Medicare and Medicare Supplement Insurance

Medicare does cover the elderly in the U.S., but there are huge gaps in coverage. Private medigap insurance can help. Senior living facilities cover the spectrum from nursing homes to luxury condominiums, with a range of services available.

There are two parts of Medicare: Part A (Hospital Insurance) and Part B (Medical Insurance). Under Medicare Part A, the Federal government will pay a portion of your expenses for inpatient hospitalization, skilled nursing facility care, hospice care services, home health care services, and for medically necessary blood transfusions. Medicare Part B covers your doctors’ services, outpatient hospital care, and other medical services. To better understand your Medicare benefits and how to use them, read the Medicare & You handbook, which is available from your local Social Security office or by calling Medicare at 800-633-4227. You may also refer to the Medicare Web site at www.medicare.gov.

For each medical service Medicare covers, there is a portion that Medicare does not pay. Medicare Part A and Part B both have a deductible (the amount you must pay or must incur before Medicare will begin to pay). You must also pay the portion of the hospital or medical expenses for which you are responsible, commonly referred to as “coinsurance” or a “co-payment.” The monthly premiums, deductibles and coinsurance for Medicare change each year. You can find out the current amount of these Medicare charges by contacting your local Social Security office.

Often people need medical services that Medicare does not cover. Such services as medical expenses incurred during foreign travel or outpatient prescription drugs are not covered by Medicare.

The Medicare handbook is reprinted each year to reflect any changes in deductibles, coinsurances, or benefits. Consult a current Medicare handbook for any changes to the Medicare plan.

Medicare Supplement Insurance Is Standardized

Congress passed legislation creating Federal standards for Medicare Supplement insurance policies that the states are required to adopt, with the exception of Massachusetts, Minnesota, and Wisconsin. Federally mandated standardization means that all Medicare Supplement insurance policies sold must contain a package of benefits conforming to one of the ten standard plans that are designated as Plan A through Plan J.

As a result of standardization, comparison-shopping among different insurance carriers for Medicare Supplement insurance is relatively simple. For example, Plan C will contain the same benefits no matter which insurer sells it. Consumers can select policies based on premium cost and the special features or services offered by the Medicare Supplement insurance company.

Who Pays First if You Have Other Health Insurance?

If you have a question about who should pay, or who should pay first, check your insurance policy or coverage. It may include a coordination of benefits clause. You may call your insurance company or the Medicare Coordination of Benefits Contractor at 800-999-1118.

Open Enrollment for Purchasing a Medicare Policy

If you are 65 years old or older, you may buy any Medicare Supplement insurance policy, regardless of the condition of your health, during the "open enrollment" period. The open enrollment period lasts for six months after you first become eligible for Medicare Part B. Effective September 27, 2000, Medicare eligible disabled individuals under the age of 65 who do not have End-Stage Renal Disease now have the right to a six month open enrollment period beginning with their entitlement to Medicare Part B to purchase selected standardized Plans A, B, C, F or a prescription drug Plan H, I, or J at the discretion of the insurer. When a Medicare beneficiary under the age of 65 turns 65, they will have a second six month open enrollment period to purchase a standardized supplement policy for plans A through J.

Once you have purchased a Medicare Supplement policy, you will have an annual open enrollment commencing with your birthday and ending 30 days later. The policy must be of equal or lesser value in coverage to your existing plan.

"Open Enrollment" means that no insurer may deny you the right to purchase any of the ten standard plans because of any preexisting medical condition, claims experience, or receipt of medical care. If you have a preexisting medical condition (a condition for which you received medical advice or treatment during the six months before your insurance begins), open enrollment is an important advantage to you.