There is a lot to learn about Medicare, including the various kinds of coverage that are available to participants. It may sounds intimidating but Total Medicare is here to help you navigate the system. You may be happy with your Original Medicare, which includes Medicare Parts A and B, and sometimes Part D. But, if you are concerned with gaps in your Medicare coverage, however, then you may want to investigate Medicare Supplemental Insurance, also called Medigap Insurance.
What Is Medigap?
While Medigap is associated with Medicare, it is not a government run program. Instead, Medicare-approved private companies provide private health plans that give applicants a way to cover the gaps that occur in health care coverage through Medicare Part A and B. That means that you can get coverage that isn’t available through Original Medicare, while allowing Medicare to continue to do its job. You don’t have to sacrifice your classic Medicare coverage in order to get things like dental and certain vision coverage.
The Rules
Of course, because Medigap is approved by the Centers for Medicare and Medicaid Services (CMS), and works in concert with the Medicare program, there are rules that must be followed. These are mostly in place to protect you as a consumer. For example, every program must be compliant with Federal and State laws, and they must all comply with certain coverage requirements. That means that your Medigap plan must be standardized, and must also be identified with the letters A through N. These policies must offer similar benefits, no matter who is selling the policies.
In fact, according to CMS:
“Cost is usually the only difference between Medigap policies with the same letter sold by different insurance companies.”
All of this works to protect you, the consumer.
Buying Medigap Policies
A Medigap policy doesn’t have any overlap with your Original Medicare policies. It is also not available to those people who elect to use Medicare Advantage. Medigap is also not connected with Medicaid coverage. You can buy these policies from many different private companies, and with the guarantee that these companies have been approved to work with Medicare, you will know that no matter what your choice, you will get the coverage you seek.
That doesn’t mean you shouldn’t be careful, of course. Because the policies are standardized, the main difference is cost. Monthly premiums can vary dramatically, so make sure you compare providers and pick one that is both highly rated and low cost.
There are many different types of health care, and one that is particularly important is not always covered by health insurance — dental care. Like many other medical health insurance plans, Medicare’s coverage of dental is scarce. In fact, the general rule is that you will pay one hundred percent of your dental services while under Medicare.
Covered Services
There are a few exceptions to the general rule. While dental care that isn’t covered includes fillings, cleanings, tooth extractions, and dentures, you will be able to get coverage for a couple of procedures with your Medicare plan. These procedures usually have more to do with an underlying health condition that will require medical treatment. For example, if you break your jaw and require your teeth to be wired, Medicare will pay in connection with the reduction of that jaw fracture. These exceptions are minute and very particular.
Dental Exclusion
The exclusion of dental coverage isn’t new. In fact, it was a part of the original Medicare program. The Social Security Act, which governs Medicare, provides for the exclusion of dental coverage in connection with the care of teeth or structures supporting the teeth. That’s why treatment of the teeth or other dental areas related to another health problem may not be covered.
This exclusion is very broad, which leads to the general presumption that dental coverage is zero. Whether you are seeking a cavity filling, routine preventative care, or denture work, you can anticipate paying for everything unless you have supplemental coverage under a different plan.
Discount Dental Plans
Because Medicare does not pay for the vast majority of dental procedures, discount dental plans have been developed as an alternative. These plans are offered at a low cost to individuals who need them, and they often fill in this particular gap in Medicare coverage for those who are enrolled. You will need to be cautious, of course, just like you would be when signing onto any insurance plan. Read all your paperwork carefully and ask a lot of questions. Your covered services under your discount dental plan will vary from plan to plan. You’ll need to follow plan guidelines for choosing a dental provider and for the procedures covered under the plan. Choose your discount dental plan based on your budget and your annual dental needs.
