Summarizing the Medigap Program HCR/230 Donna DeGrio By Jennifer Cooperman November 25, 2011 Summarizing the Medigap Program The core benefits may be covered differently depending on your plan design. As of 2011 the Medigap design still remains the same. The core benefits include hospital coinsurance for up to 365 days more than what is covered by Medicare Part A, co-pays and coinsurance for Medicare Part B, up to the first three pints of blood per year, Medicare Part A hospice care coinsurance or copayments(new benefit effective June 1, 2010), and preventive care coinsurance.
The Medigap program is a supplemental insurance policy that assits beneficiaries in paying for non-covered physician and hospital expenses. The program policy is sold by private insurers to help with these services that Medicare does not cover. The patient must be a member of Medicare part A & B to meet eligibility requirements for Medigap. The coverage cost for this program is sufficient for the needs of consumers. The Medigap program works well for people who can not afford to pay the extra out-of-pocket expense such as copayments, coinsurance, and the prices of prescription drugs.
For example, if a patient is taken a drug called Depakote which is a very expense drug, and the patient has Medicare part A & B the patient still can not afford it, then this is where the Medigap program comes into play to help cover the prescription. The types of services that are cevered as well as the ones that are not on the implications of a private insurance company associated with a government insurance program. Individuals who are covered under a government insurance program are required to get prior authorization for most of their services unless the services are deemed medically necessary.
Where to individuals who have private insurance are usually offered more services than the ones who do not have private insurance. I believe that the benefits, limits, and costs are fair. The reason being is because if you had a private insurance and pretty much a healthy person over all, then the premium and co-pays would be less expensive. Where to people who may have Medicare and Medigap depending on what needs to be paid may be more out of pocket than what they think for their premiums.