Gap Coverages

No matter what kind of health insurance or Medicare program you have chosen there are some gaps in your coverage. Most Medicare supplementals offer pretty comprehensive coverage but still have a couple of potential gaps as you will see. Medicare advantage plans because of their lowly monthly premiums definitely have some fairly large gaps in coverage. Fortunately, there is a fairly inexpensive way of covering those gaps. First let’s start by pointing out the gaps and then showing the approximate price for covering each of the gaps with an explanation of the actual gap protection type policies.

NOTE: All the gaps coverages come in one policy, but you get to pick and choose which of the gaps you want covered and are willing to pay for. The only part of this gap coverage that you have to have is the first one, the hospital indemnity, however you can buy a minimum $100 a day benefit which is less expensive than what is shown in the next paragraph.

  1. The $300 per day hospital copay for up to 6 days that you have with Medicare advantage plans. This is the biggest of the gaps and it is important to know that this is not a once a year occurrence. This could happen several times in a year. You could literally be out thousands of dollars. Most policies have maximum out of pocket limits of around $4,000 some are a few hundred more. This gap can be filled with a “hospital indemnity” product for a minimal cost. For example for a 65 year old person to have a 6 day $300 per day benefit it would cost $15.90 per month. For a 70 year old person the price is $18.55 per month. This is not a guaranteed issue product so not everyone qualifies but most people do. Also it is noteworthy to mention that unlike supplemental policies, the price for this insurance does not go up as you get older. Once you have bought this the policy price remains the same.
  2. The next biggest gap dollars wise and very easily could be the biggest one is what you have to pay for skilled nursing care after the first 20 days and sometimes during the first 20 days. Medicare says it will pay for the first 20 days and then after that from day 21 through 100 you have to pay $176 per day and Medicare will pay the difference. The problem here is that Medicare will only pay if they determine that there is a reasonable amount of improvement. Now being that on the Medicare Advantage programs the insurance companies are on the hook for the daily fee you can pretty well bet they are going to try and get you out of there as quickly as possible. Fortunately one of the benefits you can add on to this program is a $200 per day for up to 50 days payment to you if you are in need of skilled nursing. So if you get the first 20 as you are supposed to get plus this policy pays you for 50 days you now basically have about 70 days, 2 months to recover and get back home without breaking the bank. The price for this coverage for someone age 65 is about per month. Once again this is not guaranteed issue but most people do qualify. See my discussion on long term care coverage options here.
  3. The out patient surgery gap and the ambulance gaps are usually only about $250 co-payments so that in comparison to the others is not a large amount. They can be covered for fairly small additional premium but some may find they would rather take the chance and just pay those themselves rather than pay a monthly premium to cove those costs. To cover those costs the additional premium would be
  4. Many times a person’s favorite Chiropractor is not in the advantage programs network. If that is important to you, that is a gap that can be covered. It costs about per month and gives you
  5. The last one here is not necessarily a gap, but follows along those lines. Many times when someone contracts cancer they have to travel to a specialist and they obviously either need to or want to take a family member with them. That of course costs money. So the last benefit you can add on to these policies is a cancer benefit. If you have his benefit and are diagnosed with cancer this policy can pay you anywhere from $1,000 to $10,000. The cost for this benefit is

It is important to restate here that everything from number 2 on down is optional. It is basically an a la care system. You add what you want and ignore the parts that don’t matter to you.

Up until now many of us including me preferred the supplemental route because we would rather pay more per month and know that after that we are basically paid up for the year. But it has always been one of those things we are constantly mentally wrestling with. If we only go to a doctor a couple times a year and have no hospital stays would we have been quite a bit better off financially by having a Medicare advantage plan instead. But still we didn’t like him thinking of all those co-payments and the possibility of paying up to $4,000 per year in medical costs. As the supplemental programs keep getting more and more expensive we think about this decision harder and harder and that is what led me to finding the policies that fill the gaps. So now I know that for just a few dollars a month I can have the coverage I want and need and yet do it for about $150 per month less. I would be more than happy to run a free quote for you and send it to you either by email or regular mail. Of course, I am also available to discuss this or any other financial topic, whenever you need and are ready.

I use these policies to cover the gaps in Medicare coverage but they are available to everyone so if you know someone under the Medicare age of 65 who has a high deductible health insurance policy they can also get these policies. It is an extremely affordable way to help cover some of those large deductibles.