Q&A When Looking For A Medigap Plan

Selecting a Medicare supplemental insurance plan can be confusing and overwhelming. But choosing the right Medigap coverage has a significant impact on your health and finances, so you must make smart decisions.

As you start the process of evaluating your many options for Medicap plans, here are seven questions – and seven answers – that can help you figure out the type of coverage that’s right for you:

1. What does it mean to select a Medigap plan?

Medicare will cover most of your healthcare expenses, just as your current private insurance does. But as with your existing coverage, Medicare Parts A and B, sometimes called “Original Medicare,” won’t take care of everything. You will be on the hook for deductibles, copayments, coinsurance, and even premiums. As your healthcare needs increase as you get older, the amount you may need to spend out-of-pocket on your care will also increase.

Selecting a Medigap plan means enrolling in coverage issued by a private insurance company that will cover those expenses that Medicare doesn’t pay for or provide additional benefits that are not parts of Medicare Parts A and B.

2. What’s the difference between Medigap Plans and Medicare Advantage?

Unlike Medicare supplemental insurance plans, which fill in the blanks on Original Medicare coverage, Medicare Advantage plans, also known as Medicare Part C, provide an alternative to Original Medicare Parts A and B. As with Medigap plans, Medicare-approved private health insurance companies offer Medicare Advantage plans. These plans must provide at least the same benefits as Original Medicare, but they often include expanded coverage for dental and vision care, prescription drugs, or wellness programs.

3. What will I have to pay if I don’t purchase Medigap coverage?

A quick glance at out-of-pocket costs for Medicare Parts A and B in 2023 illustrates how much you could be on the hook for if you don’t have Medicare supplemental insurance.

While Part A, which primarily covers inpatient hospital stays, covers up to 60 days of hospitalization without coinsurance or copays but you’ll still need to pay a deductible of $1,556 in 2023.

The out-of-pocket costs can skyrocket after the 60th day of a hospital stay (in a benefit period, not necessarily 60 consecutive days). It will cost you $389 in coinsurance each day for days 61-90 in a benefit period, a figure that grows to $778 each day for days 91 and beyond. If your hospital stay is 150 days or more, your coverage runs out altogether.

Cost-sharing under Part B is similar. You are responsible for the Part B deductible, which is $233 in 2023. After that, Part B only covers 80 percent of approved services. This means that you must pay 20 percent of the cost of all your doctor visits, ER trips, blood tests, surgeries, X-rays, durable medical equipment, and even astronomically expensive treatments like chemotherapy.

4. Can I still choose my own physician, specialist, or hospital?

With Original Medicare, you can see any doctor, hospital, or other provider that takes Medicare. In most cases, you can make an appointment with a specialist without needing a referral. If you enroll in a Medicare Advantage plan, you will probably need to see doctors who are part of the plan’s network.

5. Do any Medigap plans cover my prescription drug costs?

Original Medicare does not usually cover all prescription medication costs. Medicare Part D offers Medicare beneficiaries access to retail prescription drugs with affordable copays.

6. Are there Medicare plans that cover hearing, vision, and dental care?

Medicare Advantage plans include the coverage of Part A and Part B and can also include prescription drug, dental, vision, and hearing coverage. Not only do Medicare Advantage plans offer extra benefits, but they are also typically very affordable.

Contact Every Way Health To Learn More About Medigap Coverage

If you need assistance in choosing the Medicare supplemental insurance plan that’s best for you, please get in touch with Every Way Health at 877-460-3943.

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