HealthCare Buzz: Turning 65 — What is a Medicare supplemental insurance plan and why do I need one? – Coeur d’Alene Press

When turning 65, there are many decisions to make related to Medicare coverage options. Looking to the internet will provide excellent search items, with special attention to Medicares publication: Medicare and Me.

As decisions are being made, it is important to learn what will heavily impact out-of-pocket expenses the amounts the patient will be paying.

First: Medicare was never intended to pay for all health care expenses for those 65 and older. Therefore, there will always be an out-of-pocket amount. This patient portion will be impacted by the Medicare plan you choose.

Traditional Medicare: Patient Portions. There will be the every-60 day inpatient deductible. There will be an average of 20 percent for all outpatient hospital services as well as other outpatient services like oxygen, walkers and rehab. There will be the average 20 percent of allowed charges for each physician visit.

For the Part D/pharmacy package, there will be varying amounts due based on the tier of the drugs you use. Highly important to review the list of drugs you are on and compare against the plan you purchase as Medicare has a patient portion plus the large do-nut hole when Medicare pays nothing until you hit the cap.

Medicare Advantage/Part C/Managed Medicare/Replacement Plan: They all represent the same thing. We will discuss the out-of-pocket expense for this exception to traditional Medicare shortly. However, there is no ability to have a supplemental insurance plan with Medicare Part C. The patient portion is significantly different than with traditional Medicare.

A Medicare supplemental insurance plan is purchased to cover the patient portion for traditional Medicare bills. General rule: If the service is approved/covered by traditional Medicare, then the patient portion/out of pocket expense is eligible for coverage by the Medicare supplemental insurance plan.

There are different levels of supplemental insurance that can be purchased with different levels of coverage.

An average Idaho cost/insurance premium is $150 a month to cover the patient portion of traditional Medicare bills. They can be purchased from numerous commercial insurance plans, not from Medicare. Without having a supplemental insurance plan, the patient will be responsible for all the out of pocket expenses as outlined above.

Help for lower income seniors with these out-of-pocket expenses will be included during an educational session in our upcoming Turning 65 Boot Camp. Plus all classes from previous boot camps are on our webpage,, at no cost.

Is health care complicated? The payment system is different for each insurance plan, Medicaid/per state and Traditional Medicare vs. Managed Medicare/Medicare Advantage. Learn more about all the areas of impact through the Patient Financial Navigator Community Boot Camp: Turning 65 on Oct. 28 at the College of Southern Idaho Fine Arts building. 8:30 a.m.-1:30 p.m. The event is free and no registration is required.


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