Medicare Supplement Insurance Shopper s Guide

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1 Kansas Medicare Supplement Insurance Shopper s Guide Rates effective as of March 1, 2011 Kansas Insurance Department Sandy Praeger, Commissioner

2 Medicare Supplement Insurance Shopper s Guide March 2011 Dear Kansas consumer, If you have picked up this guide, chances are you are somewhat familiar with Medicare a federally-funded health insurance program for people with disabilities and people 65 and older. Although Medicare may pay a large part of your health care expenses, it doesn t cover every service or medical supply. Medicare recipients are responsible for paying coinsurance and deductibles. This guide will help you evaluate your health care insurance needs. It will also help you gather accurate information concerning Medicare and other health insurance options so you can make decisions that will prevent serious, costly problems. In this book you ll find rate comparisons of companies selling the various types of Medicare supplement insurance. For the most recent rate comparisons, visit our website, If you have questions or need assistance understanding insurance issues, don t hesitate to contact the Kansas Insurance Department s Consumer Assistance Hotline toll-free at Our trained staff is dedicated to helping answer your insurance questions and finding solutions to your problems. Sincerely, Sandy Praeger, Commissioner of Insurance Tell us what you think! We are always looking for the best ways to assist consumers with their insurance needs. If you have a suggestion on how to improve this publication, send us an

3 Section I: About Medicare Supplement and Medicare Select Insurance 2 Details of Plans A - N 6 Table of Contents Plan comparison charts 26 Medicare supplement insurance at a glance 31 Section II: Medicare Supplement and Medicare Select Insurance Rates 32 Company customer service phone numbers 42 Appendix I: About Medicare and Medicare Advantage Plans 43 Medicare coverage choices at a glance 46 What you need to know in Medicare and the Affordable Care Act 53 Appendix II: Consumer Protections and Other Resources 54 Guarantee Rights in Kansas 55 Glossary of Terms 59

4 Section I: About Medicare Supplement and Medicare Select Insurance What is Medicare supplement insurance? Medicare supplement insurance can help cover the expenses that come with the gaps in Original Medicare (described in further detail in Appendix 1). Medicare supplement policies can only be purchased with Original Medicare - you may not have a Medicare supplement policy if you have a Medicare Advantage plan. This supplemental insurance is also called Medigap because it helps pay for these gaps. The Kansas Insurance Department is responsible for regulating this type of insurance in the state of Kansas. Costs that you must pay, like coinsurance, copayments and deductibles, are examples of some of the gaps in Original Medicare coverage. You might want to consider buying a Medicare supplement policy to cover these expenses. Some Medicare supplement policies also cover benefits that the Original Medicare plan doesn t cover, like emergency health care while traveling outside the United States. A Medicare supplement policy may help you save on out-of-pocket costs. How does Medicare supplement insurance work? Medicare Supplement insurance is broken down into plans identified by letters - A, B, C, D, F, G, K, L, M & N. These plans are standardized and must follow federal and state laws, which have been created to protect you, the consumer. (Details about each of these plans is available later in this booklet.) These plans are sold by private insurance companies, but they all have the same benefits. That is, plans identified as Plan A in the state of Kansas are identical, regardless of the company that is selling it. However, the cost of the plan will vary depending on the company who provides it. All companies in the state of Kansas that wish to sell Medicare supplement insurance must make Plan A available to their customers. If they want to offer additional Medicare supplement plans, they must also offer either Plan C or Plan F. Plan A features the core benefits of a Medicare supplement policy. All other plans build upon this. How are premium rates determined? Premium rates for Medicare supplement insurance policies are determined in one of two ways: Issue age - The company will not raise your premium just because you are getting older. Your premium will always be based on your age when you purchased the policy, but it will be adjusted for other factors, like inflation. If you buy a plan at age 65, you will always pay the current premiums charged to 65-year old customers, regardless of your current age. Issue age policies can be more costly up front but also can save money in the long run. Attained age - For rates determined by attained age, the premium will increase as you get older. If you buy a plan at age 65, you may have a premium increase each year. Enrollment Periods Medicare supplement enrollment periods differ from other Medicare enrollment periods. Insurers must offer a six-month open enrollment period to all Medicare beneficiaries. This six-month period begins with the first month in which the beneficiary first enrolled for benefits under Medicare Part B (for many people, this is age 65; for others, it begins when you lose em Medicare Supplement Shopper s Guide

5 Beneficiaries with disabilities Disabled Medicare beneficiaries under age 65 have equal access to all Medicare supplement policies sold in Kansas. Upon enrolling in Medicare Part B, a disabled beneficiary has a 6-month open-enrollment period to buy supplemental coverage. That period begins the day Part B coverage becomes effective. Supplement policies must be sold at the same rate as for seniors who turn 65 and are eligible for Medicare. Disabled Medicare beneficiaries cannot be turned down for any Medicare supplement plan being sold in Kansas during the initial 6-month open-enrollment period. Coverage will be guaranteed issue, but the same pre-existing condition limitation as applies to age 65 beneficiaries may apply. A second open-enrollment period will apply when the disabled Medicare beneficiary turns 65. ployer- or group-sponsored health care). During this six-month period, insurers are required to offer any Medicare supplement policy to all enrollees, regardless of their health status. During this time, the same amount is charged to both healthy individuals and those with medical conditions. After this six-month period ends, insurers are allowed to use medical underwriting to determine whether or not you are accepted into the plan and, if so, how much you will be charged, so it is important to evaluate your options carefully during your first enrollment period. Should you decide to switch to a different Medicare supplement policy after this open enrollment period, you may be subject to medical underwriting. The six-month open enrollment period for Medicare supplement insurance starts on the same day your Part B Medicare starts. This date is shown on your Medicare card. Medicare Select insurance Medicare Select is another option available to some Kansas Medicare beneficiaries. Medicare Select policies are just like standardized Medicare supplement policies. However, each Medicare Select policy has specific hospitals and, in some cases, doctors that you must use in order to be eligible for full benefits (except in the case of medical emergencies). Because the insurers negotiate directly with specific providers (sometimes called preferred providers ), premium costs for Medicare Select plans are generally lower than a standard Medicare supplement policy. When you choose to use a preferred provider, Medicare pays its share of the approved charges and the Medicare Select policy pays for the full supplemental benefits provided for in the policy. If you do not want to use the preferred provider, Medicare will still pay its share of approved charges. However, the Medicare Select policy would not be required to pay any benefits. A comparison shopper s guide for both Medicare supplement policies and Medicare Select policies for premium rates is available in Section II of this book. Services provided under Medicare supplement policies The following services are provided under Medicare. Medicare supplement plans help pay for portions of these services not covered by Medicare. The following details, from will help you determine whether or not you will need a supplemental policy. Hospitalization - Medicare covers a semiprivate room, meals, general nursing, and other hospital services and supplies. This includes care in critical access hospitals and inpatient mental health care. This does not include private duty nursing or a television or 2011 Medicare Supplement Shopper s Guide 03

6 telephone in your room. It does not include a private room, unless medically necessary. Medicare does not cover Part A deductible, coinsurance, or coverage after your allotted number of days have been used each benefit period. Skilled Nursing Facility Care - Medicare covers a semiprivate room, meals, skilled nursing and rehabilitative services, and other services and supplies (after a related 3-day hospital stay). You must have been admitted to the Medicare-approved nursing facility within 30 days of leaving the hospital. Medicare does not cover coinsurance or coverage after 100 days per benefit period. Blood - Medicare covers pints of blood you get at a hospital or skilled nursing facility during a covered stay. Medicare does not cover the first three pints or the $162 Part B deductible (in some cases). Hospice Care - Medicare covers medical and support services from a Medicare-approved hospice for people with a terminal illness, drugs for symptom control and pain relief, and other services not otherwise covered by Medicare. Hospice care is given in your home. However, short-term hospital and inpatient respite care (care given to a hospice patient by another caregiver so that the usual caregiver can rest) are covered when needed. You must have a doctor s certification of a terminal illness. Medicare does not cover the copayment or coinsurance. Medical Expenses - Medicare covers doctor s services, outpatient medical and surgical services and supplies, diagnostic tests, ambulatory surgery center facility fees for approved procedures, and durable medical equipment (such as wheelchairs, hospital beds, oxygen, and walkers). Also covers second surgical opinions, outpatient mental health care, outpatient physical and occupational therapy, including speechlanguage therapy. Medicare does not cover the Part B deductible or coinsurance. Clinical Laboratory Services - Medicare covers blood tests, urinalysis and other tests for diagnostic services. speech-language therapy, home health aide services, medical social services, durable medical equipment (such as wheelchairs, hospital beds, oxygen, and walkers) and medical supplies, and other services. Medicare does not cover the Part B deductible. The following services are not covered under Medicare, but may be covered by some Medicare supplement plans: Part B Excess charges - Excess charges are not covered under Medicare. If doctors decide not to accept the reimbursement rate they receive from Medicare for providing certain services, they are allowed to charge up to 15% more for those covered services. If the doctor you visit is one of these, you will be responsible for paying that 15% above what Medicare covers. The Medicare supplement policy may cover some or all of your expenses above the Medicare approved amounts. Foreign Travel - Some Medicare supplement policies will cover some of your expenses related to emergency care while traveling outside the United States. Benefit time frames Part A of Medicare is based on a per-benefit period timeline. According to Medicare, a benefit period begins the day you go into a hospital or skilled nursing facility (SNF). The benefit period ends when you haven t received any hospital care (or skilled care in a SNF) for 60 days in a row. If you return to the hospital or SNF before the end of that 60 day period, it will be considered part of the same benefit period. If you go into a hospital or a SNF after one benefit period has ended, a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. There is no limit to the number of benefit periods an enrollee may have. Part B benefits are based on the calendar year, which begins January 1 of each year and ends December 31. Home Health Care - Medicare covers part-time skilled nursing care, physical therapy, occupational therapy, Medicare Supplement Shopper s Guide

7 Overview of Medicare Parts A & B A In-patient hospital First 60 days $1,156 B $140 Deductible (the amount you must pay before any coverage from the insurer) Days $289 per day coinsurance 20% Coinsurance Lifetime Reserve Days Skilled Nursing Facility First 20 days Days $578 per day coinsurance 100% (no copay) $ per day coinsurance Home Health Hospice 100% Services *Benefit period ends when patient is out of the hospital or skilled nursing facility for 60 consecutive days. Amount you pay Amount Medicare pays The numbers on this page only reflect the 2012 Medicare rates. 80% of costs (after deductible is met) Physician s charges (in or out of hospital) Durable medical equipment Ambulance Outpatient hospital charges Excess Charges If doctors do not accept Medicare s reimbursement rate, they are allowed to charge up to 15% more for covered services. If the doctor you visit is one of these, you will be responsible for paying that 15% above what Medicare covers Medicare Supplement Shopper s Guide 05

8 Medicare supplement plans details PLAN A Benefits if you have Medicare Part A SERVICES MEDICARE PAYS MED SUPP PAYS YOU PAY Hospitalization First 60 days All but $1,132 $1,132 (Part A deductible) Day 61 - Day 90 Day (while using 60 lifetime reserve days) All but $283 per day $283 per day All but $566 per day $566 per day Additional 365 days 100% of Medicare eligible expenses After additional 365 days Skilled Nursing Facility Care All costs First 20 days All approved amounts Day 21 - Day 100 All but $ per day Up to $ per day Day 101 and after All costs Blood First 3 pints 3 pints Additional amounts 100% Hospice Care Medical Expenses All but very limited copayment/coinsurance for outpatient drugs and inpatient respite care Medicare copayment/ coinsurance Benefits if you have Medicare Part B First $162 of Medicare Approved Amounts $162 (Part B deductible) Medicare Supplement Shopper s Guide

9 PLAN A Benefits if you have Medicare Part B SERVICES MEDICARE PAYS MED SUPP PAYS YOU PAY Medical Expenses Remainder of Medicare Approved Amounts Generally 80% Generally 20% Blood First 3 pints All costs Next $162 of Medicare Approved Amounts $162 (Part B deductible) Remainder of Medicare Approved Amounts 80% 20% Clinical Laboratory Ser vices 100% Home Health Care Benefits if you have Medicare Part A and Part B Medically necessary skilled care services and medical supplies 100% Durable medical equipment: First $162 of Medical approved amounts $162 (Part B deductible) Remainder of Medicare Approved Amounts 80% 20% Benefits not covered under Medicare Part B Excess Charges All costs 2011 Medicare Supplement Shopper s Guide 07

10 PLAN B Benefits if you have Medicare Part A SERVICES MEDICARE PAYS MED SUPP PAYS YOU PAY Hospitalization First 60 days All but $1,132 $1,132 (Part A deductible) Day 61 - Day 90 All but $283 per day $283 per day Day (while using 60 lifetime reserve days) All but $566 per day $566 per day Additional 365 days 100% of Medicare eligible expenses After additional 365 days All costs Skilled Nursing Facility Care First 20 days All approved amounts Day 21 - Day 100 All but $ per day Up to $ per day Day 101 and after All costs Blood First 3 pints 3 pints Additional amounts 100% Hospice Care Medical Expenses All but very limited copayment/coinsurance for outpatient drugs and inpatient respite care Medicare copayment/ coinsurance Benefits if you have Medicare Part B First $162 of Medicare Approved Amounts $162 (Part B deductible) Remainder of Medicare Approved Amounts Generally 80% Generally 20% Medicare Supplement Shopper s Guide

11 Blood PLAN B Benefits if you have Medicare Part B SERVICES MEDICARE PAYS MED SUPP PAYS YOU PAY First 3 pints All costs Next $162 of Medicare Approved Amounts $162 (Part B deductible) Remainder of Medicare Approved Amounts 80% 20% Clinical Laboratory Ser vices 100% Home Health Care Benefits if you have Medicare Part A and Part B Medically necessary skilled care services and medical supplies 100% Durable medical equipment: First $162 of Medical approved amounts $162 (Part B deductible) Remainder of Medicare Approved Amounts 80% 20% Benefits not covered under Medicare Part B Excess Charges All costs 2011 Medicare Supplement Shopper s Guide 09

12 PLAN C Benefits if you have Medicare Part A SERVICES MEDICARE PAYS MED SUPP PAYS YOU PAY Hospitalization First 60 days Day 61 - Day 90 Day (while using 60 lifetime reserve days) All but $1,132 $1,132 (Part A deductible) All but $283 per day $283 per day All but $566 per day $566 per day Additional 365 days 100% of Medicare eligible expenses After additional 365 days All costs Skilled Nursing Facility Care First 20 days Day 21 - Day 100 All approved amounts All but $ per day Up to $ per day Day 101 and after All costs Blood First 3 pints 3 pints Additional amounts 100% Hospice Care All but very limited copayment/coinsurance for outpatient drugs and inpatient respite care Medicare copayment/ coinsurance Benefits if you have Medicare Part B Medical Expenses First $162 of Medicare Approved Amounts $162 (Part B deductible) Remainder of Medicare Approved Amounts Generally 80% Generally 20% Medicare Supplement Shopper s Guide

13 Blood PLAN C Benefits if you have Medicare Part B SERVICES MEDICARE PAYS MED SUPP PAYS YOU PAY First 3 pints All costs Next $162 of Medicare Approved Amounts $162 (Part B deductible) Remainder of Medicare Approved Amounts 80% 20% Clinical Laboratory Ser vices 100% Home Health Care Benefits if you have Medicare Part A and Part B Medically necessary skilled care services and medical supplies 100% Durable medical equipment: First $162 of Medical approved amounts $162 (Part B deductible) Remainder of Medicare Approved Amounts 80% 20% Benefits not covered under Medicare Part B Excess Charges All costs Foreign Travel First $250 per calendar year $250 Remainder of charges 80% to a lifetime maximum benefit of $50,000 20% and amounts over the $50,000 lifetime maximum 2011 Medicare Supplement Shopper s Guide 11

14 PLAN D Benefits if you have Medicare Part A SERVICES MEDICARE PAYS MED SUPP PAYS YOU PAY Hospitalization First 60 days All but $1,132 $1,132 (Part A deductible) Day 61 - Day 90 All but $283 per day $283 per day Day (while using 60 lifetime reserve days) All but $566 per day $566 per day Additional 365 days 100% of Medicare eligible expenses After additional 365 days All costs Skilled Nursing Facility Care First 20 days All approved amounts Day 21 - Day 100 All but $ per day Up to $ per day Day 101 and after All costs Blood First 3 pints 3 pints Additional amounts 100% Hospice Care All but very limited copayment/coinsurance for outpatient drugs and inpatient respite care Medicare copayment/ coinsurance Benefits if you have Medicare Part B Medical Expenses First $162 of Medicare Approved Amounts $162 (Part B deductible) Remainder of Medicare Approved Amounts Generally 80% Generally 20% Medicare Supplement Shopper s Guide

15 Blood PLAN D Benefits if you have Medicare Part B SERVICES MEDICARE PAYS MED SUPP PAYS YOU PAY First 3 pints All costs Next $162 of Medicare Approved Amounts $162 (Part B deductible) Remainder of Medicare Approved Amounts 80% 20% Clinical Laboratory Ser vices 100% Home Health Care Benefits if you have Medicare Part A and Part B Medically necessary skilled care services and medical supplies 100% Durable medical equipment: First $162 of Medical approved amounts $162 (Part B deductible) Remainder of Medicare Approved Amounts 80% 20% Benefits not covered under Medicare Part B Excess Charges All costs Foreign Travel First $250 per calendar year $250 Remainder of charges 80% to a lifetime maximum benefit of $50,000 20% and amounts over the $50,000 lifetime maximum 2011 Medicare Supplement Shopper s Guide 13

16 PLAN F and HIGH DEDUCTIBLE PLAN F The high deductible Plan F pays the same benefits as Plan F after one has paid a calendar year $2000 deductible. Benefits from the high deductible Plan F will not begin until out-of-pocket expenses are $2000. Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy. This includes the Medicare deductibles for Part A and Part B, but does not include the plan s separate foreign travel emergency deductible. Benefits if you have Medicare Part A SERVICES MEDICARE PAYS MED SUPP PAYS YOU PAY Hospitalization First 60 days All but $1,132 $1,132 (Part A deductible) Day 61 - Day 90 All but $283 per day $283 per day Day (while using 60 lifetime reserve days) All but $566 per day $566 per day Additional 365 days 100% of Medicare eligible expenses After additional 365 days All costs Skilled Nursing Facility Care First 20 days All approved amounts Day 21 - Day 100 All but $ per day Up to $ per day Day 101 and after All costs Blood First 3 pints 3 pints Additional amounts 100% Hospice Care All but very limited copayment/coinsurance for outpatient drugs and inpatient respite care Medicare copayment/ coinsurance Benefits if you have Medicare Part B Medical Expenses First $162 of Medicare Approved Amounts $162 (Part B deductible) Remainder of Medicare Approved Amounts Generally 80% Generally 20% Medicare Supplement Shopper s Guide

17 PLAN F and HIGH DEDUCTIBLE PLAN F Benefits if you have Medicare Part B SERVICES MEDICARE PAYS MED SUPP PAYS YOU PAY Blood First 3 pints All costs Next $162 of Medicare Approved Amounts $162 (Part B deductible) Remainder of Medicare Approved Amounts 80% 20% Clinical Laboratory Ser vices 100% Home Health Care Benefits if you have Medicare Part A and Part B Medically necessary skilled care services and medical supplies 100% Durable medical equipment: First $162 of Medical approved amounts $162 (Part B deductible) Remainder of Medicare Approved Amounts 80% 20% Benefits not covered under Medicare Part B Excess Charges 100% Foreign Travel First $250 per calendar year $250 Remainder of charges 80% to a lifetime maximum benefit of $50,000 20% and amounts over the $50,000 lifetime maximum 2011 Medicare Supplement Shopper s Guide 15

18 PLAN G Benefits if you have Medicare Part A SERVICES MEDICARE PAYS MED SUPP PAYS YOU PAY Hospitalization First 60 days All but $1,132 $1,132 (Part A deductible) Day 61 - Day 90 All but $283 per day $283 per day Day (while using 60 lifetime reserve days) All but $566 per day $566 per day Additional 365 days 100% of Medicare eligible expenses After additional 365 days All costs Skilled Nursing Facility Care First 20 days All approved amounts Day 21 - Day 100 All but $ per day Up to $ per day Day 101 and after All costs Blood First 3 pints 3 pints Additional amounts 100% Hospice Care All but very limited copayment/coinsurance for outpatient drugs and inpatient respite care Medicare copayment/ coinsurance Benefits if you have Medicare Part B Medical Expenses First $162 of Medicare Approved Amounts $162 (Part B deductible) Remainder of Medicare Approved Amounts Generally 80% Generally 20% Medicare Supplement Shopper s Guide

19 PLAN G Benefits if you have Medicare Part B SERVICES MEDICARE PAYS MED SUPP PAYS YOU PAY Blood First 3 pints All costs Next $162 of Medicare Approved Amounts $162 (Part B deductible) Remainder of Medicare Approved Amounts 80% 20% Clinical Laboratory Ser vices 100% Home Health Care Benefits if you have Medicare Part A and Part B Medically necessary skilled care services and medical supplies 100% Durable medical equipment: First $162 of Medical approved amounts $162 (Part B deductible) Remainder of Medicare Approved Amounts 80% 20% Benefits not covered under Medicare Part B Excess Charges 100% Foreign Travel First $250 per calendar year $250 Remainder of charges 80% to a lifetime maximum benefit of $50,000 20% and amounts over the $50,000 lifetime maximum 2011 Medicare Supplement Shopper s Guide 17

20 PLAN K You will pay half the cost-sharing of some covered services until you reach the annual out-of-pocket limit of $4640 each calendar year. The amounts that count toward your annual limit are noted with circles ( ) in the chart. Once you reach the annual limit, the plan pays 100% of your Medicare copayment and coinsurance for the rest of the calendar year. However, this limit does NOT include charges from your provider that exceed Medicare-approved amounts (these are called Excess Charges ) and you will be responsible for paying this difference in the amount charged by your provider and the amount paid by Medicare for the item or service. Once you have been billed $162 of Medicare-approved amounts for covered services, your Part B deductible will have been met for the calendar year. Benefits if you have Medicare Part A SERVICES MEDICARE PAYS MED SUPP PAYS YOU PAY Hospitalization First 60 days All but $1,132 Day 61 - Day 90 All but $283 per day $283 per day Day (while using 60 lifetime reserve days) All but $566 per day $566 per day Additional 365 days $566 (50% of Part A deductible) $566 (50% of Part A deductible) 100% of Medicare eligible expenses After additional 365 days All costs Skilled Nursing Facility Care First 20 days All approved amounts Day 21 - Day 100 All but $ per day Up to $70.75 per day (50% of Part A coinsurance) Up to $70.75 per day (50% of Part A coinsurance) Day 101 and after All costs Blood First 3 pints 50% 50% Additional amounts 100% Hospice Care Medical Expenses First $162 of Medicare Approved Amounts All but very limited copayment/coinsurance for outpatient drugs and inpatient respite care 50% of copayment/ coinsurance Benefits if you have Medicare Part B 50% of Medicare copayment/ coinsurance $162 (Part B deductible) Medicare Supplement Shopper s Guide

21 PLAN K Benefits if you have Medicare Part B SERVICES MEDICARE PAYS MED SUPP PAYS YOU PAY Medical Expenses Preventive Benefits for Medicare covered services Generally 80% or more of Medicare approved amounts Remainder of Medicare approved amounts All costs above Medicare approved amounts Remainder of Medicare Approved Amounts Generally 80% Generally 10% Generally 10% Blood First 3 pints 50% 50% Next $162 of Medicare Approved Amounts $162 (Part B deductible) Remainder of Medicare Approved Amounts Generally 80% Generally 10% Generally 10% Clinical Laboratory Ser vices 100% Home Health Care Benefits if you have Medicare Part A and Part B Medically necessary skilled care services and medical supplies 100% Durable medical equipment: First $162 of Medical approved amounts $162 (Part B deductible) Remainder of Medicare Approved Amounts 80% 10% 10% Part B Excess Charges Benefits not covered under Medicare All costs (and they do not count toward annual out-of-pocket limit of $4640) 2011 Medicare Supplement Shopper s Guide 19

22 PLAN L You will pay one-fourth of the cost-sharing of some covered services until you reach the annual out-of-pocket limit of $2320 each calendar year. The amounts that count toward your annual limit are noted with a square ( ) in the chart. Once you reach the annual limit, the plan pays 100% of your Medicare copayment and coinsurance for the rest of the calendar year. However, this limit does NOT include charges from your provider that exceed Medicare-approved amounts (these are called Excess Charges ) and you will be responsible for paying this difference in the amount charged by your provider and the amount paid by Medicare for the item or service. Benefits if you have Medicare Part A SERVICES MEDICARE PAYS MED SUPP PAYS YOU PAY Hospitalization First 60 days All but $1,132 $849 (75% of Part A deductible) $283(25% of Part A deductible) Day 61 - Day 90 All but $283 per day $283 per day Day (while using 60 lifetime reserve days) All but $566 per day $566 per day Additional 365 days 100% of Medicare eligible expenses After additional 365 days All costs Skilled Nursing Facility Care First 20 days All approved amounts Day 21 - Day 100 All but $ per day Up to $ per day (75% of Part A coinsurance) Up to $35.38 per day (25% of Part A coinsurance) Day 101 and after All costs Blood First 3 pints 75% 25% Additional amounts 100% Hospice Care Medical Expenses All but very limited copayment/coinsurance for outpatient drugs and inpatient respite care 75% of copayment/ coinsurance Benefits if you have Medicare Part B 25% of Medicare copyament/ coinsurance First $162 of Medicare Approved Amounts $162 (Part B deductible) Medicare Supplement Shopper s Guide

23 PLAN L Benefits if you have Medicare Part B SERVICES MEDICARE PAYS MED SUPP PAYS YOU PAY Medical Expenses Preventive Benefits for Medicare covered services Generally 80% or more of Medicare approved amounts Remainder of Medicare approved amounts All costs above Medicare approved amounts Remainder of Medicare Approved Amounts Generally 80% Generally 15% Generally 5% Blood First 3 pints 75% 25% Next $162 of Medicare Approved Amounts $162 (Part B deductible) Remainder of Medicare Approved Amounts Generally 80% Generally 15% Generally 5% Clinical Laboratory Ser vices 100% Home Health Care Benefits if you have Medicare Part A and Part B Medically necessary skilled care services and medical supplies 100% Durable medical equipment: First $162 of Medical approved amounts $162 (Part B deductible) Remainder of Medicare Approved Amounts 80% 15% 5% Benefits not covered under Medicare Part B Excess Charges All costs (and they do not count toward annual out-of-pocket limit of $2320) 2011 Medicare Supplement Shopper s Guide 21

24 PLAN M Benefits if you have Medicare Part A SERVICES MEDICARE PAYS MED SUPP PAYS YOU PAY Hospitalization First 60 days All but $1,132 $566 (50% of Part A deductible) $566 (50% of Part A deductible) Day 61 - Day 90 All but $283 per day $283 per day Day (while using 60 lifetime reserve days) All but $566 per day $566 per day Additional 365 days 100% of Medicare eligible expenses After additional 365 days All costs Skilled Nursing Facility Care First 20 days All approved amounts Day 21 - Day 100 All but $ per day Up to $ per day Day 101 and after All costs Blood First 3 pints 3 pints Additional amounts 100% Hospice Care All but very limited copayment/coinsurance for outpatient drugs and inpatient respite care Medicare copayment/ coinsurance Benefits if you have Medicare Part B Medical Expenses First $162 of Medicare Approved Amounts $162 (Part B deductible) Remainder of Medicare Approved Amounts Generally 80% Generally 20% Medicare Supplement Shopper s Guide

25 PLAN M Benefits if you have Medicare Part B SERVICES MEDICARE PAYS MED SUPP PAYS YOU PAY Blood First 3 pints All costs Next $162 of Medicare Approved Amounts $162 (Part B deductible) Remainder of Medicare Approved Amounts 80% 20% Clinical Laboratory Ser vices 100% Home Health Care Benefits if you have Medicare Part A and Part B Medically necessary skilled care services and medical supplies 100% Durable medical equipment: First $162 of Medical approved amounts $162 (Part B deductible) Remainder of Medicare Approved Amounts 80% 20% Benefits not covered under Medicare Part B Excess Charges All costs Foreign Travel First $250 per calendar year $250 Remainder of charges 80% to a lifetime maximum benefit of $50,000 20% and amounts over the $50,000 lifetime maximum 2011 Medicare Supplement Shopper s Guide 23

26 PLAN N Benefits if you have Medicare Part A SERVICES MEDICARE PAYS MED SUPP PAYS YOU PAY Hospitalization First 60 days All but $1,132 $1,132 (Part A deductible) Day 61 - Day 90 All but $283 per day $283 per day Day (while using 60 lifetime reserve days) All but $566 per day $566 per day Additional 365 days 100% of Medicare eligible expenses After additional 365 days All costs Skilled Nursing Facility Care First 20 days All approved amounts Day 21 - Day 100 All but $ per day Up to $ per day Day 101 and after All costs Blood First 3 pints 3 pints Additional amounts 100% Hospice Care Medical Expenses First $162 of Medicare Approved Amounts Remainder of Medicare Approved Amounts All but very limited copayment/coinsurance for outpatient drugs and inpatient respite care Medicare copayment/ coinsurance Benefits if you have Medicare Part B $162 (Part B deductible) Generally 80% Balance, other than up to $20 per office visit and up to $50 per emergency room visit. The copayment of up to $50 is waived if the insured is admitted to any hospital and the emergency visit is covered as a Medicare Part A expense. Up to $20 per office visit and up to $50 per emergency room visit. The copayment of up to $50 is waived if the insured is admitted to any hospital and the emergency visit is covered as a Medicare Part A expense Medicare Supplement Shopper s Guide

27 PLAN N Benefits if you have Medicare Part B SERVICES MEDICARE PAYS MED SUPP PAYS YOU PAY Blood First 3 pints Next $162 of Medicare Approved Amounts $162 (Part B deductible) Remainder of Medicare Approved Amounts 80% 20% Clinical Laboratory Ser vices 100% Home Health Care All costs Benefits if you have Medicare Part A and Part B Medically necessary skilled care services and medical supplies 100% Durable medical equipment: First $162 of Medical approved amounts $162 (Part B deductible) Remainder of Medicare Approved Amounts 80% 20% Other benefits not covered under Medicare Part B Excess Charges All costs Foreign Travel First $250 per calendar year $250 Remainder of charges 80% to a lifetime maximum benefit of $50,000 20% and amounts over the $50,000 lifetime maximum 2011 Medicare Supplement Shopper s Guide 25

28 Medicare Supplement Plans Comparison Chart Benefits under Medicare Part A Hospitalization Days 1-60 Days Days Addt l 365 days After 365 days Skilled Nursing Facility Days 1-20 Days Day 101 and after Plan A $1,132 All costs Up to $ per day All costs Plan B All costs Up to $ per day All costs Plan C All costs All costs Plan D All costs All costs Plan F* All costs All costs Plan G All costs All costs Plan K $566 All costs Up to $70.75 per day All costs Plan L $283 All costs Up to $35.38 per day All costs Plan M $566 All costs All costs Plan N All costs All costs *The High Deductible Plan F will have different cost-sharing than the standard Plan F Charts show amount consumer would pay out-of-pocket with the listed Med Supp plan Medicare Supplement Shopper s Guide

29 Benefits under Medicare Part A (cont d) Hospice Care Blood First 3 pints Add l amounts 50% 25% Plan A Plan B Plan C Plan D Plan F* Plan G Plan K Plan L Plan M Plan N Charts show amount consumer would pay out-of-pocket with the listed Med Supp plan. *The High Deductible Plan F will have different cost-sharing than the standard Plan F 2011 Medicare Supplement Shopper s Guide 27

30 Benefits under Medicare Part B Medical Expenses First $162 Preventive Benefits Remainder First 3 pints Plan A $162 N/A Plan B $162 N/A Plan C N/A Plan D $162 N/A Plan F* N/A Plan G $162 N/A Plan K $162 All costs above Medicare approved amounts Generally 10% 50% Plan L $162 All costs above Medicare approved amounts Generally 5% 25% Plan M $162 N/A Plan N $162 N/A Up to $20 per office visit and up to $50 per emergency room visit. *The High Deductible Plan F will have different cost-sharing than the standard Plan F Blood Next $162 $162 $162 $162 $162 $162 $162 $162 $162 Remainder Generally 10% Generally 5% Charts show amount consumer would pay out-of-pocket with the listed Med Supp plan Medicare Supplement Shopper s Guide

31 Benefits under Medicare Parts A and B Home Health Care Medically necessary Durable Medical Equipment services & supplies First $162 Remainder Plan A $162 Plan B $162 Benefits under Medicare Part B (cont d) Plan C Plan D $162 Plan F* Plan G $162 Plan K $162 10% Plan L $162 5% Plan M $162 Plan N $162 *The High Deductible Plan F will have different cost-sharing than the standard Plan F Clinical Laborator y Ser vices Plan A Plan B Plan C Plan D Plan F* Charts show amount consumer would pay out-of-pocket with the listed Med Supp plan. Plan G Plan K Plan L Plan M Plan N *The High Deductible Plan F will have different cost-sharing than the standard Plan F 2011 Medicare Supplement Shopper s Guide 29

32 Benefits not covered by Medicare Part B Excess Charges First $250 per year Foreign Travel Remainder Plan A All costs Plan B All costs Plan C Plan D Plan F* Plan G All costs All costs All costs All costs $250 $250 $250 $250 20% and amounts over $50,000 lifetime maximum 20% and amounts over $50,000 lifetime maximum 20% and amounts over $50,000 lifetime maximum 20% and amounts over $50,000 lifetime maximum Plan K All costs Plan L All costs Plan M Plan N All costs All costs $250 $250 20% and amounts over $50,000 lifetime maximum 20% and amounts over $50,000 lifetime maximum *The High Deductible Plan F will have different cost-sharing han the standard Plan F Charts show amount consumer would pay out-of-pocket with the listed Med Supp plan Medicare Supplement Shopper s Guide

33 Medicare supplement insurance at a glance If an appears in the chart, the Medicare supplement policy covers 100% of the described benefit. If a row lists a percentage, the policy covers that percentage of the described benefit. If a row is blank, the policy doesn t cover that benefit. NOTE: The Medicare supplement policy covers coinsurance only after you have paid the deductible (unless the supplement policy also covers the deductible). Benefits A B C D F* G K L M N Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up Part B coinsurance or copayment 50% 75% *** Blood (first 3 pints) 50% 75% Part A Hospice care coinsurance or copayment 50% 75% Skilled Nursing Facility Care coinsurance 50% 75% Medicare Part A deductible 50% 75% 50% Part B deductible Part B excess charges Foreign Travel Emergency care (up to Plan Limits) *Plan F also offers a high-deductible plan. If you choose this option, this means you must pay for Medicarecovered costs up to the deductible amount of $2,000 in 2011 before your Medicare supplement plan pays anything. **After you meet your out-of-pocket yearly limit and your yearly Part B deductible ($162 in 2011), the Medicare supplement plan pays 100% of covered services for the rest of the calendar year. ***Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don t result in an inpatient admission. Out-of-Pocket Limit** $4,640 $2, Medicare Supplement Shopper s Guide 31

34 Section II: Medicare Supplement and Medicare Select Insurance Rates A note about these rates Premium quotes listed here are for a nonsmoking man living in the ZIP code and are broken into four age categories. Premiums may vary according to your age or the area in which you live. Additionally, these rates may have changed since February 2011, when these rates were compiled. Annual costs may be higher if premiums are paid in installments. Contact the insurance company to find out exact premiums. Disclaimer This shopper s guide does not recommend or endorse any insurance company or policy. It is designed to help you comparison shop for coverage to supplement your Medicare benefits. Contact the Kansas Insurance Department s Consumer Assistance Hotline if you have any questions about how to use this guide: Plan A Issue age policies - annual premium Company Age 65 Age 70 Age 75 Age 80 Bankers Fidelity Life Insurance Company $1, $1, $1, $1, Blue Cross & Blue Shield of Kansas City $ $1, $1, $1, Everence Association Inc. $1, $1, $1, $1, Old Surety Life Insurance Company $ $1, $1, $1, Attained age policies - annual premium Company Age 65 Age 70 Age 75 Age 80 American Continental Insurance Company $1, $1, $1, $1, American Republic Corp. Insurance Company $1, $1, $1, $2, Blue Cross and Blue Shield of Kansas, Inc. $1, $1, $1, $1, Christian Fidelity Life Insurance Company $1, $1, $1, $2, Colonial Penn Life Insurance Company $1, $1, $2, $2, Combined Insurance Company of America $1, $1, $2, $2, Continental General Insurance Company $1, $1, $1, $1, Coventry Health and Life Insurance Company $1, $1, $1, $1, Equitable Life & Casualty Insurance Company $1, $1, $1, $1, Family Life Insurance Company $1, $1, $1, $1, Forethought Life Insurance Company $1, $1, $1, $1, Gerber Life Insurance Company $1, $1, $1, $1, Medicare Supplement Shopper s Guide

35 Plan A (cont d) Attained age policies - annual premium Company Age 65 Age 70 Age 75 Age 80 Globe Life & Accident Insurance Company $ $1, $1, $1, Government Personnel Mutual Life Insurance $1, $1, $1, $1, Guarantee Trust Life Insurance Company $1, $1, $1, $1, Heartland National Life Insurance Company $ $1, $1, $1, Humana Insurance Company $1, $1, $2, $2, KSKJ Life, American Slovenian Catholic Union $1, $1, $1, $1, Liberty National Life Insurance Company $1, $2, $2, $2, Loyal American Life Insurance Company $1, $1, $1, $1, Marquette National Life Insurance Company $1, $1, $1, $1, Order of United Commercial Travelers of America $1, $1, $1, $1, Physicians Mutual Insurance Company $1, $1, $1, $2, Reserve National Insurance Company $1, $1, $1, $1, Royal Neighbors of America $1, $1, $1, $1, Sentinel Security Life Insurance Company $1, $1, $1, $1, Standard Life & Accident Insurance Company $2, $2, $2, $3, Standard Security Life Insurance Co. of New York $1, $1, $1, $1, State Farm Mutual Automobile Insurance Co. $1, $1, $1, $2, State Mutual Insurance Company $1, $1, $1, $1, Sterling Investors Life Insurance Company $1, $1, $1, $1, Sterling Life Insurance Company $1, $1, $2, $2, Thrivent Financial for Lutherans $1, $1, $1, $1, United American Insurance Company $1, $1, $1, $1, United National Life Insurance Company $1, $1, $1, $1, United Teacher Associates Insurance Company $ $1, $1, $1, United World Life Insurance Company $1, $1, $1, $1, UnitedHealthcare Insurance Company AARP $1, $1, $1, $1, UnitedHealthcare Insurance Company $1, $1, $1, $1, USAA Life Insurance Company $ $ $1, $1, World Corp Insurance Company $1, $1, $1, $1, Plan B Attained age policies - annual premium Company Age 65 Age 70 Age 75 Age 80 American Continental Insurance Company $1, $1, $1, $1, Colonial Penn Life Insurance Company $1, $2, $2, $2, Family Life Insurance Company $1, $1, $1, $2, Globe Life & Accident Insurance Company $1, $1, $2, $2, Humana Insurance Company $1, $1, $2, $2, KSKJ Life, American Slovenian Catholic Union $1, $1, $1, $2, Medicare Supplement Shopper s Guide 33

36 Company Age 65 Age 70 Age 75 Age 80 Liberty National Life Insurance Company $2, $3, $ $3, Order of United Commercial Travelers of America $1, $1, $1, $2, Sentinel Security Life Insurance Company $1, $1, $1, $1, Standard Life & Accident Insurance Company $2, $2, $3, $4, Standard Security Life Insurance Co. of New York $1, $1, $1, $2, State Mutual Insurance Company $1, $1, $1, $2, Sterling Investors Life Insurance Company $1, $1, $1, $2, Sterling Life Insurance Company $1, $2, $2, $2, Thrivent Financial for Lutherans $1, $1, $1, $1, United American Insurance Company $2, $2, $2, $3, United Teacher Associates Insurance Company $1, $1, $1, $1, United World Life Insurance Company $1, $1, $1, $1, UnitedHealthcare Insurance Company $1, $1, $1, $1, Plan C Issue age policies - annual premium Company Age 65 Age 70 Age 75 Age 80 Blue Cross & Blue Shield of Kansas City $2, $2, $3, $4, Attained age policies - annual premium Company Age 65 Age 70 Age 75 Age 80 Blue Cross and Blue Shield of Kansas, Inc. $1, $1, $2, $2, Coventry Health and Life Insurance Company $1, $1, $2, $2, Everence Association Inc. $1, $2, $2, $2, Family Life Insurance Company $1, $1, $2, $2, Forethought Life Insurance Company $1, $1, $2, $2, Government Personnel Mutual Life Insurance Co. $1, $1, $2, $2, Guarantee Trust Life Insurance Company $1, $1, $1, $2, Humana Insurance Company $1, $2, $2, $3, KSKJ Life, American Slovenian Catholic Union $1, $1, $2, $2, Order of United Commercial Travelers of America $1, $1, $2, $2, Reserve National Insurance Company $1, $2, $2, $2, Sentinel Security Life Insurance Company $1, $1, $2, $2, Standard Life & Accident Insurance Company $2, $3, $3, $4, State Farm Mutual Automobile Insurance Co. $1, $2, $2, $3, State Mutual Insurance Company $1, $1, $2, $2, Sterling Investors Life Insurance Company $1, $2, $2, $2, Sterling Life Insurance Company $2, $2, $2, $2, Thrivent Financial for Lutherans $1, $1, $2, $2, United American Insurance Company $2, $3, $3, $3, United Teacher Associates Insurance Company $1, $1, $1, $2, United World Life Insurance Company $1, $1, $1, $2, UnitedHealthcare Insurance Company $1, $2, $2, $2, Medicare Supplement Shopper s Guide

37 Plan D Attained age policies - annual premium Company Age 65 Age 70 Age 75 Age 80 Family Life Insurance Company $1, $1, $1, $2, Heartland National Life Insurance Company $1, $1, $1, $1, KSKJ Life, American Slovenian Catholic Union $1, $1, $1, $2, Marquette National Life Insurance Company $1, $1, $2, $2, Order of United Commercial Travelers of America $1, $1, $1, $2, Sentinel Security Life Insurance Company $1, $1, $1, $1, Standard Life & Accident Insurance Company $1, $1, $2, $2, State Mutual Insurance Company $1, $1, $1, $2, Sterling Investors Life Insurance Company $1, $1, $2, $2, Thrivent Financial for Lutherans $1, $1, $1, $1, United American Insurance Company $2, $2, $3, $3, United National Life Insurance Co. of America $1, $1, $1, $2, United Teacher Associates Insurance Company $1, $1, $1, $1, United World Life Insurance Company $1, $1, $1, $1, Plan F Issue age policies - annual premium Company Age 65 Age 70 Age 75 Age 80 Bankers Fidelity Life Insurance Company $1, $1, $1, $2, Blue Cross & Blue Shield of Kansas City $2, $2, $3, $4, Everence Association Inc. $2, $2, $2, $2, Old Surety Life Insurance Company $1, $1, $1, $1, Attained age policies - annual premium Company Age 65 Age 70 Age 75 Age 80 American Continental Insurance Company $1, $1, $2, $2, American Republic Corp Insurance Company $1, $2, $2, $2, Blue Cross and Blue Shield of Kansas, Inc. $1, $1, $2, $2, Christian Fidelity Life Insurance Company $1, $1, $2, $2, Colonial Penn Life Insurance Company $1, $2, $2, $3, Combined Insurance Company of America $2, $2, $3, $3, Continental General Insurance Company $1, $1, $1, $1, Coventry Health and Life Insurance Company $1, $2, $2, $3, Equitable Life & Casualty Insurance Company $1, $1, $2, $2, Family Life Insurance Company $1, $1, $2, $2, Forethought Life Insurance Company $1, $1, $2, $2, Gerber Life Insurance Company $1, $1, $2, $2, Globe Life & Accident Insurance Company $1, $1, $2, $2, Government Personnel Mutual Life Insurance Co. $1, $1, $2, $2, Heartland National Life Insurance Company $1, $1, $1, $2, Medicare Supplement Shopper s Guide 35

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