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Medicare Supplement Insurance FAQs

 

For people age 65 years and older, Medicare is a federal health insurance program. It also covers certain people with a disability or end-stage renal disease. Medicare pays for much of your health expenses, with exceptions for certain costs. These cost include items like certain home nursing care expenses and your out of pocket costs. Out of pocket costs that you must pay, like coinsurance, co-payments, and deductibles, are called “gaps” in original Medicare plan coverage.

Part A (Hospital Insurance) helps pay for inpatient hospital care, some skilled nursing facility care, hospice care, and some home health care. Your out of pocket with Medicare Part A includes a fairly hefty deductible per benefit period and co-pays for days 61+ in the hospital. The part A benefit period is your stay in the hospital and 60 days after your get out of the hospital. So, you could conceivably have to meet multiple part A deductibles within a calendar year. The co-pays for days 61-90 is $267/day and the co-pays for days 91+ is $512/day. So, as you can see it can get rather expensive if you have multiple hospital stays or extended stays in the hospital.

Part B (Medical Insurance) helps pay for doctors' services, outpatient hospital care, and some other medical services that Part A doesn't cover. Part B helps pay for such covered services and supplies when they are medically necessary. The part B deductible is relatively inexpensive compared to the Part A deductible and is a calendar year deductible. However, once the deductible is met you will be responsible for 20% of your Medicare Part B-related expenses. This can also get rather expensive if you are having to undergo major medical treatment.

A Medicare supplement insurance plan is a health plan sold by private insurance companies and provided by insurance agents across the country. These Medicare supplement plans must follow federal and state laws, which protect you.

You might want to think about getting a Medicare Supplement Plan to cover the gaps in Original Medicare coverage. Some plans cover benefits that the Original Medicare Plan doesn’t cover as well, like At Home Recovery Services, emergency health care while traveling outside the United States, and Preventive services that are not otherwise be covered by Medicare. These plans may help you save on out of pocket costs. If you buy a Medicare supplemental insurance plan, you will pay a monthly premium to the private Medicare supplement insurance company. Medicare supplement plans do not have an open enrollment period, which allows you to switch to another Medicare supplement plan at any point throughout the year as long as you are qualified medically.

This depends on your personal preferences, needs and requirements. Consideration should be given to benefits, cost, your economic situation, and current health. A Compare-HealthQuotes medicare specialist partner can answer your questions and provide you with the information you need to make a wise healthcare choice.

You may need to supplement Medicare Coverage for one of the following reasons:

  • Medicare was never designed to pay all the health care costs of senior citizens.
  • Medicare coverage has many types of health expenses which are not covered or are subject to the out of pocket expenses.
  • Medicare deductibles increase every year.

Click here to get a quotes from some of the the top carriers in your area from a local insurance agent who specializes in health plans for senior citizens.

Starting January 1, 2006, Medicare recipients were offered the Medicare Part D drug coverage. All Medicare recipients can get this coverage which can help lower out of pocket expenses you incur due to drug costs. It should also protect against higher costs in the future. Medicare Part D drug coverage is a Medicare program run through private insurance companies across the country.

With Medicare Part D, you choose the drug plan and pay a monthly premium. Similar Medicare part B insurance, if you don't enroll in a Part D plan when you are first eligible, you will pay a penalty if you choose to join later.

If you wait and don’t take Medicare part D when you are initially eligible your cost for this coverage will go up at least 1% per month for every month that you wait to join. You will have to pay this penalty as long as you have Medicare drug coverage. When you join by December 31 in any year your coverage will begin January 1 of the next year.

The open enrollment period is a 6-month period that begins the first day of the month in which you are both age 65 or older and enrolled in Medicare Part B. During this time your right to buy a Medicare supplement policy is guaranteed.

This period begins three months before the month you turn 65 and ends 3 months after the month you turn 65. If you wait until you are 65 or sign up during the last 3 months of the Initial Enrollment Period, the Medicare Part B start date will be delayed.

Open enrollment allows you to be guaranteed a Medicare supplement insurance plan regardless of your health history. If you apply outside of this time, you must meet medical underwriting requirements to qualify if the insurance company requires it. The Medicare Supplemental open enrollment period includes a six-month period from the date you enrolled in Medicare Part B if age 65 or older, or a six-month period when you turn 65 if you were eligible for Part B benefits before age 65.

Guaranteed issue right situation…

If your Medicare Advantage Plan is leaving the Medicare Program, stops giving care in your area, or you move out of the plan’s service area.

You have the right to buy …


Medigap Plan A, B, C, or F, K, or L that is sold in your state by any insurance company. For this right you must switch to the Original Medicare Plan.

When you apply for a Medigap policy…

You can apply up to 60 calendar days before the date your health care coverage will end and no later than 63 days after your health care coverage ends.

If you have the Original Medicare Plan and you also have an employer group health plan or union coverage which pays after Medicare pays - and you are no longer eligible for that coverage. This event includes when your retiree or COBRA coverage expires.
Note: in this situation state laws may vary.

For Medigap Plan A, B, C, F, K, or L that is sold in your state by any insurance company - If you have COBRA coverage you can either buy a supplemental policy or wait until the COBRA coverage ends.

You must apply within 63 calendar days after the latest of these three dates.

  • the date your coverage ends,
  • the date on the notice that coverage is ending, or
  • the date on claim denial, if were only notified of the loss of coverage by receiving a denied claim.

You are in the Original Medicare Plan and have a Medicare SELECT policy. You move out of the Medicare SELECT plan's service area.You can keep your Medigap policy or you may want to switch to another Medigap policy.

Medigap Plan A, B, C, F, K, or L that is sold by any insurance company in your state or the state you are moving to.

You can apply up to 60 calendar days before the date your health care coverage will end. You must apply no later than 63 days after your health care coverage ends.

Trial Right: You joined a Medicare Advantage Plan or PACE when you are first eligible for Medicare Part A at age 65 and within the first year of joining, you decide you want to switch to the Original Medicare Plan.

ANY Medigap policy that is sold in your state by any insurance company.

You can apply up to 60 calendar days before the date your health care coverage will end. You must apply no later than 63 days after your health care coverage ends.
Note: Your rights may last for an extra 12 months under certain situations.

Trial Right: You dropped a Medigap policy to join a Medicare Advantage Plan (or to switch to a Medicare SELECT policy) for the first time; and you have been in the plan less than a year and want to switch back.

The Medigap policy you had before you joined the Medicare Advantage Plan or Medicare Select policy, if the same insurance company you had before still sells it. If it included drug coverage, you can still get that same policy, but without the drug coverage.If your former Medigap policy isn’t available, you can also buy a Medigap Plan A, B, C, F, K, or L that is sold in your state by any insurance company.

You can apply up to 60 calendar days before the date your health care coverage will end. You must apply no later than 63 days after your health care coverage ends.
Note: Your rights may last for an extra 12 months under certain circumstances.

Your Medigap insurance company goes bankrupt and you lose your coverage, or your Medigap policy coverage otherwise ends through no fault of your own.

Medigap Plan A, B, C, or F, K, or L that is sold in your state by any insurance company.

You must apply 63 calendar days from the date your coverage ends.

You leave a Medicare Advantage Plan or drop a Medigap policy because the company hasn’t followed the rules, or misled you.

Medigap Plan A, B, C, or F, K, or L that is sold in your state by any insurance company.

You must apply 63 calendar days from the date your coverage end

Creditable coverage is any previous health insurance coverage, such as a health insurance coverage under a group (employer) health plan or an individual health insurance policy. Keep in mind that if there was any time when you had no health insurance coverage for more than 63 days in a row, you can only count the creditable coverage you had after that lapse coverage.

No, but the length of time you've had your Medicare supplemental plan will affect how your new Medicare Supplement policy covers you for pre existing conditions. If you've had a Medicare Supplement insurance plan for at least six months and you decide to switch, your new Medicare supplemental insurance plan must cover you for all pre existing conditions. If you've had a Medicare supplemental insurance plan for less than six months, the new Medicare supplement policy must give you credit for the time the older policy covered you.

Because your Medicare supplemental insurance plan is guaranteed renewable, you will still have insurance coverage if you move. If you move to a new state, however, the Medicare supplement insurer may quote you a different premium. If you have a Medicare Select insurance plan, which contain network restrictions, you must change your Medicare insurance coverage. But you have the right to buy Medicare supplemental insurance plans A, B, C or F in the state you move to without having to medically qualify.

Persons living or traveling outside the United States usually cannot benefit from Medicare. This is because, generally speaking, the program provides protection against the cost of hospital and medical expenses incurred in the United States.

There are rare emergency cases where Medicare can pay for care for those who travel to Canada or Mexico. Also, Medicare can sometimes pay if a Canadian or Mexican hospital is closer to your home than the nearest U.S. hospital that can provide the care you need.

If you get emergency treatment in a Canadian or Mexican hospital or if you live near one, ask someone who works at the hospital about Medicare coverage, or have the hospital help you contact the Medicare Intermediary.

Health insurance protection may be very important to anyone temporarily abroad who plans to return to the United States. If you plan to return to the United States shortly after you are eligible for the medical insurance program, you may wish to enroll during your first enrollment period. If you expect to be abroad for a longer period of time, you may wish to enroll during a later general enrollment period.

This is the fee that Medicare establishes with providers who accept "Medicare assignment" will charge for a covered medical service. If the doctor does not accept assignment of Medicare benefits, the Medicare approved amount may be less than the actual amount charged by a doctor or supplier for a service or supply.

 

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