Q: I’m about to turn 65 and I’m so confused by the Medicare options and all the terminology. Is it critical to get a Medigap plan and what is the difference between copays, coinsurance, excess charges, etc?
A Medicare Supplement Insurance policy or “Medigap” helps pay for some of the health care costs that Original Medicare doesn’t cover. These policies are sold by private insurance companies and you pay an additional monthly premium for the coverage.
There are different plans offering varying coverage, but companies can only sell you a “standardized” policy, identified in most states with letters A through D, F, G, and K through N. All policies offer the same basic benefits but some offer additional benefits so it is important to shop around. For instance, all plans cover your Medicare A coinsurance and hospital costs, but some don’t cover skilled nursing facility coinsurance. Some have 100% coverage of hospice care, some only 75% or 50% coverage. Some pay Part B excess charges but most do not.
Coinsurance is the amount you pay as your share of the cost for services after deductibles and is usually a percentage of the total cost (oftentimes 20%.) Copayments are usually a set amount, such as $20 or $30, that you might be required to pay as your share of the cost for a medical service or supply, such as a doctor visit.
Part B excess charges come about when the amount a doctor or other health care provider is legally permitted to charge is higher than the Medicare-approved amount. The difference is called the excess charge.
If you have friends who already have a supplemental policy, be aware that some plans will no longer be available for individuals new to Medicare on or after January 1, 2020. You can learn more about supplemental policies at www.Medicare.gov. Region IV Area Agency on Aging and MMAP (Michigan Medicare/Medicaid Assistance Program) will be offering free “New-to-Medicare” classes in the coming months, as well. Check our website, www.AreaAgencyonAging.org for dates after the first of the year or call 269-408-4354 for more info.
Q: What are the new supplemental benefits some Medicare Advantage Plans have?
A supplemental benefit is an item or service covered by a Medicare Advantage Plan that is not covered by Original Medicare.These benefits do not need to be provided by Medicare providers or at Medicare-certified facilities. Instead, to receive these items or services, you need to follow your plan’s rules. Some commonly offered supplemental benefits are dental care, vision care, hearing aids, and gym membership. Medicare Advantage supplemental benefits are not to be confused with Medicare supplemental insurance, also known as a Medigap policy. Medigaps are health insurance policies that pay for some Original Medicare out-of-pocket costs.
Beginning in 2020, Medicare Advantage Plans can now begin covering supplemental benefits that are not primarily health-related for beneficiaries who have chronic illnesses. These benefits should address environmental factors that may affect the health, functioning, quality of life, and risk levels of beneficiaries with chronic conditions. Some examples of the new benefits are meal delivery, transportation for non-medical needs, and home air cleaners.
In order to be eligible for this new category of supplemental benefits, you must be considered chronically ill.This means that you:
• Have at least one medically complex chronic condition that is life-threatening or significantly limits your health or function;
• Have a high risk of hospitalization or other negative health outcomes; and
• Require intensive care coordination.
If you meet these criteria, a Medicare Advantage Plan might offer you one of these new benefits if it has a reasonable expectation of improving or maintaining your health or function. Always be sure to fully understand the details of these benefits including if there are copays or coinsurance for these services, if there are limits on how often the service can be utilized, and if a referral is needed or the service is limited to specific providers.