You are turning 65. Learning the ins and outs of Medicare is confusing. Figuring out all of the options such as Medicare Advantage and Medical Supplements are even more confusing. You know Part A covers Hospitals and part B covers Medical. But you are not sure whether or not you need any other coverage in addition to Original Medicare. Why do many people purchase a Medicare Supplemental Plan and what does it cover?
To answer that question, you must first understand how Medicare Parts A & B work, and what is and is not covered. Medicare Part A covers most hospital expenses-but not all of those expenses. In 2011, there is a deductible of $1,132 per visit (as long as each visit is separated by more than 60 days). If you are in the hospital for 61-90 days, you’ll have a per day co-pay of $283. If you are in the hospital for 91-150 days, you’ll have a per day co-pay of $566.
Concerning Medicare Part B, there is an annual deductible of $162 (in 2011) that you are responsible for. In addition to that, you’ll be responsible for 20% of all medical expenses. This 20% can really, really add up. In addition to your regular doctor visits and tests, imagine if you would need a knee or hip replacement. That would require months and months of physical therapy-you would be obligated to pay 20% of all those bills.
While Original Medicare covers most medical needs, it was never meant to cover all of your medical costs. As you can clearly see, there are a lot of “gaps” in coverage, that you are responsible to pay. For this reason, many people will purchase a Medigap or Medicare Supplement Insurance. These two phrases-Medigap and Medicare Supplement are interchangeable-two names describing the same exact insurance. Most Medicare Supplemental Plans will pick up your Hospital deductible and co-pays, as well as your Part B deductible and the 20%.
For most people, it is being exposed to the 20% of medical bills that is the scary part. A battery of test could cost a small fortune. If you need physical therapy or rehabilitation, those twice a week visits, at 20% cost to you, really adds up. Add the potential Part A hospital deductible of $1,132-per visit, and you are looking at quite a medical bill. For this reason, most people want to fill in these gaps in coverage,
With a Medicare Supplemental plan, you are adding an extra monthly expense. However, the trade-off is that you will have a known expense, as opposed to a potentially very high expense if you utilize benefits.
If you have a Medigap plan in addition to your red, white, and blue Medicare card, this Original Medicare is your primary coverage. They pay your medical bills first. Then, your Medicare Supplement Insurance will pay the gaps (the deductibles/co-pays/co-insurance) that Medicare doesn’t pay for. And voila! If you have Original Medicare and a good Medicare Supplemental Plan, you now have complete, comprehensive coverage with little or no out of pocket expenses.
