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.
Medicare Part A and Part B are responsible for different types of expenses; they are also subject to different types of deductibles, co-payments, and other benefit limitations. In reality, it is as if the insured were covered by two different insurance companies, or a third, if you consider Medicare Advantage.
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.
Medigap or Medicare Supplemental Insurance will only pay a claim if Medicare first accepts the expense as a reasonable charge.
Plan letters A-L are being used to identify the 12 Medicare Supplement plan choices. All plans labeled with the identical letter do the exact same thing. The only difference is that one company may charge substantially more for the same plan letter that another company is offering.
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.