Medicare is a Social Security benefit for which individuals age 65 and older or individuals under age 65 that have certain disabilities, such as permanent kidney failure, may be eligible. Essentially, Medicare is a federally funded health insurance program that covers treatment of acute medical conditions or those conditions from which individuals usually recover. Medicare attempts to provide reasonably priced, quality health care to the segment of the population that generally lives on a restricted income. Medicare is provided in four parts, Parts A-D, and each part covers specific services. Most people eligible for Medicare are covered under the Original Medicare Plan. Individuals covered by this plan pay a portion of their health care costs as well as an additional premium, referred to as a deductible and coinsurance, for Parts B and D.

Choosing Medicare Coverage for Seniors

The Original Medicare Plan, or Part A and Part B coverage, is a federally managed fee-for-service plan. Beneficiaries can choose the doctor and hospital from which they would like to receive services. Monthly premiums, annual deductibles and co-payments for services are required. Prescription drug coverage, or Medicare Part D, may be added to the Original Medicare Plan. Many beneficiaries covered by the Original Medicare Plan find they also need the Medigap policy to help pay for services not covered by Part A and Part B.

Medicare Advantage Plans (Part C) provides Part A and Part B coverage, but this coverage is provided by private insurance companies that have been approved by Medicare. Because private companies provide this coverage, additional benefits may be available. Additionally, the amounts charged for various services may differ between providers. Part C plans may have networks, and the beneficiary will have to utilize the services of providers in the plan’s network. Prescription drug coverage is often included in this plan. Beneficiaries of Medicare Part C do not need to purchase Medigap coverage.

What Medigap Covers

Medigap covers a range of co-insurance and deductible payments not covered by Medicare. Medigap Plans A through L offer a range of increased coverage benefits, ranging from deductibles and excess charges for Medicare Parts A and B, to Hospice care co-insurance or co-payment, to co-insurance for skilled nursing facility care. What Medigap Does Not Cover

Supplemental health insurance policies cover many, but not all, of Medicare’s insurance gaps. Medigap does not cover: long-term care (for example, nursing homes or private home care), hearing aids, dental or vision care, or eyeglasses, although some insurance companies may offer extra benefits along with your Medicare supplemental insurance policy for seniors.

Medigap also does not cover prescription medication costs. If you need greater prescription medication coverage, Medicare now offers drug plans for all members through insurance companies and privately-owned companies. You can add prescription drug coverage to your Medicare plan by either 1) adding a Medicare Prescription Drug Plan (sometimes called “PDP’s”) to your Original Medicare Plan, or by 2) joining a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug benefits.

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