Going on Medicare?
Then You Need a Medicare Supplement
MEDICARE
Medicare is the Federal health plan that is available to most people when they go on Social Security. Medicare is divided into Part A and Part B. You will not pay a monthly premium for Part A, because you paid Medicare taxes while working. Part B, however, does have a monthly premium that can change every year. In 2009 it is $96.40 a month. This is the base amount and is adjusted upwards for an individual making over $85,000 annually.
MEDICARE PART A: What Does it Cover?
Medicare Part A includes inpatient hospital and skilled nursing facility coverage. But it is important to know that it pays for only part of these medical expenses.
MEDICARE PART B: What Does it Cover?
Medicare Part B is designed to help cover part of your outpatient hospital charges, physician fees, and certain other medical expenses.
MEDICARE SUPPLEMENT (MEDIGAP)
The problem is that what Medicare covers and what you have to pay creates “gaps” in your coverage that can add up very quickly.
Protecting yourself against these expensive gaps in Medicare coverage is what supplemental or “Medigap” plans are all about.
As valuable as Medicare is, it has its limitations. It cannot be all things to all people. It covers all or part of many medical expenses — both hospital and doctor fees. But you are still responsible for deductible and coinsurance payments. Plus, if your doctor does not accept Medicare assignment, your medical expenses could exceed Medicare’s approved charges and you would be required to pay the difference out of your pocket.
A Medigap policy is a health insurance policy sold by private insurance companies to protect against the expensive gaps in Medicare. There are ten standardized plans called “A” through “J.” Each plan has a different set of benefits. If you have a private Medigap plan, as opposed to an HMO, you can go to any doctor or hospital you wish, as long as they are Medicare providers.
Explanation of Medigap
Insurance Benefits
Medicare A & B coinsurance: This Medigap insurance benefit covers the coinsurance on a hospital stay under Medicare Part A and the coinsurance or copayment on Medicare Part B services once the deductible is met.
365 days extra hospital stay: This Medigap insurance benefit covers the full cost of 365 extra days of hospital stay after all Medicare hospital benefits are exhausted.
3 pints of blood: This Medigap insurance benefit covers the cost of 3 pints of blood per year.
Part A deductible: This Medigap insurance benefit covers the deductible on Medigap Part A, which may vary from year to year. It is $1068 in 2009.
Foreign travel emergency: This Medigap insurance benefit covers 80% of emergency care administered outside the country during the first 60 days of any trip. A $250 deductible and $50,000 lifetime maximum apply.
Skilled nursing coinsurance: This Medigap insurance benefit covers up to $105 per day towards the cost of a stay in a skilled nursing facility during days 21 through 100.
Medicare Part B deductible: This Medigap insurance benefit covers the annual deductible on Medicare Part B, which may vary year to year. (It is $135 in 2009.)
Medicare Part B excess: This Medigap insurance benefit helps cover the additional cost of services by doctors who don’t accept “assignment” (that is, who don’t accept Medicare’s reimbursement as payment in full). Medigap G pays for 80% of the extra cost, and Medigap F, I, and J cover all the extra cost.
At-home recovery: This Medigap insurance benefit helps cover the additional cost of at-home care if you are already receiving Medicare-covered home health care services. A $40 per day and $1,600 per year limit both apply.
Preventative care: This Medigap insurance benefit provides for up to $120 worth of preventative care per year. (Covered services include check-ups, cholesterol screening, hearing tests, diabetes screening, and thyroid testing.)
Buying Medigap insurance is a very important process, and you want to weigh your options. But you also want to balance coverage with affordability. We can help you do this.