Is Supplemental Insurance for Medicare Right for You?
Medicare is the U.S. health insurance program designed to provide coverage to people over the age of 65, as well as individuals with end-stage renal disease and younger people with certain disabilities. One of the key benefits of Medicare is to help to control a person’s health care costs as they get older. As long as a person meets certain requirements, there are no premium payments for certain types of Medicare and the care you receive is often free or low-cost.
Although Medicare can provide coverage for much of your health care needs, it doesn’t cover everything. For that reason, some people decide to purchase supplemental Medicare coverage, also known as a Medigap policy. There are several reasons why Medigap might make sense for you and provide the most comprehensive form of health coverage. Learn more about what’s covered by Medicare and what you can get from purchasing a supplemental Medicare insurance plan in California.
Your Guide to Supplemental Insurance for Seniors
People over age 65 have a few options for getting supplemental insurance. They can purchase an insurance policy that is designed to cover the health needs of seniors, such as vision care and dental care, but that isn’t explicitly Medicare. Another option is to purchase a Medigap policy that is designed specifically to cover “gaps” in Medicare insurance coverage.
Seniors can also get a Medicare Part C plan, which combines traditional Medicare coverage with other insurance protections. Knowing what Medicare covers and having a general sense of your health care needs will help you choose the bundle of insurance policies that offers the most protection.
What Medicare Gives You
Medicare is a multi-part health insurance program. Each Medicare part covers a different type of health care need:
- Part A: Medicare Part A is also known as “hospital insurance.” There’s no premium for most people. The plan provides coverage should you need in-patient care at a hospital or if you need care at a skilled nursing facility. The insurance also covers home health care and hospice care but will not provide coverage for long-term care at a nursing home.
- Part B: Medicare Part B provides coverage for preventative care and for medically necessary treatments. It also provides coverage for ambulance services, mental health services and certain prescription medications.
- Part D: Medicare Part D provides coverage for prescription medications.
Both Medicare Part B and Part D require a monthly premium, which is based on your income. Medicare Part B also has an annual deductible that needs to be met before the plan begins to pay for your medical care. Even once you’ve paid your annual Part B deductible, you are still responsible for 20% of the Medicare-approved cost of medical services or treatments.
Medicare Part D plans can also have an annual deductible, the amount of which can vary from plan to plan. Most Part D plans require either a copayment, such as $10 per prescription, or coinsurance payment, which is a percentage of the cost of a prescription medication.
Many people will not need to pay a monthly premium for Medicare Part A, particularly if they paid Medicare taxes while working. Part A does have an annual deductible, which is considerably higher than the deductible for Part B.
Together, Medicare Part A and Part B are called “Original Medicare,” as the programs are overseen by the federal government. If you have Original Medicare coverage, you are eligible to see any health care provider who accepts Medicare.
What Medicare Doesn’t Give You
Although Medicare can make health care more affordable for people over the age of 65 and for other qualified individuals, it doesn’t cover everything. Original Medicare and Medicare Part D will not provide coverage for:
- Dental care
- Hearing aids
- Eye exams
- Cosmetic surgery
- Long-term or custodial care
- Foot care
What Is Supplemental Medicare and Supplemental Insurance?
When you become eligible for Medicare, you might find the out-of-pocket costs are more than you can comfortably afford based on the medical conditions you have and the treatments you need. Medicare also doesn’t cover everything you might need or want coverage for. Supplemental insurance or Medigap coverage can fill in gaps in your coverage or pay for costs Medicare doesn’t pay for.
Just as there are multiple types of Medicare available, there are multiple supplemental insurance options out there. Like Original Medicare, Medigap plans are lettered, starting with A and running through N, although certain plans, such E, I and J are no longer available. Changes in the law mean that certain Medigap plans, such as Plan F, will no longer be sold to people as of 2020. Those plans are still available to people who already have them.
Some of the benefits offered by Medigap plans include:
- Coverage of Part A coinsurance and hospital costs for up to an additional 365 days once Medicare Part A benefits are used up.
- Coverage of Part B copayments or coinsurance.
- Coverage of up to 3 pints of blood.
- Coverage of coinsurance for hospice care under Part A.
- Coverage of coinsurance for skilled nursing care under Part A.
- Coverage of Part A deductible.
- Coverage of Part B deductible (as of January 1, 2020, these plans are not sold to people who are newly eligible for Medicare).
- Coverage of excess charges for Part B.
- Foreign travel insurance coverage.
Medigap plans won’t cover dental expenses, eye exams, eyeglasses, hearing aids or private nursing care. If you would like coverage for any of those treatments, you should purchase a separate insurance policy, such as vision insurance or dental insurance.
What Is Medicare Part C?
Medicare Part C, also known as Medicare Advantage, is not Medigap insurance, nor is it the same as Original Medicare. Instead, it’s a sort of hybrid of Medicare Part A and Part B and supplemental insurance. If you have Original Medicare from the federal government, you have the option of enrolling in Part C. However, enrolling in Part C takes away the option of enrolling in a supplemental Medigap plan.
Medicare Advantage plans are offered by private insurance companies. They bundle the services of Medicare Part A, Part B and often Part D with other insurance coverage, such as dental insurance and vision insurance. Instead of paying your Medicare Part A and Part B premiums to the federal government and your Medigap premiums to a private insurer, under a Medicare Advantage plan, all your premiums are paid to the private insurer.
The insurance companies that offer Medicare Advantage plans need to be approved by the federal government. Medicare pays the insurance companies a set amount each month for your health care. To continue to offer Medicare Part C plans, the insurance company needs to follow the regulations and rules set forth by Medicare.
The cost of a Medicare Advantage plan depends on a range of factors. Some plans charge a monthly premium, but not all do. Some also have a deductible, but not all. The plan might also charge a copayment or coinsurance each time you see a doctor or receive treatment.
Some Medicare Part C plans will pay for your Part B premium, but not all do. Some also limit the doctors you can see or might charge you more out-of-pocket if you see a doctor or provider who is not in the plan’s network.
A notable difference between Medicare Advantage or Part C plans and Medigap supplemental insurance plans is the amount of variation found between each. Medigap plans are standardized by the federal government. If you buy Medigap Plan A, you will get the same coverage whether you purchase it from Company A or from Company B. Meanwhile, the coverage offered by a Medicare Advantage plan from Company A can be considerably different from the Medicare Advantage plan offered by Company B.
Why Seniors Should Get Supplement Insurance
Original Medicare covers many expenses related to health care, but not all of them. Medicare Part B also has a monthly premium and both Part A and Part B have deductibles, which you will need to pay out-of-pocket. If you anticipate that you will have medical expenses that won’t be covered by Medicare, getting supplemental insurance makes sense.
It can be a smart move to sign up for a Medigap plan when you are first eligible to enroll in Medicare, even if you are not sure you will need it. The reason is simple: During your Medicare open enrollment period, you can get a Medigap policy for the same premium charged to people in the best of health, no matter your current condition.
After your open enrollment period ends, you might not be able to buy a policy. If you are able to purchase supplemental insurance later on, the insurer can base your premiums on your current condition. The insurer might deny your supplement insurance coverage based on a pre-existing condition.
How to Choose the Right Supplemental Medicare Coverage
Which Medigap supplement insurance plan is right for you? Or should you skip Original Medicare and Medigap entirely and choose a Medicare Advantage plan? There are several things to consider when deciding on the supplemental coverage that will best meet your needs.
1. Coverage Available
Since Medigap plans differ in the benefits they offer and the coverage from Medicare Advantage plans can vary from insurer to insurer, it’s worthwhile to find out what your plan will cover before you select it. Medigap plans are standardized, meaning each one will offer the same benefits no matter what insurance provider you choose.
Not all insurers offer every available Medigap plan. If you need vision care, dental care or other care not covered by Original Medicare, you’ll want to confirm that your supplemental insurance covers those services or purchase a separate plan that does so.
Think about the premium costs associated with an Original Medicare and Medigap plan compared to the cost of a Medicare Advantage plan. You might also want to consider your potential out-of-pocket costs under different plans.
It can be useful to think of the future, too. Even if you don’t have many medical bills now, there is a chance your health care costs will increase as you get older and need more care. Keep in mind that some Medigap plans offer full coverage for certain costs while others might pay half or three-quarters of the expense.
3. Out-Of-Pocket Limit
Original Medicare has no annual out-of-pocket limit, but many Medicare Advantage plans do. Certain Medigap plans, notably Plan K and Plan L, also have out-of-pocket limits. If you meet the limit set by either plan and also pay your Part B deductible, the plan will cover the remainder of your costs for the year.
4. Doctors Available
As with non-Medicare insurance, there is a chance that a medical provider might not accept your insurance plan or might be out of network. In the U.S., the vast majority of primary care providers participate in the Medicare program, so the odds are very high that your current doctor will accept Medicare.
There is a caveat, though. Some providers are not accepting new Medicare patients. If you need to change doctors for whatever reason, it might be challenging to find a new doctor if you have Original Medicare. It’s a slightly different story if you decide to buy a Medicare Advantage plan. In that case, you’ll want to confirm that your current or new doctors are in the insurer’s network and that they accept your insurance.
5. Prescription Medication Options
Medicare Part D provides prescription drug coverage to people with Original Medicare, while some Medicare Advantage plans offer coverage for prescription drugs. Even if you aren’t regularly taking prescriptions now, it might be worth considering Part D, as you might have to pay a penalty for enrolling late if you don’t sign up during open enrollment and later decide you would like Part D.
6. Other Coverage You Have
Although 65 is the traditional retirement age, plenty of people are still employed at that age and continue to work for years. If you are covered by an insurance plan from your employer or by a plan from your spouse’s employer, it’s a good idea to speak with the administrator of that plan to see how enrolling in Medicare will affect your coverage under it. If you have a secondary insurance policy already, you might not need Medigap or a Medicare Advantage plan.
Let Health for California Help You Choose Your Plan
If you’re nearing 65 or have recently become eligible for Medicare and you live in California, Health for California can help you sift through your supplemental insurance options. We’ll help you choose the plan that best meets your needs, whether it’s getting a Medicare Advantage plan, getting Original Medicare with a Medigap plan or getting prescription drug coverage. We want you to get the coverage you need at a price that works for your budget.
Get a quote today for quality health insurance at a low price.
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