Key Points:
If your doctor accepts Medicare, they HAVE to take your Medicare Supplement
Medicare Supplement brand names don't affect your network or benefits, only price
Medicare Supplements can only deny claims Original Medicare denied first
The biggest and most common question for anyone choosing health insurance is: does this plan cover my doctors? When people approach Medicare eligibility, this conversation becomes even more relevant when deciding between their Medicare secondary options.
If you are weighing your Medicare choices, this article is for you. We will be diving into how a Medicare Supplement (or Medigap) works to cover your doctors. The internet is rife with misinformation on how Medigap networks work, and we are here to set the record straight.
Medicare Supplements Don’t Have a Network
You read that headline right: Medicare supplements don’t have a providers’ network. When you have a Medicare Supplement, Original Medicare is your primary insurance, and therefore it is Original Medicare that determines your network. Original Medicare decides what doctors you can see and what hospitals you can go to. Your Medicare Supplement has no say in any of these decisions.
Again, Original Medicare is your primary insurance. Your Medicare Supplement is simply helping to pay the bills.
Does Original Medicare Cover My Doctors?
We can say with a high degree of certainty, yes. In 2023, the Kaiser Family Foundation reported that a whopping 98.9% of physicians accept Original Medicare. (https://www.kff.org/medicare/issue-brief/how-many-physicians-have-opted-out-of-the-medicare-program/) The Original Medicare network is robust and nationwide. Meaning if you are enrolled in our home state of New Jersey, you most likely can see doctors in Florida with little to no hassle. In this scenario, there are no increased costs for being “Out-Of-Network”. You also won’t have to prove it was an emergency which many other types of insurance require when crossing state lines.
We have clients who live in one state but keep doctors in another and are shocked at how smooth everything can be.
Does My Medicare Supplement ‘Type’ (meaning Plan F, Plan G or Plan N) and Carrier Matter?
When it comes to seeing your doctors, no. It’s worth repeating: Original Medicare is your primary insurance when you have a Medicare Supplement. Whether you have a Plan F, Plan G, or Plan N, you will have the same exact Original Medicare network. Whether you have a Medicare Supplement from Carrier A, Carrier B or Carrier C, you will have the same exact Original Medicare network. Your Medicare Supplement CANNOT make decisions about your healthcare or which doctors you see. Original Medicare determines everything related to your Hospital and Medical coverage.
We understand the confusion that’s out there regarding this. With just about every other type of health insurance (outside of Original Medicare) your insurance carrier and plan type matter immensely. We’ve all called a doctor’s office and been told that they don’t take insurance Carrier A. We’ve all called a doctor’s office and had them say something along the lines of, “We take Carrier A, but only the PPO. Not the HMO you have”. We are conditioned to look for the brand of insurance carrier we have and the type of plan they provide. The good news is, this is something you no longer need to focus on or worry about when you sign up for Original Medicare with a Medicare Supplement.
We’ll take this example a step further. Even if your provider doesn’t normally accept Insurance Carrier A, they still must accept your Medicare Supplement from Insurance Carrier A!
Can Medicare Supplements Deny Claims?
If Original Medicare approves the claim, no! Medicare Supplements work in tandem with Original Medicare and cannot deny claims approved by Original Medicare. Again, they do not make decisions about your healthcare! They just supplement the payment for your healthcare.
Only if Original Medicare denies a claim can a Medicare Supplement deny a claim. In our experience, these denials tend to be more due to coding errors than the procedure not being covered. Many of our clients can get denials approved after bills are resubmitted with the proper coding.
Common things that Original Medicare doesn’t cover include:
Dental, Vision and Hearing
Cosmetic Surgery
Long Term Care
Concierge Care
One Thing Medicare Supplements Cover That Original Medicare Doesn’t
While we just talked about how connected Original Medicare and Medicare Supplements are, there is one extra thing a Medicare Supplement covers: emergency care while traveling internationally. There are some very rare situations where Original Medicare will cover international emergency care, but it is not nearly as robust as what Medicare Supplements provide.
Medicare Supplements C, D, E, F, G, H, I, J, M and N provide $50,000 worth of emergency foreign travel care over your lifetime. Original Medicare does not have to approve the coverage in this instance.
Is a Medicare Supplement right for me?
Choosing a Medicare secondary plan is a big decision. You want someone in your corner who can ensure that you’re fully informed of all your options and will have your back. The brokers at NJ Life and Health are here to guide you and make sure you have the right Medicare plan for your specific needs.
Reach out to us at www.njlifeandhealth.com or call our Toms River, NJ office at 848-226-6897. We work in 25 states and are happy to help you with your needs!
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