-
Medicare is a popular public health insurance plan that helps defray most medical care costs. However, Medicare regulations do not reimburse every claim, resulting in Medicare gaps.
Gaps
Original Medicare does not cover every procedure nor does it always pay for 100 percent of the cost of drugs and medical care, hence gaps in your Medicare coverage, reports the U.S. Department of Health and Human Services.
Backup
In order to pay for the items that regular Medicare does not or cannot cover, most people buy supplemental health insurance called Medigap, reports H.H.S.
Common Gaps
Medicare policies stop coverage for hospital stays longer than 150 days, reports the CMA. Almost all services and items in Part B are only reimbursed at 80 percent of the cost. Medicare also does not pay for frequent or "routine" medical care. One of the most notable gaps is the "doughnut hole" in Part D. The "doughnut gap" occurs between regular Medicare coverage and emergency payments. In 2007, for example, Medicare reimbursed up to $2,400 in drug expenses by 75 percent, but did not cover any costs between $2,400 and $3,800, according to the Center for Medicare Advocacy.
Prevention/Solution
If you have an income level close to the federal poverty line you may qualify for assistance for other public health services such as Medicaid that can close the "gap," reports the C.M.A.
Tips
If you still have gaps in your Medicare coverage consider instituting cost-cutting measures. Generic prescription drugs, for example, are much cheaper than name brands and often just as effective, reports H.H.S.
Source:
US Department of Health and Human Services; Medigap (Supplemental Insurance) Policies
Center for Medicare Advocacy; Medicare FAQ
US Department of Health and Human Services; 5 Ways to Lower Your Costs During the Coverage Gap
Resource:
Center for Medicare Advocacy; Calculating Costs To and Through the Part D Doughnut Hole
Copyright 2023, Wired Ivy, LLC