What are Medigap/Medicare Supplements Plans

 

Comparing Medicare Advantage & Medicare Supplement Plans

What are Medigap/Medicare Supplements Plans

Turning 65 and getting ready to transition onto Medicare, can be a very confusing process. There are a number of parts to Medicare and knowing what they do and do not cover is the key to getting the best possible coverage for your needs. In this article I will help you understand the many, possibly confusing, parts of Medicare , you will know What are Medigap, Medicare Supplements Plans and the basics of the Medicare parts.

I will provide you with enough information so that you can dive into your Medicare enrollment.  It is very important when choosing Medicare for the first time, that you understand many of the differences between Medicare and traditional health insurance.  The changes are important and significant.

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What Does Medicare Part A Cover?

Part A coverage provides some hospital care, some nursing facility care, some hospice and some home health services. If you or your spouse paid Medicare taxes while working you will automatically be enrolled in Medicare Part A. If you are unsure of what Medicare services you need, we suggest that you speak with your physician or your health care provider who will then be able to help you determine what medical supplies you need, and if Medicare will cover them.

 

What Does Medicare Part B Cover?

Medicare Part B, also referred to as Medical coverage for Medicare covers services that are considered medically necessary to treat a disease or a condition such as doctors visits, lab tests, surgeries, wheelchairs etc. You are NOT automatically enrolled in Part B, and you must pay a monthly premium for it. Medicare Part B also covers most preventative services such as detecting the flu at an early stage when it can be treated effectively.

In general, you will pay nothing for preventative services if a physician or health care provider that accepts Medicare treats you. Part B covers services such as ambulance services, durable medical equipment, mental health, inpatient and outpatient care, getting a second opinion before a surgical procedure and partial hospitalization.

 

What Are the Deciding Factors for Medicare?

There are three deciding factors in what is covered by Medicare. Federal,  as well as, state laws determine Medicare coverage. These laws are then used to determine whether services or certain supplies are medically necessary and should then, therefore, be covered. Local health insurance providers then use the federal and state guidelines when processing Medicare claims to determine coverage.

If you need a service or medical supplies that your provider has specified will not be covered by Medicare before you enroll, you are required to sign a notice stating that you will pay for the supplies, service or item. With gaps in coverage such as this left by Medicare, we suggest that you enroll in a Medigap policy with a licensed broker.  Call me for your free,  consulting session at 877-549-1212 today.  Helping people understand and navagating Medicare for over 30 years.

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