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Medicare Advantage & Medicare Supplement or Medigap

Medicare Advantage & Medicare Supplement or Medigap - Online Resources

Medicare supplemental health insurance is basically a plan that is sold by private insurance companies. It covers the individuals who are eligible for Medicare and provides them with additional covers for their medical needs. You can buy these plans from an insurance provider. The provider is usually bound by state and federal laws. But before deciding on any plan, you should gather all the information you can. You pay your premiums to the insurance company. However, some assistance is available for people who have incomes below a certain level. Basically, Medicare assistance helps fill the gaps that are left by standard government Medical plans.

As Medicare tries to balance between the needs of the elderly and coverage offered by the government, there are specific gaps in the plans. These may include extensions in hospital stays, prescription drugs coverage, specialized home -care and travel covers. Also try to understand coverage options under the plans and the rules governing them before you join or switch plans. It would be wise to exhaust your covers under Medicare plans available and also to explore whether you can avail of group health insurance from a trade union or your employer. Once you analyze all other options available, you may realize that you donít need this coverage at all.

There are a total of 12 plans offered by Medicare supplemental health insurance. These are categorized as plans A to L. It applies to all states except Massachusetts, Wisconsin and Minnesota. Each of these plans offers a different set of benefits.

For e.g. the plans K and L are comparatively new plans that help you in minimizing excessive out of pocket expenses on doctors and hospital care. These two plans have a lower level of premiums but you have to pay a certain amount of deductibles before the company pays your medical costs. Of course, these plans offer additional covers over those provided by the original Medicare but you take up greater chances with your share of the costs.

Plans F and J are select plans under Medicare. They are usually less expensive but they do have high deductibles. In order to get the full benefits of these plans, you have to avail of services provided by particular doctors. The reason behind the low cost of these plans is that the doctors listed by the plans offer members services at discounted rates.

You can avail services of any physician you want unless you are opting for Medicare select policy. Your expenses are covered by Medicare supplemental insurance and Medicare. The benefits you receive will depend on the plan you select. The payments you make for Medicare and Medigap will be in separate invoices. Once a month you will receive a summary from Medicare by mail and one from Medigap detailing the plan and the payments made. You should note that Medicare supplemental insurance does not replace your original Medicare coverage. It only fills the gaps left in the policy. You can also join the Medicare advantage health plan to help you with costs of drugs and deductibles on coinsurance.

Another point to note is that at times, a separate insurance you might have pays for your insurance and then Medicare pays for it. This means that the previous insurance company makes the prior payment and then Medicare pays for it. An insurance company making the primary payment could be any of the following-

  • Group health coverage provided by employers
  • No fault insurance
  • Black lung benefits
  • Liability insurance
  • Workersí compensation

You should always inform the doctor about the type of insurance covering you so that he can prepare the bills accordingly. This is also important because sometimes conditional payments are made by Medicare. If the first insurer does not make the payment initially, it has to pay Medicare later on. For this reason, it is called conditional insurance. If you have a plan covering prescription costs and you have enrolled in a Medicare prescription drug plan, you should let Medicare know about your plans. You should also know about your rights as a member of Medicare and what effect it has on your Medicare supplemental insurance.

Medicare prescription drug plans were made available from the 1st of January, 2006. This new plan includes separate deductibles and co payments in relation to the costs of prescription drugs. You also have to go to those pharmacists who are included in the plans. In case you donít do so, your costs will not be covered. Additionally, in most cases, only those medicines that are listed in the plan are covered.

For additional information on Medicare Supplementary Insurance, please visit the links below...


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