Government Medicare Supplement is a bureaucratic health care coverage program that pays most clinical costs for individuals age 65 and more established. It will also pay for medical care for some people under age 65 who have disabilities. You can buy Medicare supplement insurance to help pay some of your out-of-pocket costs that Medicare doesn’t pay. Because it helps fill in some of the coverage gaps, Medicare supplement insurance is often called Medigap insurance.
Do you need a supplement for Medicare?
Not everyone needs a Medicare supplement policy. If you have other health coverage, the gaps in coverage may already be covered. Probably don’t need Medicare supplement insurance if:
- You have group health insurance through a current or former employer, including government or military retiree plans.
- You have a Medicare Advantage plan.
- Medicaid or the Qualified Medicare Beneficiary (QMB) Program pays your Medicare insurance premiums and other out-of-pocket costs. QMB is a Medicare savings program that helps pay for Medicare insurance premiums, deductibles, copays, and coinsurances.
If you have other health insurance, ask your insurance company or agent how it works with Medicare.
Basic information about Medicare
Original Medicare has two parts. Part A covers hospital services, while Part B covers other types of medical expenses. You can go to any doctor or hospital that accepts Medicare. Medicare supplement policies only work with original Medicare.
Medicare Part A (hospital coverage) pays for
- inpatient services;
- skilled nursing facility care after a hospital stay;
- home care;
- hospice care; Y
- All blood except the first three pints for each calendar year.
Medicare Part B (medical coverage) pays for
- medical expenses;
- home health care;
- laboratory services;
- outpatient treatments in a hospital;
- durable medical equipment and supplies; Y
- Preventive health services, including exams, health screenings, and immunizations.
Government medical care Part D (physician endorsed drug inclusion) pays for brand-name and conventional professionally prescribed drugs. You can get physician endorsed drug inclusion by either joining an independent doctor prescribed drug plan or purchasing a Medicare Advantage plan that incorporates drug inclusion. Assuming that you have bunch health care coverage, your wellbeing plan may as of now cover remedies. Ask your plan sponsor if the plan has prescription drug coverage comparable to Medicare Part D.
Insurance companies approved by Medicare offer Part D coverage.
The Centers for Medicare and Medicaid Services (CMS) publishes the Medicare & You handbook that describes Medicare coverage and health plan options. CMS mails the handbook each year to all Medicare beneficiaries. The handbook is also available by calling 800-MEDICARE (800-633-4227).
Services that Medicare does not cover
- Most long-term care. Medicare only pays for medically necessary care provided in a nursing facility.
- Custodial care, if it is the only type of care you need. Custodial consideration can incorporate assistance with strolling, getting in and up, dressing, and washing, utilizing the latrine, shopping, eating, and taking prescriptions.
- Over 100 days of talented nursing office care during an advantage period after a medical clinic stay. The Medicare Part A benefit period begins the first day you receive a Medicare-covered service and ends when you’re out of a hospital or a skilled nursing facility for more than 60 days in a row.
- Services for help with household chores.
- Private nursing care.
- Most dental care and dentures.
- Medical care received while traveling outside the United States, except under limited circumstances.
- Cosmetic surgery and routine foot care.
- Routine eye care, eyeglasses (except after cataract surgery) and hearing aids.
What you will have to pay under Original Medicare
For Medicare Parts A and B, you will generally have to pay monthly insurance premiums, as well as deductibles, copays, and coinsurance. You also pay the full cost of services that Medicare doesn’t cover.
- Insurance premiums are the amounts you must pay to keep your Medicare coverage. Most people don’t have to pay an insurance premium for Part A, but everyone does have to pay an insurance premium for Part B. Insurance premium amounts can change each year in January.
- A deductible is the amount you must pay for covered medical expenses before Medicare begins to pay for them.
- Copay is a set dollar amount that you usually have to pay each time you see a doctor or go to the hospital.
- Coinsurance is the percentage of the cost of a service that you pay after Medicare pays its share of the cost. This means that if Medicare pays 80 percent of the cost of a service, you will pay the remaining 20 percent.
Ask if your doctor “accepts assignment”
An assignment is an agreement between doctors and other health care providers and Medicare. Doctors who “accept assignment” charge only the amount that Medicare will pay them for a service. You must pay any deductible, coinsurance, or copayment that you owe.
Physicians who do not accept assignment may pay more than the Medicare-approved amount. You are responsible for excess charges. Also, you may have to pay the full cost of the service when you receive it, and then wait for Medicare to reimburse you.
Use your Medicare Summary Notice to review charges. You will receive a Medicare Summary Notice each quarter. If you were overcharged or not reimbursed, follow the instructions in the notice for reporting the overcharge to Medicare. The notice will also tell you if there is a deadline for filing a complaint or appealing the charges and services that were denied. If you have Original Medicare, you can also view your Medicare claims online at MyMedicare.gov.
Medicare has a directory of doctors, hospitals, and providers that work with Medicare. The Physician Compare directory also shows you which providers have accepted assignment on Medicare claims.
