Ohio Insure Plan Logo

How Medicare Coverage Falls Short and Supplemental Insurance

Get Quotes

Medicare coverageUnderstanding the world of health insurance can definitely become challenging. If you feel overwhelmed by the policies offered to you and the coverage you need, you are not alone. Medicare and supplemental insurance policies are filled with jargon and fine print that make many of our heads spin.

We would like to help clear up the confusion. Keep reading for an overview on what Medicare covers and the gaps which supplemental insurance helps fill.

Medicare coverage is based on three factors. Federal and state laws, national coverage decisions and local or state coverage decisions come into play. While coverage is not black and white, knowing what Medicare generally covers keeps you in the know. And, it helps determine your need for supplemental insurance.

Medical Expenses Medicare Covers

While educating yourself on Medicare coverage, keep in mind that limits apply. For instance, Part A states that it covers skilled nursing home care. On a more in-depth look, this coverage does not include long-term or custodial uses of nursing home facilities. Caution is required when interpreting the wording of any policy.

To start building your understanding, check out the information below. Medicare takes care of you in regard to:

Hospital care, including acute, critical, rehabilitation and long-term care service

— Hospice care related to palliative care, therapies, social services and counseling

Home health services, such as intermittent skilled nursing care and therapies

— And, medically necessary skilled nursing home care, for a limited time

To determine if a service, test or item is covered by Medicare, talk with your healthcare provider. Often these professionals have a working knowledge of coverage and provide wise counsel. You may also visit medicare.gov and use the coverage search feature located there. Simply type in the item you question coverage for, and you are directed to an answer.

You may also contact a licensed insurance agent to understand your health insurance options. The business of these professionals is knowing what policies cover and which fit your medical and financial situation best. In any case, do your research to prevent unexpected, costly gaps in coverage. Unfortunately, the weight of understanding falls on you.

Reasons You Need Supplemental Insurance

Gaps in Medicare coverage do exist. Knowing your current medical requirements and planning for future ones gives you a picture of your need for supplemental insurance. These plans pick up the Medicare slack by providing coverage when your primary plan fails to do so. However, be aware that supplemental policies vary and may leave gaps as well.

In our example above, Medicare denies claims for custodial or long-term nursing facility care. The aging population proves the reality that you may need these services at some point. The Motley Fool reports that an average nursing home tab runs $225 per day, which averages out to $82,125 per year. The cost rises with a private room. Insured by Medicare alone, you pay these expenses out of your bank account.

Medigap or Medicare Supplemental Insurance covers some conditions and situations Medicare denies. However, some expenses remain uncovered. In the nursing home example, you are left to foot the bill even with Medigap insurance. Looking into other policies still may be needed to address your future health needs and prevent unexpected financial hits.

You may consider supplemental insurance for coverage of:

— Deductibles, coinsurance and copayment expenses

— Round-the-clock home health care

Long-term or custodial nursing facility care

Dental care, including dentures

— Eye exams and prescription glasses

— Hearing aids and related exams

— More extensive prescription coverage

— Routine foot care

— Acupuncture

— Cosmetic surgery

These medical services tend to be denied by Medicare. If you want to avoid paying out of pocket, investing in a supplemental insurance plan may be the answer. But, as with all plans, read thoroughly or seek professional expertise on what policies cover. Each plan differs in its scope of coverage.

Medicare Alone or Partnering With Supplemental Insurance?

Determining the best insurance option for you requires research and consideration. After all, you do not want to pay for services you will never use. Plus, supplemental insurance is expensive, and the cost rises as you continue to age. Is it worth the investment?

Weighing the costs of supplemental plans and potential out-of-pocket expenses helps determine the wisdom of purchasing these additional policies. Your personal health history and family medical history come into play as well. And, buying sooner rather than later also saves you money. Again, talking with a licensed insurance agent educates you as to what options exist and gives you answers as to which investment proves worth the return on your unique situation.

Thank you for reading! How can we help you with your supplemental coverage? Contact us today.

Category: Medicare Supplements

Last updated on November 28th, 2018