Who qualifies for supplemental health insurance?

Medical insurance doesn't cover everything. Supplemental insurance plans can broaden your health coverage or reduce medical costs.

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Elissa SuhSenior Editor & Disability Insurance ExpertElissa Suh is a disability insurance expert and a former senior editor at Policygenius, where she also covered wills, trusts, and advance planning. Her work has appeared in MarketWatch, CNBC, PBS, Inverse, The Philadelphia Inquirer, and more.

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Key takeaways

  • Supplemental insurance plans can help cover out-of-pocket costs, like deductibles and copays

  • Vision and dental coverage are common examples of supplemental plans

  • For Medicare beneficiaries, people who have Original Medicare qualify for buying supplemental insurance (Medigap plans)

  • You can purchase supplemental health insurance products through an insurance company or brokerage

Major medical insurance plans don’t cover everything. Even if you have a Gold metal tier health plan, the highest level of health plan with the most cost sharing, you may still have to pay some out-of-pocket expenses, like a deductible. And you may not even have dental or vision coverage — in fact, many health plans don't. That’s where supplement plans come in.

Supplemental health insurance can augment your existing insurance coverage if your current benefits aren’t robust enough. They can provide you with extra benefits, like the previously mentioned vision or dental insurance, or they can help pay for more health care costs. For example, supplemental insurance coverage can help you if you contract a critical illness or need a specific medical procedure, like if you have a stroke or need cancer treatment.

People who get health insurance coverage through Medicare are already familiar with supplemental plans, but they’re not limited to senior citizens. If you aren’t a Medicare recipient, you can purchase supplemental plans from private insurers. We'll talk about different supplemental health insurance products that you'll encounter today and what benefits they provide.

Vision and dental insurance

If you get health insurance through your employer, it is more than likely that they will offer you a vision and dental plan as well. These plans operate separately from your medical insurance, and may be from a different insurance provider. Check with your human resources department to find out more.

If you have a health insurance plan for your family, then pediatric dental and vision services will be covered for children up to age 19 (as part of the ten essential health benefits.)

In all other cases, you may have to buy a supplemental dental insurance or vision insurance plan if you want these benefits, as not all plans include them. Note that if you buy your supplemental health insurance plan through the Obamacare marketplace, you may need to wait until open enrollment.

Learn more about how health insurance works.

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Vision coverage

Medically necessary procedures for your eyes should be covered by health insurance, but your health plan won’t cover vision-related expenses, like eye exams, eyeglasses, and contact lenses. Vision coverage can help pay for these benefits, and some plans may even cover LASIK or other corrective surgery.

You have to pay a monthly premium for vision insurance, which gives you a discount or allowance toward covered expenses. Depending on how frequently you need new glasses or lenses, vision insurance might be worth it.

Some health insurance companies may let you buy vision insurance from them, but if they don’t you can shop for vision insurance on your own.

Dental coverage

Dental insurance is structured similarly to major health insurance plans. You’ll pay monthly premiums, a deductible, and copays or coinsurance. The benefits include preventive care, like routine cleanings, and coverage for other services like fillings or root canals. How extensive your coverage is will depend on your specific plan.

Also like a health plan, dental coverage may be offered as HMO or PPO plans.

Learn more about the difference between HMOs, PPOs, and other types of health insurance.

Dental discount plans for which you pay a monthly membership fee, to unlock discounts on certain services or products, are also becoming more common. These are not insurance plans and they do not offer traditional dental insurance coverage.

Supplemental health insurance products

Supplement plans are commonly added to Medicare Parts A and B, but they exist for private health insurance plans, too. Medicare Part A and Part B, together called Original Medicare, do not offer dental and vision coverage, but some Medicare Part C (Medicare Advantage) plans might.

Medicaid, which offers free or low-cost health care coverage to lower-income people, may offer dental and vision coverage, but it will depend on your state. Some states offer more generous Medicaid vision and dental coverage than others.

Learn more about the difference between private and public health insurance.

Medicare supplement plan

Medicare provides health insurance for Americans age 65 and over. While there are many covered benefits, it’s common for Medicare recipients to supplement their plan with a Medigap policy, which helps pay for out-of-pocket expenses. Medicare supplement plans are only available for recipients of Original Medicare, not Medicare Advantage, although if you have Part C you may be able get these supplemental services covered directly through your plan. You can enroll in Medigap during Medicare open enrollment.

Learn more about Medicare Supplement Insurance.

Critical illness insurance

Private insurers also offer supplemental health insurance policies. Most of these health insurance products are designed to pay a set amount of money under certain conditions. (It works similarly to a life insurance policy, which pays out a lump sum after the policyholder passes away.)

For example, an insurance company may offer supplemental health insurance coverage for a critical illness, like cancer, heart attack, or stroke. The policy pays out a lump sum of cash, which can typically be spent without any restrictions — though some supplemental health plans are intended to cover the cost of a specific medical treatment only, like chemotherapy.

Premiums for critical illness insurance depend on your age and sometimes your health. If you’re interested, Policygenius can help you compare quotes for critical illness insurance.

Indemnity insurance

Also known as a fee-for-service insurance, this insurance product pays a set fixed cost for an eligible medical expense, no matter what. This can be useful if your primary health insurance plan leaves you footing a large bill.

As an example, a hospital indemnity insurance plan may allocate $500 for a day for emergency room visit. You can go to any hospital for care. If the bill is over $500, then you’ll have to pay the hospital the difference, but if the bill is under, then you can keep the difference since the indemnity play is required to pay you the predetermined amount.

If you already have a major medical insurance (which is required to cover emergency services), then indemnity insurance can act as supplemental coverage, so you won’t have to pay anything out of pocket. You may even have money leftover to use toward other future medical expenses.

Indemnity insurance also gives you freedom of choice regarding providers since you aren’t limited to in-network doctors. (Some insurance companies may offer you incentives to use their preferred providers though.)

Disability insurance

Disability insurance can help replace a part of your income should you become unable to work due to an injury or illness.

Many people get disability insurance through their employer, but if you don’t have a policy, you can buy a short- or long-term policy on your own.

Policygenius can help you get the best rates for disability insurance.

Long-term care insurance

Private health insurance does not cover long-term care expenses, like an extended stay in a nursing home or assisted living facility. (Medicare recipients can receive long-term care coverage if they qualify for Medicaid.) A majority of older adults will need long-term care at some point in their life. Purchasing long-term care insurance policy can help pay for these costs, which can run over $100,000 a year.

Learn more about long-term care insurance.

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