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Medigap Policies, Medicare Supplemental Insurance policies

What is Medicare?

Choosing A Medigap Policy

Medicare is health insurance for people age 65 or older, under age 65 with certain disabilities, and any age with End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant). Original Medicare covers many health care services and supplies, but there are many costs (“gaps”) it doesn’t cover.

What types of Medigap policies can insurance companies sell?

Choosing A Medigap Policy

In most cases, Medigap insurance companies can sell you only a “standardized” Medigap policy. All Medigap policies must have specific benefits so you can compare them easily.

Insurance companies that sell Medigap policies don’t have to offer every Medigap policy (Medigap Plans A through L). However, they must offer Medigap Plan A if they offer any other Medigap policy. Each insurance company decides which Medigap policies it wants to sell, although state law might affect which ones they offer.

In some cases, an insurance company must sell you a Medigap policy, even if you have health problems. Listed below are certain times that you are guaranteed the right to buy a Medigap policy:

• When you are in your Medigap open enrollment period.

• If you have a guaranteed issue right

.You may also be able to buy a Medigap policy at other times, but the insurance company is allowed to deny you a Medigap policy based on your health. Also, in some cases it may be illegal for the insurance company to sell you a Medigap policy (such as if you already have Medicaid or a Medicare Advantage Plan).

Medicare Prescription Drug Coverage and Medigap Policies

Choosing A Medigap Policy

If you bought your Medigap policy before January 1, 2006, you may have a Medigap policy with prescription drug coverage. You can keep the prescription drug coverage in that policy or you can join a Medicare Prescription Drug Plan. If you join a Medicare Prescription Drug Plan, you must tell your Medigap insurance company. It will remove the prescription drug coverage from your Medigap policy. This is because you can’t have both types of prescription drug coverage at the same time.
If you have Original Medicare and already have a Medigap policy without prescription drug coverage, you can join a Medicare Prescription Drug Plan without changing your Medigap policy.

The Different Parts of Medicare

Choosing A Medigap Policy

The different parts of Medicare help cover specific services if you meet certain conditions. Medicare has the following parts:

Medicare Part A (Hospital Insurance)

Helps cover inpatient care in hospitals
Helps cover skilled nursing facility, hospice, and home health care

Medicare Part B (Medical Insurance)

Helps cover doctors’ services and outpatient care
Helps cover some preventive services to help maintain your health and to keep certain illnesses from getting worse

Medicare Part C (Medicare Advantage Plans—like an HMO or PPO)

A health coverage choice run by private companies approved by Medicare
Includes Part A, Part B, and usually other coverage including prescription drugs

Medicare Part D (Prescription Drug Coverage)

Helps cover the cost of prescription drugs
May help lower your prescription drug costs and help protect against higher costs in the future

Your Medicare Coverage Choices

Choosing A Medigap Policy

With Medicare, you can choose how you get your health and prescription drug coverage. Below are brief descriptions of your coverage choices.

Original Medicare (Parts A & B)

Run by the Federal government.
Provides your Part A and Part B coverage.
You can join a Medicare Prescription Drug Plan to add drug coverage.
You can buy a Medigap (Medicare Supplement Insurance) policy (sold by private insurance companies) to help fill the gaps in Part A and Part B coverage (like coinsurance, copayments, and deductibles).

Medicare Advantage Plans (HMO’s and PPO’s)

Run by private insurance companies approved by Medicare.
Provide your Part A and Part B coverage, but can charge different amounts for certain services. May offer extra coverage and prescription drug coverage for an extra cost. Costs for items and services vary by plan.
If you want drug coverage, you must get it through your plan (in most cases).
You don’t need a Medigap policy.

Other Medicare Health Plans

Plans that aren’t Medicare Advantage Plans but are still part of Medicare.
Include Medicare Cost Plans, Demonstration/Pilot Programs, and Programs of All-Inclusive Care for the Elderly (PACE).
Some plans provide Part A and Part B coverage, and some also provide prescription drug coverage (Part D).

Note: If you have other health and/or prescription drug coverage from a former or current employer or union, you may have other coverage choices. This coverage may affect which Medicare coverage choice is best for you.

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