Medicare Supplement Insurance

Transcription

1 Medicare Supplement Insurance 2017 SHIP Fall Conference Senior Health Insurance Program /23/2017 Medicare Supplements 1

2 What is SHIP Senior Health Insurance Program Established in 1988 Free Medicare Counseling Program Sponsored by the State of Illinois o Illinois Department on Aging Do not sell or solicit insurance Dedicated to educating people with Medicare SHIP trains volunteer counselors throughout Illinois Provide one-on-one counseling o With Medicare Beneficiaries, family members and caregivers Enroll beneficiaries into various Medicare programs o Medicare Prescription Drug Coverage, SSA Extra Help, etc. Through community based sites 10/23/2017 Medicare Supplements 2

3 Medicare Supplement Insurance Does anyone ever feel like this? 10/23/2017 Medicare Supplements 3

4 Medicare Supplement Insurance Often called Medigap or MedSup Private health insurance Supplements the financial gaps in Original Medicare o Does not work with Medicare Advantage (MA) Helps pay some health care costs that Original Medicare doesn t cover (coverage gaps ) 10/23/2017 Medicare Supplements 4

5 Medicare Supplement Insurance Medicare will pay its share of the Medicareapproved amounts for covered health care costs Then your Medigap policy pays its share A Medigap policy covers one person 10/23/2017 Medicare Supplements 5

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8 About Medigap Policies You must have both Medicare Part A and Part B to get a Medigap policy You pay a monthly premium for the Medigap policy You pay your Medicare Part B premium 10/23/2017 Medicare Supplements 8

9 Medigap Plans Standardized plans identified by a letter Plans A, B, C, D, F, G, K, L, M, and N are currently sold Companies don t have to sell all plans Plans with the same letter must offer the same basic benefits An A is an A, no matter who you buy from and what they charge Only the policy cost will vary between companies 10/23/2017 Medicare Supplements 9

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11 Medicare SELECT Policies A type of Medigap policy with a network To get full benefits (except in emergency) Must use specific hospitals, and May have to see specific doctors Can be any of the standardized policies Generally cost less than non-network policies Not all companies sell Can switch to plan with equal or lesser value at any time 10/23/2017 Medicare Supplements 11

12 Medigap Costs Premiums may vary greatly for same Medigap plan Cost (monthly premium) can depend on Your age (in some states) Where you live (e.g., urban, rural, or ZIP Code) Company selling the policy Discounts (women, non-smokers, married couples) Medicare SELECT policies generally have lower premiums 10/23/2017 Medicare Supplements 12

13 Medigap Pricing Based on Age Type of Rating No-age-rated (community-rated) Issue-age-rated Attained-age-rated Description Everyone pays same regardless of age if 65 or older Generally least expensive over lifetime Based on age when purchased Doesn t go up automatically as you get older Note: No companies in Illinois currently use the issue age method. Premium based on current age Costs less when you re 65 Cost goes up each year as you get older Note: The only company using this rating methodology in Illinois is AARP/United Healthcare (UHC). 10/23/2017 Medicare Supplements 13 Premiums may go up due to inflation and other factors.

14 The Best Time to Buy a Medigap Policy Medigap Open Enrollment Period (OEP) for beneficiary turning age 65 A 6 month guaranteed issue period, beginning when you re first enrolled in Part B During that time, an insurance company must sell you a plan Can t be changed or repeated If miss Medigap Open Enrollment and are on Medicare due to age 65, you may be able to buy a Medigap policy any time an insurance company will sell you one subject to underwriting (denial) 10/23/2017 Medicare Supplements 14

15 Open Enrollment for the Disabled Under Age 65 In Illinois, those on Medicare due to disability and are under age 65 have the same rights as those 65 and older. 6 month guaranty to get any policy, from any company Will pay that company s highest rate At age 65, you will get an additional 6 month OEP without underwriting Note: Some States do not have guaranteed issue for disability eligible Medicare 10/23/2017 enrollees Medicare Supplements 15

16 Two Guaranteed Issue Companies In Illinois, only two companies offer guaranteed issue Medigap plans for those on Medicare due to disability and not in the OEP or guaranteed issue period Blue Cross Blue Shield Health Alliance IMPORTANT: This is only offered during the Annual Open Enrollment period from October 15 December 7 10/23/2017 Medicare Supplements 16

17 Delayed Medigap Open Enrollment Period (OEP) If you defer enrolling in Medicare Part B Because you or your spouse is still working, and You have group health coverage Medigap OEP is delayed Until you re 65 or older and enroll in Part B No late enrollment penalty Notify Social Security to delay Part B 10/23/2017 Medicare Supplements 17

18 Pre-existing Conditions and Medigap Health problem(s) you had before the new insurance policy starts Treated or diagnosed 6 months before coverage start date 10/23/2017 Medicare Supplements 18

19 Pre-existing Conditions and Medigap Pre-existing Condition Waiting Period Insurance companies can refuse to cover costs for excluded conditions for up to 6 months from policy start date ( look-back period ) Occurs when no prior creditable coverage and no break in coverage more than 63 days, for the six months prior to application Note: Some plans have no pre-existing condition waiting period (0, 3 or 6 month) 10/23/2017 Medicare Supplements 19

20 Medicare and the Marketplace The Affordable Care Act does not impact the pre-existing condition waiting period for Medigap coverage. 10/23/2017 Medicare Supplements 20

21 Can I Switch Medigap Policies? You might switch policies if you Are paying for benefits you don t need Need more benefits now Want to change your insurance company Find a cheaper policy 10/23/2017 Medicare Supplements 21

22 Switching Medigap Policies? If not in your Medigap Open Enrollment Period You may pay more for the new policy There might be medical underwriting (Can be denied) Could have a delay in coverage for pre-existing condition 10/23/2017 Medicare Supplements 22

23 When Can You Switch Medigap Policies? A guaranteed right under federal law allows you to switch only: During your Medigap Open Enrollment Period or If you have a guaranteed issue right You can buy anytime insurance company will sell to you When you buy a new Medigap policy You ll have a 30-day free-look period Don t cancel policy until new one is fully in effect May need to pay premiums on both policies while in transition. 10/23/2017 Medicare Supplements 23

24 Guaranteed Issue Rights Federal protections in certain situations Companies must sell you a Medigap policy All pre-existing conditions must be covered Can t be charged more Must apply within 63 days of date other coverage ends See the next two slides for all situations 10/23/2017 Medicare Supplements 24

25 Guaranteed Issue Rights This chart describes the situations, under federal law, that give you a right to buy a policy, the kind of policy you can buy, and when you can or must apply for it. All situations have no pre-existing wait periods. Chart is on Page of the SHIP Medicare Supplement Guide 10/23/2017 Medicare Supplements 25

26 Guaranteed Issue Rights This chart describes the situations, under federal law, that give you a right to buy a policy, the kind of policy you can buy, and when you can or must apply for it. All situations have no pre-existing wait periods. Chart is on Page of the SHIP Medicare Supplement Guide 10/23/2017 Medicare Supplements 26

27 Guaranteed Renewable Medigap policies purchased after 1992 are guaranteed renewable Your insurance company can t drop you unless one of the following happens: You stop paying your premium You weren t truthful on the Medigap application The insurance company becomes bankrupt or insolvent 10/23/2017 Medicare Supplements 27

28 Right to Suspend Medigap for People With Medicaid If you have both Medicare and Medicaid You generally can t buy a Medigap policy (duplication of coverage per insurance law) You can suspend your Medigap policy Within 90 days of getting Medicaid For up to 2 years You can start it up again 10/23/2017 No new medical underwriting Medicare Supplements or waiting periods 28

29 Right to Suspend Medigap If you suspend your Medigap policy You don't pay Medigap premiums The Medigap policy won t pay benefits You may not want to suspend your policy if you see doctors who don t accept Medicaid 10/23/2017 Medicare Supplements 29

30 New Information on Plans C and F Plans C and F will no longer be available as of 2020 This applies only to newly eligible beneficiaries Defined as those individuals who: (a) have attained age 65 on or after January 1, 2020; or (b) first become eligible for Medicare due to age, disability or end-stage renal disease, on or after January 1, If you were eligible for Medicare prior to 2020, you can still buy either plan after 2020, or switch your current Med Supp for a Plan C or F If you already have a Plan C or F, you can keep it! 10/23/2017 Medicare Supplements 30

31 2020 High Deductible Option For plans sold to newly eligible, on or after January 1, 2020: Plan G will be offered as the high deductible option 10/23/2017 Medicare Supplements 31

32 FYI: New Innovative Benefits Medicare Supplemental insurers can now add innovative benefits to a standardized supplemental policy Innovative benefits may include vision and dental benefits, comparable to many managed care plans Currently, Humana is the only company in Illinois offering these benefits, calling these plans Healthy Living plans Contact Humana for more details (listed in SHIP MedSup Guide) 10/23/2017 Medicare Supplements 32

33 How can I find out more about Medigap plans? Illinois Department Aging, SHIP Or SHIP at Aging.SHIP@illinois.gov Medicare Medicare & You 2017 handbook (24 hours a day, 7 days a week) TTY SHIP Medicare Supplement Comparison Guide Web site: Download the Medicare Supplement Comparison Guide 10/23/2017 Medicare Supplements 33

34 Thank you Are There Any Questions? Senior Health Insurance Program /23/2017 Medicare Supplements 34