Why do you need a Medicare supplement?

Medicare is structured similarly to any health insurance plan in that it has deductibles and coinsurance amounts, or copayments, which are the patient’s responsibility at the point of service.  Because many on Medicare are also on fixed incomes, supplemental insurance is a popular way to limit out-of-pocket costs to more predictable amounts that the patient can manage more easily.  There are 10 Medicare supplement plans available on the market today.  These health plans are also sometimes called Medigap insurance, because they fill in some of the gaps in original Medicare.

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Medicare Part A

Medicare Part A is inpatient hospital insurance. It helps pay for medically necessary inpatient hospital stays. Part A also helps pay for some home health care and hospice care.

Inpatient hospital care is subject to a $1,340 deductible for each 60 day benefit period. If you are still in the hospital after 60 days, you will be required to pay a daily copayment between $335 and $670 until the 150th day when your hospital coverage ends.

A Medigap policy will pick up and pay an additional 365 days after Medicare runs out.

In general, Medicare Part A pays:

  • Hospital stays
  • Critical access hospitals
  • Inpatient rehabilitation facilities
  • Inpatient care in a religious, non-medical health care institution
  • Skilled nursing facility care
  • Nursing home care (as long as custodial care isn’t the only care needed)
  • Hospice care
  • Home health services
  • Lab tests, X-rays and radiation treatment received as an inpatient
  • Surgeries

Medicare Part B

Medicare Part B is called Medical on your card, but what it really means is outpatient insurance. It helps pay for medically necessary services performed on an outpatient basis that are needed to diagnose and treat a medical condition. It also covers preventive services.

Medicare Part B covers 80% of covered costs after you meet the deductible ($183 for 2018), and you would pay the other 20%, but a  Medigap policy will cover the 20% for you.

  

When should you sign up?

You should sign up when you’re first eligible, unless you have other coverage to pay the 80% such as an employer group plan. If you don’t, your monthly premium may be higher when you do sign up, and you will have to wait until the yearly general enrollment period.


Is there a monthly premium for Part B?

Yes, you need to pay the Part B premium each month. The amount you pay can change each year and may be different depending on your income. Your Part B premium may come out of your Social Security benefits, or you may get a monthly bill. The standard monthly premium in 2018 is $134, but can be as high as $428 per month for high income individuals.

 

In general, Part B covers:

  • Doctor services
  • Outpatient care
  • Home health services
  • Durable medical equipment
  • Clinical research
  • Ambulance services
  • Mental health services
  • Second opinions before surgery
  • Home health services
  • Preventive services such as physical exams, screenings and flu shots
  • Some physical and occupational therapy to prevent or lessen complications from an existing medical problem
  • Medicare approved chemotherapy and radiation for cancer

What’s not covered:

  • Dental, vision or hearing care, except in very limited situations
  • Care received outside the United States, except in very limited situations
  • Custodial care such as help with eating, bathing or dressing
  • Prescriptions
  • Routine Dental Vision & Hearing benefits
  • Some new cancer treatments. Additional cancer coverage is a available from our company to supplement this ben

Medicare Part D

Medicare Part D is prescription drug coverage. Part D coverage is available as a Stand Alone Option (PDP) or as part of a Medicare Advantage plan (Part C). Part D plans are offered by private insurance companies contracted and approved by Medicare.

  

When should you sign up?

You are eligible for Part D when you first become eligible for Part A. You can avoid late enrollment penalties by joining a Part D plan when you first become eligible. If you have had other credible coverage you are not subject to a penalty. Group insurance or Veterans benefits are examples of credible coverage. If you lose your credible coverage, you have 60 days to enroll in a plan.


Is there a monthly premium?

Yes. Premiums vary depending upon the plan option you choose. Generally they are under $30 per month and in some cases under $20 per month. The plan you chose depends on your prescriptions.

 

The two options for prescription drug coverage are:

  • Prescription drug coverage as part of a Medicare Advantage plan. You get Part A, Part B and Part D coverage in one plan.
  • Stand-alone Medicare prescription drug plan (PDP). These plans only offer prescription drug coverage. You can buy a PDP plan in addition to your existing Original Medicare (Part A and/or Part B) coverage, Medicare Supplement (Medigap) plan, Private Fee-for-Service (PFFS) plan without prescription drug coverage, some Medicare Cost Plans, or Medicare Medical Savings Account (MSA) Plans.

To learn more about your options, call us at 229.249.7014