Larry’s View

Larry’s view on any and everything.

Medicare supplement insurance

Medicare Supplement Insurance, or “Medigap” insurance, provides supplemental health insurance coverage for Medicare recipients. People who are in the “original” Medicare program may desire Medicare Supplement insurance since Medicare often covers less than the full amount of the person’s healthcare costs.

Medicare is separated into two coverage part being called, Part A and Part B. Each of the programs has gaps in coverage, thus the need for supplemental insurance to fill in the gaps.

Medicare Part A Gaps

Medicare Part A is for inpatient hospital, inpatient nursing facility, home health, and hospice services. The next is a limited list of gaps not reimbursed by Medicare:
* Hospital deductible per instance of need.
* Hospital coinsurance payments – Medicare will cover the initial 60 days assuming the deductible has been paid, however co-payments are gradually adjusted after 60 days.
* Hospital stays beyond 150 days;
* Skilled nursing facility coinsurance for the first 20 days will be paid in full, after that there will be due a co-payment.
* Skilled nursing facility services beyond 100 days per occurrence of illness;
* Home health assistant services provided on more than an intermittent basis;
* Home health nursing and aide services once skilled care is no longer needed.
Medicare Part B Gaps

Medicare Part B provides coverage for outpatient and physician care. This will also cover the DME’s, ambulance need, and physician notification. Below is a list of gaps in coverage:
* Part B deductible this must be met prior to Medicare making payment for covered services;
* Part B 20% co-payment- split with Medicare on and 80/20- basis, they will not cover the recipients 20%;
* Any cost of services provided above the approved Medicare cost.

There are a number of ways to ‘fill in the gaps’ in the Medicare Coverage. Some of those methods include government programs like Medicaid, non-standardized group retirement plans, standard medigap policies. Medicare recipients eligible for Medicaid will have no need to purchase additional coverage. Should someone not qualify for Medicaid, and still fall in the poverty level possible government assisted coverage would be known as Qualified Medical Beneficiary Program (QMB). Coverage by the QMB would provide payment for Medicare Premiums, annual deductibles, and co-payments. Should one qualify for the QMB program, additional Medicare Supplemental Insurance is not needed

Generally speaking, few people qualify for the government assistance programs, and thus need to purchase a Medigap insurance policy. Although Congress established standardizations of Medigap plans, the availability of any of the plans varies by state, and by private insurance company. Examine plans carefully, ask questions and work with someone who will make the plans easily understood. The goal is to get the coverage needed for the gaps in your healthcare services that are not provided for by Medicare.

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January 23, 2008 - Posted by | Blogroll, Medicare

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