United States citizens who are aged 65 or older are eligible to receive Original Medicare (Parts A and B) from the federal government. This public health insurance option, administered by the Department of Health and Human Services (specifically by the Centers for Medicare and Medicaid Services), offers a primary coverage base for older Americans.
However, there are gaps in Original Medicare's coverage that many Americans choose to close by purchasing supplemental Medicare insurance from private companies, such as Humana, Aetna, and Blue Cross Blue Shield – three of the largest private Medicare providers.
This article reviews some of the private supplemental Medicare policies from which beneficiaries can choose, and presents some representative options from the major providers.
Supplemental Medicare Insurance – Medicare Part D
One of the areas that beneficiaries often find lacking in their Original Medicare coverage (Parts A and B) is coverage for prescription drugs.
Many private insurance companies offer a supplemental policy called Medicare Part D. Part D policies, which are approved by the federal government and offered privately, provide additional prescription drug coverage to beneficiaries' Original Medicare. Medicare Part D can add coverage to:
- Original Medicare
- Certain Medicare Cost Plans
- Certain Medicare Private Fee-for-Service (PFFS) Plans
- Medicare Medical Savings Account Plans
Medicare Part D plans generally provide the following benefits:
- Prescription drugs are generally less expensive.
- greater access to both name-brand drugs and generic drugs
- solid plans offer low copayments and deductibles
Many private insurance companies offer Medicare Part D policies, including the three below, which are among the most popular basic Part D plans on the market:
- Humana PDP Standard – this plan provides basic drug coverage for both name-brand and generic prescription drugs, and is intended for beneficiaries who do not have intense drug requirements. The plan can be upgraded to one of Humana's other offerings at any time;
- Aetna Medicare Rx Essentials® Plan – this plan provides beneficiaries with discounted rates for a spectrum of drugs, both name-brand and generic, not covered by basic Medicare;
- Blue Medicare RX – this plan generally offers low copayments and deductibles. With many Blue Medicare plans, 100% of the drug costs are covered after a certain spending limit is reached.
While beneficiaries generally do not require the drug coverages provided by Medicare Part D when they become eligible for Medicare at age 65, those who have the financial ability to enroll in Part D at age 65 are encouraged to do so in order to avoid potential late enrollment fees down the road.
Supplemental Medicare Insurance – Medigap
Medigap is another supplemental form of insurance which can be added to Original Medicare in order to bridge some coverage gaps. Medigap, as with Part D, is approved by Medicare but sold independently by private insurance companies.
Medigap policies, while sold by different insurance companies, have basic standardized coverage requirements, and are lettered A through L. (Note: Three states – Massachusetts, Minnesota, and Wisconsin – standardize their Medigap plans differently than the rest of the country.)
Medigap policies generally add coverage to the following primary elements that are lacking in Original Medicare:
- coinsurance
- copayments
- deductibles
- short-term nursing facility care
- preventative care not covered by Medicare
- travel emergency insurance
Each of the 12 Medigap options (A-L) offer slightly different coverages, and Medigap policies also differ slightly by company. Beneficiaries interested in Medigap coverage should reference Medicare.gov's "Choosing a Medigap Policy" to find the specific differences offered by each plan.
Beneficiaries can also visit the websites of private companies like Humana, Aetna, and BCBS to compare Medigap coverages.
Supplemental Medicare Insurance – Coverages Not Found
It is important to note that Medigap and Medicare Part D do not offer coverage for long-term care facilities (such as nursing home extended stays), vision, dental, hearing, private nurses, and eyeglasses.
Beneficiaries interested in adding such coverages should consider buying a Medicare Advantage plan, which replaces Original Medicare and is sold by private insurance companies. Unlike supplemental medicare insurance plans, Medicare Advantage replaces Medicare rather than adding coverage to it.
Private insurance companies, such as Humana, Aetna, and BCBC sell a wide range of Advantage policies.
Supplemental Medicare Insurance – Health Care Reform
Many potential changes could effect Medigap and Part D coverages, including changes to Medicare funding levels, Medicare expansion, changes to issues surrounding pre-existing conditions, and the availability of expanded public option plans.
As of January, 2010, Congress has been unable to reach agreement on a health care bill, and currently no changes in plans and coverage are anticipated. (There are certainly unlikely to be any changes in the near future regardless what, if any, legislative changes are instituted.)
David Harris-Gershon - David Harris-Gershon – a blogger for Tikkun magazine and a freelance writer on Israel, the Middle East and America’s role in ...
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