What Does my Medicare Supplement Insurance Plan Cover?
You’re closer to turning 65, and soon enough, you’re going to start receiving healthcare benefits through the federal government, also known as Original Medicare or Medicare Part A and B. Though you are comforted by the fact that some of your expenses will be covered, you know that you’re going to need extra help with other costs. As you grow older, you don’t know what your health situation is going to be, and you want to set yourself up for success by signing up for as much coverage as possible.
That’s where Medicare Supplement insurance can step up to the plate and help you out. First, before going into Medicare Supplement insurance, let’s look at what Original Medicare covers in terms of your healthcare costs
COVERAGE FROM ORIGINAL MEDICARE
Original Medicare, unlike Medicare Supplement insurance, offers basic coverage. It will help cover doctor’s visits, diagnostic testing, at-home physical therapy, and part-time skilled nursing care.
If you go into the hospital, Original Medicare will also cover up to 100 days of skilled nursing home care. It takes care of inpatient hospital care and some of the medical items and doctors’ fees while you’re there. If you are in the end stages of life, or the last six months, Medicare is going to cover expenses for hospice case, nurses, doctors, personal case, homemaker services, and prescription drugs.
Original Medicare does not cover many things that the aging population needs such as prescription drugs, long-term care, caregiving support, benefits for supervision or personal care at home or in facilities. If you want to do alternative therapies like acupuncture or herbal medicine, or if you want to travel outside of the United States, you will not be covered.
Since a lot of people want to travel in retirement, as well as know they are covered for certain procedures and circumstances, they will buy a Medicare Supplement insurance policy to pay for those extra costs.
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WHAT IS MEDICARE SUPPLEMENT INSURANCE?
Medicare Supplement insurance, which is also called Medigap, is a private insurance that you can purchase in addition to your regular Original Medicare coverage. It covers the copayments, coinsurance, and deductibles that Original Medicare may not, and it may pay for medical expenses you incurred if you traveled outside of the United States.
When you sign up for Medicare Supplement insurance, you’re going to be paying a monthly premium that is in addition to your Medicare Part B premium. As long as you never forget to pay that premium, you will have coverage as long as you want it. Even if you find out you have a disease or condition, you can still keep your coverage. With a Medicare Supplement insurance plan, you and your spouse are not covered under the same plan. You’ll need two separate plans for each of you. One big benefit of a Medicare Supplement insurance plan is that you don’t need a referral to go to a specialist. Plus, you can visit any doctor that also accepts Medicare.
There are 10 different types of Medicare Supplement insurance plans, and they are pretty much the same in every state. The only states that vary in terms of coverage are Minnesota, Wisconsin, and Massachusetts. The plans are A, B, C, D, F, G, K, L, M, and N.The coverage varies according to the plan you purchase.
Plan F is the most comprehensive one – it covers the most – but it is no longer going to be available after January 1, 2020. If you sign up before then, or you already have it, you will be able to keep it, however. Plan F is the most popular Medicare Supplement insurance plan. An alternative that providers are suggesting is Plan G, since it also offers a good amount of coverage.
In terms of what they each provide, here is a general overview:
- Part B excess charge is covered 100% by F and G
- Part A coinsurance and hospital costs (up to an additional 365 days after Medicare benefits are used) is covered 100% by every plan
- Part A hospice care coinsurance or copayment is covered 100% by all except K (50%), and L (75%)
- Skilled nursing facility care coinsurance is not covered by A and B, is 50% covered by K, 75% covered by L, and covered in full by the others
- Part A hospice care coinsurance or copayment is covered fully by every plan except for K (50%) and L (75%)
- Foreign travel benefits include paying up to 80% of medical emergency costs after a $250 deductible under Plans C, D, F, G, and N
Note that only Medicare Part D will be able to provide prescription drug coverage. Medicare Supplement insurance will also not cover hearing aids, long-term care, eyeglasses, vision or dental care, or private-duty nursing. You cannot purchase a Medigap policy if you also have a Medicare Advantage plan.
If you have a pre-existing condition, you may have to wait up to six months to purchase a Medicare Supplement insurance plan. During the six month waiting period, the Medigap provider can refuse to pay your out-of-pocket expenses. To avoid this waiting period, you can purchase Medicare Supplement insurance during an open enrollment and you’ve had continuous creditable coverage or a health insurance policy for six months prior to purchasing a policy. If you choose to let go of your Medicare Supplement insurance policy, there is no guarantee that you will be able to sign up again, so don’t let it lapse.
Let’s say you’ve received Medigap plans and they don’t cover everything you need. Your other option is to continue on with your Original Medicare coverage, and to sign up for a Medicare Advantage plan, Medicaid, long-term care insurance, veterans’ benefits, and Medicare prescription drug care plans instead. Remember that you can’t have a Medigap and one of these other policies at the same time, so you need to choose.
If you do decide to get rid of your Medigap plan because of a lack of prescription drug coverage, you need to watch out for the timing. When you go to enroll in a new Medicare drug plan, you will pay a late enrollment penalty if you drop your entire policy and the drug coverage wasn’t creditable, or if you go 63 days or more in a row before your new Medicare drug coverage begins.
PURCHASING A MEDICARE SUPPLEMENT INSURANCE PLAN
When you want to purchase a Medicare Supplement insurance plan, you need to do it during open enrollment, which is six months from the first day of the month of your 65th birthday. You also need to make sure you signed up for Medicare Part B within those same six months. If you try to sign up outside of open enrollment, you won’t be guaranteed coverage.
If you’re currently in the open enrollment period, or you just want to do your research and start planning out your expenses, you can look into the various Medicare Supplement insurance policies that are available to you through Ensurem’s Medicare Supplement Quote tool. This tool makes it incredibly easy to find a Medigap policy that is within your budget and covers everything you need now and going forward.
Simply log onto Ensurem’s website, navigate to the tool, and enter basic information like your gender, date of birth, tobacco use, and location. You can choose to only show certain plans, or to display all of your options, and you can sort your options by the lowest monthly cost to the highest monthly cost, or vice versa.
Once you find a plan, research what it covers. Look at your medical history – and perhaps your family’s medical history – to determine what issues may arise for you in the future. See if you’ll be able to cover things like eyeglasses, dental appointments, and prescription drugs without the help of a Medigap policy.
If you look through all the benefits, and you see one that works for you, you can apply for coverage. All it takes is a few minutes to be empowered and find healthcare coverage that’ll work for you now and in the future.
What are you waiting for? Start looking into your options today and find coverage that’ll suit you for the rest of your life.
Ensurem Trusted Expertise
Education is crucial in finding the right Medicare solution for you. With so many Medicare resources out there, it can be difficult finding a source you can trust. That’s why Ensurem has a Compliance Program dedicated to ensuring our Medicare content meets Centers for Medicare & Medicaid Services (CMS) regulations. So, you can rest assured you’re getting the information you need to make the right coverage decisions.
Denise Austin, 65, Ensurem Ambassador
Best-Selling Author, Creator of Fit Over 50 Magazine
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