Do I need a Medicare supplement plan?
Medicare is not designed to cover all medical costs. In addition to annual deductibles and copayments, some services are limited or not covered. You may want to consider buying additional insurance to supplement your Medicare coverage. You can purchase a Medicare supplemental policy or join a Medicare managed care plan. Before making any decisions to buy additional coverage, review the coverage you now have, such as medical benefits through your previous employer.

There are many different plans from which you can choose to supplement your Medicare coverage. Different health plan choices may affect your cost, choice and benefit level.
You should look at: Cost

  • Monthly premiums tend to be lower in most managed care plans than in most supplemental policies.

  • Your out-of-pocket costs (what you pay when you visit the doctor) tend to be lower in most managed care plans and some supplemental insurance plans (also called Medigap), and higher in the Medicare plan.
Choice
  • You have the widest choice of doctors and hospitals in the original Medicare plan, and the original Medicare plan with a supplemental policy.

  • In most managed care plans, you must choose your doctors and hospitals from a list provided by the plan. You may want to check if your current doctor is on the plan's list, and if the doctor is accepting new Medicare patients.

  • In the original Medicare plan and the original Medicare plan with a supplemental policy, you can go to any specialist who accepts Medicare. With managed care you can go to any specialist who accepts the plan's terms and agrees to treat you. However, in many managed care plans, you must first get a referral from your primary care doctor before you can go to a specialist.

Extra Benefits
  • You may get extra benefits in managed care plans- like vision or dental care- beyond the benefits covered by the original Medicare plan or the original Medicare plan with a Supplemental policy.

  • Many managed care plans and a few of the more expensive supplemental policies cover certain prescription drugs up to a specified dollar limit. In general, the Original Medicare plan does not cover prescription drugs.

Charges Not Covered by Medicare When looking for a supplemental policy, check to see what the supplemental policy covers that Medicare doesn't. The following is a partial listing of charges not covered by Medicare:
  • Inpatient hospital deductible ($764 in 1998)

  • Daily hospital coinsurance ($191 in 1998)

  • Hospital charges for coverage after 90 days if "lifetime reserve" days available

  • Lifetime reserve day daily coinsurance ($382 in 1998)

  • First three pints of blood

  • Private nurse in hospital

  • Care received outside the United States and its territories, except under limited circumstances in Canada and Mexico

  • Skilled nursing daily coinsurance ($95.50 in 1998) for days 21 through 100

  • Skilled nursing costs after 100 days

  • Full-time nursing care

  • Most outpatient prescription drugs and immunizations

  • $100 annual Part B deductible

  • 20% coinsurance and permissible charges in excess of Medicare-approved amount

  • 50% of the Medicare-approved amounts for most outpatient mental health treatment

  • Routine physicals and other screening services, except for periodic mammograms and Pap smears

  • Most dental care and dentures

  • Acupuncture treatment

  • Routine eye examinations or eyeglasses, except prosthetic lenses after cataract surgery

  • Hearing aids or routine hearing loss examinations

  • Charges for care outside the United States and its territories, except in certain instances in Canada and Mexico

  • Charges for routine foot care

The information above summarizes general employee benefit provisions. It is not intended to specify details of any particular employer's plan, nor is it a guarantee of benefits. Contact your benefit representative about specific details regarding your company's employee benefit plan.