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Understanding Medicare Supplements: The Basics of Medigap

Medicare covers many health essentials for citizens sixty-five and older but it does not cover everything. Particularly for those with more complex medical histories (or futures), Original Medicare (Parts A and B) is often not enough as they move into their golden years of retirement. This is where understanding Medicare Supplements, or Medigap insurance policies come into play.

What is it?

Medigap is essentially extra insurance. Beneficiaries can buy extra insurance policies from private carriers to help pay their share of the out-of-pocket expenses that come with Original Medicare. Original Medicare is funded by the federal government.   The federal government also contracts with private carriers to ensure that their Medigap policies are safe, uniform, and sufficient. Beneficiaries must have Original Medicare in order to buy a Medigap policy. This means they must sign up for Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) to be eligible to purchase Medigap.

As previously mentioned, the insurance carriers that provide Medigap policies are contracted with the United States government. This means that the carriers must meet certain guidelines in order to keep their contract each year and continue to sell these policies. All Medigap policies are standardized, meaning that they all cover the same basic health benefits regardless of which company they were purchased from or which state the beneficiary lives in. There are ten different types of Medigap policy, and they are distinguished by letters (A, B, C, etc.). Price is the only difference between carriers’ plans of the same letter. This means that plans with the same letter offer the same coverage regardless of carrier. It is important to note, however, that in Massachusetts, Minnesota, and Wisconsin, the plans are standardized in a different way. Despite this, every Medigap policy must follow state and federal laws to protect their beneficiaries.

What does it cover?

The benefits of each Medigap plan differ (again, usually by letter, or tier), but they are all designed to do one thing: help cover the beneficiary’s share of costs from Medicare Parts A and B. This means Medigap policies can help cover co-payments, coinsurance, and deductibles. Some Medigap policies can cover services that Original Medicare doesn’t cover, like emergency medical care outside of the United States.

What’s not covered?

Medigap can’t cover everything that Medicare Parts A and B doesn’t. Some of the services that are not covered under Medigap policies are long-term care, vision or dental care, hearing aids, eyeglasses, and private nursing. Medigap plans that were sold after 2005 do not include prescription drug coverage, and beneficiaries can opt in to Medicare Part D for that kind of coverage.

Understanding Medicare Supplements – Agent Resources

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What Does Medicare Part A Cover

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Applying for Medicare in Connecticut

This post will try and give you some help when you are applying for Medicare in Connecticut.  This can be overwhelming for some people.  We want to make it easy for you.  If you are 65 years old, or are under 65 and qualify for Medicare because of a disability or other special circumstance, you are eligible for Medicare.  (Note:  You must be a US citizen or a legal resident for at least 5 consecutive years to be eligible for Medicare.)

Apply for Medicare can be done online by CLICKING HERE.  You can also enroll by phone at 1-800-MEDICARE.  Or, you can enroll in person at your local social security office.  You can call 1-800-772-1213 for help locating your local social security office.

Click here for more details regarding choosing a Medicare plan in CT.

 What is Medicare Part A Coverage?

Medicare Part A coverage is hospital care coverage.  This plan covers both lab tests and surgeries.  Doctor care during the stay is also covered.  There is also coverage for supplies like wheelchairs and walkers when they are medically necessary to treat either a disease or a condition.  Part A covers in-patient hospital stays.  These plans also cover care in a skilled nursing facility or nursing home care as well as Hospice care and some home health services.  Note:  Part A will cover nursing home care for medical purposes.  Medicare will not cover the expense if custodial care is the only care necessary.

Part A includes benefits for hospital expenses.

Other expenses part A covers are, a semi-private room and meals as well as medications.  There is also coverage provided for nursing services and other supplies from the hospital.  Part A benefits will cover home health care services when deemed medically necessary.  Your doctor must order home health services in order for this expense to gain approval. Skilled nursing facility (SNF) stays coverage will only receive approval by Part A after a qualifying hospital inpatient stay for a related illness or injury. To qualify for SNF care, the hospital stay must be a minimum of three days.  A qualified stay begins on the day you are admitted. The day the hospital dischares you does not count toward the 3 day requirement.  Patients can be kept for observation.  Time spent under observation is considered outpatient.  This time does not count towards your qualifying stay.

If your doctor has certified that you have a terminal illness, you may be eligible for hospice care coverage.   Your doctor will need to determine a 6 month or less life expectancy.  In hospice care, the focus is on palliative care.  Hospice focus is not cure.  The goal is to relieve pain and make the patient as comfortable as possible.

Click here to learn how and when to enroll in Medicare.

Click here for more information regarding Medicare Part A  benefit coverage.

Connecticut residents looking to compare plan options can click here for more details about plans available.  If you still have questions or would like to set an appointment, please call the office at 203-796-5403.  In fact, we are leading Medicare experts in CT and are here to help.  We do not charge for our consultation services.

Click here for a no cost personal and confidential Medicare quote.

Original Medicare Enrollment

Original Medicare Enrollment in parts A and B is automatic for those drawing Social Security.   Those people who are not that are not will need to enroll.

If you’re already collecting Railroad Retirement Board or Social Security retirement benefits when you turn 65, you will automatically be enrolled Medicare Part A .  If you are under 65 and you receive Social Security or Railroad Retirement Board disability benefits, you will automatically be enrolled in Medicare Part A and Part B after 24 months of disability benefits.

You will need to sign up for Medicare part B, if  you are not receiving retirement benefits before age 65 or  if you qualify for Medicare through disability. Please note, you can sign up during your Initial Enrollment Period (IEP). This is the seven-month enrollment period that begins three months before you turn 65.  This enrollment period includes the month you turn 65, and ends three months later.

Click here to visit the Medicare.gov site to learn details.

CLICK HERE TO REQUEST MEDICARE QUOTE INFORMATION.

Still have questions?  We are Medicare specialists.  Please call if you have questions or need help navigating the Medicare enrollment process.  You can either call the office at 203-796-5403 or email us at admin@croweandassociates.com.

We are a full-service brokerage and offer clients not only guidance with Medicare, but all health plan needs.  We offer dental insurance, both long and short term care policies.  Crowe and Asscoiates can help with estate planning by offering several types of life insurance as well as investment opportunities.