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Medicare Supplemental Health Insurance

Medicare supplemental health insurance, also known as Medigap insurance, is a type of health insurance offered by many private health insurance companies. This type of health insurance is meant to fill in the gaps that Medicare can leave. If you are enrolled in Medicare and yet find that it is often insufficient, Medigap might be the best option for you.

Many times finding the adequate Medigap plan for you can be confusing, which is why we’ve put together some frequently asked questions to help you comprehend all the aspects and considerations regarding Medicare supplemental insurance:   

What are the Gaps?

Gaps in Part A

Medicare Part A covers the basic services such as inpatient hospital stays, skilled nursing, home health, and hospice services. For some individuals, Medicare does not fulfill all their needs regarding medical insurance.  Some of the gaps that can be closed with Medicare supplemental health insurance include coverage for:

  • Skilled nursing facility services for more than the 100 days per spell of illness provide by standard Medicare.
  • Hospital deductible per spell of illness
  • Hospital coinsurance payments.
  • Coinsurance payment for skilled nursing facilities. Keep in mind that coinsurance payments for the year 2009 are $133.50 per day.

Gaps in Part B

Medicare Part B covers some additional services not included in Part A. Part B offers coverage for services such as influenza and pneumonia vaccinations, outpatient hospital procedures, chemotherapy, and renal dialysis, among others services. Part B also covers medical equipment such as canes, home walkers etc.  Yet there are still things that Part B does not cover. Some of the gaps found in Medicare Part B are:

  •  A 20% coinsurance payment. Keep in mind that Medicare covers only 80% of the approved rate for all services and items within part B. This amount can vary depending on the services approved.
  • Often doctors and physicians charge more than what Part B Medicare reimburses – and you are liable for the difference.

Why do I need Medigap?

While Medicare has great basic coverage, it was never designed to cover all your necessities regarding medical insurance. If you are only covered by a Medicare plan, you might already know that some of the gaps left by your plan can be really expensive.

Medigap is specially designed to help you pay for most of the gaps of Medicare, which makes it a perfect compliment to your Medicare plan.

Which Medicare Supplement Health Insurance plan is best for me?

In order to be covered properly, you need to be aware of all your necessities. Luckily, there are many options for you to consider.

Medigap plans are labeled A to L and are standardized. For instance, Medigap plan A offers basic additional coverage: hospital coinsurance for 61-90 days, 365 days of hospital additional to Medicare’s coverage and 20% of coinsurance for Medicare Part B.

The other plans offer all the benefits of Plan A plus one or more additional benefits. These “extra” benefits may include: skilled nursing facility Coinsurance for 21-100 days, higher rates than the previously approved for Medicare Part B, preventive medical care, international travel emergency coverage, and at-home recovery. As always your lifestyle and particular needs will determine which is the right supplement for you.

Can I choose my own doctor?

Most insurance companies let you choose your own doctor, specialist and hospitals; in most cases you do not even need a referral to visit a specialist or particular hospital.

If I already have a Medigap, Can I switch from plan to plan?

If you are looking to replace your current Medicare Supplemental Health Insurance you can apply for another one, but you have to sign a paper to let your company know that you are planning on leaving in order to obtain a new Medigap plan.

You always have the option to change, but it’s important for you to know that it’s illegal for health insurance companies to offer Medicare supplement insurance to individuals who are already enrolled.

Is there a waiting period?

If you have a pre-existing medical condition, many insurance companies will require a waiting period (usually up to six months), before being able to use your Medigap.  However, not all Medigap providers have such waiting periods, and if this is important to you should look for one that has no such requirement when shopping around.


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