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
AND MEDICARE SELECT
MEDICARE SUPPLEMENTAL INSURANCE
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.
