Medigap (Medicare Supplement Insurance)
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1 Medigap (Medicare Supplement Insurance)
2 Lessons Original Medicare Coverage (gaps) Medigap Basics Buying a Medigap Policy 2010 What is New Medigap Plans Medigap Rights and Protections Information Sources for Medigap 2
3 Andrew Tartella Centers for Medicare & Medicaid Services Seattle Regional Office
4 Original Medicare Coverage Gaps in Original Medicare Coverage What is covered in Original Medicare Part A Part B What is not covered 4
5 Gaps in Original Medicare Coverage Original Medicare doesn t cover everything Original Medicare pays a share You pay a share If you buy a Medigap policy The policy pays all or part of your share Coverage depends on Medigap plan you buy 5
6 Hospital Stays Skilled Nursing Facility Care Blood What You Pay in Original Medicare Part A (Hospital Insurance) $1,100 deductible for days 1 60 $275 per day for days $550 per day for days $0 for first 20 days Up to $ per day for days % after day % for first 3 pints 20% for additional pints 6
7 What You Pay in Original Medicare (continued) Part A (Hospital Insurance) Home Health Care $0 for home health care services 20% for durable medical equipment for providers accepting assignment (Contract Provider if in Competitive Bidding Area) Up to $5 copayment for outpatient prescription drugs Hospice Care 5% for inpatient respite care Room and board, in some cases $5 for prescription drugs 7
8 What You pay in Original Medicare (continued) Part B (Medical Insurance) Part B Deductible Part B Services $155 per year 20% coinsurance for most covered services* 45% coinsurance for outpatient mental health* Copayments for hospital outpatient services *For providers accepting assignment 8
9 What is Not Covered by Medicare/Medigap Long term care Vision and dental care Including eyeglasses Hearing aids Private duty nursing Outpatient prescription drugs 9
10 Medigap Basics What Medigap is Standardized plans Important Medigap terms 10
11 What is a Medigap policy? Private health insurance for individuals Sold by private insurance companies Licensed by your state Supplements Original Medicare Follow Federal/state laws that protect you Must state Medicare Supplement Insurance 11
12 What is a Medigap policy? (continued) A Medigap policy may help you Lower your out of pocket costs Get more health insurance coverage Considerations include Your other coverage and health needs If your doctor accepts assignment 12
13 What are Standardized Plans? Standardized plans in most states Identified by a letter Plans currently sold A, B, C, D, F, G, K, L, M, N Companies don t have to sell all plans Plans existing but no longer sold E, H, I, J Non standardized plans (waiver states) Massachusetts, Minnesota, Wisconsin 13
14 What are Standardized Plans? (continued) Each standardized plan in a state Must offer the same basic benefits No matter which company sells it Costs (monthly premiums) may vary by Plan Company Where you live Age Cost Example Acme Insurance Company Plan C DT Insurance Company Plan C Benefits Same Same Monthly Cost $100 $120 14
15 Important Medigap Terms to Know Pre existing condition (up to 6 months before Medigap) Could delay Medigap coverage up to 6 months Creditable coverage (certain health coverage) Could shorten waiting period 06/01/2010 Medigap (Medicare Supplement Insurance) 15
16 Important Medigap Terms to Know (continued) Medical underwriting (review of your health) Could affect acceptance, cost, and coverage date Guaranteed issue rights Certain situations when insurance companies must Sell you a Medigap policy Cover all your pre existing health conditions Can t charge you more for a Medigap policy because of past or present health problems 06/01/2010 Medigap (Medicare Supplement Insurance) 16
17 Exercise A. Medigap policies are sold by 1. The Centers for Medicare & Medicaid Services 2. Private Insurance Companies 3. State governments 17
18 Exercise B. Every Medigap Plan C costs the same, regardless of insurance company 1. True 2. False 18
19 Buying a Medigap Policy Who can buy a Medigap policy When to buy a Medigap policy Open enrollment period Switching Medigap policies Buying a Medigap policy under age 65 How much Medigap costs Pricing based on age Steps to buying a Medigap policy 19
20 Who Can Buy Medigap? Generally must have Medicare Parts A and B May not be able to buy Medigap under 65 People with a disability People with End Stage Renal Disease Guaranteed right to buy a Medigap policy In your Medigap open enrollment period Covered under a guaranteed issue right 06/01/2010 Medigap (Medicare Supplement Insurance) 20
21 When to Buy a Medigap Policy May be able to buy a Medigap policy any time 6 month Medigap open enrollment period Begins when you Are both age 65 and Enrolled in Part B Can t be changed or repeated 21
22 Open Enrollment Period (OEP) OEP may be best time to buy Companies can t Refuse to sell any Medigap policy they sell Make you wait for coverage (exception below) Charge more because of a past/present health problem Companies can Make you wait for pre existing condition without creditable coverage Policies sold after 1990 guaranteed renewable 22
23 Waiting to Enroll in Part B Consider waiting to enroll in Part B If you or your spouse is still working and You have group health coverage Notify Social Security if you want to wait 23
24 Buying a Medigap Policy Under Age 65 People with Medicare under age 65 May not be able to buy Medigap People with a disability People with End Stage Renal Disease If available, may cost more New Medigap open enrollment period at age 65 24
25 Switching Medigap Policies Usually no right under Federal law to switch When can you switch policies? During your Medigap open enrollment period If you have a guaranteed issue right If your state has more generous requirements You move from your Medigap SELECT service area Can switch to plan with same or fewer benefits 30 day free look period 25
26 Switching Medigap Policies (continued) Why might you switch policies? You re paying for benefits you don t need You need more benefits now You want to change your insurance company You find a cheaper policy 26
27 How Much Does Medigap Cost? Cost depends on Your age (in some states) Where you live (e.g., urban, rural, or ZIP Code) Company selling the policy If there are discounts (female, non smokers, married couples) Medical underwriting Premiums vary greatly for same Medigap plan 27
28 Medigap Pricing Based on Age No age rated (community rated) Everyone pays same regardless of age if 65 or older Generally least expensive over lifetime Issue age rated Based on age when purchased Doesn t go up automatically as you get older Attained age rated Premium based on current age Goes up automatically as you get older Costs less when you are 65 Costs more at age 70 or 75 28
29 Buying a Medigap Policy Important decision shop carefully Four steps 1. Decide which Plan A N meets your needs 2. Find out which companies sell Medigap in your state 3. Call the companies and compare costs 4. Buy themedigappolicy 29
30 Exercise A. Mary s Medigap open enrollment period will start in two months. She tells you she plans to buy a policy in five months. She has no other coverage. What should she know? 1. If she needs any health care during the 3 months she delays getting a Medigap policy, she would have to pay the gaps in Original Medicare coverage out of pocket. 2. She will still be in her Medigap open enrollment period. This is the best time to buy a Medigap policy. 3. Her Medigap open enrollment period ends before she plans to buy a policy. She may have to pay more. 30
31 Exercise B. Which is true about a Medigap policy that is attained age rated? 1. It will be cheaper as you age. 2. It will stay the same price as you age except for cost of living adjustments. 3. It will cost more as you age. 31
32 2010 What is New Changes to basic Medigap benefits New plans Plans no longer sold 32
33 What s new and important in 2010? 33
34 Basic Benefits Add Hospice Coverage Part A coinsurance* (Part A coinsurance days Part B coinsurance or copayments for outpatient Blood (first 3 pints per year) 2010 MIPPA Medigap Changes (* denotes new plans and benefits on or after June 1, 2010) Deleted Coverage Preventive Services No In Home Recovery Plans No Longer Sold Changes to Plan D E, H, I, J Basic, including 100% Part B coinsurance Skilled Nursing Facility coinsurance Part A deductible Foreign Travel Emergency (In Home recovery deleted) Changes to Plan G Basic, including 100% Part B coinsurance Skilled Nursing Facility coinsurance Part A deductible 100% Part B Excess * Foreign Travel Emergency (In Home Recovery deleted) New Plan M * Basic, including 100% Part B coinsurance Skilled Nursing Facility coinsurance 50% Part A deductible Foreign Travel Emergency New Plan N * Basic, including 100% Part B coinsurance (except up to $20 office visit copayment; up to $50/ER) Skilled Nursing Facility coinsurance Part A deductible Foreign Travel Emergency 34
35 Medigap Plans Medigap plans available effective June 1, 2010 Special Medigap plans 35
36 36
37 Special Types of Medigap Plans High deductible plans Plans F, J Massachusetts, Minnesota, and Wisconsin (waiver states) Medicare SELECT (network plans) Medigap plans with drug coverage No longer sold 37
38 Medigap Plans F and J* High Deductible Option $2,000 deductible for 2010 Amount can go up each year Often have lower premium Out of pocket costs may be higher May not be able to change plans Additional deductibles *Plan J no longer sold after June 1,
39 Medigap Plans K and L Pay only partial costs after Medicare pays Have annual out of pocket maximum Plan K Plan L Percent Plan Pays for Most Services 50% 75% 2010 Out of Pocket Limit $4,620 $2,310 39
40 Medigap Plans with Rx Coverage Medigap policies that covered Rx drugs Only sold before January 1, 2006 Plans H, I and J o No longer sold as of June 1, 2010 Other standardized plan with Rx policy rider Same policies were sold without drug coverage Generally don t provide creditable drug coverage 40
41 Minnesota, Massachusetts, Wisconsin (Waiver States) Different kinds of Medigap policies NOT labeled with letters Benefits comparable to standardized plans Basic and optional benefits For information Call State Insurance Department 41
42 Medicare SELECT Policies A type of Medigap policy To get full benefits (except in emergency) Must use specific hospitals May have to see specific doctors Generally cost less than non network plans Can switch to plan with equal or lesser value May not be offered in your state 42
43 Exercise A. All Plans A, B, C, D, F, G, K, L, M and N cover 1. Part A coinsurance for inpatient hospital care 2. Dental care 3. Prescription drugs 4. All of the above 43
44 B. Medigap Plans K and L Exercise 1. Have different cost sharing than Plans A J 2. Cover Hospice Care coinsurance or copayment 3. Cover at different percentages 4. All of the above 44
45 Medigap Rights and Protections Guaranteed rights to buy a Medigap policy Right to Suspend Medigap 45
46 Guaranteed Rights to Buy a Medigap Policy Called guaranteed issue rights Situations with special rights to buy Medigap After Medigap open enrollment period Companies must sell you a Medigap policy Must cover all pre existing conditions Can t charge more These are Federal protections Some states have additional protections 46
47 You have amedigap guaranteed issue right if #1: You are in a Medicare Advantage (MA) Plan, and your plan is leaving Medicare or stops giving care in your area, or you move out of the plan s service area. Note: If you immediately join another MA Plan, you can stay in that plan for up to 1 year and still have the rights described in situations #4 and #5. #2: You have Original Medicare and an employer group health plan (including retiree or COBRA coverage) or union coverage that pays after Medicare pays and that plan is ending. Note: In this situation, state laws may vary. Medigap Guaranteed Issues Rights You have the right to buy Medigap Plan A, B, C, F, K, or L that is sold in your state by any insurance company. You only have this right if you switch to Original Medicare rather than joining another Medicare Advantage Plan Medigap Plan A, B, C, F, K, or L that is sold in your state by any insurance company. If you have COBRA coverage, you can either buy a Medigap policy right away or wait until the COBRA coverage ends. You can/must apply for a Medigap policy As early as 60 calendar days before the date your health care coverage will end, but no later than 63 calendar days after your health care coverage ends. Medigap coverage can t start until your Medicare Advantage Plan coverage has ended. No later than 63 calendar days after the latest of these 3 dates: 1.Date the coverage ends 2.Date on the notice you get telling you that coverage is ending (if you get one) 3.Date on a claim denial, if this is the only way you know that your coverage ended. 47
48 You have amedigap guaranteed issue right if #3: You have Original Medicare and a Medicare SELECT policy. You move out of the Medicare SELECT policy s service area. You can keep your Medigap policy, or you may want to switch to another Medigap policy. #4: (Trial Right) You joined a Medicare Advantage Plan or Program of All inclusive Care for the Elderly (PACE) when you were first eligible for Medicare Part A at age 65, and within the first year of joining, you decide you want to switch to Original Medicare. Medigap Guaranteed Issues Rights You have the right to buy Medigap Plan A, B, C, F, K, or L that is sold by any insurance company in your state or the state you are moving to. Any Medigap policy that is sold in your state by any insurance company. You can/must apply for a Medigap policy As early as 60 calendar days before the date your health care coverage will end, but no later than 63 calendar days after your health care coverage ends. As early as 60 calendar days before the date your coverage will end, but no later than 63 calendar days after your coverage ends. Note: Your rights may last for an extra 12 months under certain circumstances. 48
49 You have a Medigap guaranteed issue right if #5: (Trial Right) You dropped a Medigap policy to join a Medicare Advantage Plan (or to switch to a Medicare SELECT policy) for the first time; you have been in the plan less than a year, and you want to switch back. #6: Your Medigap insurance company goes bankrupt and you lose your coverage, or your Medigap policy coverage otherwise ends through no fault of your own. #7: You leave a Medicare Advantage Plan or drop a Medigap policy because the company hasn t followed the rules, or it misled you. Medigap Guaranteed Issues Rights You have the right to buy The Medigap policy you had before you joined the Medicare Advantage Plan or Medicare SELECT policy, if the same insurance company you had before still sells it. If it included drug coverage, you can still get that same policy, but without the drug coverage. If your former Medigap policy isn t available, you can buy amedigapplan A, B, C, F, K, or L that is sold in your state by any insurance company. Medigap Plan A, B, C, F, K, or L that is sold in your state by any insurance company Medigap Plan A, B, C, F, K, L, M, or N that is sold in your state by any insurance company. You can/must apply for a Medigap policy As early as 60 calendar days before the date your coverage will end, but no later than 63 calendar days after your coverage ends. Note: Your rights may last for an extra 12 months under certain circumstances. No later than 63 calendar days from the date your coverage ends. No later than 63 calendar days from the date your coverage ends. 49
50 Right to Suspend Medigap Suspend up to 2 years if under 65 While enrolled in your/spouse s employer group health plan Get your Medigap policy back at any time Notify insurer within 90 days of losing employer group plan No waiting period (Group Health Plan) 50
51 Right to Suspend Medigap (Medicaid) If you have both Medicare and Medicaid You generally can t buy a Medigap policy Can suspend Medigap policy Within 90 days of getting Medicaid (up to 2 years) Can start it up again No new medical underwriting or waiting periods 51
52 Right to Suspend Medigap (Medicaid) If you suspend your Medigap policy You do not pay Medigap premiums The Medigap policy will not pay benefits May not want to suspend To see doctors who don t accept Medicaid Call state Medicaid office or SHIP for help 52
53 Exercise A. John is 58 and has Original Medicare because he has a disability. He has a Medigap policy. His wife is working and John is covered by her group health plan. The coverage is creditable. What should he do about his Medigap policy? 1. Drop both his Medigap policy and his wife s group health coverage. 2. Drop his Medigap policy. 3. Suspend his Medigap policy and keep both Original Medicare and his wife s group health coverage. 53
54 Exercise B. Federal law is the only protection you have with Medigap policies. 1. True 2. False 54
55 Information Sources for Medigap 2010 Choosing a Medigap Policy: A Guide to Health Insurance for People With Medicare, CMS Pub. # View at Publications/Pubs/pdf/02110.pdf Order copies at 55
56 Information Sources for Medigap (continued) State Health Insurance Assistance Programs (SHIPs) State Insurance Department MEDICARE for TTY users 56
57 This training module provided by the For questions about training products, To view all available NMTP materials or to subscribe to our listserv, visit cms.hhs.gov/ NationalMedicareTrainingProgram
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