| Medicare Supplemental Insurance, (MEDIGAP) Medicare Part D & Medicare Doughnut Hole |
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Medigap coverage provides supplemental health insurance for Medicare recipients. While Medicare Parts A and B cover many hospitalization and outpatient services, you are still required to make co-payments and pay for some treatments out-of-pocket. A Medigap plan generally offers low-cost health insurance to cover the "gaps" in Medicare
Health Insurance Quotes. -- Low Rates on the New Discount Plans, PPOs, HMOs and Traditional Medical Insurance. -- LoveTheRates.com
For most of the country, Medigap plans are standardized and labeled Plans A-N. This means that the federal government requires all Medigap supplemental health insurance policies under the same plan letter to provide the same coverage. Therefore, Plan A offered by one insurance company is the same as Plan A offered by another insurance company. The only difference may be the premium amount, which is why it is important to compare rates and shop around for coverage.
Supplemental health insurance through Medigap pays many of your Medicare co-insurance and deductibles. In addition, you may want to purchase a Medigap supplemental health insurance policy if you:
- Expect to be hospitalized more than 60 days a year
- Want coverage for preventative care such as annual check-ups
- Need frequent blood transfusions
- Travel out of the country
- Want to use a skilled nursing facility or hospice
While Medigap plans can be a smart choice for low-cost health insurance, these policies are not for everyone. If you have a Medicare Part C plan, otherwise known as Medicare Advantage, you should not apply for a Medigap policy. Supplemental health insurance is not necessary for Medicare Advantage participants, and your Medigap plan may not provide you with any additional medical coverage
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Medicare Part A is a type of hospital health insurance provided by Medicare. It helps cover stays in and services at many hospitals, nursing homes and hospices. However, Medicare Part A does not cover custodial or long-term care.
Medicare Part A is often called "premium-free Part A." If you or your spouse paid Medicare taxes while employed, you typically don't have to pay monthly premiums for this coverage.
Medicare Part A: services covered
The following services are covered under Medicare Part A:
- Hospital inpatient care: Includes stays in semi-private rooms, meals, nursing care and hospital services and supplies. Stays at a hospital or other care facility have to be at least three complete days.
- Nursing home or skilled nursing facility: Care at a nursing home or skilled nursing facility is only covered after a minimum of a three day inpatient hospital stay for a related illness or injury.
- Home health services: In order to receive home health services you must be homebound and coverage only includes medically-necessary part-time or intermittent skilled nursing care, physical therapy, speech-language pathology or a continuing need for occupational therapy. Care must be ordered by a doctor and services must be provided by a Medicare-certified home agency. Other services may include durable equipment such as walkers and oxygen.
- Hospice care: This coverage is provided for patients with a terminal illness in which a physician has certified that there is less than six months to live. Coverage includes pain relief drugs, grief counseling and medical support.
- Blood transfusions
Medicare Part A: Eligibility
If you are not eligible for premium-free Medicare Part A coverage, you can still buy Part A if you are over the age of 65, and you are entitled to or are enrolling in Part B coverage, and you meet the residency and citizenship requirements.
You may also buy coverage if you are under the age of 65 and are disabled, and your premium-free Part A coverage was terminated because you could not go back to work.
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Medicare Part B is health insurance through Medicare that helps to cover the cost of necessary health care services such as visits to your physician, outpatient care and screening and some preventative services.
Medicare Part B: Covered Services
- Examples of some of the expenses covered by Medicare Part B include:
- Emergency ambulance ground transportation
- Durable medical equipment such as scooters, canes and oxygen supplies
- Medical screenings, tests and supplies for conditions including diabetes
- Cancer treatments
- Non-emergency urgent care
- Smoking cessation programs
Medicare Part B: Costs
While Medicare Part A usually provides coverage for hospitalization and other medically-necessary services at no cost, most recipients of Medicare Part B pay a standard premium for coverage. However, if your income is above a certain level, you may have to pay more for Medicare Part B coverage.
Some medical services are provided without additional cost under Medicare Part B, but you may have to pay for the cost of visiting your physician. In addition, a deductible may apply to certain services. If this is the case, you are financially responsible for all costs until you meet the annual deductible before Medicare Part B coverage kicks in. Once your deductible has been met, you are responsible for a 20 percent co-payment on the Medicare approved amount for a given service.
Medicare Part B: Eligibility
To be eligible for Medicare Part B, you must fall into one of the following categories:
- Be 65 years of age or older and receive benefits from Social Security or the Railroad Retirement Board
- Be younger than 65 years of age but disabled and receiving Social Security Disability benefits
The government automatically enrolls individuals in Medicare Part B supplemental health insurance when they begin their Medicare Part A benefits. However, you can opt out of Medicare Part B by returning the Part B medical card when it is mailed to you and following the opt-out instructions.
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Medicare Part D is supplemental health insurance that pays for prescription drug coverage. All Medicare recipients are eligible for Medicare Part D. Depending on the type of Medicare Part D plan you select, you may be required to have Medicare Part A, Part B or both.
Medicare Part D is offered through private health insurance companies
Medicare Part D prescription drug plans are intended to work with and supplement your Medicare Part A and Part B health insurance coverage.
Unlike Medicare Part A and Part B, prescription drug coverage through Medicare Part D is provided by private health insurance approved by and under contract with Medicare. Each plan may have different medical coverage limits and the types of drugs they cover may vary.
How to access Medicare Part D coverage
There are two ways to access Medicare Part D coverage:
- Medicare Prescription Drug Plan
- Medicare Advantage Plan
These policies provide all the medical coverage included individually in Medicare Parts A, B and D. In addition, Medicare Advantage plans may provide additional benefits such as coverage for vision, hearing and dental services.
To receive supplemental health insurance coverage through a Medicare Part D prescription drug plan, you must have either, Medicare Part A, Part B or Part C (also known as Medicare Advantage). If you choose Part C for prescription drug benefits, your plan should also include Medicare Part A and Part B medical coverage.
Enrolling in Medicare Part D
Before enrolling in a Medicare Part D plan, compare health insurance quotes and carefully review the plan benefits. It is important to consider the coverage, as well as the premium payment when deciding which coverage is right for your needs.
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The Medicare doughnut hole refers to a gap in coverage experienced by seniors who are enrolled in Medicare Part A and Part B, and who purchase Medicare Part D supplemental insurance for prescription drug benefits.
Health Insurance Quotes. -- Low Rates on the New Discount Plans, PPOs, HMOs and Traditional Medical Insurance. -- LoveTheRates.com
Those who purchase the supplemental insurance must pay a $310 deductible before prescription drug benefits kick in. At that point, beneficiaries pay for 25% of drug costs. The doughnut hole occurs when there is a difference between the initial coverage limit for prescription drugs, $2,830 annually, and the catastrophic coverage threshold. Once the initial coverage benefit has been surpassed, seniors must then pay the full price of medications until an additional $3,610 has been spent. Catastrophic coverage then kicks in and participants then pay 5% of the cost of their medications
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| Yes, but the changes are set to take place over a number of years: |
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| According to published reports, Congress is looking at ways to shorten the timeframes and provide relief to seniors before 2020 |
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