Beyond Basic Medicare: Understanding Medicare Supplemental Coverage

By Ron Pollack Modified: August 2, 2013 at 11:03 am •  Published: August 2, 2013
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People who can’t get job-based supplemental coverage have other options: Those with very low incomes and assets can get help through their state Medicaid programs (see below). Otherwise, private Medicare supplemental insurance (often called “Medigap”) or a private Medicare Advantage plan can help. But these options may be expensive, and they have other limitations. About 12 percent of people with Medicare do not have any supplemental coverage and are at risk of facing high out-of-pocket costs.

 

Q: What are Medigap plans?

 

A: Medigap plans are sold by private insurance companies, but these plans have to follow state and federal rules. Medigap plans come in several standard varieties, which helps consumers compare plans. They cover some of Medicare’s cost-sharing (for example, deductibles and co-insurance), but they do not pay for services that Medicare does not cover. Medigap plans are popular because they rarely change from year to year, and they allow you to see any health care provider who accepts Medicare. But Medigap plans can have high premiums that increase annually, and policyholders usually must also buy separate Part D prescription drug plans.

If you currently have a Medigap plan, think twice before dropping it for some other coverage—you may not be able to get it back later.

 

Q: What are Medicare Advantage plans?

 

A: Medicare Advantage plans are run by private insurance companies that contract with Medicare to provide the full range of Medicare benefits. Most include Part D prescription drug coverage, and some offer supplemental benefits and have out-of-pocket limits.

Medicare Advantage plans have grown more popular in recent years, but they have important drawbacks. In general, they limit which doctors and hospitals you can use, and plans decide what services they will approve. Plans can leave a market, forcing people to change their coverage. Beneficiaries can join, switch, or leave their Medicare Advantage plans only during Medicare’s open enrollment period each fall.

 

Q: What if I can’t afford supplemental coverage?

 

A: You may be eligible for Medicaid or a Medicare Savings Program in your state, or for the Part D Extra Help program through Social Security.

 

Q: How can I get more information?

 

A: Anyone with Medicare can get help from a local counselor through their State Health Insurance Assistance Program (SHIP). You can call 1-800-MEDICARE and ask for a referral to your local SHIP or go to this website and click on your state: www.familiesusa.org/resources/program-locator.

 

 

Q: Should I expect changes to Medicare rules in the future?

 

A: No immediate changes are planned for Medicare supplemental coverage. But private plans can change their offerings each year. There’s also a chance that, in the next few years, Congress may make changes to Medicare, Medigap, and other supplemental coverage. So, as always, it’s good to stay informed.