Understanding Medicare Supplemental Plans
A Medicare supplement provides financial security and additional health coverage for people with Medicare. The plan pays for some of the healthcare costs that Original Medicare doesn't cover. These include out-of-pocket costs like co-pays, coinsurance, and deductibles.
A Medicare supplement is also known as a Medigap plan because it helps to fill the gaps in healthcare costs.
This type of coverage can go by multiple names, which adds to some of the confusion. If you hear “Medicare Supplement,” “Medicare Supplemental insurance,” “Medigap,” “Medigap plan,” or “Medigap policy,” it’s all referring to the same thing.
Please note that the costs involved in Medicare Supplement policies may vary and will increase as you get older.
Facts You Need to Know
You Must Have Original Medicare
You must have Medicare Part A and Part B to enroll in a Medicare supplement plan. These plans are meant to wrap around your existing Medicare coverage. Medicare supplement plans cannot be used with a Medicare Advantage policy (i.e., Medicare Part C).
You also have a one-time, six-month Medicare Supplement Open Enrollment Period, which starts the first month you are enrolled in Medicare Part B. During this period, you are guaranteed an issue of a Medicare Supplement policy, regardless of your health status.
It Involves Separate Payment From Original Medicare
You will pay a private insurance company for Medicare Supplement coverage. This payment is separate from your Medicare payment to the federal government.
That being said, Medicare Supplement policies must follow federal and state laws. Insurance companies may only sell standardized policies that are identified by the letters A-N.
It Involves Individual Plans Only, Not a Family Plan
Medicare supplement coverage is available only to individuals. You and your spouse must complete one individual application each.
There’s No Prescription Drug Coverage Under Medigap
Medicare supplement plans sold after January 1, 2006 do not include prescription drug coverage. For prescription drug coverage, you'll want to purchase a separate Medicare Part D policy.
Medicare Supplement Covers the Costs of Basic Medicare Benefits
This covers basic Medicare benefits (including Part A coinsurance, Part B coinsurance and copayment, deductibles, hospital costs, hospice care, and preventative care). Additional benefits depend on the plan. On the other hand, it doesn't cover long-term care, dental, vision, hearing aid, or other types of lifestyle bills.
See Any Doctor That Takes Medicare
You can choose to see any doctor or healthcare provider that accepts Medicare. Billing and claims are coordinated with Medicare.
The billing between Original Medicare and Medigap plans for covered Medicare services and products is automatically coordinated between Medicare and the insurance company. You will not have to file separate claims.
( TTY users should call 1-877-486-2048), 24 hours a day / 7 days a week or consult Medicare.
What should I consider when selecting my Medicare Plan?
Call Hendricks Insurance today for your answers at (919) 473-6728.
We/I do not offer every plan available in your area. Currently, We/I represent organizations which offer products in your area.
Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
What Are the Healthcare Expenses That Original Medicare Doesn’t Cover?
Original Medicare can leave significant coverage gaps, even when you are enrolled in Part A and Part B. Some of the important coverage gaps include:
Medicare Part A Deductible + Medicare Part B Deductible
Each year, you are responsible for paying the deductible before Original Medicare coverage begins. For 2023, Part A and Part B deductibles are $1,600.00 and $226.00, respectively.
Medicare Part A Coinsurance (for Hospital Visits and Stays)
Once you’ve paid the $1,600.00 deductible, Medicare Part A covers only the first 60 days of care. After that, you pay daily coinsurance – for 2023, it’s $400.00 a day – for the next 30 days.
After 90 days, you can use up to 60 lifetime reserve days with a daily coinsurance of $800.00 for 2023. After that, unless you have Medigap or other supplemental coverage, you must pay your inpatient care costs in full.
Medicare Part B Coinsurance (for Doctor’s Visits and Medical Equipment)
Once you’ve paid the Medicare Part B deductible of $226.00, you are responsible for 20% of everything that Medicare covers.
Foreign Medical Care
Original Medicare normally does not cover any healthcare costs outside of the US and its territories, though it makes exceptions in emergency situations if the closest hospital that can treat you is in a foreign country or if a foreign hospital that can treat your condition, emergency or not, is closer to your home than a US hospital.
Generally, if you are hospitalized while traveling overseas you are responsible for all the costs. Certain Medigap plan types provide coverage for this.