Supplemental Insurance Covers What Medicare Doesn’t

    Published: 06-16-2009
    Views: 8,457
    Mary Alexander from Home Instead Senior Care discusses how supplemental insurance works in addition to medicare coverage.

    Mary Alexander: Hi! I'm Mary Alexander from Home Instead Senior Care; today I'm talking about Supplemental Insurance Coverage and other insurance considerations around Medicare. According to the centers from Medicare and Medicaid Services, a Medigap Policy also called Medicare Supplement Insurance is private Health Insurance that's designed to supplement original Medicare, which is Part A and B.

    You must have both Parts A and B to get Medigap Insurance, and do note, Medicare does not pay any of the costs for you to get a Medigap Policy. Medigap Insurance helps pay some of the healthcare costs that an original Medicare doesn't cover, such as co-payments, co-insurance, and deductables. If you have Original Medicare and Medigap Policy, Medicare will pay its share of the Medicare approved amounts, for covered healthcare costs first.

    Then your Medigap Policy pays its share, Medigap Policies do not cover your share of the costs under other types of Health Coverage, including, Medicare Advantage Plans known as Parts C, Stand-alone Medicare Prescription Drug Plan known as Part D. Employer or Union Group Health Coverage, Medicaid, Department of Veterans Affairs, also known as VA Benefits or Tricare.

    Generally speaking, insurance companies can't sell you a Medigap Policy if you've coverage through Medicaid or Medicare Advantage Plan Part C. There are protections in place to help you. For instance, every Medigap Policy must follow Federal and State laws and the policy must be clearly identified as Medicare Supplement Insurance.

    Most Medicare Drug Plans have a coverage gap called the donut hole. This donut hole begins after you and your Drug Plan has spent a certain amount for covered drugs. When you reach that amount you then have to pay the full cost for your Prescription Drugs, up to a certain limit. You can reduce your gap by using generic drugs or applying for extra help from Medicare, State and Local Programs. Many people, who are on Medicare, also have Other Types of Primary Insurance Coverage, such as Employee Health Insurance Plan, Spousal Employer Health Insurance or are getting Workers compensation, Auto Insurance or Liability Insurance that is covering the cost of Medical Care related to an accident. In these instances, Medicare would pay after the Primary Insurance. Other situations exist for those on Medicaid, Veteran's Benefits or Tricare, among others. If you have questions about what policy pays first, you should contacts Medicare at 1-800-999-1118. More details can also be found in the centers for Medicare and Medicaid Services booklet, titled Medicare and other Health Benefits, your guide who pays first available online at medicare.