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If you’re over the age of 65, chances are you have Medicare. And, chances are you’ll need a supplemental insurance to help with additional healthcare costs. While Medicare covers quite a bit, you need to know what it does and does not cover to ensure all your needs are met.

Medicare is a federal government program that provides health care coverage to mostly senior citizens. There are two parts to this coverage, Part A and Part B.

Part A generally covers:  

• Inpatient care in a hospital 

• Skilled nursing facility care 

• Inpatient care in a skilled nursing facility (not custodial or long-term care) 

• Hospice care 

• Home health care

Part B generally covers: 

• Clinical research  

• Ambulance services

• Durable medical equipment (DME)

• Mental health

• Inpatient

• Outpatient

• Partial hospitalization

• Limited outpatient prescription drugs

Medicare does not cover:

• Copayments

• Coinsurance

• Deductibles

• Long-term care (also called custodial care )

• Most dental care

• Eye exams related to prescribing glasses

• Dentures

• Cosmetic surgery  

• Acupuncture  

• Hearing aids and exams for fitting them

• Routine foot care

This is where supplemental insurance, also known as Medigap, can help. A Medicare supplement is a type of health insurance sold by private insurers to cover the gaps in Medicare. 

About supplemental Medicare insurance:

• You must have Medicare Part A and Part B.

• You pay a private insurance company a monthly premium for your policy. This is paid monthly in addition to the Part B premium.

• Any standardized supplemental policy is guaranteed renewable even if you have health problems. It can’t be canceled as long as you pay the premium.

• Medicare supplement plans cover only one person. Your spouse must have his or her own individual policy.

• You can drop your supplement at any time and there is no annual election period for supplement plans.

• Plans do not include Part D. This is separate.

Benefits that some Medicare Supplement insurance plans may cover are:

• Skilled nursing facility care coinsurance

• Part A deductible

• Part B deductible*

• Part B excess charges

• Foreign travel emergencies

Advantages of a traditional Medicare supplement policy are:

• Freedom to choose your own doctors and hospitals

• No referrals required to see a specialist

• Predictable out-of-pocket expenses 

• Nationwide coverage 

• Guaranteed renewability 

• No claims paperwork – Medicare supplement companies have crossover filing with Medicare. When your provider files a claim with Medicare, that claim is automatically filed with your supplement company 

Medicare Supplement insurance plans are rated (or priced) in 3 ways:

• Community-rated – Does not depend on age. People of different ages and gender pay the same premium. Premiums may go up because of inflation and other factors but not because of your age.

• Issue-age-rated – Sets the rate depending on the age of the person when he or she purchases the policy. Premiums may go up because of inflation and other factors but not because of your age.

• Attained-age-rated – Sets a premium at your current age and continues to go up as you get older. Premiums may also go up because of inflation and other factors.
If you are searching for a low-cost Medicare supplement policy, a DFW Direct Insurance licensed insurance agent can help you compare plans in your area.  We work with multiple top-rated carriers like Mutual of Omaha, Aetna and Cigna. Monthly premiums start at $99.75 per month. There is no cost to you for our professional services. Call us at DFW Direct Insurance at 817-449-5557 or get a free rate quote in less than 2 minutes at www.dfwdirectinsurance.com.

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