Medicare Supplement Insurance Can Fill Gaps in Medicare Coverage

Medicare Advantage plans, or Medicare Supplement (Medigap Insurance) can fill the gaps in Medicare coverage. To find the best fit for your needs, you need to understand Medicare. Medicare includes Parts A, B, C, and D. What's it all mean?

Let's Start at the Beginning

Medicare is divided into four parts. Part A deals with home health care, hospice, hospital, and skilled nursing care. Part B handles doctors' services, other medical services, and supplies not covered by Part A. Part C allows you to receive Medicare benefits through private health insurance (Medicare Advantage Insurance) in place of Parts A and B. Part D provides prescription drug coverage.

What Is Medicare Advantage Insurance?

With a Medicare Advantage Plan, generally all of your Medicare-covered health care is provided through that plan, which can include prescription drug coverage. These plans may offer more benefits, and lower co-payments than Medicare Part A and B.

Medicare Advantage Plans include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), private Fee-for-Service Plans, and Medicare Special Needs Plans.

Private Fee-For-Service plans are offered by state-licensed risk-bearing entities with yearly contracts to provide Medicare benefits. They may also offer additional benefits, and do not usually require you to use a network of providers.

Special Needs Plans focus on certain vulnerable groups, such as those who are institutionalized, are dual-eligible, and/or have severe or disabling chronic conditions.

What Are HMOs?

Doctors, hospitals, and insurers participate in HMOs, which provide medical treatment on a prepaid basis. HMO members pay a fixed monthly fee regardless of how much care is needed in a given month. Most HMOs provide a wide variety of services, but members must usually obtain medical treatment from in-network facilities and physicians.

With HMOs, you must see a primary care physician before you can see a specialist. Rather than paying a percentage of the bill every time you receive medical care, you pay a fixed monthly fee, and HMOs often have nominal co-payments rather than deductibles. HMOs generally do not limit lifetime benefits, but will not pay for non-emergency care from a non-HMO physician.

What Are PPOs?

PPOs are made up of doctors and/or hospitals that provide medical services only to a specific group or association at discounted rates. PPO members pay for services as they are rendered, and are generally reimbursed for treatment costs minus co-payment percentages. Physicians may submit bills directly to insurance companies so members pay only a co-payment.

PPO members are not required to seek care from PPO physicians, but members may receive 90-percent reimbursement for in-network care as opposed to 60 percent for non-network treatment. PPOs may also require a deductible. You may have to fill out paperwork for reimbursement, and most PPOs have larger co-payments than HMOs.

You must have Medicare Part A and B to join a Medicare Advantage Plan. You'll have to pay a monthly Part B premium, and may also have a monthly premium for the Medicare Advantage Plan for the extra benefits it offers.

When you join a Medicare Advantage Plan, your Medicare Supplement Insurance or Medigap Insurance won't pay co-payments, deductibles, or other cost sharing under your Medicare Health Plan.

What Is Medigap Insurance?

If you don't have a Medicare Advantage Plan, Medigap Insurance can cover expenses that Medicare doesn't. When you have Medicare and a Medigap policy, both pay their share of covered health care costs.

Medigap policies must have standardized benefits, but costs can vary. You may be able to choose up to 12 different Medigap policies (Plans A through L), which have different sets of basic and extra benefits. The benefits of any Medigap Plan (A through L) are the same for every insurance company, and companies choose which policies to offer.

Generally, you must have Medicare Part A and B to buy Medigap Insurance. You'll pay a monthly Part B premium, and a premium for the Medigap policy. Medigap Insurance won't cover your spouse, so you both need separate policies.

With some basic insight into how Medicare works, you can select the Medicare Advantage Insurance or Medicare Supplement Insurance that best fits your needs. Expert advisors with years of experience working with these plans can answer your questions, and show you how to compare plans to get the most for your money. Begin ensuring that your retirement will be secure now so you'll have the right coverage when you need it!