The. Buying a Medicare Supplement Plan. Definitive Guide. (Large Print Edition) All Rights Reserved

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1 The Definitive Guide To Buying a Medicare Supplement Plan (Large Print Edition) All Rights Reserved

2 Table of contents: If you are thinking of buying a Medicare Supplement plan but are not sure how to do it, this is the guide you need. Before buying, knowing everything about what Medicare supplements are all about is a sensible thing to do. You can t just gather information from friends, family or relatives and decide immediately which one is the best for you, judging only from what they said. So let s run down some important details before heading to the buying process. Quick rundown a. What is Medigap? b. The benefits of Medigap c. What Medigap doesn t cover d. The Medigap comparison chart e. How Medigap premiums are set by companies? f. Am I eligible to buy a Medigap Insurance Plan? g. When Can I Buy a Medicare Supplement Insurance? h. Why buy a Medigap policy when I m first eligible? i. What do I need to know if I want to buy a Medigap policy? 4 Steps to buying Medigap policies Illegal Practices References 1 2

3 What is a Medicare Supplement plan (Medigap)? The Core Benefits of Medigap A Medicare supplement insurance policy or Medigap plan is a kind of private health insurance that works with your Original Medicare. It helps you pay for all or some of the costs (out-of-pocket expenses) that the Original Medicare did not cover. These costs include, but are not limited to deductibles, copayments, and coinsurance collectively known as Medicare Gaps. These Medicare gaps may add up over time and might cause a heavy burden to you and your finances. All Medicare Supplement plans have these core benefits at different levels of coverage. 1.Medicare Part A Coinsurance and Hospital Costs Medicare supplement will cover your daily coinsurance from day 61 up to an additional 365 days after Medicare benefits are used up. 2. Medicare Part A Hospice care copayment or coinsurance Medigap will cover all or part of coinsurance in Hospice care and also the 5% copayment for the inpatient respite care. 3 4

4 Other benefits of Medigap 3. Medicare Part B coinsurance or copayment Medigap will cover all or part of Medicare Part B for an unlimited amount of Medicare-approved outpatient care 4. Three Pints of Blood Medigap will pay for your initial blood supply when you need to undergo a blood transfusion. Without a plan, it would cost you about a whopping $1200 for the three pints of blood. Original Medicare will take over paying for the rest of the blood you might need. Other Medigap plans offer additional benefits in addition to the core benefits. Like the core, these plans provide the additional features at different levels or percentage. Skilled nursing facility care coinsurance Certain types of Medigap plans will pay all or part of your Skilled Nursing facility stay. These facilities provide intensive physical and behavioral rehabilitation after you had a severe medical condition. Who will benefit from this feature? Those who are already healthy to stay in a hospital but are still weak to return to normal day to day life at home. Those who still need to recover from a joint replacement surgery, or any other medical conditions that require time for recovery and rehabilitation. Other issues such as difficulty to go to the hospital without needing an intermediate assistance, still looking for caregivers, and those who are in need of oxygen therapy. 5 6

5 Part A deductible There are types of Medigap plans that won t let you pay out-of-pocket expenses such as Part A deductible which is worth $1340. Who will benefit from this feature? Those who got admitted or in need of hospital care but did not exceed or exceeded the Part A deductible of $1340. Part B deductible There are types of Medigap plans that will pay for Part B deductible, which is $183 for the year Who will benefit from this? Those who want to save $183 which you can use to cover other bills instead. Part B excess charge There are doctors who do not use the Medicareapproved prices but participates in Medicare. They are allowed to charge you a 15% more than the approved rate. Who will benefit from this? Those who want the widest options of doctors who also participate in Medicare. If your preferred doctor doesn t accept Medicare assignments. Foreign travel exchange Medicare alone, don t provide coverage when you travel outside the US. Medicare supplements, on the other hand, can travel with you and pay up to 80% of your emergency medical costs in other countries. Who will benefit from this? Those who travel to other countries and those who don t want to get a separate travel insurance. 7 8

6 What Medigap does not cover? How Medigap premiums are set by companies? Medigap policies don t cover long-term care (like care in a nursing home), vision or dental care, hearing aids, eyeglasses, or private-duty nursing. You can t also use Medigap to pay for premiums of Medicare Part B or any other policies Before buying a Medigap policy in your chosen private insurance company, you have to consider the premiums that you will be paying in the future. Private insurance companies use different rating systems to set Medicare Supplement cost. It means the premiums that you will be paying might increase over time. The rate how it will increase can be described as follows: a. Community-Rated NOT Policyholders, regardless of their age, are each charged the same monthly premium rate. Rates in this system will not increase as a beneficiary age. However, inflation may allow monthly premiums to increase over time. COVERED 9 10

7 b. Issue-Age-Rated Monthly premiums will be based on the age a beneficiary first enrolls for a Medigap policy. As such, the younger an applicant is, the lower the premium may be. Medicare supplement rates in this system will not increase as a beneficiary age. However, inflation may allow monthly premiums to increase over time. c. Attained-Age-Rated Monthly premiums will be based on the beneficiary s current age. As such, the younger an applicant is, the lower the premium may be. Monthly premiums are subject to increases over time. As you shop around for a Medigap, make sure that you will compare plans of the same type in different insurance companies. For example, compare Medigap Plan G of one insurance company with Plan G of another company. Also, don t forget to consider how companies are setting their prices (it affects how much you will pay today and in the future). Obtain Medigap quotes to check the cost of policies from different insurance companies

8 Am I eligible to buy a Medigap Insurance Plan? When Can I Buy a Medicare Supplement Insurance? Medicare supplements will work with your Original Medicare, that is Medicare Part A and Part B. So, to be able to qualify for a Medigap plan, you should first be enrolled in Medicare. You will be eligible to buy any of the supplement insurance plans if you are 65 and have Medicare Part B. Actually, you can enroll in a Medicare supplement plan anytime, once you got your Medicare Part A and B. But, there is only one best time to buy a Medigap policy that is during your Medigap open enrollment period. Your Medigap open enrollment period only lasts for six months, hence a very crucial time to grab yourself a Medigap plan. It begins on the first day of the month in which you are both 65 or older and are enrolled in Medicare Part B. It only comes once in your lifetime and could not be repeated anymore! However, states require insurance companies to offer at least one kind of Medigap plan to those who are under 65 and are qualified to buy a policy. The best time to buy a Medigap policy is during your Medigap Open Enrollment Period! 13 14

9 Why Is It Important To Buy A Medigap Policy When I m First Eligible? You do not want to miss these benefits of buying a Medigap plan when you are first eligible because 1. Insurance companies can t require you to undergo a medical underwriting process. 2. They also can t reject your application or charge you a more expensive premium because of your preexisting conditions or any health conditions you have when applying. 3. You can get policies at better prices and have more choices among the different plans. If you choose to enroll in Medicare part B later than you were first eligible for Medicare, you might have to pay penalties for late enrollment in Part B and miss your Medigap open enrollment period. The case if you are still under health coverage provided by your employer You can delay enrolling in Medicare Part B if you or your spouse are still under a health coverage provided by an employer. When the coverage provided by your employer ends, that s when you get a chance to enroll in part B without incurring late enrollment penalties. Also, only during that time that your Medigap open enrollment period will start. It is better to confirm this with your employer to make sure when it will end and if it works with Medicare. Guaranteed Issue Rights Scenarios 15 16

10 What do I need to know if I want to buy a Medigap policy? Medigap policies only cover one person. As long as you pay your monthly premium, your Medigap policy is guaranteed renewable. During your Medigap open enrollment period, you can buy a policy from any insurance company licensed to sell Medigap in your state. Insurance companies may charge different prices for same exact policy. Be sure to also compare the prices of the same kind of Medigap, as you shop around. If you want to buy a Medicare supplement plan, you have to review the basic benefits covered by the different policies then follow the buying process. Read:The Core benefits of Medigap. Your insurance agent doesn t have the power to cancel policy for you. You should be the one to inform the insurance company if you wish to cancel or leave your Medigap plan. Current Medigap plans don t have prescription drug coverage anymore. If you want to have coverage for prescription drugs, you can enroll in a Medicare Prescription drug plan or Medicare Part D

11 How To Buy A Medigap Plan? ( 4 Steps) After reviewing important details about Medicare supplement insurance plans, you can now move to the process of buying a policy. Please, before buying a Medigap policy, shop carefully and compare all the available Medigap policies to find which of them perfectly fits your needs. As you shop around, keep in mind that insurance companies can charge the same plans differently and not all of them offer all the types of Medigap plans. Here are the steps in buying a Medigap policy. (Massachusetts, Minnesota or Wisconsin may have different rules for their Medigap) Step 1 Know the benefits you want and find which Medigap policy meets your needs. Consider your current, as well as your future health status. Do this right now, because you may not be able to switch policies later in life. Decide what benefits you will need, and choose Medigap plan according to your needs

12 Step 2 Find out which insurance companies sell Medigap in your state. To do this You can call your State Health Insurance Assistance Program and request for a Medigap comparison shopping guide for your state. You can also call your State Insurance Department and ask for a list of companies. You can also use Medicare.gov/find-a-plan and find information on Medigap options available in your area. You can access this through the internet or you may use a computer or find help in your local library or senior center

13 You can also call and talk to a customer representative of Medicare to help you find information on all the Medigap policies available in your area. You can also request for quotes from us, and find which companies sell policies in your location and how much it costs. Be sure to check the credibility of the insurance companies. You can also ask those above about the background and integrity of the insurance companies that you are eyeing to get your policy. You can also ask someone you trust like family, friends, relatives or an agent who has a policy from a certain Medigap insurance provider. Step 3 Call the insurance company that sells the kind of Medigap plan you like and compare costs. Before you make your calls, know if you are in your Medigap open enrollment period and have a guaranteed issue right. You may want to call back your State Health Insurance Assistance Program if you are still unsure of your status. Ask these questions to each of the insurance companies that you will call: 1.Are you licensed to sell Medigap in? (The name of your state/location) If they answer no, stop here then proceed to the next company in your list

14 2.Do you sell Medicare supplement plan? (the letter of the Medigap you want) Make sure the company is selling the plan you are interested to buy. Inform them if you are interested in a Medicare SELECT or high-deductible Medigap policy to know if they also have it. 3. Do you require Medical underwriting for this policy? If you are on Medigap open enrollment period or have guaranteed issue rights you can proceed to the next steps. If not, then you may continue to ask the company how likely you will qualify for the policy. 4. Do you have a waiting period for pre-existing conditions? If they have, ask how long and take note of the answer of each company. 5. What rating do you use in setting the price of your Medigap policies? Is it community-rating, issue-agerating, or attained age-rating? Take note or write down the answers of each company. 6. I m years old. What would be my premium under this Medigap policy? If they use Attained-age rating, ask how frequently will the premium increase due to your age. 7. Has the premium for this Medigap policy increased for the past 3 years due to inflation or other reasons? If they answer Yes, ask how much it has increased 8. Do you offer any discounts or additional benefits? Take note of their answers then compare

15 Step Buy the Medigap policy 4 Once you are done with the previous steps and are sure which insurance company and Medigap policy you want, you can now apply for a plan. The insurance company where you apply should provide you with a copy of your Medigap policy in a clearly worded summary. Read it thoroughly and if there is something you don t understand in the policy, ask immediately. Don t hesitate to ask questions. Remember these things as you buy your Medigap policy: Filling an application form: Fill your application thoroughly and truthfully, including the medical questions. If another person, such as your insurance agent, fills the application form, check if everything is correct. If you buy a policy during your Medigap open enrollment period, know that the insurance company can t use any of the information in the medical questions that you answered to reject your application or give you a higher premium. They can t also ask you questions about family history or ask you to take genetic tests

16 Illegal Practices Paying for the policy: Make sure that you make it payable to the insurance company, not the agent. If you bought your policy through an agent, make sure to get a receipt complete with insurance company s information such as name, address, and phone numbers. Keep it in your records. Starting your Medicare supplement policy: Usually, Medigap policies begin the first of the month after you apply. But you may ask for your policy to begin at a certain time you want to start the coverage. If for some reasons they won t give you the effective date for the month you want, you may call your State Insurance Department. According to Medicare.gov, it is illegal to... Sell you a Medigap if they know that you already have Medicaid (except in some situations) Claim that a Medigap is part of Medicare or any federal program. Medigap is sold by private companies. Claim that Medicare advantage is same with Medigap. Getting your Medigap Policy: If you don t have your policy in 30 days call the insurance company provider. If you don t get it in 60 days call your State Insurance Department

17 Sell you a Medigap policy even if you have Medicare Advantage plan. Sell you a second Medigap policy. Pressure you into getting a Medigap policy. Lie or mislead you into switching from one company or policy to other. Sell you a Medigap plan that is not legally sold in your state. Misuse the names, letters, or symbols of the U.S. Department of Health & Human Services (HHS), Social Security Administration (SSA), Centers for Medicare & Medicaid Services (CMS), or any of their various programs like Medicare. Claim to be a Medicare representative if they are working for Medigap insurance company.sell you a Medicare Advantage Plan when you say you want to stay in Original Medicare and buy a Medigap policy. References 2018 Choosing A Medigap Policy: A Guide to Health Insurance for People with Medicare Medigap.pdf #SHIP&SID FreeMedSuppQuotes If you feel that any one of those things are done, or any of the federal law has been violated, call the Inspector General s hotline at TTY users can call

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