Health

What Are Medigap Insurance Plans and Their Additional Benefits?

Medicare Supplement vs Medicare Advantage | JL Smith

Two of the most frequently chosen options for patient Medicare benefits are Medicare Advantage or Medigap Insurance plans. Medicare Supplement Insurance is usually purchased to be the second payer for Medicare Parts A and B, while Medicare Advantage Plans are chosen to offer an alternative to Original Medicare through private companies. 

These two plans cover different sets of “exotic” health care services not covered by Medicare Parts A or B, and may vary from plan to plan. Although these two options are similar in that they both pay a percentage of claims, the differences in their coverage result in a considerable variation in premiums, enrollment, and benefits.

Best Medicare supplement plans 2022 generally offer greater choice in the service providers covered, but also contain some of the same costs and other conveniences of Medicare Parts A and B. However, some Medigap Insurance Plans do not cover all services provided by Medicare Parts A or B. In addition, in most cases (but not all areas of the country), Medicare Advantage Plans are required to have a Medicare Part A deductible and Medicare Part B deductible before benefits can be paid. This means that there is a co-payment for services, with the amount of the co-payment determined by a Medicare Advantage Plan’s premiums.

Medigap Insurance Plans generally offer coverage only for inpatient hospital stays, skilled nursing facility visits, emergency room visits, and extended medical care such as prescription drugs and surgery. 

These services are generally not covered by Medicare Parts A or B. When Medicare is used to finance the costs of inpatient hospital care, it is known as a guaranteed issue; when it is used to pay for professional services it is called a non-guaranteed issue. Medicare Supplement Plans that are similar to Medigap Insurance generally cover all services that are not otherwise covered by Medicare.

What are the additional benefits that are covered by these types of policies? Many times, these additional benefits include: vision care provided by optometrists and ophthalmologists; hearing aids; hospice care; chiropractic services; and dental care. In order to receive all of these services, you will generally have to enroll in a Medicare Part B supplement policy. 

Although Medicare Parts A and B provide insurance for almost everything that is not considered medically related, they do not cover any additional benefits that are not specifically listed. This includes prescription drugs, behavioral health services, and some dental care.

Because the additional benefits contained in themedigap policies can increase the overall plan costs, some insurance companies rebate the premium to the individual who has the ability to pay the higher premiums. There are additional restrictions placed on these rebates as well. 

For example, if the individual who receives the rebate does not use all of the benefits that are available, then he or she will not be allowed to receive the rebate for those services. Another restriction that is placed on these plans is that the individuals who are eligible for Medicare must be below age 65.

Are there any other types of supplemental plans that are available? Yes, there are. Although medicare does not offer any coverage for vision care, many individuals purchase supplementary planand their Medicare coverage. Usually, these plans provide some vision benefits along with some of the services provided by the medigap plans. 

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