As people get older, their health often begins to fail, and when that happens, their need for medical care naturally increases; Medigap is a program that can offer assistance is paying deductibles, copayments, and coinsurance. This is actually not a single program but rather a collection of private supplemental insurance policies for those who already have Medicare. It pays those expenses that Medicare does not cover at all or only partially.
Only those who are enrolled in Medicare parts A and B (the various things that they cover are discussed below) may enroll in the program. However, only about 18 percent of those who have some sort of Medicare coverage also have the other plan, according to statistics gathered in 2006. About a third of these people live in rural areas, and out of this portion, two thirds have incomes below $30,000. This is too bad because this is really the best choice for those over 65. In the following sections we will explain why.
Absence of screening
When one turns 64 1/2, he or she gets the opportunity to benefit from the “open enrollment” program. It is called “open” because no medical screening is performed on applicants. Afterwards, an applicant may be required by his insurance company to undergo screening.
Medicare Plans A and B
The information contained in the following two sections is taken from Medicare’s website.
Federal and state laws determine the details of what coverage Medicare recipients can get. But in general, Part A covers the following things:
- care given in hospitals, skilled nursing facilities and nursing homes
- hospice and respite care
- home care
In each of these categories there are certain limitations on what Medicare pays for. Thus, inpatient hospital care does not include private nursing, razors and other personal items, private rooms not deemed “medically necessary” or room TVs and phones unless those are included in the cost of the room. Nursing home treatment is covered only if the patient needs more than just custodial care, while hospice excludes treatment for terminal illness, care not set up by the hospice team, room and board, and emergency room care. Finally, homemaker services, meal delivery, or personal or 24-hour care.
Medicare Part B
Insurance is dealt with in Part B, under which Medicare pays for two types of services — those deemed “medically necessary” and personal care. This includes clinical research; inpatient, outpatient and partial hospital care; ”durable” medical equipment (e. g. crutches, hospital beds, wheelchairs, patient lifts, suction pumps); second opinions, if desired before surgery; and outpatient prescription drugs (limited). Among those classified as “preventive and screening services” are those for cardiovascular disease, depression, diabetes self-management training, glaucoma, STDs, prostate cancer, nutrition therapy, cervical and vaginal cancer, and bone mass measurements. Anyone who has questions about what is and is not covered by either of these plans should consult a doctor or other health care provider, or go to the Medicare website.
Options available for Medigap
Plan F gives the most complete medical coverage available. Its benefits include the basic ones provided by Plans A and B, plus skilled nursing facility care and medical emergency help that requires travel abroad.
Plan G pays coinsurance with Plan A for hospice and hospitalization plus an additional coverage for a year after Medicare benefits expire, and with Plan B for medical expenses. Many of the same items are also included in Plan F (above), except one must pay the Part B deductible out of pocket on Plan G.
The premiums on Plan N are lower than those for Plans A thru G. Once those premiums have been paid, the only thing the beneficiary is charged for are copays of $20 and $50 for office visits and emergency rooms respectively.