The idea of getting a Medicare supplement is not a difficult one to grasp, but in and of itself, it is a very basic thing, and without context, anyone would be left with questions. To fully understand Medicare supplements, one must understand Medicare as a whole. Medicare is on the surface a fairly simple aid program intended to help retirees with their mounting medical costs. As individuals age, they tend to require more medical coverage and find themselves without insurance. Medicare is intended to assist these individuals through their later years as a component of Social Security. However, while this is the basic concept, the functionality of Medicare runs much deeper and extends to a number of individuals. While the original intent was to cover those 65 and older, it’s now applicable to other individuals receiving aid from Social Security, generally those who are permanently disabled. In this way, Medicare serves as a safety net, albeit a limited one. It does not apply to every citizen of the United States, but it does much to cover a number of them against medical catastrophe.
Even so, Medicare is limited, and this is why Medicare supplemental insurance is a relevant thing to be aware of. Medicare supplemental insurance is a special form of insurance available only to certain subsets of those individuals receiving Medicare. Medicare supplemental insurance serves the primary purpose of reducing the cost of medical treatment even further for Medicare recipients. Because Medicare cannot effectively cover 100% of all medical costs, this Medigap coverage can guarantee that individuals still do not fall into dire financial straits as a result of their medical downfalls even if Medicare leaves them with a significant bill—their Medicare supplement policy takes over, bridging more if not all of the remaining costs left over from Medicare.
Medigap insurance companies are private groups. This creates an interesting parallel, as Medicare is a purely-public form of health coverage. Any coverage provided by a Medigap insurance company is therefore a joint venture of public and private enterprise, which creates a unique set of benefits for Medicare recipients—while adding a fresh set of stipulations at the same time. Receiving Medigap coverage carries more requirements than receiving Medicare, more often than not, as a means of keeping Medicare supplemental plans affordable for as many people as possible.
Medicare itself is divided into Part A, Part B, Part C and Part D. Part A is intended solely for hospital care. Costs incurred by hospital visitation as required by illness or injury fall under Part A coverage. Part B is intended for medical care. Specifically, visiting a doctor, receiving a particular treatment, receiving a particular surgery and etcetera falls under part B. Skipping Part C, Part D is used to cover the cost of prescription drugs, which can be quite expensive on their own—ore than enough to warrant their own insurance (and frequently what Medigap coverage is taken out to back up). Part C is actually not a form of medical coverage, but rather an alternate means to pay for Part A, Part B and Part D.
Part C is also known as Medicare Advantage. It is a means by which private insurance can be used to cover Part A, Part B and Part D, with additions as laid out by private insurance. These Medicare Advantage plans are generally favored in households where at least one individual is still working, and is intended as a means to expand coverage while saving money through Medicare receipt. There are still certain standards of coverage that cannot be overstepped—some drugs may not be paid for under Plan D, for instance, under any circumstances—but the rough concept is that Medicare Advantage is intended to expand care.
This is a distinct function from Medicare supplemental insurance, which is intended to fill in blanks in cost, not coverage type. Medicare supplement plans help balance high costs that Medicare cannot cover in full, but will not help to actually expand coverage to things that Medicare does not ordinarily cover. Although Medicare Advantage and Medicare supplemental insurance serve distinct purposes, they are not compatible. Individuals receiving Plan C care are ineligible for a [Medicare supplement plan], and vice-versa. They do not stack, and Medigap Plans will not cover any costs for partial coverage brought on by a Plan C setup.
Medicare Supplement Insurance companies have to abide by strict rules in their coverage offerings, and this is confounded further by the existence of State laws which specifically reference and cover the proper usage and offering of [Medicare Supplement Insurance] coverage. Most frequently, however, Medigap coverage becomes available for a six-month window after an individual turns 65 or begins receiving Medicare, whichever comes later. In this way, individuals that are on Medicare prior to age 65 still eventually become eligible for Medicare supplemental insurance. There are very, very limited conditions of eligibility for people under the age of 65. In most States, only very specific terminal health conditions enable it, late-stage kidney disease being the most common individual ailment that opens Medicare Supplemental Insurance coverage up.
This six-month period is not the only time an individual is eligible for a [Medicare supplemental insurance] policy, however. They remain eligible after the six month period. However, following that six month period, the Medicare Supplement insurance companies providing care have the option of requiring a full physical examination. This physical examination may alter the cost of care somewhat, driving it up. Starting on a Medicare supplemental insurance policy during the six-month window prevents this potential difficulty and allows individuals to start receiving Medigap coverage straightaway by fiat. By taking advantage of the six-month admission period, one can secure themselves the best Medicare supplemental insurance rates for their needs.
Even when an individual is found to have pre-existing conditions, which may raise their rates, Medicare Supplement Plans are kept priced as affordable as possible. As supplemental policies, they are much less expensive than full health insurance plans. Medicare Supplement companies make their money by banking on Medicare covering a significant percentage of the relevant costs, and the more Medicare covers, the better they do. It is this unique interplay that allows the private-public dichotomy to be beneficial for the government, the insurance companies, and most importantly, the insurance recipients. Medicare Supplement plans are scaled to cost what individuals in retirement can reasonably afford, and to that end they are easily manageable for even the tightest budgets.
All-in-all, Medigap coverage is an excellent way to shore up one’s Medicare out of pocket costs, particularly for the intended recipients as they enter their later years and, very likely, an increase in medical costs to keep them healthy and active. Once one understands the stipulations, Medicare supplemental insurance plans can become a true lifesaver for keeping one’s finances stable after retirement and into one’s later years.
