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Medicare does not pay for everything. Medicare beneficiaries also pay a portion of their medical expenses, which includes deductibles, copayments, services not covered by Medicare, and excess charges when doctors do not accept assignment.
Therefore, it is not a true Medicare Supplement policy because it does not coordinate benefits with Medicare. $0Do I Need a Medicare Supplement Policy? The answer to this question depends on one factor. Do you know you will always have adequate income and assets to cover all medical costs NOT covered by Medicare, such as deductibles, copayments, or non-covered services? If you are not sure the answer is yes, or if you do not want to risk it, you should explore your options for supplementing Medicare.
These ten plans are standardized, which means that benefits will be the same no matter which company sells the policy to you. Plan D from one company is the same as Plan D from another company. Since Medicare Supplement policies are standardized, you are free to shop for the company with the best price and customer service.
Generally, Medicare Supplement policies pay most, if not all, Medicare copayment amounts, and policies may pay Medicare deductible amounts. Also, some of the ten standard plans pay for services not covered by Medicare, such as prescriptions.
Although the benefits are the same for each standard plan, the premiums may vary greatly. Before purchasing a supplement policy, determine how the company calculates its premiums.
An insurance company can calculate premiums one of three ways. $0 $0Issue Age: If you were 65 when you bought the policy, you will pay the same premium the company charges people who are 65 regardless of your age. $0 $0Attained Age: The premium is based on your current age and will increase as you grow older. $0 $0No Age Rating: Everyone pays the same premium regardless of age.$0 $0 $0The Indiana Department of Insurance must approve premium rates for all Medicare Supplement policies. $0 $0Medicare SELECT Insurance Policies $0 $0Medicare SELECT policies are a type of Medicare Supplement insurance sold by a few private insurance companies. A Medicare SELECT policy is one of the ten standardized supplement policies. $0 $0It differs from Medicare Supplement insurance because you are expected to use a network of hospitals associated with the insurance company. $0 $0In return, you will usually pay lower premiums. Also, in order to enroll in a Medicare SELECT plan, you must live within the service area of a network facility. $0 $0Back to top$0 $0$0 $0What does Medicare Supplement insurance cover? $0 $0Medicare Supplement insurance is sold in 12 standard plans. As of January 1, 2006, Plans H, I, J are no longer sold with drug coverage. $0 $0View all plans types and the benefits they include. $0 $0Every company must sell Plan A, which is the basic plan, or the "core benefit" plan. The standard plans are labeled A through L. $0 $0Remember, the plans are standardized. So, Plan F from one company will be the same as Plan F from another company. $0 $0Select the supplement policy which fits your needs, and then purchase that plan from the company which offers the lowest premiums and best customer service. Core Benefits: $0 $0 $0Included in all plans. $0 $0Pays Part A Hospital copayment ($296 per day for 61-90 days and $592 per day for 91-150 days in 2013) $0 $0Pays for an additional 365 days of hospitalization after Medicare benefits end. $0 $0Pays Part B copayment (usually 20% of the Medicare approved amount) $0 $0Pays for the first three pints of blood per year.$0 $0 $0You will have to pay part of the cost-sharing of some covered services until you meet the annual out-of-pocket limit. Plan K has a $4,660 out-of-pocket limit. Plan L has a $2,330 out-of-pocket limit. Once you meet the annual limit, the plan pays 100% of the Medicare copayments, coinsurance, and deductibles for the rest of the calendar year. These amounts can change each year. $0 $0Part A Deductible$0 $0The initial amount Medicare does not pay for an inpatient hospital stay per benefit period ($1,156 in 2012). $0 $0Skilled Nursing Copayment$0 $0The amount Medicare does not pay for days 21-100 in a skilled nursing facility ($148/day in 2013). $0 $0Part B Deductible$0 $0The initial amount Medicare will not pay for covered physical or other outpatient services each calendar year ($147 in 2013). $0 $0Foreign Travel Emergency$0 $0(Medicare does not pay for care received in a foreign country.) This benefit covers, after a $250 deductible per year, 80% of health expenses for emergency care received in the first 60 days of a trip to a foreign country, up to a lifetime maximum of $50,000. $0 $0At Home Recovery$0 $0(Medicare only pays for skilled nursing home health care.) This benefit covers home health visits for assistance with activities of daily living, when either Medicare home health coverage is currently being received or within eight weeks from the last Medicare home health visit, up to $1,600 per year. $0 $0Preventive Care$0 $0Part B also covers preventive services at $0 copay and $0 deductible. These include welcome to Medicare physical exam, abdominal aortic aneurysm screening, annual wellness exam, bone mass measurement, cardiovascular disease screening, colorectal cancer screening, diabetes screening, mammogram screening, pap test/pelvic exam/clinical breast exam, vaccines, flu H1N1 flu, hepatitis B, pneumonia. Copay and deductible apply to glaucoma tests, HIV screening, Medicare nutrition therapy services, prostate cancer screening, smoking cessation counseling.$0 $0Part B Excess$0 $0(Medicare does not pay excess charges above its approved amount.) This benefit covers the difference between the Medicare approved amount and the limiting charge (which is no more than 15% above the Medicare approved amount). This benefit pays either 80% or 100% of the Part B excess charges. $0 $0Basic Drug & Extended Drug Coverage$0 $0*(No longer offered after January 1, 2006).* $0 $0Back to top$0 $0$0 $0Does the company have to sell a Medicare Supplement policy to me?$0 $0There is a time period when a company must sell a Medicare Supplement policy to you. This six-month period is called "Open Enrollment." Open Enrollment begins when you are 65 or older and enroll in Medicare Part B. $0 $0During Open Enrollment, a company: $0 $0 $0Cannot refuse to sell you a Medicare supplement policy, regardless of your health. $0 $0Can ask you health related questions on the application. $0 $0Cannot charge you a higher premium because of your health history.$0 $0 $0If you are 65 years old or older: $0 $0 $0If you enroll in Medicare Part B when you turn 65, your Medigap Open Enrollment begins the day your Medicare Part B becomes effective. $0 $0If you continue to work past age 65 (to any age) and delay enrolling in Medicare Part B, you "trigger" your Open Enrollment period by enrolling in Medicare Part B. It begins the day your Medicare Part B becomes effective. $0 $0If you are 65 or older and delayed enrolling in Medicare Part B because you were covered by your working spouse's employer group health plan, you "trigger" your Open Enrollment period by enrolling in Medicare Part B. It begins the day your Medicare Part B becomes effective.$0 $0 $0If you are under 65 and receive Medicare due to disability: $0 $0Currently, there is no Open Enrollment period for disabled Medicare beneficiaries until they are 65. However, some new laws are being proposed that would give disabled Medicare beneficiaries an open enrollment period. $0 $0There are other options for those who are under 65 and disabled: $0 $0 $0Medicare Advantage Plans cannot turn you down if you are on Medicare due to a disability $0 $0Some companies accept applications for a Medicare Supplement policy application from those under 65 and disabled. However, there is no guarantee that they will sell a policy to you.$0 $0 $0If you are under 65 and receive Medicare due to a disability, you trigger an Open Enrollment period when you turn 65. When you turn 65, your Medicare is due to age and no longer due to disability. A company must then sell you any plan it offers. $0 $0Back to top$0 $0$0 $0What if I am under 65 and disabled?$0 $0If I am under 65 and receive Medicare due to disability, does the supplement company have to sell a policy to me? No. At this time, there is no "Open Enrollment" period for disabled Medicare beneficiaries until they are 65. However, new laws are being proposed that would give disabled Medicare beneficiaries an Open Enrollment period. $0 $0If I am still working and have Medicare due to disability, can my employer group health plan turn me down? $0 $0That depends on the size of your employer. $0 $0If your company employs 100 or more employees and: $0 $0 $0You work full time and your employer group health plan offers coverage to other full-time employees, they cannot turn you down, or charge you premiums which are higher than other employee premiums. $0 $0You work part time and your employer group health plan offers coverage to other part-time employees, they cannot turn you down or charge you premiums which are higher than other employee premiums. $0 $0If your company employs fewer than 100 employees, Medicare would be your primary insurance.$0 $0 $0Can my working spouse's employer group plan turn me down? $0 $0That depends on the size of the employer. $0 $0 $0Your working spouse's employer group health plan can only turn you down if the company has fewer than 100 employees. They have to cover you the same as any other spouse. They cannot give you less coverage or charge you a higher premium. $0 $0If your working spouse's employer has less than 100 employees, Medicare would be your primary insurance.$0 $0 $0What are my other options? $0 $0 $0Medicare Managed Health Maintenance Organizations (HMOs) cannot turn you down if you are on Medicare due to a disability.$0 $0 $0Some companies accept applications for a Medicare supplement policy application from those under 65 and disabled. However, there is no guarantee that they will sell a policy to you.$0 $0 $0ICHIA, the Indiana Comprehensive Health Insurance Association, can provide major medical coverage. The premiums and deductibles are usually very high. Call SHIP at (800) 452-4800 for more information.$0 $0 $0If you are under 65 and receiving Medicare due to a disability, you trigger an "Open Enrollment" period when you turn 65. At this time, your Medicare is due to age and no longer due to disability. $0View a complete list of companies that sell Medicare Supplement insurance. $0 $0Back to top$0 $0$0 $0Compare Medicare Supplement Policies$0 $0 $0 $0Compare Medicare Supplement policies. $0 $0$0