Medicare can be confusing and there are things about it that some people do not like. However, it does provide health care for people aged 65 and older, as well as for younger people who are disabled. However, to have complete coverage, some type of supplemental Medicare or medigap coverage may be necessary.
This discussion will focus on the elderly, who perhaps never had to worry about insurance premiums. For example, if they had a company-sponsored group policy while working, they did not pay any direct premiums; the premiums were deducted from the employee’s paycheck. Therefore, while it was the employee’s money paying the premium, he never saw it and usually did not miss it. Once people turn 65, they have to switch to Medicare, unless they are still working and are covered by a credible group insurance plan.
Let’s assume that you are 65 or older and are receiving Medicare benefits. Getting help with the cost of the premiums is going to be difficult. People with low incomes may qualify for Medicaid or assistance from some state program. However, the part where help can be obtained is by acquiring coverage that will help pay a portion the expenses that Medicare does not pay.
Many independent insurance agents offer supplemental coverage. Like most insurance, there are several varieties that offer various levels of coverage at different costs. To understand what is going on, a look at how Medicare has advanced is in order. Original Medicare, or Part A, covered hospital visits. That was later supplemented with Plan B, which covered doctors and related services.
Under both plans, Medicare sets the maximum amount the provider, such as a doctor or hospital, can charge for services and Medicare often pays 80 percent of that cost. The remaining 20 percent is either paid by the patient, or through a supplemental or medigap insurance policy. Plan D covers prescription medications and has its own set of rules.
Now, many people use an advantage plan, which for a single fee handles the premiums and the co-pays that you might encounter.
The cost of these extra plans will vary from state to state. There could also be other benefits. Therefore, your monthly premium may be higher than if you only had parts A, B and D of Medicare, but your deductibles would be covered and some additional services, such as skilled nursing-home services might be provided, again depending on the policy.
All medigap policies are standardized by the federal government and then the state government. However, different companies can offer options above and beyond the traditional plans or the other supplemental plans.
The important thing to remember is that while medigap policies charge a higher monthly premium, they usually pay all the co-payments, allowing the individual to budget his money and not be hit with unexpected medical expenses. There may be some exceptions depending on the policy.
However, with medigap policies, no changes can be made during the policy year and there is an annual enrollment period where you can switch plans.
Your health is our priority. Call Loftis & Wetzel Corporation at (855) 360-0466 for more information on Oklahoma City health insurance.