Medicare Supplemental Insurance
Supplemental health care insurance, more commonly known as Medigap, provides coverage of insurance-related costs not covered by the original Medicare (Part A and Part B plans.) You cannot enroll in a Medigap plan if you have a Medicare Part C plan.
Medigap policies are sold by private companies and are not provided by Medicare. Before enrolling in a Medigap plan, you need to learn more about these plans, including what they cover, when to enroll and how to enroll.
By taking the time to learn more about Medigap, you will be better prepared to make an informed decision regarding your health coverage.
Understanding Medicare Supplements and Their UsesMedicare supplements help cover costs that are not covered by your Medicare plan, including expenses such as:
- Coinsurance payments to Medicare.
- Copayments to your doctor or another medical facility for services.
- Your annual Medicare deductible.
In some cases, Medigap policies may also provide coverage for additional services.
Supplemental health care insurance policies require you to pay monthly premiums. This premium is paid per person. For example, if you are married and you and your spouse would both like to receive Medigap benefits, you must purchase two policies and pay two additional premium fees. The amount of these premiums is determined by the insurance provider.
Medicare supplements can be offered by any licensed insurer within your state. This allows you to “shop around” for a Medigap policy to ensure that you receive the best coverage for the lowest price. Once you are enrolled in a policy, the insurer cannot legally cancel your plan due to any health plans that you have, as long as you continue paying your premium.
What Does Medigap Cover?
Supplemental health care insurance policies are designed to provide additional covered services, not to replace your Medicare Part A or Part B plans. Medigap policies may include help with your Medicare costs and they may include additional covered services.
While Medigap does commonly provide additional medical service coverage, these policies do not usually include:
- Long-term medical care
- Dental services
- Vision care or eyeglasses
- Private-duty nursing facilities or programs
If you are interested in a plan that is completely different than the coverage you currently have through your Medicare plan, Medicare Part C plans may be the best option.
Medicare Supplements and Travel
Medicare supplements will sometimes include healthcare coverage for when you are traveling outside of the United States. However, care is generally restricted to emergency health care coverage. Medigap plans that include emergency care when traveling are C, D, E, F, G, H, I, J, M and N.
If you have any of the above plans, your coverage will only apply if you require emergency care within the first 60 days of your trip. Policies include a $250 annual deductible that must be met before the insurer begins to pay its portion of your services.
Medigap policies that provide this type of coverage will pay 80 percent of the billed charges you receive for medically necessary care while you are traveling outside of the United States.
Supplemental health care policies that include emergency care while traveling will include a lifetime limit of $50,000 in coverage. If you exceed that limit, you will have to pay for the additional charges yourself.
When and How to Purchase Supplemental Health Care
If you are interested in Medicare supplements, try to purchase a policy within your six-month Medigap open enrollment period. This period will generally be the same as your Medicare open enrollment period but will be based on your current situation.
If you are younger than 65 years of age, federal laws will not require insurers to sell Medigap policies to you, so you may or may not be eligible. Your eligibility will then depend on the insurer.
While you can purchase Medigap policies outside of the initial open enrollment period, you may not qualify or you may need to pay more. After the open enrollment period is over, insurers can legally charge more or even deny you coverage based on your health, including any medical conditions that you have or any prescription drugs you take.
Medicare supplements are provided by private insurance companies. You can purchase a policy by contacting a provider directly. Many providers will also accept applications online through their websites.