Taking Care of Mom and Dad: Benefit Provisions

The benefit provisions of a Medigap policy include the details of how the deductibles and copayments under Medicare Parts A and B are reimbursed, how the policy treats allowable Medicare charges and excess charges and how important it is for your parents to use participating providers. Optional benefits -- such as private hospital rooms, coverage for blood and coverage of outpatient prescription medication -- are also described here.

It's essential that your parents understand the claims process under both Medicare and the Medicare supplement policy. The mandatory provisions in their policy will define the steps for filing a claim.

Generally, Medicare supplements exclude the same services that Parts A and B do; but some supplements offer coverage for certain Medicare exclusions. These additional benefits (available for an additional premium) might include a benefit for private hospital rooms or prescription drugs. In addition, the Medicare supplement normally excludes conditions common to most health insurance policies. These would include losses from war or act of war and self-inflicted injuries.

Most Medigap policies (Plans A to G) exclude coverage for prescription drugs. While your parents may never need inpatient hospitalization, they'll probably need prescriptions filled at some point. So, unless your parents are very healthy, very wealthy -- or both -- it's worth the extra premium for them to have this coverage.