Medicare Supplemental Insurance: Benefits and Considerations

Doctor talking to patient in office. Getty Images/Ariel Skelley

If you are a senior on Medicare, you probably already know that it does not provide all the health insurance coverage you need — this is where a Medicare supplement plan, also sometimes referred to as Medicare gap coverage, comes in. There are many different plans of gap coverage you can purchase to help supplement the medical expenses Medicare will not cover.

What Medicare Does Not Cover

What you may not know about Medicare is that prescription benefits are suspended after you reach a certain dollar amount.

This is referred to as the “Medicare donut hole.” After you reach your deductible for prescription expenses, Medicare pays for a certain percentage of your prescription drug costs — that is, until you reach the donut hole portion. This is the time frame between when Medicare stops paying for prescription care until your prescription costs reach “catastrophic” levels.

Once you reach the catastrophic level, Medicare will pay 95 percent of prescription drug costs. Many seniors stop taking their medications once they reach this gap in coverage. This makes them more susceptible to illness and even death. Seniors should never be put in the position of having to choose between medicine and other necessities. You do not have to worry about being without life-sustaining prescription medications if you have proper Medicare gap coverage.

Another flaw of Medicare is that is leaves seniors without important coverage for other essential services such as vision and hearing.

A large percentage of all seniors who are on Medicare have vision or hearing problems. Again, here is another way where Medicare gap coverage can make the difference for seniors to be able to afford the health care services they really need.

Considerations for Buying a Medicare Supplement Plan

When choosing a Medigap Plan, you have 10 standardized plans to choose from (A,B,C,D,F,G,K,L,M and N) and most are guaranteed renewable for life, meaning that if you pay your premium on time, you won’t be cancelled because of any health conditions or because of age.

To find the medical supplemental policy that will work best to meet your medical needs, you will have to compare and carefully weigh the benefits and options provided by each plan. Here are some of the top considerations for comparing Medicare supplemental plans:

  • Type of Provider Plans that are Available: You will want to find out what types of provider plans are available. This is important as it will determine the healthcare professionals you are approved to see. You need to know whether you can choose your own healthcare provider or whether you must use a doctor or health care facility that is part of a HMO or PPO. Find out whether or not a referral is necessary if you have to see a specialist and if the cost is paid for by the supplemental insurance plan.
  • Prescription Drug Coverage: Prescription costs make up a large percentage of healthcare expenses. Find out if the plan has a co-pay amount, how much it is, and if there is a deductible you can satisfy so that all your prescription costs are covered.
  • Additional Benefits: There may be additional benefits you want that are not covered by regular Medicare. Depending on your situation, these could be very important. Some of the additional coverage options you need to find out about include coverage for hearing and vision services.
  • Overall Cost of the Plan: A plan that provides more options to you will generally be more expensive. You will have to determine what is more important to you — freedom to choose your own services and providers or keeping health care costs at a minimum. If you compare plans carefully, you might be able to achieve a “happy medium” where you can keep costs down while still being able to have some of the provider and service options you want.

Medicare gap coverage may help ease any worries you have about paying for medical care that is not covered by your current Medicare plan. You become eligible to purchase a Medigap policy as soon as you reach age 65 and are eligible to enroll in regular Medicare Benefits (Parts A & B). If you are retiring, see if your employer offers an extension of your current health care benefits to supplement your Medicare benefits.

If you are still unsure of the amount of supplemental Medicare insurance you may need, talk to your insurance agent who may be able to help you find an affordable plan with the right coverage options.