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Medicare Supplement Insurance

What is Medicare Supplement Insurance?

The federal Medicare program pays most medical expenses for people 65 or older, or for individuals under 65 receiving Social Security disability benefits. However, Medicare does not pay all expenses. As a result, you may want to buy a Medicare Supplement policy that helps pay for certain expenses, including deductibles not covered by Medicare.

The Division of Insurance publishes annually a Medicare Supplement Insurance Premium Comparison Guide.

When should I apply for a Medicare supplement policy?

When you elect coverage under Medicare Part B either due to age or disability, you have a 6-month open enrollment for a Medicare supplement policy, which guarantees you coverage with a plan and company of your choice. You may choose from a list of standardized plans – listed as A through L. If you do not purchase a plan within your 6-month open enrollment, any company you apply to can deny coverage based on your health conditions. There are some limited additional open enrollment periods available to some persons disenrolling from a Medicare HMO.

Do Medicare supplement policies cover prescription drugs?

After January 1, 2006, Medicare supplement policies may not include prescription drug coverage. Those that currently have a policy with prescription drug coverage may opt to keep that coverage or switch to the new Medicare prescription drug plans after January 1, 2006.

What are MedicareAdvantage Plans?

MedicareAdvantage plans (formerly known as Medicare+Choice plans) are private managed care plans that provide the standard Medicare benefits plus additional supplemental benefits for a monthly fee. These plans may include prescription drug coverage, even after January 1, 2006, if the benefits are similar to the new Medicare benefit. MedicareAdvantage participants may even receive a subsidy for their prescription drug benefits in most cases.

What are Medicare Select Plans?

Medicare Select plans provide supplemental benefits through a network of providers similar to a Preferred Provider Organziation (PPO). If the participant received care for a provider under contract with the insurer the cost will be lower.

Medigap Insurance

What is a Medigap policy?

A Medigap policy is health insurance sold by private insurance companies to fill the “gaps” in Original Medicare Plan coverage. Medigap policies help pay some of the health care costs that the Original Medicare Plan does not cover. If you are in the Original Medicare Plan and have a Medigap policy, then Medicare and your Medigap policy will each pay their share of covered health care costs.

How do I know if I’m eligible for a Medigap policy?

To buy a Medigap policy, you generally must have Medicare Part A and Part B. You are guaranteed the right to buy a Medigap policy if you are in your Medigap open enrollment period or covered under a Medigap protection. You might not be able to buy a Medigap policy if you are in a Medicare Advantage Plan, have Medicaid, already have a Medigap policy or are under the age of 65 and you are disabled or have End-Stage Renal Disease.

What isn’t covered in my Medicare that is covered by Medigap?

You may want to buy a Medigap policy because Medicare does not pay for all of your health care. There are “gaps” or “out-of-pocket” costs that you must pay in the Original Medicare Plan. Some examples of costs not covered are hospital stays, skilled nursing facility stays, blood, Medicare Part B yearly deductible and Medicare Part B covered services. A Medigap policy will not cover long-term care, vision or dental care, hearing aids and private-duty nursing.

Can I be dropped from my Medigap policy?

If you bought your policy after 1990, the policy is guaranteed renewable. This means your insurance company can drop you only if you stop paying your premium, you are not truthful about something under the policy or the insurance company goes bankrupt. Insurance companies in some states may be able to drop you if you bought your policy before 1990. If this happens, you have the right to buy another Medigap policy.

What are my rights with Medigap?

You need to know that under Federal law, you have rights and protections regarding your Medigap coverage. These include your right to buy Medigap coverage, protections if you lose or drop your health care and your protections for people with Medicare under the age of 65. You should know it is illegal for anyone to pressure you into buying a Medigap policy, lie or mislead you to switch to another company or sell you a second Medigap policy when they know that you already have one. It is also illegal to sell you a policy that cannot be sold in your state. Call your State Health Insurance Assistance Program to better understand these rights and protections.