What is the difference between Medicare and Medicare Supplements?
The US federal government medical insurance program for those over 65 and people with disabilities is called Medicare.
Medicare provides basic coverage, but it does not pay for all your healthcare expenses. For many with out-of-pocket costs, Medicare Supplements help fill in the gap. This is why you may have heard the term Medigap Insurance.
You may not need supplemental coverage if you have healthcare insurance in addition to your Medicare coverage.
Medicare Coverage
Original Medicare Part A covers hospital care, and Part B covers other medical expenses.
Medicare doesn’t provide coverage for:
- Most long-term care, except in a nursing home.
- Custodial care, except as part of other care.
- Over 100 days of skilled nursing home care after your hospital stay.
- Homemakers.
- Private nursing care.
- Dental care
- Most travel outside the US.
- Cosmetic surgery.
- Routine foot care.
- Eye care or hearing aids
You pay any monthly premiums, deductibles, all copays, and any coinsurance, plus the total cost of services Medicare does not cover.
Add Medicare Supplement Policies
Because so many services are not covered under basic Medicare, it’s advisable to consider supplemental policies. Medicare supplement policies only apply when you have original Medicare.
Your Medicare supplement insurance helps pay your out-of-pocket costs for medically necessary deductibles, copayments, and coinsurance at the Medicare-approved rate.
Medicare supplement policies are offered by private insurance companies licensed by TDI. But the supplement benefits are determined by the federal government.
Medicare open enrollment periods don’t apply to any of the Medicare supplement plans. Your open enrollment period starts with your enrollment in Medicare Part B. In this initial time, the private insurance companies must sell you a supplemental policy even if you have problems with your health. After that open enrollment, a preexisting condition could make it impossible to get a supplemental policy.
Standard Medicare supplement plans
The 10 Medicare supplement plans are labeled with letters. Each one has a specific combination of healthcare benefits. Plan F offers a high deductible. K through N have different cost-sharing components.
Reach out to learn more about which plan is right for you. Here are some basics.
- Additional Hospitalization coverage for copays and expenses after 60 days until 90 days, and another 60 days in your lifetime.
- Part A coinsurance and 365 more days after Medicare stops paying.
- Coinsurance coverage for skilled nursing facility care.
- Hospice copayment for some outpatient medications and coinsurance on inpatient respite care.
- Some supplemental plans pay the medical expenses portion of Part B coinsurance, but K, L, and N do not.
- First 3 pints of blood every year.
- And more.
Moving from State to State
If you move, check to be sure your Medicare plan remains in effect. With original Medicare, you are usually covered under federal rules, so you can keep your supplemental policies. But there are exceptions, so check to be sure.
In Conclusion
Your Original Medicare plan is the foundation of your health insurance in the US when you turn 65 or have a disability. You can build on that foundation with Medicare supplements for the health insurance coverage that is right for you and your budget.
Call us for more information about navigating the Medicare Supplemental insurance options.
