Medicare Supplement Coverage

If you are 65, you are eligible for Medicare. As you approach your 65^th birthday, you should consider applying for Medicare.

There are two types of Medicare: original Medicare and Medicare Advantage.

Original Medicare is divided into two parts: Part A and Part B. Part A covers you when you’re in the hospital, a skilled nursing facility, or receiving hospice or home health services. If you worked and paid Medicare taxes for at least 10 years, there is no additional charge for Part A. If not, there is a monthly charge.

Part B covers services from doctors and other health care providers, outpatient care, durable medical equipment, and preventive services. You must pay a monthly premium that varies according to your income for part B.

Original Medicare provides coverage for hospital stays and for seeing your doctor but does not cover all of these costs. There are deductibles and copayments. Since these amounts not covered by Medicare can be substantial, you may want to think about buying another health insurance policy to pay the rest.

This is where Medicare supplement insurance, sometimes called Medigap, comes in. Medicare supplement insurance is private insurance that fills in the gaps left by Medicare. For instance, when you have a hospital or doctor bill, Medicare pays its approved amount first, then the supplemental insurance pays other costs, such as deductibles and copays.

There are several different Medicare supplement plans, and each are identified by a letter. The type and amount of benefits covered by each plan determines how expensive it is. Here is a chart listing the various benefits provided by each plan:

All insurance companies must offer the same benefits under a given plan. In other words, Medicare Supplement Plan A will have the same benefits regardless of which company sells it. However, the premium you pay for that plan may differ from one company to another. It is important to note that most Medicare supplement plans do not include dental or vision coverage.

An alternative to Original Medicare and Medicare supplement insurance is Medicare Part C, or Medicare Advantage. These Medicare-approved health plans are run by private insurance companies and provide benefits for hospital, doctor, and other health care provider services covered under Original Medicare Parts A and B as well as supplemental benefits that vary by plan. The insurer receives money from Medicare and may also charge you a premium in some cases, depending on the benefits covered. Medicare Advantage might require you to use certain doctors and hospitals.

Prescription drug coverage is available under Medicare Part D. Prescription drug benefits are included in some Medicare Advantage plans but otherwise must be purchased separately.

One other important piece of information to note is that, unlike many employer or private insurance policies, you and your spouse must purchase individual policies. Your policy will not cover your spouse.

Choosing the right Medicare supplement plan can be complicated. There are a number of questions to ask. Talking with family members, friends, and a trusted financial adviser are good ideas before picking a Medicare supplement plan, but you can get more information on Medicare's website. You can also visit the Pennsylvania Department of Aging's Apprise Program, which is licensed by the federal government to provide insurance counseling services to seniors.

Though we can’t recommend any specific plans, we may be able to help answer some questions. Contact our Consumer Services Bureau online or call our consumer hotline at 1-877-881-6388.