Original Medicare (Part A and Part B) offer a lot of coverage including health care services and some supplies, but they don’t cover everything. Medicare Supplement Insurance, also known as Medigap insurance, helps cover some of the additional expenses that an original Medicare policy may not. This additional coverage does not cancel or alter your current Medicare policy. It picks up some of the expenses that your original policy may not. You must be enrolled in Medicare Part A or Part B in order to qualify for Medigap insurance since it supports your original plan. It is not meant to be a separate policy as it only pays certain expenses that “Standard” Medicare does not cover.
We will showcase and explain each aspect of Medicare Supplement Insurance (Medigap).
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Medicare Advantage Plans must cover all of the services that Original Medicare covers. However, if you’re in a Medicare Advantage Plan, Original Medicare will still cover the cost for hospice care, some new Medicare benefits, and some costs for clinical research studies. In all types of Medicare Advantage Plans, you’re always covered for emergency and urgently needed care.
The plan can choose not to cover the costs of services that aren’t medically necessary under Medicare. If you’re not sure whether a service is covered, check with your provider before you get the service.
Most Medicare Advantage Plans offer extra coverage, like vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D). In addition to your Part B premium, you usually pay a monthly premium for the Medicare Advantage Plan.
A Medicare Supplement Insurance (Medigap) policy, sold by private companies, can help pay some of the health care costs that Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles.
Some Medigap policies also offer coverage for services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Then your Medigap policy pays its share.
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.
Medicare Part D (Prescription Coverage)
To get Medicare drug coverage, you must join a plan run by an insurance company or other private company approved by Medicare. Each plan can vary in cost and drugs covered.
2 ways to get drug coverage
1) Medicare Advantage Plan (Part C) or other Medicare health plan that offers Medicare prescription drug coverage. You get all of your Medicare Part A and Medicare Part B coverage, and prescription drug coverage (Part D), through these plans. Medicare Advantage Plans with prescription drug coverage are sometimes called “MA-PDs.” You must have Part A and Part B to join a Medicare Advantage Plan.
2) Medicare Prescription Drug Plan (Part D). These plans (sometimes called “PDPs”) add drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans.
Medicare Part F
Medigap Plan F has also been the #1 seller with Baby Boomers for many years. According to a 2014 report from America’s Health Insurance professionals, about 56% of all Medigap policies in force were a Medicare Plan F policy.
The reason Medicare Plan F is so well-liked is that it will pay for ALL of the gaps in Original Medicare Part A and Part B, including both your hospital and outpatient deductible. It even pays the 20% that Medicare Part B does not cover.
This means zero out-of-pocket for you at the doctor’s office.
Original Medicare (Parts A and B) helps pay for “medically necessary” care. This means care that’s required to diagnose or treat an illness or condition.
Dental and vision care are not seen as medically necessary. Original Medicare doesn’t cover dental exams, eye exams, eyeglasses or other related services.
You have options if you have Medicare and want some help with the cost of dental and vision care. Many Medicare Advantage Plans cover dental expenses. Also certain Medigap Plans cover some aspects of dental coverage or you can simply purchase a separate dental insurance plan.