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Medicare Supplement Insurance, Or Medigap Policies
Medicare supplement insurance, also known as Medigap policy, is offered by private insurance companies to cover gaps in original Medicare plans. Standardized Medigap policies, labeled A through N, must follow Federal and state laws designed to protect consumers. All Medigap policies must allow the same basic benefits, no matter which company offers them.
Medicare Part A is hospital insurance, which covers inpatient hospital stays and care in hospice, home health care, and nursing facilities. Medicare Part B is medical insurance. It covers services from doctors, outpatient services, and preventative services. Medicare Part C, also known as a Medicare Advantage Plan, includes Part A, Part B, and sometimes prescription drugs. The fourth, Medicare Part D, is prescription drug coverage, and may end up lowering costs for prescriptions overall.
If you have original Medicare, Part A or Part B, you can get a Medigap policy to cover co-payments, coinsurance, and deductibles. How this works is that original Medicare pays a set, approved amount for your health care costs. Medigap supplements your coverage by paying its share afterward.
There are some things that Medigap policies won’t cover. Vision and dental care, hearing aids, glasses, long-term nursing facilities, and private nursing services are not part of Medigap. The states Massachusetts, Minnesota, and Wisconsin are also standardized a different way than others.
Effective June 1, 2010, new laws have changed Medigap coverage. The benefits for Parts A through G have changed as follows. Hospice Part A is now covered, paying 50% and 75% with Plan K and Plan L respectively. With Part B coinsurance, Plans K, L, and M require copayments. Plans D and G have been changed, but only for those policies bought after the effective date; older policies will remain the same. And now, new Plans M and N are being offered. However, Plans E, H, I and J will no longer be offered to new policy holders.
There is a special window for buying Medigap coverage that many people may not know about, called an open enrollment period. This window begins when two conditions have been met: the consumer has turned 65 years old, AND has Medicare Part B. Some states have other open enrollment periods, which should be discussed individually. During these special windows of time, insurance companies are forbidden from refusing to sell you any of their Medigap policies, making you wait for coverage, or charging you more due to health issues. These practices are known as medical underwriting, and are not allowed during your open enrollment period.
There are three main ways that insurance companies calculate price for Medigap policies. They are known as “no-age-rated” or community-rated, “entry-age-rated” or issue-age rated, and attained-age-rated. These calculation methods can help you determine how the company will set your premium payments during the open enrollment period and afterwards. Certain other calculations can be made as well, such as geographical rating, discounts offered, and the previously mentioned medical underwriting. All companies rate and charge for Medigap premiums differently, which is why it is so important for consumers to be informed about their options.
There are many factors to be considered with Medicare supplement insurance, called Medigap policies. Medicare Parts and Plans help you determine what is available to you. There are strict rules about Medicare and Medigap coverage, so knowing what they cover and what they don’t help map out a consumer’s treatment options. Timing is also crucial, as Medigap coverage has recently been revised, and things such as open enrollment period windows can change coverage drastically. Overall, Medicare recipients need to be diligent in learning all the facts and exercising their rights when looking for and buying Medigap coverage.
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