The Combination of Medicare Part A and Medicare Part B with a Medigap Plan
Most people have both Medicare Part A and Medicare Part B coverage. This combination provides all the hospital and medical coverage that is available under Medicare. The two parts of the Medicare program are intended to work together to give participants a broad range of coverage, although it is not total coverage.
Until 2003 Medicare has not provided coverage for outpatient prescription medications. The Medicare Prescription Drug Improvement and Modernization Act was signed into law in 2003. The new program did not begin until 2006. Laws passed by Congress allow Medicare the right to determine what it will and will not cover including prescription medications. One must fully understand the program as all medical treatments are subject to Medicare approval.
The responsibilities of Medicare Part A and Medicare Part B are different from one another and subject to different limitations and deductibles. Participating in both portions of Medicare is similar to being protected by two different insurance plans. As if that’s not confusing enough, participants in Medicare Advantage really have three separate plans.
For Medicare to cover medical care, it must be medically necessary or considered appropriate for the treatment of an insureds medical condition based on the usual standards applied by the health-care profession. This determination is usually made by the attending physician but is subject to acceptance by Medicare. Usually Medicare will not pay for any care that is not considered mainstream or medically prooven to be beneficial. Most alternative types of health care, such as acupuncture, are not covered. Experimental procedures generally are not covered either. If Medicare refuses to pay for something because they judged it not medically necessary, then the insured has the right to appeal the decision.
Medicare Supplement Insurance also known as Medigap Insurance will only provide coverage if Medicare first approves the charges. Only individuals with Medicare Part A and Medicare Part B can purchase a Medigap plan.
Medigap Insurance is standardized and the 12 plans are labled with the letters A-L. All plans with the same letter do the identical thing regardless of the company. Prices may vary widely from one company to the next even though the plans are the same.
Since the plans have been standardized, Plan F has been the most widely purchased plan. Most consumers site the full coverage offered by Plan F as the reason for choosing that plan. Since most all doctors and hospitals don’t require the consumer to pay more than what Medicare approves, Plan C, Plan D or Plan G are viable alternatives.
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