold to new beneficiaries are no longer allowed to cover the Part B deductible ($198 in 2020). Two of the 10 standardized plans – Plans C and F – cover the Part B deductible but are not available to new registrants. People already covered by plans C or F can keep their plans and take advantage of the Part B deductible.

Many plans cover 80% of medically necessary emergency services outside the U.S. after reaching a $250 deductible.

Medigap policies do not cover:

  • Long-term care.
  • Vision care.
  • Dental.
  • Hearing aids.
  • Private nursing.

In addition to:

Medigap policies sold after January 1, 2006, are not allowed to include prescription drug coverage. But if you have a plan purchased before that date that includes prescription drug coverage, that coverage will continue. You can get coverage for prescription drugs as part of a Medicare Part D plan.

What you will pay

You pay premiums for Medicare Supplement plans, and they're not standardized. Private insurers may charge different premiums for the same plan. Additional charges may also depend on whether your insurer offers discounts for certain people such as non-smokers or married people. You will likely pay lower premiums if you join a Medicare Select policy that offers coverage for a network of providers.

You may pay higher premiums if you register outside the initial open registration period. And in some cases, insurers may increase your premiums based on your health.

Some Medigap F and G plans charge high deductibles in exchange for lower premiums (and Plan F is no longer available to new registrants). You pay the first $2340 in fees not paid by Medicare before the policy comes into effect.

Plans that provide coverage for emergency medical services abroad charge a $250 deductible for these services.

Other Ways to Supplement Your Medicare 

  • Job-based insurance: If you are still working and have an insurance offered through your employer, it may supplement Medicare. You need to find out if your Job-based insurance is secondary or primary to Medicare.
  • Retiree insurance: Some employers provide health insurance to retirees to take care of the gaps in the Medicare plan. This will typically pay as a secondary policy after the Medicare coverage.
  • Stand-alone Medicare private drug plan (Part D): once enrolled in Medicare, you can go further and add Medical Private Plan which will offer drug coverage. Keep in mind that different Medicare plans offer a different list of drugs coverage and varying costs. So, make sure the plan you choose covers the drugs you need at a cost you can afford.

Once you've chosen the type of plan you want, you'll need to compare prices from all the insurers that offer that plan in your area. Keep in mind that prices can vary greatly, but coverage is the same for each letter plan for the case of Medigap. Be sure to contact the insurer for each policy you plan to check prices and coverage availability. The information available online can quickly become obsolete.

References 

https://www.medicare.gov/what-medicare-covers

https://www.medicare.gov/medigap-supplemental-insurance-plans/#/m?lang=en&year=2021

https://www.medicare.gov/supplements-other-insurance/when-can-i-buy-medigap/4-steps-to-buy-a-medigap-policy