What Is Medicare? Understanding What Medicare Covers
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Published on: 21 July 2023
Last Updated on: 14 December 2023
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Medicare is a government-funded health insurance program in the United States. It was established in 1965 by President Lyndon Johnson and primarily provides health coverage for individuals 65 or older, as well as specific younger individuals with particular disabilities and those with end-stage renal disease (ESRD). Medicare aims to help eligible individuals access necessary medical services and reduce the financial burden associated with healthcare costs.
What Are Medicare Supplement Insurance Plans?
Medicare Supplement Insurance Plans, or Medigap plans, are private health insurance policies designed to work alongside Original Medicare (Parts A and B) to help cover certain healthcare costs that Medicare doesn’t fully pay for. Private insurance companies offer these plans and are regulated by federal and state laws.
Medicare Supplement Insurance Plans are standardized and labeled with letters from A to N, except for E, H, I, and J, which are no longer available for purchase. Although coverage may vary depending on the plan type, there are common areas where Medigap plans provide additional financial protection.
Some typical coverage and benefits offered by Medigap plans include:
1. Coinsurance and Copayments
Medigap plans may cover some or all of the coinsurance and copayment amounts required under Medicare Part A and B. This can include coverage for hospital stays, doctor visits, outpatient care, and other medical services.
2. Medicare Part A Deductible
Some Medigap plans cover some of the deductible associated with Medicare Part A, which beneficiaries must pay for inpatient hospital stays. Once the deductible is met, the Medigap plan can cover the remaining costs.
3. Medicare Part B Deductible
Specific Medigap plans cover the deductible associated with Medicare Part B, which beneficiaries must pay for outpatient care and doctor visits.
4. Medicare Part B Excess Charges
Original Medicare has a standard payment rate for services, but some doctors and healthcare providers may charge more than the approved amount. However, Medigap plans that cover Part B excess charges can help pay for these additional costs.
5. Foreign Travel Emergency Coverage
Medigap plans may cover certain emergency services if you require emergency medical care while traveling outside the United States. This benefit is available in select Medigap plans and has limits on coverage and deductibles.
How Can You Apply for Medigap Plans
When applying for a Medigap Plan, there are several steps to ensure a smooth enrollment process which include:
A. Determine Your Eligibility
To be eligible for a Medigap Plan, you must be part of Medicare Parts A and B.
B. Research and Compare Plans
Several Medigap plans are available, offering different coverage and benefits. Therefore, research and compare the plans to identify which best meets your healthcare needs and budget.
C. Enroll during the Medigap Open Enrollment Period
The best time to apply for a Medigap plan is during the Medigap Open Enrollment Period, which begins on the first day of the month you turn 65 and lasts for six months. During this period, insurance companies are generally required to sell you a Medigap policy regardless of your health condition. Furthermore, they cannot charge higher premiums or deny coverage based on pre-existing conditions.
However, you may miss the Medigap Open Enrollment Period. In that case, insurance companies may apply medical underwriting, which means they can consider your health status and charge higher premiums or deny coverage based on your medical history.
D. Contact insurance companies
Once you enroll, contact different insurance companies that offer Medigap plans in your area. Inquire about their available plans, pricing, and enrollment process. Obtain quotes and compare the costs, as these plans have monthly premiums that vary depending on several factors, including the plan type, location, age, gender, and tobacco use.
These premiums can be community-rated, issue-age-rated, or attained-age-rated. Community-rated premiums are the same for everyone in a specific area. In contrast, issue-age-rated premiums are based on age when you first enroll, and attained-age-rated premiums increase as you age.
E. Complete the application
Once you have selected an insurance company and Medigap plan, complete the application form provided by the insurance company. You’ll need to provide personal information, including your Medicare information and any required health history details. Furthermore, carefully review the terms and conditions of the Medigap policy before signing the application and ensure you understand the coverage, benefits, premiums, and any other vital aspects of the plan.
F. Wait for approval
The insurer will then examine your application and determine whether to approve it. The approval process usually takes a few weeks, and during this time, the insurance company may request additional information or clarification if needed.
G. Pay premiums and start coverage
If the insurance company approves your application, you will receive your Medigap policy and instructions on how to pay the monthly premiums. Once the premiums are paid, your coverage will begin, and you can utilize the benefits provided by the Medigap plans.
Base-line
By understanding the coverage and benefits of Medigap plans, you can make informed decisions about your healthcare coverage, ensuring you have comprehensive protection and a better ability to manage your healthcare expenses. Furthermore, Medigap plans to provide an essential option for individuals seeking additional coverage and financial stability beyond Original Medicare.
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