Medicare is a healthcare program offered by the federal government of the United States for individuals who are 65 and older and individuals with disabilities. While Medicare successfully provides high-quality healthcare at an affordable price for millions of Americans every year, recipients still have to cover around 20% of their medical costs. For extended hospital stays or serious illnesses, this can still be a significant financial burden. Supplemental health insurance is often needed for medical expenses not covered by Medicare.
Medigap
Medigap is health insurance offered by private insurance companies for costs not covered by Medicare, including coinsurance and deductibles, as well as providing coverage for individuals when they travel outside of the United States. All Medigap policies have monthly premiums and cover only one individual. It is important to note that Medigap can only be purchased by Medicare customers who have both Part A and Part B of Medicare, also known as Standard Medicare or Original Medicare. These policies cannot be purchased by individuals who have Medicare Part C, a separate portion of Medicare known as a Medicare Advantage plan. Currently, there are 11 different Medigap plans offered in most states, all providing the same basic benefits with some variations. All Medigap policies assist in paying for the following costs:
- Medicare Part A - Hospice coinsurance or copayments
- Medicare Part B - Coinsurance or copayments for all services
- The first 3 pints of blood received by hospital patients
Most Medigap plans also cover 50%-100% of skilled nursing facility costs.It is important to note that Medigap insurance programs do not cover the following costs:
- Long-term care in a nursing home
- Common vision or dental care
- Hearing aids
- Glasses
- Private-duty nursing
Medicaid
Another great supplement to Medicare customers is Medicaid, a federal and state-run health insurance program for low-income individuals. For individuals with both Medicare and Medicaid, Medicare will always pay for covered services first. There are several different ways that Medicaid can work with Medicare to assist customers with their medical expenses:
- Premium assistance - Customers who are enrolled in both Medicare and Medicaid are often enrolled in a Medicare Savings Program. A Medicare Savings Program helps customers in many ways including paying Medicare Part B premiums.
- Cost-sharing assistance - If an individual's income is low enough, they will qualify for the Qualified Medical Beneficiary, a part of the Medicare Savings Program. This program exempts all beneficiaries from paying any deductibles, coinsurance payments, or copays.
- Prescription drug assistance - The Extra Help Program pays a certain amount of the premium for Medicare Part D up to an amount specified by the state the individual resides in. This program also lowers the costs of the prescription drugs themselves and even eliminates any late enrollment penalties incurred for Medicare Part D.
- Care coordination - Many states require some customers to enroll in privately administered Medicaid health plans commonly known as Medicaid Managed Care plans. These plans allow individuals to enroll in a Medicare Advantage Plan, which helps facilitate and coordinate the benefits of Medicare and Medicaid.
Overall, Medicare patients who can supplement their coverage with Medicaid will have access to good healthcare for very little cost.
https://www.healthcare.com/can-you-have-private-insurance-and-medicare-11768https://www.webmd.com/health-insurance/medigap#1
https://medicare.com/medicare-supplement/what-medigap-policies-cover/
https://www.medicare.gov/supplements-other-insurance/how-medicare-works-with-other-insurance
https://www.medicareinteractive.org/get-answers/cost-saving-programs-for-people-with-medicare/medicare-and-medicaid/how-medicaid-works-with-medicare
https://www.medicareinteractive.org/pdf/Benchmarks.pdf
