Medicare Supplement Insurance

Beneficiaries or individuals in the ‘original’ Medicare program sometimes opt to obtain Medicare supplement insurance for the reason that Medicare often covers less than the total cost of the beneficiary’s health care. Medicare supplement insurance provides supplemental health coverage to Medicare beneficiaries. This medical insurance is also called as “Medigap.” Medicare comprises of two components, namely: Part A and Part B. And both components have gaps in coverage and that are covered by supplemental insurance.

Medicare Part A, otherwise known as hospital insurance takes care of inpatient hospital, inpatient skilled nursing facility, home health and hospice services. Medicare does not reimburse gaps such as: hospital deductible per spell of illness, hospital coinsurance payments, hospital services beyond 150 days per spell of illness, skilled nursing facility coinsurance payments; skilled nursing facility services beyond 100 days per spell of illness; home health aid services that are provided on more than a part-time or intermittent basis; and home health nursing and aid services when there is no longer a skilled care component.

Medicare Part B, also known as supplementary medical insurance takes care of a variety of out-patient and physician services. It contributes for durable medical equipment; prosthetic devices; physicians’ services and for ambulance. Medicare does not entertain expenses such as: Part B deductible; Part B 20 percent coinsurance payment; balance billing above the Medicare approved charge etc. Beneficiaries of Medicare, therefore, fill in Medicare’s gaps through Government Programs; Group retirement policies; Non-standard Individual Medigap policies; Standard Individual Medigap Policies and so on. Medicare beneficiaries, who are equally eligible for Medicaid, do not need Medigap insurance since Medicaid will cover the cost of their health care requirements.

There are twelve standardized Medicare Supplement Insurance  Policies that are labeled A to L. Policy A contains the basic benefits. The remaining eleven policies contain the basic benefits plus one or more additional benefits. The list of benefits that are contained in the core policy and that must be contained in all new Medigap polices, sold beginning July 31, 1992 are: part A hospital coinsurance for days 61-90; part A hospital lifetime reserve coinsurance for days 91-150; 365 Lifetime Hospital Days Beyond Medicare coverage; Part A and B Three pint Blood Deductible and Part B 20% coinsurance.

B to L provides for additional benefits. Each plan offers a different combination of these benefits in addition to the basic benefits. The additional benefits are: part A Skilled Nursing facility coinsurance for days 21-100; Part A hospital deductible; Part B Deductible; Part B charges above the Medicare Approved amount; Foreign Travel emergency coverage; At-home recovery and Preventive Medical Care.

B through L polices vary considerably. Beneficiaries are recommended to review the policy packages and decide on the policies that are appropriate for them. There are many issues like what specific benefits does one require? How much will the premium cost? Etc. These must be considered before going for a Medigap Insurance.