Confused about the differences between Medicare Supplemental Insurance and Original Medicare? Our blog explains the key distinctions and helps you make an informed decision about your healthcare coverage. Stay informed and protect your health with our comprehensive guide
Components: Original Medicare is divided into Part A (hospital insurance) and Part B (medical insurance). It covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care under Part A. Part B covers doctor’s services, outpatient care, medical supplies, and preventive services.
Costs: Beneficiaries pay premiums, deductibles, copayments, and coinsurance. Part A generally does not have a premium while Part B has a standard monthly premium and a deductible.
Provider Choice: Patients can visit any doctor or hospital that accepts Medicare in the United States.
Coverage Limits: Original Medicare does not cover certain services such as routine dental or eye care, hearing aids, or long-term care. There’s also no out-of-pocket maximum, which means there’s no limit to what beneficiaries might spend on healthcare in a year.
Medicare Supplemental Insurance (Medigap)
Purpose: Medigap plans are sold by private insurance companies to complement Original Medicare. These plans cover some of the costs not covered by Original Medicare, such as deductibles, copayments, and coinsurance. Some plans also cover services that Original Medicare does not, like medical care when you travel outside the U.S.
Costs: Medigap plans require paying a monthly premium in addition to the Part B premium. Costs can vary by plan, location, and provider.
Eligibility: To be eligible for a Medigap policy, you must have Medicare Part A and Part B. Medigap policies are individual, meaning spouses need to buy separate policies.
Provider Choice: Medigap policyholders can see any doctor or provider that accepts Medicare. Medigap plans do not restrict you to a network.
Coverage Limits: Medigap plans do not cover long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing. Plans vary, but some offer coverage for foreign travel emergency care.
Enrollment: The best time to buy a Medigap policy is during your 6-month Medigap open enrollment period, starting the first month you have Medicare Part B and are 65 or older. During this period, you can buy any Medigap policy sold in your state, even if you have health problems, without being charged more due to pre-existing conditions.
Understanding the differences between Original Medicare and Medigap is crucial for making informed decisions about healthcare coverage