Filling gaps in Medicare coverage and getting help with Medicare costs
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Last Update: February 02, 2011
There are a number of ways to get coverage to fill gaps in Medicare or to get assistance with Medicare costs:
- Employer Insurance: If you or your spouse is still working, and you have insurance through that job, it will work with Medicare to cover your health care costs. You should know whether your employer insurance is primary or secondary to Medicare. Primary insurance is health insurance that pays first on a claim for medical and hospital care. Secondary insurance pays after primary insurance.
- Retiree Insurance: Some employers provide health insurance to retirees and their spouses to fill in the gaps of Medicare coverage. Retiree insurance always pays secondary to Medicare.
- Veterans' Administration Benefits: If you are a veteran and qualify for VA health benefits, health care and prescription drugs that you get through the VA may be the cheapest. The VA may also cover certain health care that Medicare will not cover for you. VA benefits do not work with Medicare and if you receive care outside of a VA facility you might need Medicare. Medicare does not pay for any care at a VA facility.
- Supplemental Insurance (Medigap): Insurance that you can buy from a private insurance company to fill in the gaps in Original Medicare coverage by paying for your Medicare deductibles, coinsurances and copayments. Depending on where you live, you have up to 10 different Medigap plans to choose from, A, B, C, D, F, G, K, L, M, N (plans in Wisconsin, Massachusetts, and Minnesota have different names). Each offers a different set of benefits. Premiums vary, depending on the plan you choose and the company you buy it from.
- Stand-alone Medicare private drug plan (Part D): If you have Original Medicare and want Medicare drug coverage, you need to sign up for a private plan that only offers drug coverage (PDP). All Medicare drug plans have different costs and a different list of drugs that they cover. Make sure the plan you choose covers the drugs you need at a cost you can afford.
- You can also get your Medicare benefits through a Medicare Advantage plan (such as an HMO or PPO). These plans contract with the government to provide Medicare benefits. They must provide at least the same set of benefits offered by Original Medicare, but may have different rules, costs and restrictions. Some private health plans may offer extra benefits, such as vision or dental services. While premiums may be low, service costs may be higher than in Original Medicare for certain services. You may pay more for your care if you not follow the plan rules. Medicare Advantage plans must have annual limits on out of pocket costs. Although these limits are usually high, they should protect you from excessive costs if you need a lot of health care. Benefit packages may change every year.
If you have a limited income, you may be able to get assistance through certain programs:
- Medicaid: If you have a low monthly income and assets, you may be eligible for coverage from Medicaid to pay Medicare costs and for health care not covered by Medicare, such as transportation to medical appointments.
- Medicare Savings Programs: If you do not qualify for Medicaid but still have problems paying for health care, you may qualify for government programs that help pay your Medicare costs. All Medicare Savings Programs pay the Medicare Part B premium and the Qualified Medicare Beneficiary (QMB) Program covers deductibles and coinsurances as well.
Note: There are many programs that can help pay for prescription drugs.