For those who are enrolled in the Medicare program the coverage may simply not be enough. That is why there are Medicare Supplemental Insurance or Medigap programs in place. If you are unsure of whether or not you need Medigap insurance for your Medicare program please read what is contained below.
What is Medicare
Medicare is an entitlement program created by the federal government as its principal health care plan for seniors. To qualify for Medicare all you need to do is reach the age of 65, become permanently disabled or have end stage renal disease. Medicare was originally created to help our elderly with the burden of paying for health care. Medicare is not free however; recipients pay a monthly premium as well as portion of the cost of services they receive as a co-payment or deductible amount.
Medicare also does not cover certain needed services such as nursing homes and in-home health care. To pay for services that are not covered by Medicare most recipients turn to private insurance policies that are called Medigap. What are the gaps in coverage?
Medicare Part A
There are actually quite a few gaps in Medicare coverage you should be aware of depending upon which Medicare program you are enrolled in. Medicare Part A coverage is known as hospital coverage because it takes care of such things as inpatient hospital and skilled nursing, home health and hospice.
What Medicare currently does not cover however is:
The hospital deductible: This is the amount you must pay for your hospital stay before Medicare will cover the rest. The amount as of last year was over $1000.00
The hospital coinsurance coverage: Medicare covers your hospital stay in full, besides the deductible, for the first 60 days of your stay. However after the 60 days are up if you still need to be in hospital Medicare will no longer cover all of the charges but will charge you a daily coinsurance payment.
Hospital services: Once you have been in hospital for 150 Medicare will no longer bear any of the cost
Skilled Nursing facility: Medicare covers a skilled nursing facility stay for up to 20 days, if you need skilled care beyond that you will need to pay a daily coinsurance amount
Skilled nursing facility services: If you need to be in a nursing home for more than 100 days, Medicare will not cover any of the expenses.
Home health aide services: While Medicare will defray some of the cost of occasional home health aide services it does not cover extended services.
Home health aide or nursing services: Medicare will not cover home health aide or home health nursing unless skilled care is necessary.
Medicare Part B
Although Medicare Part B was created to be Medicare’s premier supplemental insurance it ended up becoming more of an outpatient and preventative medicine type of coverage. The types of coverage Part B covers is durable medical equipment, supplies the physician uses, prosthetic devices, and ambulance services. Just like with Part A there are gaps in the coverage here as well, although not as many.
Deductible: Medicare Part B has a flat yearly deductible that must be met before any services are covered under Medicare. While minimal in cost the amount last year was $135 and goes up each January 1.
Part B coinsurance coverage: While Medicare Part A covers 80% of the items that Part B takes care of neither covers all and there is a 20% coinsurance payment you must cover.
Any person who is eligible and enrolled in the Medicare program needs a Medigap or Medicare supplemental insurance to help defray the costs missed by Medicare Part A and Part B.
For information on Medigap plan N premiums click here.