Like spackle on a wall or a filling in a tooth, Medicare Supplement insurance, a.k.a., Medigap, exists to fill in any potential gaps in coverage. In the case of supplemental Medicare insurance, it covers the difference between what is paid for by original Medicare and the overall cost of the health care treatment provided. Sold by private insurers, supplemental health insurance helps with charges like copays, deductibles, and coinsurance so it’s a solution that can make a real difference when it comes to your finances and peace of mind.
Read on to learn the answers to the most common Medicare Supplement insurance questions, including who is eligible, how to shop for it, and the real difference between Medicare Advantage and Medicare Supplement plans.
Most states — 33 of the 50 — require insurance companies to offer supplemental insurance to those under 65 on Medicare disability.
If you’re 65 and enrolled in Medicare Part A and Part B, you can apply for Medicare Supplement insurance. An open enrollment period occurs within 6 months of obtaining Medicare Part B, and you can apply for a Medicare Supplement policy without having to answer health questions.
Companies can deny you Medicare Supplement insurance coverage, depending on pre-existing conditions and other considerations, if you apply outside of the 6-month window, so be sure to ask your insurer about what qualifications make someone eligible for their specific Medicare Supplement insurance.
If you’re not in your open enrollment period or are not eligible for guaranteed issue, you will have to answer health questions in order to qualify. Those individuals within their open enrollment period or eligible for guaranteed issue would not need to answer the health questions to qualify.
Are you curious whether you have to have supplemental insurance with Medicare? The answer is no, Medicare Supplement insurance is an add-on, just like Medicare Part D, which covers prescriptions.
However, many individuals elect to add other supplemental coverage, such as Hospital Indemnity insurance, to their Original Medicare or Medicare Advantage plans to limit their out-of-pocket exposure to medical costs.
Just like many health care coverage decisions, the answer to, “Do I need supplemental insurance with Medicare?” is a personal one. About 23% of Americans enroll in Medigap coverage.
Simply put: Original Medicare has deductibles and copays built within Part A and Part B. If you do not want to be responsible for those deductibles and copays, add a Medicare Supplement policy to cover those costs.
As mentioned, it covers many copays, deductibles, and coinsurance. But does supplemental insurance cover routine physical exams, hospice, or hearing aids? Medicare may help with some of those charges, but Medicare Supplement policies do not usually cover dental, vision, hearing, long-term, and private-duty nursing care. They do cover hospice care.
Medicare Parts A and B pay first, then Medicare Supplement insurance kicks in to help cover the gaps. Most health care providers have signed an agreement with Medicare to accept all Medicare-covered services and bill accordingly, but always check with your doctor or provider before receiving treatment if you’re unsure.
There are four main steps to choose a Medicare Supplement insurance plan, according to the U.S. Centers for Medicare and Medicaid Services:
Medicare Supplement plans come in A, B, C, D, F, G, K, L, M, and N, with varying amounts of costs and coverage, depending on the deductible level and specific plan. Premiums vary by state and plan, so it’s best to contact an insurance agent to get a quote.
Medicare Supplement insurance is designed to cover the remaining costs, like deductibles and copays generated from Original Medicare Part A and Part B. Medicare replacement insurance is another term for Medicare Advantage, and Medicare Advantage acts as the main payor regarding medical services received while insured under a Medicare Advantage plan. It replaces Original Medicare as the primary payor.
That means you cannot have Medicare Supplement insurance with Medicare Advantage plans.
Some premiums — including Medicare Part B and Part B supplemental insurance — are tax deductible through Schedule A on Form 1040. But they’re only valid over a certain income threshold. If you’re self-employed, you may be able to deduct your supplemental Medicare insurance premiums as part of a self-employed health insurance deduction. Please contact a professional tax consultant for specific tax advice.
To learn how Wellabe’s Medicare Supplement insurance plan can help fill your coverage gaps, visit the Medicare Supplement page. You may also request a personalized, free quote, or call 877-257-2663 to speak with an agent.
Photo credit: iStock
Kelly Rayburn, AVP national sales and distribution at Wellabe, and Olga Villaverde, from Lifetime TV’s The Balancing Act, discuss what Medicare Supplement insurance is and how it differs from Medicare Advantage.
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