What does original Medicare pay?
After deductibles, Original Medicare only pays for 80% of medical costs and nothing for prescriptions. If you do not have a Medicare health insurance policy, they you pay the remaining 20% out-of-pocket.
What does a Medicare Advantage plan pay?
A Medicare Advantage policy pays Part A and Part B deductibles and the 20% not paid by Medicare. Most plans have co-pays for doctor appointments and other types of care. A yearly maximum out-of-pocket dollar limit for co-pays and co-insurance are standard on all policies. Co-insurance means you pay a per centage of the total amount of care.
What does Medigap or Supplemental policy pay?
A Supplemental or Medigap policy pays Part A and Part B deductibles and depending on the riders in the policy, pays for all health care with no deductible, no co-pays, and no co-insurance. Unlike an Advantage plan, Medigap or Supplemental plan benefits never change for as long as you pay the premium and you can relocate out of state and keep the plan.
What is the Golden Rule?
If Medicare does not pay, then your Medicare Advantage or Medicare Supplemental insurance policy will not pay. All claims must be medically necessary and be approved by Medicare.
It is especially important that you understand your plan benefits and networks before you seek care. Depending on the policy, you may have in-network or out-of-network co-pay or co-insurance costs before the 20% is paid by your policy.