Shopping around for Medicare Supplement Insurance to supplement your Original Medicare policy can feel daunting and overwhelming. This can cause some people to make coverage decisions that are either ill-informed or not in their best interests. When you work with the team at Mckenzie Life and Health, you can let our team do all of the legwork for you. We’ll have an in-depth conversation with you to understand your specific coverage requirements so that we can pair you with a supplemental insurance plan that suits your needs and your budget. Contact our insurance agency at 682-257-8455 today to make an appointment for a free Medicare Supplement Insurance quote in DFW and review the Medigap coverage information below.

The Basics of Medicare Supplement Insurance

What Is Medicare Supplement Insurance?

Let’s start by answering the most basic question about this type of insurance — exactly what is it? As the name implies, Medicare Supplement Insurance (also known as Medigap) is a type of private health insurance that is designed to fill in the coverage gaps by covering many of the healthcare costs that Original Medicare doesn’t cover. It is not designed to replace an Original Medicare plan, but rather, it is meant to provide individuals with supplemental coverage to ensure maximum benefit.

What Is Covered and How Does It Work?

There are quite a few things that Medigap insurance covers and each standardized Medigap policy must offer the same basic benefits, no matter which insurance company sells it. While Original Medicare will not cover expenses like Medicare Part A and Part B deductibles, Part B premiums, and coinsurance costs, Medigap will. In the absence of this supplemental coverage, you could be left owing hefty amounts on these medical-related expenses.

However, there are some things that Medicare Supplement Insurance cannot help you out with. It is not designed to cover any type of long-term care costs or skilled nursing expenses, and it cannot assist you with costs associated with dental or vision care, eyeglasses, or hearing aids.

With Medigap plans, you may generally use any doctor or hospital that accepts Medicare. Once you receive medical services, the doctor or hospital will bill your Original Medicare insurance. Medicare will then pay roughly 80 percent of the bill. Next, the doctor or hospital will bill your Medicare Supplement Insurance. Depending on the plan you choose, your Medigap plan will then pay its share. Any remaining balance owed will then be billed to you directly.

Who Is Eligible for Medigap Coverage?

It is a common misconception that individuals are automatically eligible for Medicare Supplement Insurance if they have Medicare. Not all who are eligible for Original Medicare are eligible for Medigap Insurance, however, in order to qualify for Medigap coverage, you must be eligible for Medicare. Sounds a little confusing, doesn’t it? Let’s clarify a bit.

Legal U.S. citizens and individuals who have been a permanent legal resident for a minimum of five continuous years are eligible for both Original Medicare and Medigap if they meet one of the following criteria:

  • Are age 65 or older
  • Have been diagnosed with Lou Gehrig’s disease (ALS)
  • Have been diagnosed with permanent kidney failure that requires dialysis or a transplant
  • Have been receiving disability benefits from the Railroad Retirement Fund or the Social Security Administration for 24 months in a row

If you are eligible for Medicare, there are three circumstances that could bar your eligibility for Medicare Supplement Insurance coverage. Individuals are not eligible for Medigap coverage if they:

  • Have a Medicare Advantage Plan (Medicare Part C)
  • Have Original Medicare coverage in addition to an employer group health plan or union coverage
  • Have both Original Medicare and a Medicare SELECT plan

These circumstances don’t permanently prevent you from obtaining Medicare Supplemental Insurance, and there are some instances in which changes can be made to make you eligible for Medigap coverage. Our team is happy to review your unique situation to determine your eligibility for coverage.