We are always asked, “Will Medicare cover my procedure (surgery, lab test, injection, prescription…)?” We wish that the answers could be as simple as yes or no.

Unfortunately, the answer to this question isn’t always as cut and dry of an answer as you’d like.

Yes, Medicare states what they do and don’t cover, but there are other correlating factors that go into a service or procedure being covered.

Factors like the procedure’s medical necessity, the doctor’s participation, and how the bill is coded are some variables that affect the answer to this question. Continue reading to see what we mean

If you’re new to Medicare, you might not be aware of all the health benefits that come with your new coverage. The Welcome to Medicare Visit, for example, is one benefit that is often overlooked and misunderstood. According to the National Institutes of Health, only about 13% of new Medicare enrollees take advantage of this free health visit in a given year.

The Welcome to Medicare Visit, also called the Initial Preventive Physical Exam, is a great opportunity for you to get to know your doctor and discuss your health status. It’s also the perfect time to catch up on all your preventive screenings and learn about your Medicare benefits and how they can help you stay healthy.

If you’re enrolling in Medicare this year or you’ve been enrolled in the program for less than 12 months, here’s what you need to know to get the most out of your Welcome to Medicare Visit.

By definition, Medigap is private insurance that fills in the gaps between your Medicare benefits and what you must pay out of pocket. You purchase them from private insurance companies to help pay for things that Medicare does not pay for. This includes deductibles and copays that otherwise you would be responsible for.

Sometimes called a Medicare supplement, Medigap policies give you the freedom to choose your own doctor. Once insured, you can never be dropped due to health reasons.

What Does Medigap Cover?

Medigap carriers offer 10 standardized insurance plans. They are each labeled with a letter of the alphabet. Each insurance plan has a different combination of benefits. (There is also one high deductible insurance plan.)

Some of the gaps that Medigap plans can cover for you are:

- Hospital deductibles, copays, and an extra 365 days in the hospital

- The first 3 pints of blood as necessary in a transfusion

- Outpatient deductibles, coinsurance, and excess charges

- Skilled Nursing coinsurance

- Foreign travel emergency care

Insurance companies can set their rates for Medicare supplement policies by a number of factors, including gender, age, zip code, and tobacco usage.

An Attained-age policy is one in which the premiums are based on your age at enrollment. The prices will be lower when you first enroll but may increase as you get older. There are three primary methods that insurance companies use to price their Medigap plans: attained-age-rated, issue-age-rated, and community-rated.

What Is An Attained-Age Policy

No matter how the policies are rated, ALL Medigap policies will have annual rate increases due to healthcare inflation. Let’s take a look at each of these more closely so we can show you how they work and what to expect.

Attained-Age Medigap Policies

An Attained-age rating is probably the most common pricing method in the United States. The monthly premiums for these policies will be based on your current age at the policy start. The rates will increase slowly over time.

Don’t let that scare you. As we mentioned, All Medicare supplements will incur rate increases to keep up with inflation. For the most part, they are reasonable since most increases must first be approved by the Department of Insurance before they can take effect.

Also, because attained-age-rated policies are so common, they represent the biggest group of insured policyholders. This helps to minimize and spread the insurance risk out over many people, thereby keeping pricing on these policies competitive.