Below are a list of frequently asked questions and answers about Medicare and Medicare Supplement insurance.
Q: What is Medicare Supplement Insurance?
A: Medicare Supplement insurance (Medigap) is a private form of medical insurance that covers some Medicare out-of-pocket costs. A policy can help pay for Medicare deductibles, co-payments, co-insurance and other costs.
Q: What is Medicare?
A: Medicare is a federal health insurance program that provides affordable health care options for seniors 65 and older, disabled citizens, and those suffering from ESRD. There are 4 parts: Part A, Part B, Part C, and Part D. Medicare Part A and Part B (also known as Original Medicare) provide hospital and medical insurance. Medicare Part C is known as Medicare Advantage. Medicare Part D provides prescription drug coverage.
Q: Am I Eligible for Medicare Supplement Insurance?
A: If you are enrolled in Medicare Part A and Part B and are 65 years or older, or have a qualifying disability, you are likely eligible to purchase Medicare Supplement Insurance. If you apply during your Medigap open enrollment period, you cannot be denied coverage or charged more for your policy based on your health.
Q: What are the differences between Medigap Plans?
A: There are 10 different Medigap plans currently available for purchase in most states: Plans A, B, C, D, F, G, K, L, M and N. Each plan offers a different array of benefits. Insurance companies must offer the same benefits for each plan option. For example, one insurer’s Plan G will have the same benefits as another insurer’s Plan G. The only difference between the two companies’ policies is price.
Q: Can an insurance company refuse to sell me a Medigap Plan?
A: If you enroll during the open enrollment period, an insurance company cannot deny you coverage. If you miss your open enrollment period, an insurance company is legally allowed to deny your application.
Q: What is the “Waiting Period”?
A: The Medigap waiting period is only applicable to those who sign up for a Medigap plan outside of the open enrollment period. If you enroll after your OEP, the insurance company may enforce a waiting period that lasts up to 6 months. During this time, the insurance company can refuse to cover the out-of-pocket treatment costs related to any pre-existing conditions.
Q: Does Medigap cover Prescription Drugs?
A: Medigap policies do not provide prescription drug coverage. Medigap plans stopped providing prescription drug coverage in 2006. If you are enrolled in a Medigap policy, you can get prescription drug coverage through Medicare Part D.
Q: Will my premium change?
A: The pricing structure used on your Medigap policy will impact how your premium increases in the future. There are 3 types of pricing structures: attained-age pricing, community-rated pricing, and issue-age pricing. If your policy is attained-age, the premium will increase as you age. If your policy is issue-age, the premium will not increase as you age but can increase based on other factors. If your policy is community-rated, the premium can increase based on inflation.
Q: What happened to Medigap Plans E, H, I and J?
A: Medigap plans E, H, I and J are no longer available for purchase. In 2010, the federal government added new plans and removed older plans including plans E, H, I and J. If you have plan E, H, I or J, you are still allowed to use your policy.
Q: What is Medicare SELECT?
A: Medicare SELECT is a form of Medicare Supplement insurance that requires the enrollee to use a specified network of hospitals and health care providers to gain full benefits. Medicare SELECT plans can be any one of the 10 standardized Medigap plans. The SELECT version of a Medigap plan is usually less expensive than the regular version.
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1 WA residents: All references to "agent" should be replaced with "producer."