Why Medicare is Not Enough

Why Medicare is Not Enough

It is important to understand all of the potential gaps in Medicare so you are clear about the benefits provided by your Medicare policy, as well as where you may need to seek opportunities for supplemental coverage. There are several different reasons why you need to consider a Medicare supplement. You are able to minimize your out of pocket medical cost with a Medicare supplement policy and a policy like this also helps you cover the gaps that are not available in your Medicare coverage. If you are like most seniors in the St. Louis area, you probably have questions about the best way to structure your health insurance coverage as you get older. Maximizing benefits is a key concern for anyone who qualifies for Medicare.

 Medicare Part A covers you when you need to visit the hospital. Over the course of your first 60 days in the hospital, Medicare will pay for the complete bill, once you have reached the deductible of $1288. Between days 61 and 90, you will have a co-pay of $322. If you are still in the hospital at days 91 and beyond, your per-day copay will be $644. As you can see, it is very important to have supplemental coverage to help assist you in the event that your hospital stay is longer than 60 days. There are various types of Medicare supplement plans. Some will cover half of the out-of-pocket expenses while others will cover 100% or even none.

Be clear about whether you want your Medicare supplement policy to cover these expenses or whether you accept it as your out-of-pocket responsibility. Medicare Part B gives you essential coverage at your doctor's office as well as labs and other providers of medical care. The calendar year deductible for Medicare Part B is $166. Certain Medicare supplement plans may cover this deductible, but you should always read the fine print of your policy. Once you have met the deductible on your Medicare Part B policy, Medicare covers 80% of the amount that has been approved for your care.

Your provider or doctor can only bill up to that approved amount. In this scenario, once Medicare has paid their 80%, you are responsible for the additional 20% of the total approved amount. This is just one instance where having a Medicare supplement plan can help you minimize your out-of-pocket expenses. If your provider or a physician does not accept assignment of this coverage, they can bill you up to what is known as the original amount charged. You would then be responsible for 20% of the approved amount plus the difference between the original charge and that approved amount.

Without a Medicare supplement plan, you will be responsible for the deductibles for both Part A and Part B coverage in addition to the daily coinsurance, hospital copay and Part B coinsurance as well as Part B excess. An additional reason to consider a Medicare supplement policy is that your Medicare coverage only protects you in the borders of the United States. If you travel abroad and get sick, you may benefit from a foreign travel emergency benefit associated with your Medicare supplement coverage. As always, read the fine print, make sure that your policy comes with this if this is an important benefit for you.

Stay tuned to Senior Health Solutions, LLC to learn more about planning for your healthy future.  Our St. Louis insurance professionals provide every client with individual insurance guidance, including Medicare, Medigap and supplemental insurance information. Contact us at 636-244-4415 or contact us online to schedule an appointment.

Important Information
How to enroll into Medicare
We can help you find a Medicare plan in your area to fit your needs. Once you decide on a plan we can walk you through the Medicare enrollment process.
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How much is the cost?
These are the basic costs for people with Medicare. If you want specific cost information (like whether you've met your deductible, how much you'll pay for an item or service you got, or the status of a claim)
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Do my doctors accept these plans?
Use this helpful link on the Medicare and Medicaid Services (CMS) website to find and choose Physicians and Other Healthcare Professionals enrolled in the Medicare program, as required by the Affordable Care Act (ACA) of 2010.
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What to do if you don't want a part D
If you want to drop your Medicare Prescription Drug Plan (Part D) and you don't want to join a new plan, you can do so during the Open Enrollment Period, between October 15–December 7 each year. The change goes into effect January 1 of the following year.
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Keeping your work benefits
Employer or union health coverage refers to health coverage from your, your spouse's, or other family member's current or former employer or union.
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Medicare - Advantage Plans
A Medicare Advantage Plan is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits.
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