Medicare Additional Insurance


Medicare does not cover all medical services. Therefore, most people will want more insurance to fill the gaps in original Medicare (Federal) coverage. Whether you want this additional insurance is an individuals decision. There are several types of supplemental insurance policies. Many private insurance companies sell Medicare Supplemental Insurance policies (Medigap or Medicare SELECT). Similar coverage may be available to retirees through an employer or union provided group health plan.

If you are eligible for full Medicaid (State) benefits, you may not need more insurance. Besides the standard Medicaid program, there are other programs that help certain low income Medicare beneficiaries pay their health care costs. These programs are known as the Qualified Medicare Beneficiary (QMB), the Specified Low-Income Medicare Beneficiary (SLMB) and the Qualifying Individual (QI) programs. While these programs do not take the place of supplemental insurance, they could save you hundreds of dollars, if you qualify.

Your State Health Insurance Assistance Program can answer questions about Medicare and other health insurance. The services are free. You can get help in deciding whether you need more insurance and, what kind and how much to buy. For more information look at a copy of the Guide to Health Insurance for People with Medicare.



Medigap insurance (Medicare Supplement Insurance) is specifically designed to supplement Medicare's benefits and is regulated by Federal and State law. It must be clearly identified as Medicare Supplemental Insurance and it must provide specific benefits that help fill the gaps in your Medicare coverage. Other kinds of insurance may help you with out-of-pocket health care costs but they do not qualify or can be called Medigap plans.

There are 10 standard Medigap policies. Each policy is labeled with the letter "A" through "J". Plan A is the basic benefit package. Plan J provides the most coverage of all the plans. Some states do not allow the sale of all 10 of these standard plans. Contact your State Health Insurance Assistance Program to find out which Medigap policies are available in your State.

Medigap policies pay most, if not all, Medicare coinsurance amounts and may provide full coverage for Medicare's deductibles. Some of the 10 standard plans pay for services not covered by Medicare such as outpatient prescription drugs, preventive screening, and emergency only medical care while traveling outside the United States.

As you shop for a Medigap policy, keep in mind that each company's products are alike, however there are big differences between company's as they are competing on service, dependability and price. Compare total benefits and premiums and be satisfied that the insurer is reputable and has a good track record before buying.

Unlike some types of health coverage (HMOs that limit where and from whom you can receive care), Medigap policies pay the same supplemental benefits regardless of your choice of health care provider. If Medicare pays for a service, wherever provided, the standard Medigap policy must also pay its share of benefits.

Although the benefits are identical for all Medigap plans of the same type, the premiums may differ from one company to another and from area to area. Your State Insurance Department must approve the rates charged for all Medigap policies. The insurance company can raise your premiums only when it has approval to raise the premiums for everyone else with the same policy.

Another Medicare supplemental health insurance product called Medicare SELECT and is permitted to be sold by insurance companies or managed care plans throughout the country. Medicare SELECT is the same as standard Medigap insurance in nearly all respects. If you buy a Medicare SELECT policy, you are buying one of the standard Medigap plans.

The only difference between Medicare SELECT and standard Medigap Supplemental Insurance is that you must use specific hospitals, and specific doctors, except in an emergency, in order to be eligible for full benefits. Medicare SELECT policies generally have lower premiums because of this requirement.

For more complete information, look at a copy of the 2011 Guide to Health Insurance for People with Medicare.


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