Medicare Supplement Insurance, Medicare, Medicare Advantage, Part A, Part B, Part C…
If you are just turning 65 or will be soon, these terms can be a bit bewildering. And, even if you’ve been on Medicare for a few years already, much of this can still be confusing. But, while it is a great benefit, one of the unfortunate realities of Medicare is that it doesn’t cover all the costs of health care services. And this is where Medigap, or Medicare Supplement Insurance, comes in.
A Brief Overview of Medicare and the Role of Medicare Supplement Insurance
We covered the topic of Medicare Advantage plans in a previous article. However, a Medigap policy or Medicare Supplement Insurance is somewhat different. Medicare states that Advantage Plans, or Medicare “Part C,” is an “all in one” alternative to Original Medicare. In addition, Medicare Advantage plans are only offered by private companies that Medicare approves. Although Original Medicare pays for much of the cost for covered health care services and supplies, it does not cover everything. Therefore, a Medicare Supplement Insurance (also known as Medigap) policy can help pay some of the remaining health care costs, like:
And, while Medicare Supplement Insurance, or Medigap, policies are extremely helpful in light of rising health care costs, they still do not cover every cost that might be incurred. For example, Medigap policies generally don’t cover:
- long-term care
- vision or dental care
- hearing aids, eyeglasses
- private-duty nursing
And What is Medicare Exactly?
Simply put, Medicare is a federal health insurance program for people who are 65 or older, as well as some others with disabilities, as well as those with End-Stage Renal Disease, or ESRD. This is permanent kidney failure that requires dialysis or a transplant. Medicare is structured with different parts to help cover specific services. These are:
- Medicare Part A (Hospital Insurance) – This covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
- Medicare Part B (Medical Insurance) – Covers certain doctors’ services, outpatient care, medical supplies, and preventive services.
- Medicare Part D (prescription drug coverage) – Helps cover the cost of prescription drugs (including many recommended shots or vaccines).
If you have not signed up for Medicare yet, there are few key facts to be aware of:
- Some people get Medicare automatically
- You may have to sign up if you’re 65 (or almost 65) and not getting Social Security
- There is an enrollment period for signing up or changing your Medicare Coverage
- If you sign up for Medicare Part B when you’re first eligible, you can avoid a penalty
- You can choose how you get your Medicare coverage
- You may be able to get help with your Medicare costs
How California Medicare Supplement Insurance Works
According to the federal government’s Medicare.gov website, this is how Original Medicare works with a Medigap policy:
- Medicare pays its share of “Medicare-Approved Amounts” for covered health care costs.
- Then the Medigap policy pays its share.
In addition, there are several points to take note of concerning Medigap policies:
- You must have Medicare Part A and Part B.
- A Medigap policy is different from a Medicare Advantage Plan. Those plans are ways to get Medicare benefits, while a Medigap policy only supplements your Original Medicare benefits.
- You pay the private insurance company a monthly premium for your Medigap policy. You pay this monthly premium in addition to the monthly Part B premium that you pay to Medicare.
- A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you’ll each have to buy separate policies.
- You can buy a Medigap policy from any insurance company that’s licensed in your state to sell one.
- Any standardized Medigap policy is guaranteed renewable even if you have health problems. This means the insurance company can’t cancel your Medigap policy as long as you pay the premium.
- Some Medigap policies sold in the past cover prescription drugs. But, Medigap policies sold after January 1, 2006, aren’t allowed to include prescription drug coverage. If you want prescription drug coverage, you can join a Medicare Prescription Drug Plan (Part D). If you buy Medigap and a Medicare drug plan from the same company, you may need to make two separate premium payments. Contact the company to find out how to pay your premiums.
- It’s illegal for anyone to sell you a Medigap policy if you have a Medicare Advantage Plan unless you’re switching back to Original Medicare.
Medigap plans are lettered, similar to Medicare, starting with A and running through N, although specific plans, such as E, I, and J, are no longer available. Recent changes in the law now mean that certain Medigap plans, such as Plan F, are no longer being sold as of 2020. However, those plans are still active for people who already have them.
When California Medicare Supplement Insurance Makes Sense
As we’ve noted here previously, your Medicare coverage will not pay for all the expenses related to your health care. For example, Medicare Part B has a monthly premium, and both Part A and Part B have deductibles, all of which you will need to pay out-of-pocket. In addition, if you anticipate having medical expenses that won’t be covered by Medicare, getting supplemental insurance makes sense.
For many seniors, it’s also a good idea to sign up for a Medigap plan when you are first eligible to enroll in Medicare, even if you think you may not need it. That’s because, during the Medicare open enrollment period, you can get a Medigap policy for the same premium charged to people in the best of health, no matter what your current health condition is. However, after the open enrollment period ends, you might not be able to buy a policy.
And, if you are able to purchase Medicare Supplement Insurance, later on, the insurer can base your premiums on your current condition. And, in some cases, the insurer might deny your supplement insurance coverage based on a pre-existing condition, according to HealthForCalifornia and Covered California. According to HealthForCalifornia, some of the benefits offered by Medigap plans include:
- Coverage of Part A coinsurance and hospital costs for up to an additional 365 days once Medicare Part A benefits are used up.
- Coverage of Part B copayments or coinsurance.
- Coverage of up to 3 pints of blood.
- Coverage of coinsurance for hospice care under Part A.
- Coverage of coinsurance for skilled nursing care under Part A.
- Coverage of Part A deductible.
- Coverage of Part B deductible (as of January 1, 2020, these plans are not sold to people who are newly eligible for Medicare).
- Coverage of excess charges for Part B.
- Foreign travel insurance coverage.
We Can Help with Medicare Supplement Insurance Decisions
For help in finding the right California Medicare health or prescription drug plan and finding Medicare providers in your area, give J.C. Lewis Insurance Services a call toll-free at 866-745-9555. We’ll help you understand your options so you can make an informed decision. J.C. Lewis Insurance, a family-owned firm of expert agents, based in Sonoma County, offers California health insurance plans only from the leading health insurance carriers licensed to do business in California. Not only are we expert agents, but we are also licensed and certified by each of these insurance carriers to offer coverage to individuals, families, and small group employers in addition to Medicare supplement insurance and prescription drug plans for seniors.