Understanding Medicare/Medicaid Supplement Insurance

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Medicare/medicaid is an insurance program for people that are 65 years of age and over, and it is operated and managed by the federal government. One person becomes eligible to receive Medicare/Medicaid benefits every eight seconds. This program has been available for almost 50 years and provides much needed health care to seniors.

What is Medicare?

Medicare is health care insurance that provides coverage for individuals 65 and over. It is a systematic answer, which became a law by signature of President Lyndon B. Johnson in 1965 as a means of helping seniors pay for medically incurred expenses. The federally operated program for low-income individuals, Medicaid was also established at this time.

The Medicare program has undergone expansions and changes throughout the years to make it possible to cover younger individuals who have disabilities, as well as those in the final state of kidney disease. Medicare Part D was established by President George W. Bush in 2003 to assist with the cost of prescription drugs. Until they reach 65, most individuals acquire health insurance via group plans that their or their spouse’s employers made available to them. Those who are unemployed or self-employed without insurance may purchase coverage for themselves.

Once you become 65-years of age, you will probably become eligible for one of the most significant health plans available. Medicare can play the role as your primary health coverage or complement existing insurance you have through an employer, former employer or spouse.

  • Medicare Parts A & B – also referenced as Original/Traditional Medicare. Part A assists in the payment of hospital bills and people primarily pay the premiums through payroll taxes while they work. Part B pays towards visits to the doctor and other medical provisions, such as heart disease, screenings, diabetes and some cancer types.
  • Medicare Part C – also referenced as Medicare Advantage plans and are plans provided by private insurance companies and approved by Medicare. These plans serve as an alternative to Original Medicare and provide coverage for prescription drugs also.
  • Medicare Part D – these are private plans approved by Medicare and assist people with Parts A and B with the costs of prescription drugs.

It is important to recall that Medicare will not cover the cost of health care in its entirety. There are several services, like routine vision and dental care do not fall under the coverage umbrella of Medicare. Without supplemental insurance or other income based assistance programs, even those who have Medicare will be required to pay parts of their premiums, copays and deductible.

Additional Health Plan Options

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Those who are at least 65 or over and also insured through a spouse private plan, employer or via a retiree, there may be no immediate need for Medicare, or you could possibly be okay with just a portion of it. Those health care providers other than Medicare, will affect how Medicare is utilized and the amount you will be responsible for paying for those benefits. Prior to deciding if you should or shouldn’t utilize Medicare, or adjust any supplemental coverage you have, determine the impact these decisions will have on your overall health coverage.

Medicare and benefits managers for employers can clear up any discrepancies and answer questions. Speaking to a professional in the area is always beneficial to help you fully understand what you have, what you need and what would change if you adjusted, dropped or added additional coverage. Most importantly, you could possibly drop specific areas or types of coverage and not be able to get it back.

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Understanding Medicare/medicaid Supplement Plans

To make an informed decision when choosing supplemental plans for Medicare it is imperative that you have wide-spread knowledge of the plan options and what they can do for you. You won’t be able to base your decision on how a supplemental plan helped or helps a family member, co-worker or any other person. To gain the most from these plans, you must understand what they can do for you.

What You Should Know

  • Your Medicare Rights are Protected – even after you acquire Medicare Supplement insurance, Medicare Parts A and B are not affected. These plans are not canceled, nor are they replaced.
  • Standardized Plans – Benefits are similar with all insurance companies, while some businesses have the right to make innovative benefits available. Though the plans don’t change because of the company, there may be a difference in the quality of the service and the cost. These are the elements that make supplemental plans such as Mutual of Omaha Medicare more sought after than the others.

Medicare/medicaid Supplement coverage that was placed on the market and sold beyond 2006 does not cover prescription drugs. There is always the option of Humana Medicare prescription drug plan.

When to Purchase Medicare/medicaid Supplement Insurance

Simply put, it is best to purchase supplement insurance to Medicare during the period of open enrollment. This period covers a span of six months which begins on the first day of the month in which you:

  • Reach the age of 65 or older and,
  • Signed up for Medicare Part B

Once the enrollment period begins, changes to it cannot be made. There are certain instances where a policy can be purchased outside of the initial enrollment period. There are some states that have plans for individuals under the age of 65. Individuals that apply for a Medicare Supplement policy before they reach the age of 65, the open enrollment period starts on the first day of your enrollment in the Part B plan. You are allowed to submit your application for Medicare Supplement insurance prior to the enrollment period begins. In the event your existing coverage will end when you reach 65, you can submit your Medicare Supplement insurance application before open enrollment starts. This will possibly bridge any gap in coverage and prevent you from experiencing the possibility of being without health coverage for any length of time.

Eligibility Requirements

You are eligible to apply for a Medicare Supplement plan if you:

  • Reside in a state that offers the plan
  • Are enrolled in Medicare Parts A and B
  • Over the age of 65, some states allow applicants to be younger with a disability or living with the end stage of kidney disease

You may also qualify for guaranteed acceptance into the plan, despite your medical history, as long as you meet specific criteria, like applying during the open enrollment plans. The rules could vary in some states.


This is a Guest post from Alex Wender

About Alex Wender 

Alex wenderAlex Wender is the agency owner of Blue Wave Insurance Services. Every day, he works with people all over the United States, helping them understand their Medicare options, and ensuring they are receiving the best service, pricing and resources. Alex is a licensed insurance agent in over 36 states.

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