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Medicare: How Does It Work?

Covering the Gap: Medi-Gap

Okay, back to the 20 percent that Medicare doesn't cover for medical services. Dad can buy a Medi-gap insurance policy that will cover the 20 percent. It is vital that he gets this insurance—unless he chooses to get into a Medicare managed care (HMO) plan. As soon as he's receiving his Medicare Part B insurance benefit, he should be applying for a Medi-gap policy.

To make life easier, there are 10 standard Medi-gap plans from which to choose. Get ready for alphabet soup: They range from A (very basic) to J (the whole ball of wax). Of course, the more coverage, the more you pay. Two of the standardized plans that companies can offer to sell your parents can bear the title Medicare SELECT. These policies are less costly; however, your parent can select only from the plan's hospitals and doctors.

The federal government has a first-rate Web site where you can find out what Medi-gap policies are offered in your parents' area (see the following Sage Source). You can identify what kind of coverage you want, and then you'll get a reading of what insurance company offers what you want. You can also get a printout that compares different plans with each other. It's called Medi-gap Compare.

Buying a Medi-Gap Policy

Senior Alert

When mom and dad hit 65 years old and right after they have enrolled in Medicare Part B, they have six months to buy a Medi-gap policy. During this open enrollment period the insurance company cannot deny your parents coverage or change the price of a policy because of past or current health problems. If your parents don't buy it during that six-month window, insurance companies can deny them a Medi-gap policy and charge them more. So now you know what to buy your parents for their sixty-fifth birthdays!

You need to be careful buying Medi-gap policies; here's what you want to watch out for:

  • Buy only one plan. It's illegal for insurance companies to sell you a second Medi-gap plan.
  • Watch out for clauses that exclude pre-existing conditions. Shop for a plan that will cover your parents' conditions.
  • Be careful when you switch plans. Make sure that you're switching for better coverage at an affordable price.
  • Make sure the insurance plan can be delivered in 30 days.
  • Don't let anyone scare your parents into buying a policy or use high-pressured tactics.
  • Request that the insurance company show you verification that it has been approved by the state insurance department to sell its policies. The state approval means the company meets the standards to sell a Medi-gap policy.
  • Don't pay cash! Pay by check so that you have proof of purchase. Know who you're dealing with—get a business card.
  • If your parents are confused or overwhelmed in making insurance decisions, go over the information with them or have them talk to a SHIP counselor.
  • Once your parent decides to buy a policy, fill out the medical history section very carefully. If you omit any information, the company will use this as a reason to not cover a bill linked to the condition you didn't report.
  • Stay clear of nonstandard plans. Insurance companies can't call it a Medi-gap plan if it hasn't met government standards and been approved by your state insurance department.

Out in the Cold: What Medicare Doesn't Cover

Medicare does a great deal, but it doesn't cover everything. Here's what's not covered:

  • Almost all outpatient prescription drugs
  • Routine physical exams
  • Routine eye exams
  • Custodial care (help with bathing, dressing, using the toilet, eating)
  • Most dental care and dentures
  • Routine foot care
  • Hearing aids
  • Orthopedic shoes
  • Cosmetic surgery (got to keep the wrinkles)

You can, of course, shop around for other insurance to pay for some of these services. Medicare may cover the first 100 days of nursing home care if it follows a three-day hospital stay and meets other conditions. Then, you're on your own.

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Excerpted from The Complete Idiot's Guide to Caring for Aging Parents © 2001 by Linda Colvin Rhodes, Ed.D. All rights reserved including the right of reproduction in whole or in part in any form. Used by arrangement with Alpha Books, a member of Penguin Group (USA) Inc.

To order this book visit the Idiot's Guide web site or call 1-800-253-6476.


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