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Supplemental Health Insurance 101
Everything you need to know about supplementing your health insurance.
Supplemental health insurance is used to fill any coverage holes left by a health insurance plan. There are several different types of supplemental insurance plans, many of which are targeted to specific health issues. It can be bought in a private marketplace, from an agent, or directly from a supplemental insurance company.
If you have health insurance provided by your employer, you may not be too familiar with supplemental insurance because you’ve never thought that you needed it. Well, that is until you open that bill from the doctor’s office only to see that a recent service was not adequately covered by your plan.
Or maybe you bought your own individual health insurance plan and had to sacrifice coverage in one area in order to gain better protection in another. And then there are some things that are just not covered by most health insurance plans to begin with.
No matter the scenario, supplemental health insurance can be instrumental to the healthcare coverage of a family or individual.
So What is Supplemental Insurance?
Think of supplemental insurance as a collection of mini insurance plans that you can sprinkle on top of your regular health insurance. While normal health insurance is rather broad and general, supplemental insurance plans tend to be more specific to one particular area of coverage. Basically, supplemental health insurance is an added layer of protection used to cover what a traditional health insurance plan does not.
Some forms of supplemental health insurance can cover some out-of-pocket expenses left in the wake of regular—or primary—health insurance plans. These can include copayments, coinsurance, and deductibles. Supplemental plans will pay out either periodic benefits or a lump sum of cash to the customer. This money can be used to pay for lost wages, transportation, medication, or anything else resulting from an injury or illness.
Just as with normal health insurance, there’s a lot consumers need to know about supplemental insurance. What are the different types? Why should you get it? And how? Read on for these answers and more.
Types of Supplemental Health Insurance
As is the case with traditional health insurance, there are many different types of supplemental insurance.
Critical Illness Insurance
Sometimes called “critical care insurance,” this type of supplemental insurance provides coverage for illnesses such as cancer, major organ transplants, strokes, heart attacks, kidney failures, and more.
Some types of critical illness insurance plans are specific to one particular type of illness or disease. If diagnosed, you may receive cash benefits paid per procedure or round of treatment. There is often a minimum daily benefit as well as a policy maximum.
Accident insurance pays lump-sum cash benefits if you are injured in an accident. This type of supplemental insurance can help you pay medical costs and living expenses while you are healing.
Covered expenses often include surgery, emergency treatment, hospital confinement, and physical therapy.
Also called a “hospital indemnity plan,” this kind of insurance will provide coverage for hospital stays. A one-night stay in a hospital can cost over $4,000, so hospital insurance can prove to be a worthy investment.
Fixed Indemnity Insurance
Out-of-pocket expenses can get out of control after an illness or injury. A fixed indemnity plan can help you manage those expenses with cash benefits paid directly to you.
Health insurance helps cover your medical bills if you are sick or injured. Disability insurance helps retain some of your income if you become too sick or injured to continue working. Some disability plans pay out benefits only for an illness, while others pay for illness and injuries.
Long-term Care Insurance
Protecting your independence and finances becomes more important as you age. This type of plan can help protect your assets, as well as give you more choice and control, when you need long-term care.
A life insurance policy pays out a lump sum to a beneficiary in the event of one’s death. Just like health insurance, monthly premiums are required to maintain coverage.
Preventing lasting damage to your teeth and gums is essential to your long-term health, not to mention your smile. Some health insurance plans include dental coverage, but because dental is not one of the required benefits of the ACA, the majority of plans do not. Dental coverage for children however, is a required benefit and comes standard with all ACA-approved plans.
Dental insurance works just like health insurance with monthly premiums, copayments, coinsurance, and deductibles.
Preventive care for your eyes and prescription eyewear are not covered under normal health insurance terms. But benefits like these, and even laser eye surgery, can be acquired through vision insurance.
Most vision insurance plans provide services at discounted rates in exchange for a monthly premium.
Metal Gap Insurance
A Metal Gap Plan helps fill the gaps left by metal level health plans (Bronze, Silver, and Gold). It can help you manage deductibles, coinsurance, and copays. This type of plan may come in handy for those who have lower premiums but higher deductibles and other out-of-pocket expenses.
Supplemental Plans for Medicare
Medicare is beneficial to many Americans, but like health insurance, not everything is covered. Because of this, Original Medicare (Parts A & B) has its own family of supplemental insurance. Many consumers use this supplemental insurance to complement their Medicare benefits.
A Medigap plan can help with extra hospital benefits, nursing home services, preventive care, and more. Essentially, it covers the gap between what your Original Medicare benefits cover and what your actual coverage needs are.
Medicare Part ‘D’
Medicare Part D helps bridge the cost gap for prescription drugs.
Medicare Advantage is more of a combined type of Medicare coverage as opposed to a supplement. It combines Original Parts A and B, and often includes Part D (prescription drug) coverage as well. With a Medicare Advantage plan, it is not necessary (or even allowed) to purchase a Medigap plan.
Supplemental Insurance for Seniors
There are standalone supplemental plans that have been modified to meet seniors’ unique needs. These plans are not part of Medicare but can be used to supplement Original Medicare coverage, as well as traditional health coverage.
These senior specific plans include dental, vision, fixed indemnity, and final expense insurance. Coverage options are geared towards seniors’ needs and come at affordable prices.
“Supplemental” and “secondary” insurance are terms that are often used interchangeably. They are both phrases for the same products: additional insurance plans that compliment your health insurance.
Because it is a second insurance plan, your health plan being the first, some like to refer to it as “secondary health insurance.” Meanwhile, others like to refer to these plans as “supplemental” because they complement your health plan, supplementing for gaps in coverage.
Supplemental vs. Short-Term
Supplemental insurance is sometimes confused with short-term insurance, but they are in fact two very different things.
While supplemental insurance is used in addition to a regular health insurance plan, short-term insurance is used in place of a normal insurance policy. Short-term, or “temporary” insurance, is a health insurance plan that can be quickly put into place to satisfy a short-term need for health coverage.
People who are between jobs can find themselves in a gap between health insurance plans, and a temporary insurance plan can help bridge the gap. Or, those who travel outside of their network coverage area for an extended period of time might need it to ensure they are covered while away from home. Recent divorcees or those who missed the open enrollment period may also benefit from short-term health insurance.
Supplemental insurance can be used on top of short-term insurance in the same way that it can be used to complement normal health insurance.
How to Buy Supplemental Health Insurance
Supplemental health insurance can be acquired in the same fashion as primary insurance. Some supplemental insurance can be purchased through a private marketplace like HealthMarkets, through licensed agents, or directly from an insurance company.
One difference that exists between primary and supplemental health insurance is that you do not need to wait for an open enrollment period to purchase supplemental insurance. You can add a supplemental plan at any time, but many plans do exclude pre-existing conditions.
Examine any holes in coverage in your primary plan and gauge your chances of needing a supplemental plan.
You’ll also want to consider how often you see a doctor and whether you have any conditions that require periodic treatments or visits. Looking at your family health history can also provide an indicator of potential risks.
Of course, you’ll want to also measure how much you can afford to pay for insurance each month, as well as how much you can afford if an accident or serious illness occurs.
Reading up on supplemental health insurance is smart, but there’s no substitute for speaking with an agent. Call HealthMarkets at (800) 360-1402, and one of our 3,000 licensed agents will be happy to help you find the supplemental health insurance you need.