Filling in the Medicare coverage gaps
Medicare provides a lot of coverage, but it doesn’t cover everything. There are 2 ways to get coverage for the gaps in Original Medicare:
If you need additional gap coverage, then a Medicare supplement insurance policy might be for you.
Medicare Supplement Insurance policies are also known as “Medigap” polices. Medicare supplement insurance policies work with and supplement “Original Medicare”. They can help you pay for some of the healthcare costs associated with Original Medicare, including deductibles, coinsurance, and copayments. Claims are paid after Medicare pays theirs through a process called “coordination of benefits”. Some policies also cover services that Original Medicare doesn’t, like limited medical care outside of the U.S. for vacationers.
Medicare supplement insurance policies are Standardized Plans (A though N) throughout the insurance industry and are sold by private insurance companies. Each Plan has a monthly premium based on your underwritten status (age, residence, and health) at the time of application unless you are in your open enrollment or guaranteed issue period. In order to qualify for them you must have Original Medicare, that is, both Medicare Part A and Part B. They are also guaranteed renewable policies, meaning you can keep them for the rest of your life as long as you pay the required premiums on time.
A note for Missouri residents: Missouri is one of only two states (the other being California) that allow a guarantee issue period annually for those having a Medicare Supplement to change plans. All other states subject you to the underwriting process for any plan changes.
If you are turning 65 and continue employment with group insurance, it is imperative that you seek guidance from a licensed agent so that you don’t miss out on some important information regarding your options enrolling in Medicare Part B. I stand ready to help.
Please take note that neither Original Medicare nor Medicare Supplement Insurance plans provide for Prescription Drug coverage. For this, you must purchase a Part D Prescription Drug Plan.
Replace your Original Medicare insurance with a Medicare Advantage Plan (Part C of Medicare)
Medicare Advantage Plans are health plans overseen by Medicare under their Part C rules that replace “Original Medicare” with a Medicare-approved private insurance carrier’s policy. These rules stipulate that a Medicare Advantage plan MUST cover benefits as good or better than the Original Medicare it replaces. Unlike Supplement plans many of these Part C plans include Part D drug coverage. These plans use private insurance carriers to administer your Medicare benefits and pay your claims instead of Medicare. The concept of “Advantage” in the name is derived from the value-added benefits they may provide that are over and above Original Medicare. These plans are commonly called “co-pay plans”. In other words they are HMOs, PPOs, and other managed care plans. They also change features, benefits, and rates annually. However, there is an annual election period (AEP) every Fall (October 15th to December 7th) in which you are allowed to make plan changes, and Special Election Periods (SEP) for significant events such as moving out of your plan’s service area. As your agent, I will aid you in this decision process.
Important Note: If you have a Medicare Advantage plan, you can’t use or be sold a Medicare Supplement plan. You can, however, purchase a Hospital Indemnity policy to cover hospital co-pays and incidentals not covered by your Medicare Advantage plan.