Covering the Extras: 6 Important Things Covered by Supplemental Insurance

There is so much about Medicare you need to know. For instance, the Original Medicare caters to numerous health care services and supplies but does not pay for all services and supplies. The Medigap policies, also called the Medicare Supplement Insurance policies, can take care of those health care costs which the Original Medicare does not cover. These include aspects such as deductibles, coinsurance, and copayments. In addition, some Medigap plans also cover services not covered by the Original Medicare such as foreign travel. If you purchased the Original Medicare and also purchased a Medigap plan, Medicare will take care of its share of medical costs within its limits of the approved amount. After that, the Medicare Supplemental Insurance will pay its share once you have paid its premiums.

You also need to note that the Medigap policy differs from the Medicare Advantage Plan such as the PPO or HMO because these plans are platforms for attaining the Medicare benefits while the Medigap only supplements the benefits of the Original Medicare. Generally, it is not legal for any insurance organization to sell the Medigap policy to any person who is enrolled in the Medicare Advantage Plan. If you switch to enroll in Medicare Advantage from the Medigap Plan, you have all the right to decide otherwise, and you’ll be at liberty, under the federal law, to purchase a Supplemental Insurance policy if you go back to Original Medicare twelve months after enrolling in a Medicare Advantage Plan.

Which Policies are Available?

Every Supplemental Insurance Plan should follow the state and federal laws which are meant to protect you, and this policy should be explicitly identified as so – Medicare Supplemental Insurance. Private insurance firms can only sell the “standardized” policies which are identifiable by letter A through to N. However, it’s imperative to note that Medigap policies are standardized differently in different states more especially Minnesota, Massachusetts, and Wisconsin.

Irrespective of what company sells the Medigap policies, it’s important to remember that standardized policies provide the same level of benefits. However, there are some Medigap policies that provide additional benefits, so you can decide which among them is suitable for your needs. Although Plans E, H, I, and J are not available for purchase anymore, you can still keep it if you already purchased one of these policies. For information regarding these policies, you can contact your insurance provider.

Medicare SELECT is also another type of policy that is only available in some states. These plans are often standardized Medigap policies which require an individual to utilize specific health care facilities and in other cases, specific doctors to obtain full supplemental coverage. If you already switched to a Medicare SELECT from the Medigap plan, you have a right under the federal law to switch back to the Medigap policy within twelve months.

What are the Important Things Covered by Supplemental Insurance

The Medicare Supplemental Insurance covers those aspects which the Medicare itself does not cover. These include:

  1. Part A & Part B Deductible

The primary objective of the Medicare Supplemental policy (also Medigap) is to take care of the out-of-pocket expenses that Part A and Part B of your Original Medicare cannot cover such as the deductibles and con-insurance. Every standardized plan offers different out-of-pocket benefits. For instance, if you are sick regularly, or you are in and out of hospitals more often, you may end up accumulating a significant amount of medical bills. In such a case, your Medigap plan will come in handy. However, you need to note that a Medigap plan isn’t a cure-all. For instance, your Supplemental Insurance does not pick up some costs not covered by Medicare such as vision and dental expenses. In this case, Advantage Plans may cover these areas.

  1. First 3 Pints of Blood

As harsh as this may seem, Medicare does not cover the first three pints of blood, unless they are donated to you. Therefore, if blood that is not donated is administered to you, you will be required to pay for the first three pints, in addition to the Part B deductible, coinsurance, and copays, for processing and handling the blood. On the other hand, with a Medigap plan from a private insurance; your plan might be in a position to cater to that portion of blood transfusion which Medicare does not cover. Your Medicare Supplemental plan may assist in covering the first 3 pints of blood. Moreover, a Medigap plan may also cover part of the Medicare Part A or B of the coinsurance amount for your blood transfusion. Some Medigap plan types also cover the Medicare deductibles. For more Medicare info, and for more information regarding blood transfusion coverage, you can always inquire from your insurance providers.

  1. Skilled Nursing Facility Coinsurance

To prevent you from making out-of-pocket payments for the high coinsurance, there are some Medicare Supplement policies which cover the copayments or coinsurance which are available due to Skilled Nursing Facilities. For instance, Plans C, D, F, G, M & N of the Medigap Plans cover 100 percent of copayments or coinsurance you accumulated in a Skilled Nursing Facility. On the other hand, Plan K of the Medigap policy covers 50 percent of the Skilled Nursing Facility copayments, while L covers 75 percent of the copayments for Skilled Nursing Facilities.

In case you require 24/7 intensive care, you’ll be in a position to get the services as well as expertise needed to ensure you get the care you deserve. Although some of these costs can be covered by Medicare, the high copayments may add up quickly, leaving you with no option but to pay out-of-pocket at a time when you are must desperate. The security you get from a Medigap plan during your stay in a Skilled Nursing Facility makes it possible for you to obtain the services you need free of costs and worries.

  1. Foreign Travel Emergency

Another advantage of the Medicare Supplemental Insurance is that it covers Foreign Travel Emergency. For instance, with Medigap plans C, D, M, N, F, & G, you’ll be in a position to get emergency health coverage for your foreign travel outside the United States. Nevertheless, there are some limitations to foreign travel emergency you need to know. This coverage kicks in after the $250 deductible and only caters to cases of emergency. Apart from that, the lifetime cap for the benefits obtained is $50, 000. Moreover, you need to remember that the foreign travel coverage is only applicable for expenses incurred in emergency care outside the United States within the first 60 days. Therefore, if you are planning to take a vacation for more than two months, you need to know that the Foreign Travel Emergency Coverage will not work after the sixty days have lapsed.

  1. Part B Excess Charges

When you seek the services of a medical professional who doesn’t accept “assignment” by Medicare, then they can “balance bill” above the payment schedule of Medicare. If you fail to ask them whether or not they accept assignment, you could be astonished to get a bill once the services have been rendered and once Medicare and supplement insurance have made their portion of payments. This bill, in most cases, will come after two to four weeks once you have visited a non-participating practitioner. “Excess charges” are usually limited to fifteen percent above the amount approved by Medicare, hence the Part B Excess charges.

In most cases, the Medicare excess charges occur with specialist’s visit than with visits to the primary care physicians. You can avoid the excess charges by enrolling in a Medicare Supplement plan. Most Medigap plans cover such excess charges, although Plan N does not. If you have a Medigap Plan N, then you’ll be required to pay for Part B excess charges if the practitioner doesn’t accept Medicare.

  1. Medicare Part A Coinsurance and Hospital Costs

Every individual’s situation differs from another. However, it’s imperative to learn about out-of-pocket costs for Medicare Part A (hospital insurance). For some, a Medigap plan may help in managing the hospital costs as they cover Part A coinsurance, for the additional 365 days of medical coverage. If you have signed up for Medicare Part A & B, you can apply for a Medigap policy at any given time. Nevertheless, the companies that sell these policies are not always obliged to accept your application for the Supplemental Insurance. For instance, in case you are sick or have a medical condition, the company may charge you more than they would charge a healthy person if they accept to sell you the plan. This information is important especially if you are suffering from a health condition and are in need of managing your hospital expenses.

The above are the six most important things covered by Supplemental Insurance plans. If you are still unsure about what these plans have to offer, you can always consult an insurance agent near you. Pay for a Medigap or Supplemental Insurance Policy and avoid incurring out-of-pocket charges that are excess of what your Original Medicare can offer.


Arnel Ariate is the webmaster of Money Soldiers.

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