2015 Choosing a Medigap Policy: A Guide to Health Insurance for - PDF document

C E N T E R S F O R M E D I C A R E & M E D I C A I D S E R V I C E S 2015 Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare This official government guide has important information about: �� Medicare Supplement Insurance (Medigap) policies �� What Medigap policies cover �� Your rights to buy a Medigap policy �� How to buy a Medigap policy This guide can help if you’re thinking about buying a Medigap policy or already have one. Developed jointly by the Centers for Medicare & Medicaid Services (CMS) and the National Association of Insurance Commissioners (NAIC)

Who should read this guide? Tis guide helps people with Medicare understand Medicare Supplement Insurance policies (also called Medigap policies). A Medigap policy is a type of private insurance that helps you pay for some of the costs that Original Medicare doesn’t cover. Important information about this guide Te information in this booklet describes the Medicare program at the time this booklet was printed. Changes may occur afer printing. Visit Medicare.gov, or call 1-800-MEDICARE (1-800-633-4227) to get the most current information. TTY users should call 1-877-486-2048. Te “2015 Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare” isn’t a legal document. Official Medicare Program legal guidance is contained in the relevant statutes, regulations, and rulings.

3 Table of Contents Section 1: Medicare Basics 5 A brief look at Medicare. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 What's Medicare? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Te different parts of Medicare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Your Medicare coverage choices at a glance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Section 2: Medigap Basics 9 What's a Medigap policy? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 What Medigap policies cover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 What Medigap policies don’t cover. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Types of coverage that are NOT Medigap policies . . . . . . . . . . . . . . . . . . . . . . . . . 12 What types of Medigap policies can insurance companies sell? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 What do I need to know if I want to buy a Medigap policy?. . . . . . . . . . . . . . . . . 13 When's the best time to buy a Medigap policy? . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Why is it important to buy a Medigap policy when I'm first eligible? . . . . . . . . 16 How do insurance companies set prices for Medigap policies? . . . . . . . . . . . . . . 17 What this pricing may mean for you . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Comparing Medigap costs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 What's Medicare SELECT? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 How does Medigap help pay my Medicare Part B bills? . . . . . . . . . . . . . . . . . . . . 20 Section 3: Your Right to Buy a Medigap Policy 21 What are guaranteed issue rights? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 When do I have guaranteed issue rights? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Can I buy a Medigap policy if I lose my health care coverage? . . . . . . . . . . . . . . 24 Section 4: Steps to Buying a Medigap Policy 25 Step-by-step guide to buying a Medigap policy . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Section 5: If You Already Have a Medigap Policy 31 Switching Medigap policies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Losing Medigap coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Medigap policies and Medicare prescription drug coverage . . . . . . . . . . . . . . . . 36

4 Table of Contents Section 6: Medigap Policies for People with a Disability or ESRD 39 Information for people under 65 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Section 7: Medigap Coverage in Massachusetts, Minnesota, and Wisconsin 41 Massachusetts benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Minnesota benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Wisconsin benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44 Section 8: For More Information 45 Where to get more information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 How to get help with Medicare and Medigap questions . . . . . . . . . . . . . . . . . . . . 46 State Health Insurance Assistance Program and State Insurance Department. . 47 Section 9: Definitions 49 Where words in BLUE are defined . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

5 SECTION 1 Medicare Basics A brief look at Medicare A Medigap policy is health insurance sold by private insurance companies to fill gaps in Original Medicare coverage. Medigap policies can help pay your share (like coinsurance, copayments, or deductibles) of the costs of Medicare-covered services. Some Medigap policies also cover certain benefits Original Medicare doesn’t cover like emergency foreign travel expenses. Medigap policies don’t cover your share of the costs under other types of health coverage, including Medicare Advantage Plans, stand-alone Medicare Prescription Drug Plans, employer/union group health coverage, Medicaid, Department of Veterans Affairs (VA) benefits, or TRICARE. Insurance companies generally can’t sell you a Medigap policy if you have coverage through Medicaid or a Medicare Advantage Plan. Before you learn more about Medigap policies, the next few pages provide a brief look at Medicare. If you already know the basics about Medicare and only want to learn about Medigap, skip to page 9. Words in blue are defined on pages 49–50.

6 Section 1: Medicare Basics What's Medicare? Medicare is health insurance for: �� People 65 or older �� People under 65 with certain disabilities �� People of any age with End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant) The different parts of Medicare Te different parts of Medicare help cover specific services: Medicare Part A (Hospital Insurance) helps cover �� Inpatient care in hospitals �� Skilled nursing facility, hospice, and home health care Medicare Part B (Medical Insurance) helps cover �� Services from doctors and other health care providers, hospital outpatient care, durable medical equipment, and home health care �� Preventive services to help maintain your health and to keep certain illnesses from getting worse Medicare Part C (Medicare Advantage) �� Includes all benefits and services covered under Part A and Part B �� Run by Medicare-approved private insurance companies �� Usually includes Medicare prescription drug coverage (Part D) as part of the plan �� May include extra benefits and services for an extra cost Medicare Part D (Medicare Prescription Drug Coverage) �� Helps cover the cost of outpatient prescription drugs �� Run by Medicare-approved private insurance companies �� May help lower your prescription drug costs and help protect against higher costs in the future

7 Section 1: Medicare Basics Your Medicare coverage choices at a glance Tere are 2 main ways to get your Medicare coverage — Original Medicare or a Medicare Advantage Plan. Use these steps to help you decide which way to get your coverage. See page 35 for information about Medicare Advantage Plans and Medigap policies. START STEP 1: Decide how you want to get your coverage . ORIGINAL MEDICARE MEDICARE ADVANTAGE PLAN or Part C (like an HMO or PPO) Part A Part B Part C Hospital Medical Combines Part A, Part B, and usually Insurance Insurance Part D STEP 2: Decide if you need to STEP 2: Decide if you need to Step 2: Decide if you need to add drug coverage . add drug coverage . add drug coverage . Part D Part D Prescription Prescription Drug Drug Coverage Coverage (Most Medicare Advantage Plans cover prescription drugs. You may be able to STEP 3: Decide if you need to add add drug coverage in supplemental coverage . some plan types if not already included.) Medicare Supplement Insurance END (Medigap) policy If you join a Medicare Advantage Plan, you can’t use and can’t be sold a Medigap policy. See page 35. END