Anyone who has Medicare can tell you that it most definitely does not cover all medical expenses. Often the Medicare recipient is left to pay expenses such as copayments, coinsurance, and deductibles. The out-of-pocket expenses or “gaps” as they are commonly known can add up quickly, especially in the event of a serious illness or hospitalization. The private insurance market offers Medicare Supplement Insurance or “Medigap” policies to cover these costs. However, in order to determine if Medigap coverage is right for you, it is important to know certain aspects of how the coverage operates.
Medicare consists of four parts – A, B, C and D. Parts A (hospital care), B (medical care) and D (prescription drugs) do not cover gap costs. To address this, Medicare recipients have the choice of buying Part C (Medicare Advantage Coverage), or purchasing a Medigap policy, both of which are offered through private insurance companies. While these policies cover some expenses, neither usually cover long-term care, vision or dental care, hearing aids, eyeglasses, or private nursing.
To have a Medigap policy, you must have Medicare Parts A and B and pay a premium to the policyholder. Your monthly premium to your Medigap policyholder does not negate the monthly Part B premium you pay to Medicare. Your Medigap policy is only for your coverage and does not extend to spouses. Medigap policies are renewable even if you develop a debilitating health condition. As long as the premium is paid, you can maintain the coverage
It is illegal for an insurance company to sell you both a Medicare Advantage and a Medigap policy. Each plan offers a type of supplemental coverage but may differ in terms the amount of out-of-pocket expenses, amount of services covered, choice of provider, and location of services. In the event you elect to supplement Medicare, it will be important to carefully examine the options presented by these plans and consider your circumstances and how each plan best addresses your needs today and in the future.
Understanding medical coverage related to Medicare can become daunting. Our office has expert sources who are knowledgeable about Medicare and its options and can help you understand your choices and make informed decisions about your coverage. Please contact us if we may be of assistance.