People With Medicare
Medicare covers many health care costs, but it does not pay all of your health care costs. There are some costs that you may have to pay. These are sometimes called the "gaps" in Medicare coverage.
Some people pay for the gaps with a secondary, or supplemental, health plan. Examples are retiree insurance or coverage from the Veterans Administration.
You also can cover these gaps by buying a Medigap policy.
What are the current gaps in Medicare?
If your only insurance is Medicare Parts A and B, you will need to pay for some of the services Medicare does not cover, or gaps. These gaps can cost a lot, especially if you do not have other insurance to help pay for the costs.
Some of the costs you may have to pay for:
- Part A Hospital Deductible: ($1,184 per year in 2013)
- Part B Annual Deductible: ($147 per year in 2013)
- Most Outpatient Services and Medical Supplies: 20% of the total amount Medicare approves
- Part A Hospitalization days 61-90: ($296 per day in 2013)
- Part A Hospitalization days 91-150: ($592 per day in 2013)
- Skilled Nursing Facility Care days 21-100: ($148 per day in 2013)
- Skilled Nursing Facility Care after 100 days: The entire cost (unless you have long-term care insurance or Medicaid)
- Blood: The cost of the first three pints
- Other costs
How does Medigap work?
Medigap is a type of insurance that covers the gaps in Medicare costs. You can buy it from private insurance companies in your state. Medigap is also called Medicare Supplement insurance.
There are 11 different standard Medigap plans that can be sold, except in Massachusetts, Minnesota, and Wisconsin. (These states have their own standardized plans you can buy.) The 11 standard plans are labeled A-D, F, high-deductible F, G, and K-N. Each of these plans covers different services.
You can learn about these plans in our Choosing a Policy section.
What Doctors Can I See with Medigap?
With Medigap, you can see any doctor, whether the doctor takes Medicare or not.
Who do I pay?
- If your doctor "accepts assignment," meaning he or she takes Medicare, your Medigap insurance company usually pays your doctor directly.
- If your doctor does not take Medicare, you may have to send claims to your insurance company and pay the doctor yourself.
How Else Can I Cover the Gaps?
You also can pay for the gaps in Medicare with secondary insurance. This insurance may pay first, before Medicare pays. This can include:
- Insurance through Employers or Unions: If you are working or retired or your spouse is, you may be able to get coverage from your current or former employer or union. Most of these group plans have better rates than you can get on your own. Your employer or union may also help pay part of the cost.
- COBRA: When you lose your job or retire, your employer must offer you continuation coverage, or COBRA. You will have to pay the entire premium yourself, and the coverage is short-term. It usually lasts only up to 18 months.
- Medicaid: If you have limited income and savings, you can apply for this coverage. You must also be over 65 or under 65 with disabilities. Some children also qualify. You can apply for this benefit at your local Medicaid office.
- Medicare Savings Programs: These programs help people on Medicare with limited income and savings pay for some of Medicare's costs. Learn more about Medicare Savings Programs.
- TRICARE for Life: This insurance is for you and your family members if you are a military retiree, eligible for Medicare, and age 65 or older.
- Veteran's Benefits: Veterans who served active duty can get health coverage benefits from the U.S. Veteran's Administration (VA).
- Tribal or Indian Health Benefits: This benefit is for members of federally recognized tribes. Care is given at tribal health centers and local Indian Health Services clinics in the clinic's health service area. In some cases, tribal members may receive benefits at another tribe's health center.
NEXT: Who Can Buy Medigap?