Original Medicare Parts C and D cover many health services and products, but do not cover your entire cost. Medigap or Medicare Supplemental Insurance Plans can help. These plans fill in some or all of the gaps in coverage by paying your deductibles, copayments and coinsurance.
These plans are private, non-profit insurance companies that contract with Medicare to provide coverage and services. They offer many plan options and benefits including extra coverage of dental, hearing, fitness, telehealth and fitness services, gym memberships, as well as other wellness incentives. The monthly payments are paid directly by the insurer and not taken from your Social Security.
In general, supplemental policies do not cover prescription drug costs. However, many do cover Medicare Part D cost, such as the out-ofpocket limit and deductible. Some supplemental plans pay for foreign travel emergency expenses, and they might be required to use network providers (although that is not the case with all supplemental coverage).
Medicare Advantage Plans are generally less comprehensive in terms of health services and payment methods than traditional Medicare. Additional fees may be charged for services and items that aren’t directly health related. For example, a fitness centre membership or transportation.
For 2022 virtually all Medicare Advantage Plans available for general enrollment offer some extra benefits that are not offered by traditional Medicare. More then 90% of individual plans provide fitness, vision and telehealth, as well as dental benefits. Additionally, over the counter items, a meal benefit and transportation assistance are also frequently available. A smaller percentage of plans include bathroom safety devices. However, a slightly higher proportion of those who serve people with chronic diseases offer telemonitoring to caregivers.
Many HMO plans restrict health care provider choice to in-network doctors and hospitals. Some POS plans permit beneficiaries to choose health care providers outside of the network, but cost sharing is higher for out-of -network visits. PFFS and PPO plans do not require that beneficiaries see in-network providers, and they usually have lower deductibles and copayment/coinsurance than HMOs. Some Medicare Advantage plans require referrals only for specialists, while others do.
Medicare Advantage plans often serve a population with high-needs and specific health care requirements. They can use rebate dollars to provide extra benefits primarily related to health to these individuals. A small percentage (about 5%) of Medicare Advantage Plans offer extra benefits to chronically-ill enrollees. These include telemonitoring, caregiver support and other health-related services.
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