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Are you retired, or thinking about retirement, and wondering if you need a Medicare Supplement insurance plan? The answer involves a look at your personal circumstances and a little educated guesswork into the future. It might seem scary, trying to figure out what kind of Medicare and related insurance you need when you retire – but you can generally make a plan based on your past and present health-care needs and costs, and your budget.
Before you can get a Medicare Supplement insurance plan, you need to be enrolled in Original Medicare, Part A and Part B. So, if:
…then you’re not yet eligible for a Medicare Supplement insurance plan, as you must be enrolled in both Medicare Part A and Part B.
But let’s suppose you are enrolled in both Medicare Part A and Part B. That coverage typically pays a portion of many health-care expenses, leaving you responsible for deductibles, copayments, coinsurance and sometimes other health-care costs. In other words, you pay the “out-of-pocket” expenses—out of your pocket.
Before deciding whether you need a Medicare Supplement insurance plan when you retire, you may want to read this brief overview of this type of plan.
The difference between what Medicare pays and the amount you owe for medical care is sometimes called the Medicare coverage “gap”. If you have Medicare Part A and Part B, you might have the option of purchasing a Medicare Supplement insurance plan to help pay the out-of-pocket costs of Medicare Part A and Part B. These plans are offered by private insurance companies.
In most states, Medicare Supplement insurance plan are standardized and assigned lettered names: Medicare Supplement insurance plans A-N. (There are up to 10 of these lettered plans available in most states – Plans E, H, I, and J are no longer sold.) Each plan may cover a different combination of Original Medicare’s out-of-pocket costs, at different levels. For example, Medicare Supplement insurance plan F covers all of the Medicare Part A deductible, while Medicare Supplement insurance plan K covers 50% of the Part A deductible.
In Massachusetts, Minnesota, and Wisconsin, Medicare Supplement insurance plan are standardized differently.
With most Medicare Supplement insurance plans you can use any doctor, health professional or hospital in the United States that accepts Medicare patients. Only one type of Medicare Supplement insurance plan, called Medicare SELECT, may require you to see doctors and other providers in the plan network.
Basically, Medicare Supplement insurance plan may provide protection from high out-of-pocket medical costs resulting from numerous hospital visits or doctor visits. So, you might want to consider a Medicare Supplement insurance plan to supplement your Medicare Part A and Part B coverage, especially if one or more of the following situations applies to you now or after your retirement:
You pay a premium for any Medicare Supplement insurance plan, but the plan in turn may cover your hospital costs and other out-of-pocket expenses. So you might need to do some math to figure out whether your out-of-pocket costs under Original Medicare would likely be higher than your Medicare Supplement premium costs. If so, a Medicare Supplement insurance plan might save you money.
On the other hand, if you don’t typically have many doctor or hospital visits, you might want to consider a Medicare Advantage plan, discussed later in this article.
If you purchase a Medicare Supplement insurance plan, remember you might end up paying several different monthly premiums:
Another factor to consider when you’re thinking about a Medicare Supplement insurance plan upon retirement is whether you’d qualify for such a plan. Although you can apply for a Medicare Supplement insurance plan anytime (unlike some Medicare coverage or plan options, where you’re usually restricted to certain enrollment periods), you’re not always guaranteed to be able to purchase a Medicare Supplement insurance plan.
Your Medicare Supplement Open Enrollment Period (OEP) is generally the best time to sign up for a Medicare Supplement insurance plan. This six-month period starts the month you’re both 65 and enrolled in Medicare Part B. During this period, you can’t be denied acceptance into a plan, or charged extra, because of a health condition. In some cases, a waiting period may apply for coverage of a pre-existing condition*. Some states have additional Open Enrollment Periods including those for people under the age of 65.
After your Medicare Supplement OEP is over, you may be faced with medical underwriting, which could result in your paying a higher premium – or even denied coverage – if you have a health condition.
Remember that you must also be enrolled in both Medicare Part A and Part B to qualify for a Medicare Supplement insurance plan.
A different option you may have is to receive your Medicare benefits through the Medicare Advantage (Medicare Part C) program.
Offered by private insurance companies contracted with Medicare, Medicare Advantage plans must offer at least the same benefits of Medicare Part A and Part B (except for hospice care, which is still covered under Part A). Many Medicare Advantage plans offer additional benefits such as prescription drug coverage, routine vision coverage, and wellness programs. Some Medicare Advantage plans are designed to help people with special health-care needs, such as diabetes or congestive heart failure.
Deductibles, copayments and coinsurance amounts may vary among Medicare Advantage plans. Medicare Advantage plan premiums vary as well, and some plan premiums may be as low as $0. You will still have to pay your Medicare Part B premium if you sign up for a Medicare Advantage plan. Other points to know:
If you choose a Medicare Advantage plan, you won’t need a Medicare Supplement insurance plan; these plan types don’t work together.
*Pre-existing conditions are generally health conditions that existed before the start of a policy. They may limit coverage, be excluded from coverage, or even prevent you from being approved for a policy; however, the exact definition and relevant limitations or exclusions of coverage will vary with each plan, so check a specific plan’s official plan documents to understand how that plan handles pre-existing conditions.
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