Imagine getting surgery and thinking that you're fully covered under Original Medicare. A few weeks later, you get a bill in the mail and it's not at all what you expected. Sounds like a nightmare that you shouldn't have to deal with, and that can be avoided.
It starts with choosing the right Medicare plan. It's important to know that Original Medicare (Parts A and B) doesn't cover everything. Part A covers inpatient hospital care, skilled nursing facility, hospice, lab tests, surgery, and home health care. Part B covers doctor and other health care providers' services and outpatient care. Part B also covers durable medical equipment, home health care, and some preventive services.
This sounds like a lot, but you could be responsible for paying a deductible and/or coinsurance for Part A services. And Original Medicare only covers 80% of Part B services. What about the other 20%? To fill the gap with Original Medicare, you can enroll in a Medicare Supplement plan, also called a Medigap plan.
Fill your coverage gap with a Medicare Supplement plan
A Medicare Supplement plan can help pay some of the health care that Original Medicare doesn't cover, like copayments, coinsurance, and deductibles. There are types of plans you can choose from – A, B, C, D, F, G, K, L, M, and N. Not every state will provide all these plans. It depends on where you live. Costs and benefits can also vary greatly, so it's best to do your research and understand the coverage and costs for each plan. For example, some letter plans cover nursing home stays and hospice care, while others don't.
Here are more important things to know about Medicare Supplement plans:
- You must have Medicare Part A and Part B to enroll in a Medicare Supplement plan.
- They're sold by private insurance companies. You pay the private insurance company a monthly premium for your plan.
- A Medigap plan only covers one person. So if you and your spouse both want Medigap plans, you'll need to purchase them separately.
- According to , if you're turning 65 the best time to get a Medigap plan is the six-month period that starts the first day of the month you're 65 or older and enrolled in Part B. For example, if you turn 65 and are enrolled in Part B in June, the best time for you to buy a Medigap policy is from June to November.
- Your plan may offer additional coverage for health care services or supplies that you need while traveling outside the U.S.
Weigh your options and make a good decision
A Medicare Supplement plan can help fill coverage gaps so that there are no surprises in what's covered and how much it costs. You also have another choice for medical coverage: Medicare Advantage plans (Part C). Medicare Advantage combines Parts A and B and may even offer prescription drug coverage (also known as Part D). And Medicare Advantage can include additional benefits like eye care, hearing aids and exams, wellness services, or a nurse phone line. No matter which plan you choose, if you do your research, you can feel confident in your decision.
Amy Capomaccio is a health care writer at Aetna with experience in senior wellness, Medicare, Medicaid, and commercial health care. When she's not practicing new mindfulness techniques, Amy is spending time outdoors and traveling. Amy hails from Wakefield, MA and has a degree in Advertising and Public Relations from the University of Tampa.