Frequently Asked Questions


What is Medicare?

Medicare is a Federal health insurance program for people 65 years of age or older. People under 65 with certain disabilities or those who need permanent kidney treatment with dialysis or a transplant also qualify for Medicare. Medicare has three parts: Part A, which covers hospital insurance, Part B, which is medical insurance, and Part C, which is prescription drug coverage. Medicare answers most of its holder’s health care costs, but not all.

What do the different parts of Medicare cover?

Generally, Medicare has two coverage components: Part A and Part B. Part A, called Hospital Insurance, covers hospital care costs such as nursing facilities, home health care, inpatient hospital, inpatient skilled nursing facility, and hospice services. Part B, also called Supplementary Medical Insurance, covers doctors' services, some outpatient hospital care, and some other medical services that Part A doesn't cover. Part B helps pay for such covered services and supplies when they are medically necessary. It also covers certain preventive services, physical therapy, mental health services, medical equipment and supplies, laboratory services, X-rays, ambulance services, and blood. However, Medicare does not cover all expenses.

How can Medigap benefit me?

The Original Medicare insurance often pays less than the beneficiary’s total health care cost. There are many “gaps” in Medicare that you would want Medigap to answer for you. Depending on which Medicare program you have, there are several expenses that you will be required to pay on your own. With a Medigap plan, you will have a supplementary assistance in paying your medically important health care costs.

What are the Medicare “gaps” that I would need Medigap for?

Medicare is divided into two coverage components, Part A and Part B. Both programs have gaps in coverage that may be covered by supplemental insurance. Gaps vary depending on which Medicare package you have. Generally, you will have to pay for these gaps, including deductibles, co-payments, and other fees not covered by Medicare. You will also have to pay any excess charges outside Medicare’s budget or allowable expenses.

What are the Gaps in Medicare Part A?

Part A’s gaps include:

1. Hospital deductible per spell of illness

2. Hospital coinsurance payments (Medicare only fully covers the first 60 days after the deductible has been met)

3. Hospital services beyond 150 days per spell of illness

4. Skilled nursing facility coinsurance payments (Medicare only fully covers the first 20 days)

5. Skilled nursing facility services beyond 100 days per spell of illness

6. Home health aide services that are provided on more than a part-time or intermittent basis;

7. Home health nursing and aide services when there is no longer a skilled care component;

6. What are the Gaps in Medicare Part B?

Part B’s gaps are:

1.The Part B deductible remains unchanged at $147. Some beneficiaries pay a higher Part B premium based on their income: those with annual incomes above $85,000 (single) or $170,000 (married) will pay from $146.90 to $335.70 per month in 2015.

2. Part B 20% coinsurance payment

3. Balance billing above the Medicare-approved charge