How Medicare Supplement coverage works

As the name implies, Medicare Supplement coverage supplements or adds to the coverage provided under Medicare Parts A and B. It also provides benefits for some expenses that are not covered by Medicare.

When you retire, your medical coverage through the Board of Pensions ends. If you are age 65 or older (or under age 65 with certain disabilities), you can enroll for Medicare, which provides the foundation for your healthcare coverage in retirement. However, Medicare alone may not provide all the coverage you need. Therefore, you may want to consider enrolling in the Medicare Supplement Plan.

Benefits that complement Medicare

Medicare Supplement coverage generally provides benefits for the same services and supplies covered by Medicare Parts A and B, including

  • prolonged hospitalization;
  • skilled nursing facility care;
  • inpatient and outpatient psychiatric treatment;
  • medical supplies and services;
  • ambulance services; and
  • your Medicare Part A and Part B deductibles.

After Medicare pays its portion of covered medical charges, Medicare Supplement coverage typically pays 80 percent of Medicare's allowance for the remaining balance after your Medicare Supplement deductible is met.

Benefits in addition to what Medicare covers

Medicare Supplement coverage also provides benefits for the following expenses that are not covered by Medicare Parts A and B:

Medicare Supplement coverage does not cover the following:

  • routine dental or hearing care
  • custodial care
  • services for you if you reside outside the United States

Medicare-participating providers

You can use any provider who participates in Medicare; there is no special network you must use. Providers who participate in Medicare have agreed to accept the Medicare-approved amount for covered services and supplies as payment in full.

Medicare Supplement coverage does not pay for care from providers that don’t participate in Medicare or for charges in excess of what Medicare allows (the Medicare-approved amount).

Getting reimbursed

To get claims paid under Medicare Supplement, you usually don’t need to do anything. Because Medicare provides your primary medical coverage, all of your medical claims (except for prescription drugs and medical services while traveling outside the United States) go to Medicare first. Your provider usually submits your claim to Medicare for you. Medicare processes your claim, paying its portion, and then passes the claim electronically to Highmark Blue Cross Blue Shield for secondary payment under Medicare Supplement.

Highmark then pays the Medicare Supplement Plan’s portion of the claim to the provider and sends you an explanation of benefits statement. Your provider will bill you for any remaining balance.