Definition & Meaning
A Medicare Select Policy is a type of Medicare Supplement (Medigap) insurance that requires policyholders to use hospitals and, in some cases, doctors within its network in order to receive full benefits. If you choose to go outside the network, you might have to pay more for services, except in emergencies.
Etymology & Background
The term Medicare Select Policy stems from the integration of “Medicare,” a national health insurance program primarily for individuals 65 and older, and “Select,” indicating a predefined network of medical providers. These policies emerged to offer a more cost-effective option for obtaining supplemental Medicare coverage by restricting the choice of healthcare providers.
Key Takeaways
- Network Restrictions: Only certain hospitals and healthcare professionals are covered.
- Cost Savings: Often less expensive due to the use of network providers.
- Emergency Coverage: Typically still applies outside the network.
- Approval Requirement: Policies and networks must be approved by state insurance departments.
Differences and Similarities with Other Supplemental Policies
Differences:
- Medicare Supplement Plan: Standard Medigap policies may offer more flexibility in choosing providers.
- Medicare Advantage: These are often inclusive of additional benefits like vision or dental, whereas Medicare Select might not.
Similarities:
- Both are designed to supplement Original Medicare.
- Both may cover copayments, coinsurance, and deductibles.
Synonyms
- Medigap Select Policy
- Network-Based Medicare Supplement Plan
Antonyms
- Public Coverage
- Standard Medigap Policies (without network restrictions)
Related Terms
- Medicare: The federal health insurance program for seniors and certain younger people with disabilities.
- Medicare Advantage: An alternative to Original Medicare that includes managed care features.
- Network Provider: Healthcare providers contracted within an insurance plan’s network.
Frequently Asked Questions
What is the main advantage of a Medicare Select policy?
The main advantage is lower premiums due to the use of a limited network of providers.
Can I use a non-network provider with this policy?
Yes, but you’ll likely pay more out-of-pocket expenses compared to using a network provider unless it’s an emergency situation.
Are these policies available in every state?
Policies and their networks must be approved by state insurance departments, so availability can vary.
Exciting Facts
- Medicare Select was introduced as a cost-saving measure for Medicare Supplement policies.
- Network restrictions often do not apply in emergencies, offering a degree of flexibility.
Quotations
“Insurance: Paying for something you hope you never need, from someone you hope never to meet.” - Anonymous
Proverbs & Idioms
“You don’t know what you’ve got till it’s gone.” - Perhaps most relevant when it comes to the perceived non-need of health insurance—until it’s truly needed.
Government Regulations
- Centers for Medicare & Medicaid Services (CMS) regulate the approval and functioning of Medicare Select Policies.
- Each state’s Department of Insurance also oversees approvals and sets specific regulations.
Further Studies & Literature
Suggested Books:
- “Medicare For Dummies” by Patricia Barry
- “Get What’s Yours for Medicare: Maximize Your Coverage, Minimize Your Costs” by Philip Moeller
- “The Complete Idiot’s Guide to Medicare and Medicaid” by Patricia Barry
Journals & Articles:
- “The Impact of Network Restrictions on Medicare Beneficiaries” - Health Affairs
- “Medicare Supplement Coverage Trends” - Journal of Health Insurance
Quizzes
Keep navigating the ins and outs of your insurance with a smile! - Daniel Roberts
