Medicare Supplement Insurance FAQs
Medicare - What Is It?
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 and Part B of Medicare
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.
What is a Medicare Supplemental plan?
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.
Which type of Medigap Plan is Right for Me?
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.
Why Should I Consider a Medicare supplement Also Known As a "Medigap" Policy?
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.
How do I get a Medigap quote?
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.
What is Medicare drug coverage (Part D)?
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.
What is the Open Enrollment Period?
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.
When is the Initial Enrollment Period for Medicare?
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.
What are "Open Enrollment" and "Guaranteed Issue" in Medicare?
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.
Useful Medicare Resources
|
When You Are Provided Guaranteed Issue for Your Supplement Plan
|
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
|
|
What is Creditable Coverage?
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.
Can I Wait to Switch to a Different Medicare Supplement Policy?
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.
What Happens When I Move With My Medicare Supplement Plan
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.
Will Medicare cover my medical expenses outside of the U.S.?
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.
What is a Medicare Approved Amount?
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.
|