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Medicare Basics

Medicare Basics. Medicare Supplement Insurance (Medigap) Policies. Once the slide has finished loading and you have finished reviewing the content, click on the slide to proceed. Medicare Supplement Insurance (Medigap) Policies. What are Medicare Supplement Insurance (Medigap) Policies? :

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Medicare Basics

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  1. Medicare Basics Medicare Supplement Insurance (Medigap) Policies Once the slide has finished loading and you have finished reviewing the content, click on the slide to proceed.

  2. Medicare Supplement Insurance (Medigap) Policies What are Medicare Supplement Insurance (Medigap) Policies?: • 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 the beneficiary travels outside the U.S. • If the beneficiary has Original Medicare and they want to buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Then the beneficiaries Medigap policy pays its share. • The beneficiary has to pay the premiums for Medigap policy.

  3. Medicare Supplement Insurance (Medigap) Policies (Continued) What are Medicare Supplement Insurance (Medigap) Policies? (Continued): Medigap policies are standardized: • Every Medigap policy must follow federal and state laws designed to protect the beneficiary, and it must be cleary identified as “Medicare Supplement Insurance.” • Insurance companies can only sell the beneficiary 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 the beneficiary can choose which one meets their 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 the beneficiary already has one of those policies, they can keep it. They need to contact their insurance company for more information.

  4. Medicare Supplement Insurance (Medigap) Policies (Continued) What are Medicare Supplement Insurance (Medigap) Policies? (Continued): How does the beneficiary compare Medigap policies?: • Different insurance companies may charge different premiums for the same exact policy. • As the beneficiary shops for a policy, they need to be sure they’re comparing the same policy (for example, compare Plan A from one company with Plan A from another company). • In some states, the beneficiary may be able to buy a type of Medigap policy called Medicare SELECT (a policy that requires them to use specific hospitals and, in some cases, specific doctors or other health care providers to get full coverage). • If the beneficiary buys a Medicare SELECT policy, they have the right to change their mind within 12 months and switch to a standard Medigap policy.

  5. Medicare Supplement Insurance (Medigap) Policies (Continued) What are Medicare Supplement Insurance (Medigap) Policies? (Continued): How does the beneficiary compare Medigap policies? (Continued): • The chart on the following slide 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 the beneficiary is responsible for the rest. Note: • The beneficiary will need more details than this chart provides to compare and choose a policy.

  6. Medicare Supplement Insurance (Medigap) Policies (Continued) • Plan F offers a high-deductible plan in some states. If the beneficiary chooses this option, they must pay for Medicare-covered costs (coinsurance, copayments, and deductibles) up to the deductible amount of $2,140 in 2015 before their 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.

  7. Medicare Supplement Insurance (Medigap) Policies (Continued) What are Medicare Supplement Insurance (Medigap) Policies? (Continued): What else should the beneficiary know about Medicare Supplement Insurance (Medigap)?: Important Facts: • They must have Part A and Part B. • They pay the private insurance company a monthly premium for their Medigap policy in addition to their monthly Part B premium that they pay to Medicare. To find out how to pay their premium, they may contact the company. • A Medigap policy only covers one person. Spouses must buy separate policies. • They can’t have prescription drug coverage in both their Medigap policy and a Medicare drug plan. • It’s important they compare Medigap policies since the costs can vary and may go up as they get older. Some states limit Medigap premium costs.

  8. Medicare Supplement Insurance (Medigap) Policies (Continued) What are Medicare Supplement Insurance (Medigap) Policies? (Continued): What else should the beneficiary know about Medicare Supplement Insurance (Medigap)? (Continued): When to buy: • The best time to buy a Medigap policy is during their Medigap Open Enrollment Period. This 6-month period begins on the first day of the month in which they’re 65 or older and enrolled in Part B. (Some states have additional Open Enrollment Periods.) After this enrollment period, their option to buy a Medigap policy may be limited and it may cost more. • If they delay enrolling in Part B because they have group health coverage based on their (or their spouse’s) current employment, their Medigap Open Enrollment Period won’t start until they sign up for Part B. • Federal law doesn’t require insurance companies to sell Medigap policies to people under 65. If they’re under 65, they might not be able to buy the Medigap policy they want, or any Medigap policy, until they turn 65. However, some states require Medigap insurance companies to sell Medigap policies to people under 65.

  9. Medicare Supplement Insurance (Medigap) Policies (Continued) What are Medicare Supplement Insurance (Medigap) Policies? (Continued): How does Medigap work with Medicare Advantage Plans?: • If the beneficiary has a Medicare Advantage Plan, it’s illegal for anyone to sell them a Medigap policy unless they’re switching back to Original Medicare. If they want to switch to Original Medicare and buy a Medigap policy, they need to find out what policies are available to them and contact their Medicare Advantage Plan to see if they’re able to disenroll. They’ll need to let the Medigap insurer know the date their plan coverage will end. If they don’t intend to leave their Medicare Advantage Plan, and someone tries to sell them a Medigap policy, they must report it to their State Insurance Department. • If they have a Medigap policy and join a Medicare Advantage Plan (like an HMO or PPO), they may want to drop their Medigap policy. Their Medigap policy can’t be used to pay their Medicare Advantage Plan copayments, deductibles, and premiums. If they want to cancel their Medigap policy, they should contact their insurance company. In most cases, if they drop their Medigap policy to join a Medicare Advantage Plan, they won’t be able to get it back.

  10. Medicare Supplement Insurance (Medigap) Policies (Continued) What are Medicare Supplement Insurance (Medigap) Policies? (Continued): How does Medigap work with Medicare Advantage Plans? (Continued): • If the beneficiary joins a Medicare Advantage Plan for the first time, and they aren’t happy with the plan, they’ll have special rights to buy a Medigap policy if they return to Original Medicare within 12 months of joining. • If the beneficiary had a Medigap policy before they joined, they may be able to get the same policy back if the company still sells it. If it isn’t available, they can buy another Medigap policy. • If the beneficiary joined Medicare Advantage Plan when they were first eligible for Medicare, they can choose from any Medigap policy within the first year of joining. • The Medigap policy can no longer have prescription drug coverage even if they had it before, but they may be able to join a Medicare Prescription Drug Plan.

  11. Medicare Supplement Insurance (Medigap) Policies (Continued) What are Medicare Supplement Insurance (Medigap) Policies? (Continued): Where can the beneficiary get more information about Medicare Supplement Insurance (Medigap)?: • They can visit Medicare.gov to find policies in their area. • They can visit Medicare.gov/publications to view the booklet “Choosing Medigap Policy: A Guide to Health Insurance for People with Medicare.” They can also call 1-800-MEDICARE (1-800-633-4227) to find out if a copy can be mailed to them. TTY users should call 1-877-486-2048. • They can call their State Insurance Department. Visit Medicare.gov/contacts, or call 1-800-MEDICARE to get the phone number. • They can call their State Health Insurance Assistance Program (SHIP).

  12. Medicare Basics Medicare Supplement Insurance (Medigap) Policies All the information within this presentation was obtained from the Centers for Medicare & Medicaid Services The End

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