Insurance Information

Author: Mili Bose

Medicare, a federally funded healthcare program, provides coverage for hospital and physician expenses. However, Medicare doesn't provide coverage for all sorts of medical expenses and thus the need for Medicare supplements comes into play. This type of health insurance is offered by the private insurance companies. Supplement plans help to cover the costs like coinsurance, co-payments and deductibles that are not covered by traditional Medicare plans. There are 12 different plans to select from. The coverage offered differs from plan to plan.

1. What are Medicare supplement plans?

Medicare supplement, also referred to as Medigap plans, can be purchased by any individual who presently have both Parts A and B coverage. Medicare supplements plans are named according to the English alphabet, so they are available from A through L. these are standardized plans operated and controlled by the federal and state laws as well. Nevertheless, unlike original Medicare, such plans are not issued by government; they are issued by private insurers. Any insurance provider that sells such plans should offer Medicare Plan A together with other fundamental benefits. The benefits may include Part A and Part B co-insurance coverage along with coverage for 365 days of hospital stays per lifetime and coverage 3 pints of blood per year.2. What do you need to know about Part B costs?

Part B is designed to work together with the physicians on the basis of ‘assignment'. Physicians, who work on assignment basis, have agreed accepting reimbursement from the Medicare as payment. But if a physician doesn't work on such an assignment, then the patients have to pay the fees upfront from their pocket. There are some supplement plans that bear a particular percentage of these costs. Supplement plans F, I and J provide 100% coverage for these expenses, while Plan G provides 80% coverage of the expense.

3. What about deductibles?

Before the Medicare coverage starts commencing, the applicants should pay particular amount as deductible for both Parts A and B. once Part B deductible is paid, the Medicare provides coverage of 80% of the approved expenses. Different types of supplement policies are created to provide coverage for different types of costs. The more costs covered the more expensive the plan is. If deductible coverage is considered, then plans B through J provide coverage for Part A deductible and plans C, F and J cover part B deductibles.

4. What about additional coverage?

Since Medicare Part A and Part B provide coverage for hospice stay and physician fees, different supplement plans cover additional services such as skilled nursing care, prescription medications, and preventive care. Plan H and plan I provide 50% coverage on prescription expenses up to a certain amount every year, while plan J provides coverage for 50% up to a certain amount of money every year. However, a certain amount of deductible has to be paid under all of these plans before they commence. Holders of plans C through J are entitled to get skilled nursing care. The benefit allows a particular amount of money per day for the nursing services after 21st day to 100th day. Plan E and plan J provide coverage of a particular amount every year for preventive care.

Depending on the above mentioned factors the Medicare supplements plans differ from one another. Since these plans are regulated by both federal and state laws, some states may impose different regulations on how the plans are administered. In states like Wisconsin, Massachusetts and Minnesota, where supplement plans provide coverage for copayments and deductibles, policyholders are still needed to pay for Medicare Part B premium as well as premium needed by the insurance provider.

About the Author

Shelly Baker is a health insurance industry expert. From Medicare supplements plans to advantage plans – she writes on all topics related to the health insurance.