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Medicare Supplemental Insurance
Frequently Asked Questions
What is Medicare Supplemental Insurance? Why should I consider buying Medicare Supplemental Insurance? When can I buy Medicare Supplemental Insurance? What is the best plan for me? How do I compare plans? If I have questions while completing an application, whom can I call? What are my options for making my first payment? Can I buy supplemental insurance for less if I buy directly from the insurance company? Where are the other companies I am familiar with? The following questions and answers are the most frequently asked questions by callers to the Medicare + Choice toll free line for the time period from January 1,through January 31, 2000 run by HFCA. These questions and answers will be updated monthly. If you have specific questions about Medicare, Medicaid, or Medicare + Choice, please call 1-800-MEDICARE (1-800-633-4227, TTY/TDD;1-877-486-2048 for the hearing and speech impaired).
What does the Original Medicare Part B Plan not pay for? Do I have to pay a premium for Medicare Part B? How are these premiums paid? What types of services are covered under Medicare Part A and Part B? What is Medicaid and who does it cover? What are the Plans/Choices available under Medicare + Choice? I cannot afford my Medicare premiums. What can I do? How, when and where do I sign up for Medicare when I turn 65? Who is eligible for Medicare Part A? I didn't enroll in Medicare Part B when I turned 65 because I was still working. Can I enroll now? I'm confused about who pays my medical bills first -- Medicare or my Employer's Group Health Plan? How do I know if I am eligible for both Part A and Part B? How can I get a replacement Medicare card? How do I re-enroll in Original Medicare if I want to leave the plan I have chosen? Will the Medicare rates change in 2000? What are the new rates? How does a Medicare Managed Care Plan differ from Medigap? How much do I pay for Original Medicare Part A and Part B coverage? How can I leave a Medicare Health Plan?
Q) What is Medicare Supplemental Insurance?
Medicare Supplemental Insurance is also known as Medigap Insurance. A Medigap policy is a private insurance policy. It is designed to work with the Original Medicare Plan to cover some of the costs that Original Medicare does not cover. Medigap insurance fills gaps in Medicare coverage. Medigap insurance must follow Federal and State laws that protect you. In most states, a Medigap policy must be one of ten standardized policies to help you compare them easily. Each policy has a different set of benefits. Two of the standardized policies may have a high deductible option. In addition, any standardized policy may be sold as a “Medicare SELECT” policy. Medicare SELECT policies usually cost less because you must use certain hospitals and doctors. In an emergency, you may use any doctor or hospital.
If you are in a Medicare managed care plan, or if you are covered by Medicaid, you do not need a Medigap policy
Q) Why should I consider buying Medicare Supplemental Insurance?
Though Medicare covers many health care costs, there are many medical services that Medicare does not cover. Supplemental insurance policies fill the gaps in your Medicare coverage. Before Medicare will pay for any of the medical services you want or need, you must first pay the Medicare deductibles. When combined with the coinsurance you are also required to pay, you may be out hundreds, even thousands of dollars before any benefits are paid by Medicare. Under Part B of Medicare, you could have out-of-pocket costs if your physician or provider does not accept assignment of your Medicare claim and charges more than Medicare’s approved amount. In addition, Medicare does not cover any outpatient prescription drug costs.
Q) When can I buy Medicare Supplemental Insurance?
For six months after the first day of the month in which you are age 65 or older and first join Medicare Part B, you have the right to buy the Medigap policy of your choice. During this open enrollment period, the insurance company cannot deny you insurance coverage or change the price of a policy because of past or current health problems. Once you enroll in Part B, the six month Medigap open enrollment period starts and cannot be changed.
Except as described below, if you do not buy a Medigap policy during your open enrollment period you may not be able to buy the one you want, or you may be charged more for the policy. If you drop your Medigap policy, you may not be able to get it back. There are certain situations however, where you may have the right to get a Medigap policy after your open enrollment period. In these cases, the insurance company can not deny you coverage, or change the price of a policy because of past or present health problems. To find out if these rights apply to your situation, call 1-800-MEDICARE (1-800-633-4227). You can also order a pamphlet called Medicare Supplemental Insurance (Medigap) Policies and Protections
Q) What is the best plan for me?
Although there is no one "best" plan, there are some plans that will be better than others for you and your family’s needs. Plans differ in how much you have to pay and the benefits that are provided. Although no plan will pay for all the costs associated with your medical care, some plans will cover more than others.
With any supplemental plan you will pay a premium, usually monthly. In addition, there are often other payments you must make. These payments will vary by plan but essentially are deductibles and copayments.
In the "Senior Issues" section under "Medicare" of the site, there are some excellent guides about choosing and comparing supplemental plans.
Q) How do I compare plans?
Here’s a list of some key questions to consider when choosing a supplemental plan:
How much will it cost me on a monthly basis? Are there deductibles I must pay before the insurance begins to help cover my costs? What doctors and specialists are part of the plan? What hospitals can I go to? Where will I go for care? Are these places near where I work or live? If I use doctors outside a plan's network, how much more will I pay to get care? Does it cover the “excess charge” if the doctor charges more than Medicare’s approved amount? Does it cover the costs of prescription drugs if I have a major illness?
Q) If I have questions while completing an application, whom can I call?
Please call us for any assistance you may need and speak to our friendly and enthusiastic customer service representatives. Feel free to call us anytime even after hours and leave a message, which will be immediately returned the next business day.
Q) How can I be sure that my data is kept secure and private?
We are committed to protecting your privacy. We will NOT SELL, TRADE or GIVE AWAY your personal information to anyone, except those specifically involved in the referral or processing of your health insurance quote or application. Additionally, we use industry leading technologies to ensure the SECURITY of the information under our control.
Q) What are my options for making my first payment?
Most plans require the first month’s payment accompany your application. Health insurance companies usually require the payment by check, although some pay accept credit card payments. Any financial information submitted over the web is kept private and secure. Once accepted as a plan member, all bills will be sent from the health insurance company and you will pay them via the choices offered by that company.
Q) Can I buy supplemental insurance for less if I buy directly from the insurance company?
No. Insurance companies charge the same premium whether the plan is purchased directly from the company, through a broker, or online through us.
Q) Where are the other companies I am familiar with?
Not all health insurance companies sell Medicare Supplement Insurance.
Q) What does the Original Medicare Part B Plan not pay for?
Although Medicare helps with health care costs, it does not pay for everything. You are responsible for deductibles and coinsurance. Generally, the Original Medicare Plan does not cover outpatient prescription drugs. It also generally does not cover: routine physical examinations eye glasses custodial care dental care dentures routine foot care hearing aids orthopedic shoes.
Q) Do I have to pay a premium for Medicare Part B? How are these premiums paid?
Yes, you must pay a monthly premium for Medicare Part B. The 2000 premium is $45.50 per month for most beneficiaries. Medicare Part B premiums will be deducted from your Social Security, Railroad Retirement, or Civil Service Retirement benefits. If you do not receive any of these, Medicare will bill you every 3 months for your Part B premium. You should call the Social Security Administration for more specific questions on your premium. The monthly premium may be higher than $45.50 for those beneficiaries who originally delayed filing or declined Part B coverage when they first became eligible.
Q) What types of services are covered under Medicare Part A and Part B?
Medicare Part A covers a variety of services including: Hospital stays Home Health Care Hospice Care Skilled Nursing Facility Care Medicare Part B covers a variety of services including:
Doctor Services Laboratory Tests Outpatient Hospital Services Medical Equipment Blood Home Health Care Part B also covers some preventive services such as mammograms and flu shots.
Q) What is Medicaid and who does it cover?
Medicaid is a health insurance program for certain low-income people. It covers children, the aged, blind, disabled, and people who are eligible to receive other federal assistance. In some cases, Medicaid will help pay for Medicare premiums, deductibles, and coinsurance. For more information, you can contact your State medical assistance office.
Q) What are the Plans/Choices available under Medicare + Choice?
Medicare + Choice expands your options. The Original Medicare Plan and Medicare Managed Care Plans are available now. The Original Medicare Plan, the fee-for-service arrangement, is available to everyone. Also, Medicare Managed Care Plans are available in many parts of the country. Preferred Provider Organizations, Provider Sponsored Organizations, and other insurance options like Private-Fee-For-Service Plans and Medicare Medical Savings Accounts, might become available in your area. No matter what option you choose, you are still in the Medicare program and will receive all of the Medicare covered services
Q) I cannot afford my Medicare premiums. What can I do?
If your income is limited, your State may help you pay your Medicare costs, such as your premiums and deductibles. Your State medical assistance office can help you determine if you qualify for help.
Q) How, when and where do I sign up for Medicare when I turn 65?
If you are already getting Social Security or Railroad Retirement checks when you turn 65, you will automatically be enrolled in Medicare. Your Medicare card (a red, white and blue card) will automatically be mailed to you about three months before your 65th birthday as part of your enrollment information package.
However, if you are not yet receiving Social Security or Railroad Retirement benefits, when you turn 65, you will need to contact your local Social Security Office. You will need to file your application during your 7-month enrollment period. That period starts three months before you turn 65 and ends three months after.
Q) Who is eligible for Medicare Part A?
Almost everyone who is 65 is eligible for Medicare Part A (Hospital Insurance). You may also be eligible if you are under 65 and have been receiving Social Security Disability benefits for 24 months. You should contact your local Social Security office for more specific information about your eligibility and enrollment for Part A
Q) I didn't enroll in Medicare Part B when I turned 65 because I was still working. Can I enroll now?
If you didn't enroll in Medicare Part B during the initial enrollment period, you can enroll during one of two time periods.
The General Enrollment Period from January through March of each year. You will be entitled to Medicare Part B effective July 1 of that year. If you have waited to enroll in Medicare Part B, the monthly premium that you pay will go up by 10% for each year that you could have had Medicare Part B but did not sign up.
If you did not enroll in Medicare Part B because you were covered by an employer group health plan at the time you became eligible, you can enroll during any month that you are still in the plan. In that case, your Part B coverage will begin the first day of the month after you leave the health plan, up to 3 months after your enrollment in Part B. If you wait until leaving your employer's health plan to enroll, you can enroll up to 8 months after the end of the month you leave the plan. Your Part B coverage will begin the first day of the next month
Q) I’m confused about who pays my medical bills first -- Medicare or my Employer’s Group Health Plan?
It depends on your situation. Medicare is the secondary payer IF: you are age 65 or older, and are still working for an employers who has 20 or more employees; or you are under 65 and disabled, and have group health plan coverage through your own or spouse’s current employment for an employer who has 100 or more employees; or you have Medicare because of permanent kidney failure and have group health plan coverage through your own or spouse’s employment.
You should talk to your Part B carrier about your specific situation.
Q) How do I know if I am eligible for both Part A and Part B?
You should contact your local Social Security office. The staff there can tell you if you are eligible for Part A and Part B
Q) How can I get a replacement Medicare card?
You should call the Social Security Administration at 1-800-772-1213 or contact your local Social Security Office to get a replacement card.
Q) How do I re-enroll in Original Medicare if I want to leave the plan I have chosen?
You will automatically return to Original Medicare if you leave your plan. You do not need to re-enroll. You may leave your plan by calling the Social Security office, or notifying your plan that you wish to leave and asking to disenroll from your Medicare managed care plan
Q) Will the Medicare rates change in 2000?
What are the new rates? Effective January 1, 2000 there will be some changes in Medicare rates. Inpatient Hospital Insurance(Part A): DEDUCTIBLE - $776 (Per Benefit Period) COINSURANCE - $194 a day for the 61st-90th day in each Benefit Period. $388 a day for the 91st-150th day for each lifetime reserve day (total lifetime reserve days - nonrenewable) SKILLED NURSING FACILITY DEDUCTIBLE -$97 per day for each Benefit Period (paid after first 20 days of care) Part A Hospital Insurance Premium - $301 per month (NOTE: this premium is paid only by individuals not otherwise eligible for Premium-free hospital insurance). In addition,there is a Part A premium of $166 for individuals having 30 or more Quarters of Coverage Supplemental Medical Insurance (SMI) - Part B deductible - $100 per year (unchanged from 1999).
Part B Monthly Premium - $45.50 per month (unchanged from 1999) .
Q) How does a Medicare Managed Care Plan differ from Medigap?
A Medicare Managed Care Plan provides a full range of health care services, including all Medicare covered services. A Medigap policy is a private insurance policy. It is designed to work with the Original Medicare Plan to cover some of the costs that Original Medicare does not cover.
Q) How much do I pay for Original Medicare Part A and Part B coverage?
Most people do not have to pay a monthly premium for Part A because they (or a spouse) paid Medicare taxes while they were working. You pay the Medicare Part B premium of $45.50 per month for the year 2000. In some cases, this amount may be higher if you do not choose Part B when you first became eligible. The cost of Part B may go up 10% for each 12-month period that you could have had Part B but did not take it.
In addition, you may also have to pay some additional expenses such as deductibles and co-insurance. Your Medicare & You 2000 handbook explains these expenses in more detail.
Q) How can I leave a Medicare Health Plan?
You can leave a Medicare Health Plan in one of three ways:
Calling 1-800-MEDICARE and ask to disenroll or notifying the plan you wish to leave and ask to disenroll from your Medicare Managed care plan or calling the Social Security Office and completing a disenrollment form.