America’s biggest healthcare plan sponsored by the government, which offers coverage to close to 44 million Seniors and to which qualified individuals can sign up is the Medicare program. Though coverage is provided for most of the medical expenses, there are some costs which are left uncovered by the program. Hence, the participants who have Medicare coverage should know the elements that are covered and those left uncovered so that they can opt for Supplemental medical insurance to cover the additional expenses incurred.
Before enrolling for Medicare Supplemental insurance, the individual must know the current health plan they have enrolled for. The health plans that the participants will have are Medicare Part A or Part B.
Medicare Part A - Gaps
Since the Part A plan covers expenses incurred due to inpatient care, hospital fees, nursing services, hospice services and home health care, this plan is called the hospital plan. The drawback is that there are a significant number of gaps in this plan, since many costs are not covered under it.
1. There is a hospital deductable for every new illness which during 2009 stood at $1,068
2. There are coinsurance payments applicable for the hospital charges. Once the deductible amount has been paid, the plan will cover the hospital costs for 60 days and post that for the next 30 days, from day 61 to day 90, a coinsurance of $267 had to be paid by the participant as coinsurance in 2009. The payment for the next 60 days, from day 91 to day 150, the coinsurance payment in 2009 was $534.
3. The cost of staying in the hospital after 150 days has to be borne by the participant completely.
4. Skilled nursing facilities also involve coinsurance payments post a certain time limit. While the plan will cover the complete costs for this in full for the first 20 days, a daily coinsurance payment of $133.50 was applicable for this service in 2009.
5. Coverage for full time home health services.
6. Coverage for home health services when not provided by skilled professionals.
Medicare Part B - Gaps
This plan that provides coverage for many outpatient services and physician fees is also called the Supplemental Medicare Insurance. Prosthetic devices, and durable medical equipment are covered under this plan. The gaps in this plan are as follows.
1. There is an annual deductible which has to be paid before availing coverage under Plan B. The annual deductible payment for 2009 was $135.
2. There is a coinsurance payment of 20% applicable since this plan will reimburse only 80% of the total costs incurred under approved services.
3. A portion of the bill which is not covered by the Medicare Plan B should be paid by the participants.
Filling the gaps in Medicare coverage
It is recommended that the participant ensures comprehensive health coverage by opting to close the gaps in the current plan they hold. The options that one has to close the gaps are as follows.
1. Opting for programs like Medicaid, Special Low Income Medicare Beneficiary Program, Qualified Medical Beneficiary Program and Qualified Individual Program, all of which come under the umbrella of Government programs.
2. Group retirement policies which are non-standardized.
3. Medicare Supplement Plans, issued prior to July 31, 1992 which are non- standardized plans.
4. Medicare Supplement Plans, issued post July 31, 1992 which are standardized plans.
It is important for participants to know that people who have Medicaid need not avail Medigap insurance since the former will cover their healthcare expenses. QMB can be availed by people who are within the 100% poverty level set by the federal government and not eligible for Medicaid. This plan will cover their annual deductibles, coinsurance payments and Medicare premiums.
All people should be aware of the gaps in their policy and avail the best possible option to cover these gaps to ensure they are fully covered in case of medical emergencies.
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