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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. Do 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.
The Indiana Department of Insurance must approve premium rates for all Medicare Supplement policies.
Medicare 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.
It 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.
Medicare Supplement insurance is sold in 12 standard plans. As of January 1, 2006, Plans H, I, J are no longer sold with drug coverage.
View all plans types and the benefits they include. (updated 1/24/14)
Every company must sell Plan A, which is the basic plan, or the "core benefit" plan. The standard plans are labeled A through L. Remember, the plans are standardized. So, Plan F from one company will be the same as Plan F from another company.
Select the supplement policy which fits your needs, and then purchase that plan from the company which offers the lowest premiums and best customer service.
Included in all plans.
You 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 $4,940 (2014) out-of-pocket limit. Plan L has a $2,470 out-of-pocket limit (2014). 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.
The initial amount Medicare does not pay for an inpatient hospital stay per benefit period ($1,216 in 2014).
The amount Medicare does not pay for days 21-100 in a skilled nursing facility ($148/day in 2013).
The initial amount Medicare will not pay for covered physical or other outpatient services each calendar year ($147 in 2014). Most people pay $104.90 each month for the Part B Premium.
(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.
(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.
Part 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.
(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.
*(No longer offered after January 1, 2006).*
There 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.
During Open Enrollment, a company:
If you are 65 years old or older:
If you enroll in Medicare Part B when you turn 65, your Medigap Open Enrollment begins the day your Medicare Part B becomes effective.
If 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.
If 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.
If you are under 65 and receive Medicare due to disability:
Currently, 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.
There are other options for those who are under 65 and disabled:
Medicare Advantage Plans cannot turn you down if you are on Medicare due to a disability
Some 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.
If 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.
If 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.
If I am still working and have Medicare due to disability, can my employer group health plan turn me down? That depends on the size of your employer.
Can my working spouse's employer group plan turn me down? That depends on the size of the employer.
Your 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.
If your working spouse's employer has less than 100 employees, Medicare would be your primary insurance.
What are my other options?
Medicare Managed Health Maintenance Organizations (HMOs) cannot turn you down if you are on Medicare due to a disability. Some 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.
ICHIA, 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.
If 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.
View a complete list of companies that sell Medicare Supplement insurance. (updated 1/24/14) Back to top