Medicare is not 100 percent coverage of all your medical care. There are "gaps" in the coverage that Medicare supplemental insurance plans are designed to fill. That's why supplemental Medicare insurance is also called "Medigap" insurance.
Basic Medicare coverage - what the insurance folks call original Medicare - provides coverage of most medically necessary hospital bills and doctor's fees for participating providers, up to about 80 percent. And therein lies the first big gap: the 20 percent you have to pay.
Medicare also does not cover vision, dental and hearing care. There is no coverage for routine checkups. Nor are outpatient prescription drugs covered. You also won't find long-term care included. Now Medicare is beginning to look more like a sieve than a safety net.
This isn't to say that Medicare coverage can't be a financial lifesaver. It can. But the things Medicare doesn't cover can add up pretty quickly if illness strikes.
But let's talk about what Medicare does before going too far into what it doesn't do. First, who's eligible? That's easy. You are eligible for Medicare if you are:
• 65 years old or better and eligible to receive Social Security • Disabled • Receiving dialysis or awaiting a transplant for permanent kidney failure (end-stage renal disease, ESRD)
Original Medicare consists of a Part A and a Part B. These should not be confused with Medicare supplemental insurance Plan A and Plan B. These Medicare supplemental insurance plans are designed to help fill the gaps in Medicare Part A and Part B.
Original Medicare Part A covers most hospital bills as well as hospice care. Original Medicare Part B handles doctor's fees, medical equipment, diagnostics, outpatient care and certain kinds of rehabilitation. But there are important limitations. For example, inpatient hospital care coverage won't last forever, and once the original Medicare coverage runs out, you're on your own.
There are some other caveats, as well. For instance, although the majority of doctors in the U.S. accept Medicare payments, yours might not. In that case, your doctor can charge up to 15 percent more than the Medicare-approved amount. This charge is on top of the 20 percent coinsurance plus any deductible or co-pay. It can get expensive.
Remember, all Medicare supplemental insurance plans are the same in most states. However, their cost can vary significantly from insurance provider to insurance provider. It's important to shop around, and the process can be made much easier and less frustrating with a little expert advice.
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