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What You Need to Know About Medicare Supplement Insurance

Medicare is the federal health insurance plan for individuals aged 65 and older, some younger people with disabilities, or those with end-stage renal disease. Medicare covers a substantial amount of the costs associated with health care services and supplies, but not all. Medicare Supplement Insurance can be purchased to fill in these gaps, to help pay for things like deductibles, copayments, and coinsurance, which Medicare does not cover.

What Does Medicare Cover in General?

Medicare covers a significant range of medical services and supplies. There are four parts of Medicare coverage, Medicare Parts A, B, C and D. Medicare Parts A and B, known as “Original Medicare,” are the most popular.
Medicare Part A

Medicare Part A covers hospital inpatient costs if you are admitted to a hospital by a doctor, in addition to hospice care, at-home care, or skilled nursing facility care. Medicare Part A also provides coverage for wheelchairs or walkers, blood transfusions, surgery, and lab tests.

What it Covers
  • Hospital care (inpatient)
  • Limited home health services
  • Care in a skilled nursing facility (SNF), provided that custodial care not be the only care required
  • Hospice care
Medicare Part B

Medicare Part B covers preventive healthcare, such as yearly doctor visits and tests, cancer screenings, some vaccinations, diabetes supplies, and ambulance and emergency room services.

What it Covers
  • Visits to a healthcare facility
  • Ambulance services
  • Part-time or temporary home health care
  • Rehabilitation services and physical therapy
  • Cardiovascular, cancer, and diabetes screenings
  • Mental health services
  • Clinical research
  • Durable medical equipment
  • Limited outpatient prescription drugs
  • Flu and hepatitis b shots
Medicare Part C

Medicare Part C, which is also known as Medicare Advantage, is sold privately. It includes all of the coverage of Medicare Parts A and B, with additional coverage for dental care (including X-Rays), vision care, and hearing care, plus some fitness benefits (such as coverage for gym memberships). Medicare Part C can be tailored to suit individual healthcare needs for chronically ill enrollees.

Medicare Part D

Medicare Part D covers prescription drugs that are not covered by Part B, which covers medication that needs to be administered by a doctor (such as injections).

Medigap Plan

For coverage that extends to medical supplies and services that are not covered by Medicare Parts A, B, C or D, many individuals will choose to enroll in a Medigap plan. Medigap, which is sold by private insurance companies, is also lettered, and there are ten different types of plan available: A, B, C, D, F, G, K, L, M and N. A Medigap plan supplements your original Medicare benefits, and covers things like co-payments, deductibles, and health care costs when you travel outside of the United States. Individuals who enroll in Medigap plans will have to pay a premium on top of the cost of their original Medicare benefits.

Comparison Of Medicare Supplement Plans

Medicare supplement plans are regulated by state and federal laws, which means that the basic benefits offered by lettered supplementary plans (A, B, C, etc.) are generally the same, regardless of insurance provider. The major difference will be in cost, which varies by provider.

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How Much Does Medicare Insurance Cost?

The cost of your Medicare plan will depend on which parts you enroll in, whether you purchase any supplement insurance or Medigap, and the private insurance provider from whom you purchase any supplement coverage.
Part A and Part B Medicare costs are federally regulated.
Part A

For Part A, your monthly premium will be up to $471 per month. If you have been paying Medicare taxes for fewer than 30 quarters, the premium is $471, and if you paid Medicare taxes for 30-39 quarters, the monthly premium is $259. For hospital inpatient services, your coinsurance cost for stays of 1-60 days is $0 for each benefit period; for days 61-90, the cost is $371 per day of each benefit period; and for days 91 and beyond, the coinsurance cost is $742 for each “lifetime reserve day” of each benefit period, up to 60 days

Part B

For Part B, the standard monthly premium is $148.50 but may be higher depending on your income, and the deductible and coinsurance cost is $203. After this deductible is met, you typically pay 20% of the Medicare-approved amount for medical services.

Part C & D

The Part C and Part D/Medicare Advantage cost varies depending on your plan and insurance provider.

Who Should Buy Medicare Supplement Insurance?
Because Medicare is not a fully comprehensive insurance policy, many individuals with advanced medical and healthcare needs may not be covered by it.
Because Medicare is not a fully comprehensive insurance policy, many individuals with advanced medical and healthcare needs may not be covered by it. Original Medicare (Parts A and B), when combined with the prescription coverage of Plan D, may pay most of your medical expenses. Still, if you become seriously ill or injured, your out-of-pocket medical expenses may be extremely high without the protection of Medigap or supplement insurance.
Medicare Part A, B & Medigap
Medigap is a supplementary plan designed to cover healthcare costs not covered by Medicare. It can only be purchased by individuals who have already enrolled in Medicare Part A and B. If you choose to enroll in a Medigap policy, you will pay a private insurance company a monthly premium, in addition to the premium you pay for your Part B Medicare plan. A Medigap policy only covers one person, and can only be purchased from licensed insurance providers.

Medigap policies are guaranteed renewable, even if you have serious health problems, which means that as long as you pay your premium, your insurance company can’t cancel your Medigap plan.

Original Medicare (Parts A and B), when combined with the prescription coverage of Plan D, may pay most of your medical expenses. Still, if you become seriously ill or injured, your out-of-pocket medical expenses may be extremely high without the protection of Medigap or supplement insurance.
What is Medicare Advantage?
Medicare Advantage is meant to be an all-in-one insurance plan that covers healthcare costs and expenses that are not covered by Medicare Part A and B. Usually, Medicare Advantage includes all of the benefits of Part A, B and D (prescription drug coverage), in addition to coverage for services like transportation to doctor visits, over-the-counter drugs, and services that promote your health and wellness such as gym memberships. Medicare Advantage also offers coverage for dental care (including X-Rays), vision care, and hearing care.
Original Medicare (Parts A and B), when combined with the prescription coverage of Plan D, may pay most of your medical expenses. Still, if you become seriously ill or injured, your out-of-pocket medical expenses may be extremely high without the protection of Medigap or supplement insurance.
How do I get a Medicare Supplement plan?
Medicare Supplement insurance plans can only be purchased if you already have Medicare coverage (Parts A and B). If you do, you can purchase Medicare Supplement plans, such as Medicare Advantage or a Medigap policy, from a private insurance company.

Medicare Supplement Premiums & Copayments

How Insurance Companies Set Medigap Premiums

In addition to accounting for factors such as location and medical underwriting, a private insurance company can set Medigap premium rates for Medicare Supplement plans three ways:
1
Community-rated
(or “no-age-rated”)
These premiums cost the same for everyone, regardless of their age.
2
Issue-age-rated
(or “entry-age-rated”)
These premiums are based on your age when you first buy the policy.
3
Attained-age-rated
These premiums are based on your current age. They increase as you get older.
Frequently Asked Questions
Medicare Insurance Quotes FAQs
How do I enroll in Medicare?

You can enroll for original Medicare, which means Parts A and B, through medicare.gov. All other types of coverage, including supplement plans, Medigap and Medicare Advantage, can be purchased through private insurance companies.

What are the Best Medicare Advantage Plan Providers?

The best Medicare Advantage plan provider for you will depend on your individual health and insurance needs. According to The Balance, the best Medicare Advantage providers by category for 2021 are:

Best Reputation: Kaiser Foundation Health Plan
Best Customer Ratings: Highmark Blue Cross Blue Shield
Best for Extra Benefits: Aetna Medicare Advantage
Best for Large Network: Cigna-HealthSpring
Best for Promoting Health for Seniors: AARP/UnitedHealthcare
Best for Variety of Plans: Humana

Is it mandatory to go on Medicare when you turn 65?

It is not mandatory to enroll in Medicare when you turn 65. If you are still actively working for an employer who provides health insurance when you turn 65, you are entitled to a special enrollment period of eight months after your employment ends.

Can I drop my employer health insurance and go on Medicare?

It is likely advisable to remain on your employer’s health insurance plan until your employment ends, at which time you may enroll in Medicare.

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