Many Medicare recipients are surprised to discover that it does not pay for all medical expenses -- even if they have enrolled in both part A and part B of the Original Medicare Plan. If you have Medicare, you may have already discovered the "gaps" in the coverage. The gaps are services and treatments not covered, as well as co-insurance amounts and deductibles.
To get insurance to cover the gaps in your coverage, you will need to find what is known as a Medigap policy, or Medicare supplemental health insurance. These policies are available through private insurance companies and work only with the Original Medicare Plan.
The Centers for Medicare and Medicaid Services (CMS) have standardized the coverage that may be offered as Medigap insurance into a number of basic plans. (Basic plans and details are updated annually so always check with CMS for the latest information.) Insurance companies may offer some, or all, of these basic plans.
Use the following checklist to apply for Medicare supplemental health insurance:
Medicare Parts A and B Explained. When someone turns 65 years of age they are automatically eligible for Medicare parts A and B. But what is this? Part A is hospital insurance. Some of this coverage is paid by Social Security and the other part is paid by the patient.
Part B covers medical insurance. The costs associated with this insurance is paid in part by the premiums collected from others and also by the U.S. Treasury. There may also be a co-payment to the patient.
- Compare Available Policies. A number of different policies may be available in your area. It is important to compare supplements because coverage varies depending on the plan you choose, and also because you will be responsible for paying the insurance premium. Premium charges vary because each insurance company sets its own specific rates or insurance premiums.
- Verify Coverage. As you compare insurance policies, make certain that the coverage you are comparing is indeed a Medicare supplemental health insurance policy. By law, the front of a Medigap policy should identify it as Medicare supplement insurance. Currently there are 12 standard plans, A through L, which may be offered by insurance companies.
- Enroll Your Spouse Separately. It is important to note that your spouse will need to select his or her own policy. This is because a Medigap policy covers only the health costs of the insured and not those of his or her spouse.
- Use Your Open Enrollment Period. It is best to buy a Medigap policy during your open enrollment period. This is the period that begins (once you reach age 65) on the first day of the month in which you were born and lasts for six months. During your open enrollment period, you can't be denied any Medigap coverage that an insurance company sells. You also cannot be made to wait for coverage to start or be charged more for a supplemental policy because of poor health. (Refer to your CMS office for exceptions to this rule.)
- Buy Your Policy. Once you have selected the plan that you want, apply for it directly through your insurance company. Be sure to ask any questions you may have before you make your purchase.
- Research Prescription Help. Even with Medicare, prescriptions can be one of the largest expenses for seniors. This is due to the fact that the cost of these items has skyrocketed in recent years. It is not uncommon to see a drug that costs as much as $300 a month even with health insurance. This is unaffordable for those who are on a budget. But there are ways to save on the medication you need.
Medicare Part D. Part D can help with this cost. It is available to those already enrolled in parts A or B. This coverage is provided by a third party and will differ from company to company. However, the plan is designed to drastically cut the cost of prescription drugs. This is an addition to Medicare that came about in 2003 as a response to the rising price of medication.
Prescription Deals. Another way is to shop at the store with the best deal. For example, Walmart has a variety of brand name prescriptions that are just $4 a month. Even those with Medicare health insurance and/or supplemental health insurance can get their prescriptions at this lower rate. This is a great deal for anyone with high drug bills.
Discount Drug Cards. Another way to save is with a discount drug card. Among the newest additions to the supplemental insurance industry are companies that offer a discount on all prescriptions. They enroll hundreds of people per day who pay a low monthly fee of approximately $6 for the membership. The benefit is cheap prescription drugs for all who sign up.
Community Resources. The final way is to reach out to the community. Due to the need for help, many charities take donations for those whose health insurance does not cover their medical costs. They offer seniors an application to determine eligibility for assistance. The elderly with a low enough income will receive help with their prescriptions.
Once you have selected your policy, the insurance company cannot change what it covers or cancel it as long as you keep paying the premiums. The insurance company may, however, increase the amount of the premium at any time.
Without preparation and knowledge, the process of selecting and enrolling in Medicare supplemental health insurance can seem like a daunting task. However, with a little research, you can select Medigap coverage that will make a big difference in your medical costs. You may also choose to take the time to enroll in a medical billing course or another related health care policy class online so that you're certain that you are well educated on your rights when it comes to your insurance policies.