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MEDICARE SUPPLEMENTAL INSURANCE PLANS

Strategic Partners Unlimited

WHAT’S MEDICARE SUPPLEMENT INSURANCE (MEDIGAP)?

Medigap is Medicare Supplement Insurance that helps fill “gaps” in Original Medicare and is sold by private companies. Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. A Medicare Supplement Insurance (Medigap) policy can help pay some of the remaining health care costs, like:

  • Copayments
  • Coinsurance
  • Deductibles

8 things to know about Medigap policies

  • You must have Medicare Part A and Part B.
  • If you have a Medicare Advantage Plan, you can apply for a Medigap policy, but make sure you can leave the Medicare Advantage Plan before your Medigap policy begins.
  •  You pay the private insurance company a monthly premium for your Medigap policy in addition to the monthly Part B premium that you pay to Medicare.
  • A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you’ll each have to buy separate policies.
  • You can buy a Medigap policy from any insurance company that’s licensed in your state to sell one.
  • Any standardized Medigap policy is guaranteed renewable even if you have health problems. This means the insurance company can’t cancel your Medigap policy as long as you pay the premium.
  • Some Medigap policies sold in the past cover prescription drugs, but Medigap policies sold after January 1, 2006 aren’t allowed to include prescription drug coverage. If you want prescription drug coverage, you can join a Medicare Prescription Drug Plan (Part D).
  •  It’s illegal for anyone to sell you a Medigap policy if you have a Medicare Medical Savings Account (MSA) Plan.

Medigap policies don’t cover everything

Medigap policies generally don’t cover long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing.

Insurance plans that aren’t Medigap

Some types of insurance aren’t Medigap plans, they include:

  • Medicare Advantage Plans (like an HMO, PPO, or Private Fee-for-Service Plan)
  • Medicare Prescription Drug Plans
  • Medicaid
  • Employer or union plans, including the Federal Employees Health Benefits Program (FEHBP)
  • TRICARE
  • Veterans’ benefits
  • Long-term care insurance policies
  • Indian Health Service, Tribal, and Urban Indian Health plans

Dropping your entire Medigap policy (not just the drug coverage)

If you decide to drop the entire Medigap policy, you need to be careful about the timing. For example, you may want a completely different Medigap policy (not just your old Medigap policy without the prescription drug coverage), or you might decide to switch to a Medicare Advantage Plan that offers prescription drug coverage.

If you drop your entire Medigap policy and the drug coverage wasn’t creditable or you go more than 63 days before your new Medicare coverage begins, you have to pay a late enrollment penalty for your Medicare Prescription Drug Plan, if you choose to join one.

10 QUESTIONS TO ASK BEFORE BUYING A MEDICARE PLAN

To get the most from Medicare — and your health care dollars — you need to carefully evaluate the costs and benefits of all of your plan options.
To get the most from Medicare — and your health care dollars — you need to carefully evaluate the costs and benefits of all of your plan options.

How much will I have to pay for premiums, deductibles, doctor visits and hospital stays?

Part A Premium – Most people don’t pay a monthly premium for Part A. However, if you buy Part A, you’ll pay up to $458 each month in 2020. If you paid Medicare taxes for less than 30 quarters, the standard Part A premium is $458. If you paid Medicare taxes for 30-39 quarters, the standard Part A premium is $252.

Part B Premium – The standard Part B premium amount is $144.60 (or higher depending on your income).

Part C Premium – The Part C monthly premium varies by plan.

Part D Premium – The Part D monthly premium varies by plan (higher-income consumers may pay more).

Will I have to choose hospital and health care providers from a network?

If you get Original Medicare, you can use any doctor or hospital that takes Medicare, anywhere in the U.S. However, for Medicare Advantage Plans, in many cases, you’ll need to use doctors and other providers who are in the plan’s network and service area for the lowest costs. Most Medicare Advantage Plans offer extra benefits that Original Medicare doesn’t cover—like vision, hearing, dental, and more.

Will my doctors accept the coverage? If not, are there doctors near me who will?

In most cases, yes. You can go to any doctor, health care provider, hospital, or facility that is enrolled in Medicare and accepting new Medicare patients.

Will I need referrals to visit specialists?

In most cases, no. In Original Medicare, you don’t need a referral, but the specialist must be enrolled in Medicare.

Will the plan cover me if I get sick while traveling in another state?

If you are a Medicare beneficiary with Original Medicare, Part A and Part B, you can travel anywhere in the United States and still be covered, as long as you use doctors and hospitals that accept Medicare. If you travel outside of the United States, however, your Medicare coverage is limited.

What will my prescription drugs cost?

Medicare drug plans have different coverage and costs, but all must offer at least a standard level of coverage set by Medicare. How much you actually pay for Medicare drug coverage depends on which drugs you use, which Medicare drug plan you join, whether you go to a pharmacy in your plan’s network, and whether you get Extra Help paying for your drug costs.

Are my drugs on the plan's drug list (or formulary)?

Generally, your drug plan will give you a one-time, temporary supply of your current drug during your first 90 days in a plan. Plans must give you this temporary supply so that you and your prescriber have time to find another drug on the plan’s formulary (drug list) that will work as well as what you’re taking now, or you or your prescriber can contact the plan to ask for an exception. There may be different rules for people who move into or already live in an institution (like a nursing home or long-term care hospital). However, if you already tried similar drugs on your plan’s drug list and they didn’t work, or if your prescriber decides you need a certain drug because of your medical condition, you or your prescriber can contact your plan to ask for an exception as soon as your coverage begins.

Does the plan include the pharmacies I currently use?

Medicare drug plans have contracts with pharmacies that are part of the plan’s “network.” If you go to a pharmacy that isn’t in your plan’s network, your plan might not cover your drugs. Along with retail pharmacies, your plan’s network might include preferred pharmacies, a mail-order program, or an option for retail pharmacies to supply a 2- or 3-month supply.

Can I get my prescriptions through the mail?

Some plans may offer a mail-order program that allows you to get up to a 3-month supply of your covered prescription drugs sent directly to your home. This may be a cost-effective and convenient way to fill prescriptions you take regularly.

Does the plan have a good quality rating?

Medicare scores how well plans perform in several categories, including quality of care and customer service. Ratings range from one to five stars, with five being the highest and one being the lowest. Plans are rated in each individual category. Medicare also assigns plans one overall star rating to summarize the plan’s performance as a whole. You can use the overall star rating to compare performance among several different plans. To learn more about differences among plans, look at plans’ ratings in each category.

Whether you are new to Medicare or are deciding if you should change plans during Medicare’s Annual Enrollment Period, more commonly called Medicare open enrollment, you should gather information from a variety of sources.

If you’re considering a Medicare Advantage or Part D prescription drug plan, both of which are run by private insurers, don’t rely solely on information from the sponsoring insurance company.

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