If you’re shopping for Medicare plans, this article will help you understand what you get from a Medicare supplement plan.
Medicare supplement plans don’t work like most health insurance plans. They don’t actually cover any health benefits. Instead, these plans cover the costs you’re responsible for with Original Medicare.
These costs can include:
- Your Medicare deductibles
- Your coinsurance
- Hospital costs after you run out of Medicare-covered days
- Skilled nursing facility costs after you run out of Medicare-covered days
Here’s how it works: You pay a monthly premium for your Medicare supplement plan. These plans are also called Medigap. In return, the plan pays most of your out-of-pocket expenses. So when you go to the doctor, for example, you don’t have to pay the 20 percent coinsurance required by Medicare. Your Medigap plan pays it for you. With some Medigap plans, you might have a copay instead of the 20 percent coinsurance.
Medicare supplement plans aren’t your only option. Medicare Advantage plans help with your Medicare costs, too. They also offer additional health coverage that Medicare supplement plans don’t.
The table below breaks down the differences between Medicare supplement plans and Medicare Advantage plans. It might be a good place to start if you’re wondering which type of plan is right for you.
| Medicare supplement | Medicare Advantage |
| You could have up to three different insurance cards. | You have one insurance card. |
| You coordinate between Medicare, your Medigap plan and your Part D prescription drug plan, if you have one. | One company coordinates all your care. |
| Helps pay for costs you have with Original Medicare. | Many plans include extra benefits Original Medicare doesn’t offer like dental, vision and prescription coverage. |
| No network rules. You can see any doctor that accepts Medicare. | Some plans won’t cover care you get outside their network. |
Medicare supplement plans don’t include Part D prescription drug coverage. So if you’re thinking about buying one of these plans, you’ll want to make sure you buy a separate Part D plan. A Medicare supplement plan might be a good choice for you if you already have prescription coverage through an employer or military benefits.
How it works
Generally, before you can buy a supplement plan, you have to be at least 65 and enrolled in Original Medicare Part A and Part B.
You apply for a Medicare supplement plan offered by a health insurance company. These plans only cover one person, so if you and your spouse both want supplement coverage, you’ll each need a plan. It doesn’t have to be the same plan.
Budget basics
You’ll have up to three monthly payments:
- Your Medicare Part B premium. Most people have this taken out of their Social Security check.
- Your Medicare supplement plan premium you pay to your health insurance company.
- Supplement plans sold after 2006 don’t include Part D prescription drug coverage. If you don’t have drug coverage from another source that meets certain standards, you’ll need a Part D plan. You’ll likely have a premium for that too.
When you need care
With most Medicare supplement plans, you can go to any doctor or hospital that accepts Medicare. You’ll give them your Medicare card and your supplement plan ID card.
Original Medicare will pay its share. Your supplement plan will pay your share of the costs, depending on what the plan covers. It may also coordinate payment with Medicare and your health care providers. That means you won’t have to bother with claim filing or paperwork.
Your supplement plan choices
The government decides which supplement plans health insurance companies can offer. There are 10 different plans: A, B, C, D, F, G, K, L, M and N. Plan F and Plan G also offer a high-deductible option. Each plan pays the same amount for the same services, no matter which health insurance company is selling it. There are two main differences:
- Which plans a company offers. But all companies that sell Medicare supplement plans or Medigap plans have to offer Plan A.
- What the company charges for their supplement plans.
What’s not covered
At one time, some Medicare supplement plans included prescription drug coverage. That ended in 2006. All plans sold after that year don’t cover prescription drugs. A supplement plan with drug coverage you have from before 2006 might not meet current health care standards.
Original Medicare covers some dental, vision and hearing services. Your Medicare supplement plan will pay your share of the cost in those cases. Medicare doesn’t cover routine dental or vision care or hearing aids. These are not part of Medicare supplement plans either.
By David Lasman – “Ask Medicare Dave” | President – Senior Healthcare Team
wwww.SeniorHealthcareTeam.com | 866-333-7340
Selecting the right healthcare plan through Medicare can be overwhelming and downright stressful. Senior Healthcare Team is a nationwide resource that provides guidance and support about Medicare to seniors at no cost to them and helps them to choose the most suitable insurance plan tailored to their specific needs and budget. Our goal is to educate and empower our clients to make the best decisions regarding their healthcare and clear up the confusion of Medicare. At Senior Healthcare Team, we aren’t partial to any one insurance company. Our loyalty is to our clients and our mission is to provide them with the best healthcare options at the very lowest cost.