Affordable Health Care Group — AHCgroup

Medicare Supplemental Health Insurance

Medicare supplemental health insurance is a plan sold by a private insurance company to those eligible for Medicare as additional coverage for medical needs. These policies can be purchased directly from an insurance provider, which is bound by the federal and state laws governing health insurance. Before you sign up for a Medicare plan make sure you get all the Medicare health insurance plan information. You are required to pay a monthly premium directly to the insurance company, although assistance is available below a certain income level. Medicare supplemental insurance is designed to help cover the "gaps" left by the standard government Medicare plan.

Because Medicare is a compromise between what is needed by the elderly population and what the government can afford to cover, there are obvious gaps in coverage, such as coverage of prescription drugs, extended hospital stays, specialized in-home care, and coverage for travel abroad.

Before you consider purchasing Medicare supplemental insurance, you should understand the coverage options under Medicare and the rules for joining or switching Medicare policies. You should first maximize your benefits under available Medicare options as well as consider the effect of other coverage options such as group health insurance from your employer or trade union. Analyzing your Medicare costs after accounting for any other health insurance sources may show that you do not need a Medicare supplemental insurance policy.

There’re 12 standardized policies for Medicare supplemental health insurance and they are categorized as plans A thru L. This applies to every state except Massachusetts, Minnesota and Wisconsin. Each plan provides different set of benefits. For instance, Plans K and L are new policies that will help you limit extensive out of pocket expenses for doctor and hospital service. Plans K and L will have a lower premium than some other Medigap policies, but you will pay a larger amount of Medicare’s deductibles before the policy pays for any of the medical costs. With these new plans you are assuming a greater risk toward your share of costs while receiving additional protection over what is provided under original Medicare.

Medicare SELECT policies (Plans F and J) usually cost less but have a high-deductible. You will have to use specific doctors to get full insurance benefits on these plans. In an emergency you may use any hospital or doctor. The plans are less expensive because the physicians that are on the "Select" list agree to see Medicare patients at a reduced "assignment" fee.

Unless you buy a Medicare SELECT policy, you may go to any doctor or hospital for treatment. The Medicare supplemental insurance policy pays for its share of the expenses and your Medicare policy covers its share. The level of benefits you receive will depend on which plan you choose. You will pay for your Medicare supplemental insurance and pay the Medigap insurance company on a separate invoice. You will receive a Medicare Summary once a month by mail and your Medigap insurance company will also send you Medicare health insurance plan information on what has been paid. A Medicare supplemental health insurance policy does not replace your original Medicare coverage. It simply provides additional benefits to help cover the medical expenses that are not paid for by the original Medicare policy. You may also want to join a Medicare Advantage Health Plan that will help with drug costs and coinsurance deductibles.

If you have other insurance, they sometimes pay your bills first and then Medicare Plan pays second. This would mean that your other insurance plan would-be the primary payer on your medical expenses. Other insurance that may pay first could be any of the following:

• Employer sponsored group health coverage
• No fault Insurance
• Liability insurance
• Black lung benefits
• Workers compensation

These types of insurance will pay first in most cases. It is important that you let your doctor and hospital know if you have other insurance so they will know how to handle your billing. Medicare may make a conditional payment is some cases. If your insurance that is supposed to pay first does not, this payment must be repaid to Medicare. That is why it is called "conditional." If you currently have other insurance that pays prescription costs and you enroll in a Medicare prescription drug plan, you must let your Medicare know about your other coverage. You should be familiar with all of your rights as a Medicare recipient and how they affect your Medicare supplemental insurance plan.

On January 1, 2006, new Medicare Prescription Drug Plans were made available to everyone on Medicare. Under these new plans, there is a separate co-payment and deductible associated with the costs of your prescription drugs. You must also go to pharmacies that belong to the Medicare Prescription Drug plan. If you choose to go to a pharmacy that isn't part of the plan your drugs will not be covered. Inmost, cases only prescription drugs that show on the Medicare Prescription Drug Plan lists will be covered.