Medicare Supplement Insurance FAQs

Medicare Supplement Insurance FAQs

What is Medicare?

Medicare is a federal health insurance program for people 65 years of age or older and certain people with a disability or end-stage renal disease (permanent kidney failure). It pays for much of your health care, but not all of it. There are some costs that you will have to pay yourself. These are called out of pocket costs.  Costs that you must pay, like coinsurance, co-payments, and deductibles, are called “gaps” in original Medicare plan coverage.

What are Part A and Part B of Medicare?

Part A (Hospital Insurance) helps pay for inpatient hospital care, some skilled nursing facility care, hospice care, and some home health care.   Your exposure with Medicare Part A includes a fairly hefty deductible per benefit period and co-pays for days 61+ in the hospital.  The part A benefit period is your stay in the hospital and 60 days after your release.  So, you could conceivably have to meet multiple part A deductibles within a calendar year.  The co-pays for days 61-90 is $267/day and the co-pays for days 91+ is $512/day.  So, as you can see it can get rather expensive if you have multiple hospital stays or extended stays in the hospital.

Part B (Medical Insurance) helps pay for doctors' services, outpatient hospital care, and some other medical services that Part A doesn't cover. Part B helps pay for such covered services and supplies when they are medically necessary.  The part B deductible is relatively inexpensive compared to the Part A deductible and is a calendar year deductible.  However, once the deductible is met you will be responsible for 20% of your Medicare Part B-related expenses.  This can also get rather expensive if you are having to undergo major medical treatment.

What is a Medicare Supplement plan?

A Medicare supplement insurance plan is a health insurance policy sold by private insurance companies. These Medicare supplement plans must follow federal and state laws. These laws protect you. The front of the Medicare supplement insurance plan material must clearly identify it as a “Medicare supplement insurance” plan.

You might want to consider buying a Medicare Supplement plan to cover the above described gaps in Original Medicare coverage. Some Medicare supplemental plans also cover benefits that the Original Medicare Plan doesn’t cover, like emergency health care while traveling outside the United States, At Home Recovery Services, and Preventive services that might not otherwise be covered by Medicare. A Medicare Supplement insurance plan may help you save on out of pocket costs. If you buy a Medicare supplemental insurance plan, you will pay a monthly premium to the private Medicare supplement insurance company that sells you the policy.  Medicare supplement plans do not have an open enrollment period.  This allows you to switch another Medicare supplement plan at any point throughout the year as long as you qualify medically.
 
Why do I Need a Medicare supplement or “Medigap” policy?

You may need to supplement Medicare Coverage for one or more of the following reasons:

• Medicare was never designed to pay all the health care costs of the elderly.
• Medicare coverage has many gaps.
• Medicare deductibles increase every year.

How do I get a quote for Medigap (Medicare Supplement Coverage)?

Simply click here to get an online quote from some of the companies we represent.  Or for faster service call us toll free at 1-866-894-3258.  We can help you understand how the various plans work and select from many more companies.  Only a few of our providers allow us to show their rates on our website.

What is Medicare drug coverage (Part D)?

Starting January 1, 2006, new Medicare Part D drug coverage was available to all Medicare recipients. All Medicare recipients can get this coverage that can help lower drug costs and help protect against higher costs in the future. Medicare Part D drug coverage is a Medicare program run through private insurance companies.

You choose the drug plan and pay a monthly premium.  Like Medicare part B insurance, if you decide not to enroll in a drug plan when you are first eligible, you will pay a penalty if you choose to join later.

If you delay taking and don’t take Medicare part D when you are initially eligible your premium cost will go up at least 1% per month for every month that you wait to join.  You will have to pay this penalty as long as you have Medicare drug coverage. If you join by December 31 in any year your coverage will begin January 1 of the next year.

When is Medicare’s Initial Enrollment Period?

The Initial Enrollment Period begins 3 months before the month a beneficiary turns 65 and ends 3 months after the month the beneficiary turns 65. If beneficiaries wait until they are 65 or sign up during the last 3 months of the Initial Enrollment Period, their Medicare Part B start date will be delayed.

What is the Medigap open enrollment period?

The 6-month period that begins the first day of the month in which a beneficiary is both age 65 or older and enrolled in Medicare Part B. During this period you right to purchase a Medicare supplement policy is guaranteed.

What are "open enrollment" and "guaranteed issue" in Medicare?

Open enrollment allows the applicant to be guaranteed a Medicare supplement insurance plan regardless of their current or past health history. Otherwise, the applicant must meet medical underwriting standards to qualify if required by the insurance company. Open enrollment includes a six-month period from the date you enrolled in Medicare Part B if age 65 or older, or a six-month period when you turn 65 if you were eligible for Part B benefits before age 65.

What is creditable coverage?

Creditable coverage is any previous health insurance coverage that can be used to shorten the pre existing waiting period, such as a health insurance coverage under a group (employer) health plan or an individual health insurance policy. However, if there was any time that you had no health insurance coverage of any kind, and during that time you were without health insurance coverage for more than 63 days in a row, you can only count the creditable coverage you had after the break in health insurance coverage.

What is a Medicare approved amount?

This is the fee that Medicare sets as reasonable, which providers who accept "Medicare assignment" will charge for a covered medical service. Otherwise, the Medicare approved amount may be less than the actual amount charged by a doctor or supplier for a service or supply.

Do I have to wait to switch to a different Medicare supplement policy?

No, but the length of time you've had your Medicare supplemental plan will affect how your new Medicare Supplement policy covers you for pre existing conditions. If you've had a Medicare Supplement insurance plan for at least six months and you decide to switch, your new Medicare supplemental insurance plan must cover you for all pre existing conditions. If you've had a Medicare supplemental insurance plan for less than six months, the new Medicare supplement policy must give you credit for the time the older policy covered you.

What happens to my Medicare supplement plan if I move?

Because your Medicare supplemental insurance plan is guaranteed renewable, you will still have insurance coverage if you move. If you move to a new state, however, the Medicare supplement insurer may quote you a different premium. If you have a Medicare Select insurance plan, which contain network restrictions, you must change your Medicare insurance coverage. But you have the right to buy Medicare supplemental insurance plans A, B, C or F in the state you move to without having to medically qualify.

Will Medicare cover my medical expenses outside of the U.S.?

Persons living or traveling outside the United States usually cannot benefit from Medicare. This is because, generally speaking, the program provides protection against the cost of hospital and medical expenses incurred in the United States.

There are rare emergency cases where Medicare can pay for care for those who travel to Canada or Mexico. Also, Medicare can sometimes pay if a Canadian or Mexican hospital is closer to your home than the nearest U.S. hospital that can provide the care you need.

If you get emergency treatment in a Canadian or Mexican hospital or if you live near one, ask someone who works at the hospital about Medicare coverage, or have the hospital help you contact the Medicare Intermediary.

Health insurance protection may be very important to anyone temporarily abroad who plans to return to the United States. If you plan to return to the United States shortly after you are eligible for the medical insurance program, you may wish to enroll during your first enrollment period. If you expect to be abroad for a longer period of time, you may wish to enroll during a later general enrollment period.

Which type of Medigap plan is best for me?

This depends on your personal preferences, needs and requirements. Consideration should be given to benefits, cost, your economic situation, and current health. A Texas Health & Life specialist can answer your questions and provide you with the information you need to make a wise healthcare choice.