& Medicare. You This is the official U.S. government Medicare handbook. What s important in 2016 (page 12) What Medicare covers (page 37)
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1 & Medicare You 2016 This is the official U.S. government Medicare handbook. What s important in 2016 (page 12) What Medicare covers (page 37) CENTERS for MEDICARE & MEDICAID SERVICES
2 Section 6 What are Medicare Supplement Insurance (Medigap) Policies? 99 Original Medicare pays for many, but not all, health care services and supplies. Medicare Supplement Insurance policies, sold by private companies, can help pay some of the health care costs that Original Medicare doesn t cover, like copayments, coinsurance, and deductibles. Medicare Supplement Insurance policies are also called Medigap policies. Some Medigap policies also offer coverage for services that Original Medicare doesn t cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Then, your Medigap policy pays its share. You have to pay the premiums for a Medigap policy. Section 6 What are Medigap Policies?
3 100 Section 6 What are Medicare Supplement Insurance (Medigap) Policies? Medigap policies are standardized Every Medigap policy must follow federal and state laws designed to protect you, and they must be clearly identified as Medicare Supplement Insurance. Insurance companies can sell you only a standardized policy identified in most states by letters A through D, F through G, and K through N. All policies offer the same basic benefits, but some offer additional benefits so you can choose which one meets your needs. In Massachusetts, Minnesota, and Wisconsin, Medigap policies are standardized in a different way. Note: Plans E, H, I, and J are no longer available to buy, but if you already have one of those policies, you can keep it. Contact your insurance company for more information. How do I compare Medigap policies? Different insurance companies may charge different premiums for the same exact policy. As you shop for a policy, be sure you re comparing the same policy (for example, compare Plan A from one company with Plan A from another company). In some states, you may be able to buy a type of Medigap policy called Medicare SELECT (a policy that requires you to use specific hospitals and, in some cases, specific doctors or other health care providers to get full coverage). If you buy a Medicare SELECT policy, you have the right to change your mind within 12 months and switch to a standard Medigap policy. Definitions of blue words are on pages
4 Section 6 What are Medicare Supplement Insurance (Medigap) Policies? 101 Benefits A B C D F* G K L M N Medicare Part A coinsurance and hospital costs (up to an additional 365 days after Medicare benefits are used) Medicare Part B coinsurance or copayment The chart below shows basic information about the different benefits that Medigap policies cover. If a percentage appears, the Medigap plan covers that percentage of the benefit, and you re responsible for the rest. Note: You ll need more details than this chart provides to compare and choose a policy. See page 104 to find out where to get more information. Medicare Supplement Insurance (Medigap) plans 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 50% 75% 100% 100% ** Blood (first 3 pints) 100% 100% 100% 100% 100% 100% 50% 75% 100% 100% Part A hospice care 100% 100% 100% 100% 100% 100% 50% 75% 100% 100% coinsurance or copayment Skilled nursing facility care 100% 100% 100% 100% 50% 75% 100% 100% coinsurance Part A deductible 100% 100% 100% 100% 100% 50% 75% 50% 100% Part B deductible 100% 100% Part B excess charges 100% 100% Foreign travel emergency (up to plan limits) 80% 80% 80% 80% 80% 80% Out-ofpocket limit in 2015 $4,940 $2,470 * Plan F also offers a high-deductible plan in some states. If you choose this option, this means you must pay for Medicare-covered costs (coinsurance, copayments, and deductibles) up to the deductible amount of $2,180 in 2015 before your policy pays anything. ** Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don t result in an inpatient admission.
5 102 Section 6 What are Medicare Supplement Insurance (Medigap) Policies? What else should I know about Medicare Supplement Insurance (Medigap)? Important facts You must have Part A and Part B. You pay the private insurance company a monthly premium for your Medigap policy in addition to your monthly Part B premium that you pay to Medicare. Contact the company to find out how to pay your premium. A Medigap policy only covers one person. Spouses must buy separate policies. You can t have prescription drug coverage in both your Medigap policy and a Medicare drug plan. See page 117. It s important to compare Medigap policies since the costs can vary and may go up as you get older. Some states limit Medigap premium costs. When to buy The best time to buy a Medigap policy is during your Medigap Open Enrollment Period. This 6-month period begins on the first day of the month in which you re 65 or older and enrolled in Part B. (Some states have additional Open Enrollment Periods.) After this enrollment period, you may not be able to buy a Medigap policy. If you re able to buy one, it may cost more. If you delay enrolling in Part B because you have group health coverage based on your (or your spouse s) current employment, your Medigap Open Enrollment Period won t start until you sign up for Part B. Federal law generally doesn t require insurance companies to sell Medigap policies to people under 65. If you re under 65, you might not be able to buy the Medigap policy you want, or any Medigap policy, until you turn 65. However, some states require Medigap insurance companies to sell Medigap policies to people under 65. Definitions of blue words are on pages
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