Shopping for Medicare Supplement Insurance

Transcription

1 CONSUMER TIPS PUBLISHED BY THE VERMONT DIVISION OF HEALTH CARE ADMINISTRATION Shopping for Medicare Supplement Insurance JANUARY 2009 The rates published in this booklet are current as of the date of the publication. However, rates are submitted on a continuous basis. You should check with the insurer for the most current terms and rates before deciding on a particular plan. DEPARTMENT OF BANKING, INSURANCE, SECURITIES & HEALTH CARE ADMINISTRATION 89 MAIN STREET, MONTPELIER, VERMONT TOLL FREE: (800) TEL: (802) FAX: (802) CONSUMER WEBSITE:

2 SPECIAL NEEDS This publication is also available on the Department s website at the Division of Health Care Administration s Consumer Publications link, or to speak with a health insurance consumer specialist, call Persons with hearing impairments may contact the Vermont Relay Service at: (TTY), or (voice). Persons with reading or visual impairments may contact the Vermont Association for the Blind and Visually Impaired (VABVI) at:

3 SHOPPING FOR MEDICARE SUPPLEMENT INSURANCE TABLE OF CONTENTS Page Table of Contents 3 Section One Introduction 4 Section Two Do You Need Medicare Supplement Insurance? 5 An Important Note About Medicare Advantage Plans 6 Section Three Eligibility and Enrollment 7 Section Four Community Rate Pricing 9 Section Five Medicare D Prescription Drug Plan Coverage 10 Section Six Comparing Medicare Supplement Plans 13 Section Seven Shopping Hints 16 Section Eight And Remember 17 Section Nine Agencies that Provide Assistance 18 Section Ten State Health Insurance Counselors 19 Section Eleven Insurers Approved to Sell Medicare Supplement 20 Polices in VT Section Twelve Medicare Supplement Plan Rates (Over 65) 21 Section Thirteen Medicare Supplement Plan Rates (Disabled under 65) 22 Information contained in this booklet is courtesy of the Centers for Medicare and Medicaid Services (CMS). 3

4 Section One: Introduction Medicare Supplement insurance, sometimes called Medigap or MedSupp, is health insurance sold by private insurance companies to fill the gaps in Original Medical Plan coverage, which is a government health insurance program. Medicare Supplement insurance is designed to cover some health care expenses that the Original Medicare Plan does not or when the Original Medicare Plan pays part of the cost and you have to pay the rest. To make it easier for consumers to comparison shop, insurers are required by law to offer standardized Medicare Supplement policies, called plans. For your protection, Med Supp policies must comply with federal and state laws. Each policy must be clearly identified as Medicare Supplement Insurance. Since 1992, standardized Medicare Supplement plans A, B, C, D, E, H, and J have been approved for sale in Vermont. Starting in 2006, two new standardized Medicare Supplement plans, K and L, are now available. Each plan has a different set of basic and extra benefits. Plan A has the most basic benefits. The plan comparison charts on page 14 and 15 shows the Vermont-approved Medicare Supplement plans. The information in this brochure is designed to provide you with the guidelines you can use when shopping for a Medicare Supplement policy. It also includes a list of insurance companies that sell Medicare Supplement policies approved for Vermont residents. 4

5 Section Two: Do you Need Medicare Supplement Insurance? Not everyone does. You may already be covered for health care expenses not paid by Medicare through one of the following: Group Health Insurance through your employer or professional organizations. Medicaid. Medicaid is a health program for low income and disabled persons, administered by each state, and jointly funded by states and the federal government. Medicaid picks up where Medicare leaves off. Medicaid recipients do not need supplement insurance. For more information about Medicaid, please contact the Office of Vermont Health Access (OVHA) at (toll free). If you are covered under the Original Medicare Plan, you may want to buy a Medicare Supplement policy because the Original Medicare Plan does not pay for all of your health care. These are gaps or out-ofpocket costs that you must pay yourself. A Medicare Supplement policy may cover some, but not all the gaps in your Original Medicare Plan. A Medicare Supplement policy may help lower your out-of-pocket costs and give you more health insurance. Before making a decision to buy Medicare Supplement insurance, read through this publication and obtain more information by discussing your needs with a state health insurance counselor, by contacting Medicare or an insurance agent directly. See pages 18 through 20 for contact information. 5

6 AN IMPORTANT NOTE ABOUT MEDICARE ADVANTAGE S: Medicare Advantage Plans are not addressed in this booklet, but are available in many areas. If you have one of these plans, you don t need a Medicare Supplement policy. If you have a Medicare Supplement policy, do not change to a Medicare Advantage Plan without a full understanding of how this would likely affect your coverage and your out-of-pocket costs. Not all health care providers accept Medicare Advantage Plans. Before you buy, contact your local Area Agency on Aging at (toll free) to speak with a trained state health insurance counselor. 6

7 Section Three: Eligibility and Enrollment To buy a Medicare Supplement policy, generally you must have Medicare Part A and Part B. All Medicare Supplement insurance companies selling policies to Vermonters must accept you into any Medicare Supplement plan during certain times called Open Enrollment periods. You may not be accepted if you have been diagnosed with End Stage Renal Disease (ESRD). The six-month open enrollment period begins on the first day of the first month in which you turn 65 years old or older and have enrolled in Medicare Part B. If you apply for a Medicare Supplement policy after this six-month period, you may not be accepted. All insurance companies that offer Medicare Supplement policies to people who are 65 years or older and eligible for Medicare, must now offer the same policies to people who are disabled under 65 years old, during the six months after becoming eligible for Medicare. Even if you had Medicare before age 65, once you reach age 65 you have another 6- month open enrollment period during which you can buy a Medicare Supplement policy or change policies. If you have a pre-existing condition, which is a health problem or condition you had before the date a new policy starts, an insurer can refuse to cover that health condition(s) for up to six months. This is called a pre-existing condition waiting period. The insurer can only apply this waiting period if your health problem was diagnosed or treated within the six months before the Medicare Supplement policy started. If you buy a Medicare Supplement policy during the open enrollment period, and you had at least six months of previous health insurance coverage that qualifies as creditable coverage, the insurance company cannot give you a pre-existing condition waiting period. Examples of creditable coverage include group health insurance, individual insurance policies, or Medicaid. 7

8 All Medicare Supplement policies sold to Vermonters are guaranteed renewable. This means that once you buy a Medicare Supplement policy, the insurance carrier cannot cancel your coverage for any reason except non-payment of premiums or material misrepresentation on your application. Please keep in mind that Medicare Supplement policies cover the policyholder only. Spouses, if they qualify, must have their own Medicare Supplement policy. Under federal law, you have rights and protections regarding your Medicare Supplement coverage. These include the right to buy Medicare Supplement coverage, protections if you lose or drop your health coverage and protections for people under age 65 with Medicare. Call your State Health Insurance Assistance Program (SHIP) (see page 19) to better understand these rights and protections. 8

9 Section Four: Community Rate Pricing The Department reviews and approves rates for each insurance company for each Medicare Supplement policy. Each Medicare Supplement plan is community rated. That means that everyone age 65 and older will pay the same price for each Medicare Supplement plan offered by each insurance company, regardless of age, health condition (including pre-existing conditions) or status. Rates for disabled Vermonters under age 65 may be higher than for people over age 65, but will be the same for all persons with disabilities. Remember that prices are different from one insurer to the next for the same product and that you may be charged a rate that differs from the rate in this publication. Shop carefully and compare. 9

10 Section Five: Medicare Part D Prescription Drug Plan Coverage Since January 1, 2006, people eligible for Medicare are also able to buy Medicare prescription drug coverage under Medicare Part D to help pay prescription drug costs. Enrollment in Medicare Part D is optional. You may join a Medicare Part D Prescription Drug Plan to save money and limit high out-ofpocket costs for prescription drugs. If you join a Medicare Part D Prescription Drug Plan, you will pay a monthly premium for standard coverage unless your premium is covered by a federal or state assistance program. Premiums vary by plan. Should I sign up for the Medicare Part D Prescription Drug Plan If I have a military health program? Certain people should not sign up for Medicare Part D if their current prescription drug coverage is more generous than that provided by Medicare Part D. For nearly all Medicare beneficiaries who have TRICARE, a military health program, there is no added value in buying the Medicare Part D prescription drug plan coverage. The exception to this general rule may be for those with limited incomes and assets who qualify for Medicare s extra help with prescription drug plan costs; such individuals may benefit by enrolling in a Medicare prescription drug plan. If I am receiving drug coverage under an employer-sponsored plan? Medicare Part D may not be necessary or advisable. You should closely compare your present coverage against the available Medicare Part D plans for making a change to determine if it is as generous or more generous than Medicare Part D. 10

11 If your employer plan is as generous or more generous, it is considered to be creditable coverage and you will not be subject to a late enrollment penalty if you did not sign up for Medicare Part D before May 15, Your plan or employer should have notified you if you current drug coverage is considered as creditable coverage. If not, contact your plan or employer and find out if your coverage is creditable to find out if you will be subject to a penalty if you did not switch. If I have Medicare and Medicaid or I have Medicare and a State pharmacy program? In 2006, Medicare Part D began providing prescription drug plans. If you did not choose a Medicare Part D drug plan, you may have been automatically assigned to one. If so, you may change plans at any time to ensure that you have a plan that best suits your needs. To find out if you have been assigned to a drug plan or if you need help with choosing a Part D drug plan, contact Medicare or your local Agency on Aging (see contact information on page 19 of this publication). If I already have a Medicare Supplement policy with prescription drug coverage (Plan H or Plan J): Plans H and J are only available to renewing policyholders; no one will be able to make a new purchase of Plan H or Plan J. Part D Prescription Drug Plans generally provide more coverage than Medicare Supplement plan s drug coverage. If you choose to keep your Medicare Supplement prescription drug coverage and do not join a Medicare Part D drug plan, you will have to pay a penalty if you choose to join later and your premium costs will be higher. If you choose to keep Medicare Supplement Plan H or Plan J, you may not sign up for a prescription drug plan under Medicare Part D. For more help about common coverage situations or questions about Medicare Part D prescription drug plans, contact your local Agency on Aging at (toll free) to speak with a trained State Health Insurance Assistance counselor. You may also call MEDICARE ( ); TTY-users should call (toll free). You can also visit the Medicare website at 11

12 If you have limited income and resources, you may qualify for extra help paying your prescription drug costs. If you qualify, you will get help paying for your drug plan s monthly premium, yearly deductible, and prescription co-payments. The extra help you will receive is based on income and resources (stocks and savings, not counting your house or car). If you don t automatically qualify for extra help with Medicare Part D, call the Social Security Administration (SSA) at (toll free) or visit the SSA website at After you apply, you will receive a letter letting you know if you qualify or not and what you need to do next. You may also call your local Social Security Administration office listed in the phone book or your local Agency on Aging for assistance. The State of Vermont also offers prescription drug coverage to low income Vermonters through the Vermont Health Access Program (VHAP) and the Vermont Pharmacy Program (V-Pharm). You can call them for more information at (toll free). 12

13 Section Six: Comparing Medicare Supplement Plans Approved Medicare Supplement Plans offered in Vermont include: A, B, C, D, E, H, J, K and L, but do not include Plans F, G and I. Each Medicare Supplement plan must cover basic benefits. Basic benefits for Plan A through J include: Medicare Part A coinsurance and hospital benefits Medicare Part B coinsurance or co-payment Blood Plans K and L include the basic benefits shown above and hospice care. Medicare Supplement policies do not cover vision or dental care, hearing aids, long-term care or private duty nursing. A full description of basic and extra benefits covered under Medicare Supplement policies can be found in Medicare s publication, Choosing a Medigap Policy. Contact Medicare at MEDICARE or visit the Medicare website at for a copy of this publication. When comparing Medicare Supplement plans, Plans A through J will have higher premiums, but lower (or no) out-of-pocket costs, while Plans K and L have lower premiums and higher out-of pocket cost, but have annual out-of-pocket limits. Some insurers may offer two Plan J options; one option is a high-deductible plan. The high deductible option has an annual deductible for 2009 of $2,000. The deductible amount for the Plan J high deductible option represents the annual out-of-pocket expenses (excluding premiums) that you must pay before the policy begins paying benefits. The Charts on the next two pages show how the existing Medicare Supplement Plans compare to each other. Both charts are the courtesy of the Center for Medicare and Medicaid Services. 13

14 Some examples of costs you could pay if you are in the Original Medicare Plan and don t have a Medigap Policy Cost Sharing What YOU PAY in 2009 (These amounts can change each year.) Medicare Part A Coinsurance and Hospital Benefits are exhausted Medicare Part B Coinsurance or Copayment for other than preventive services For each benefit period, YOU PAY: $267 per day for days $534 per day for days (while using your 60 day lifetime reserve days), and all costs after 150 days. YOU PAY all coinsurance, generally 20% of the Medicareapproved amounts for most covered services and any copayment after you meet the $135 yearly Part B deductible. Medigap policies in Vermont that may help pay all or some of these costs Medigap Plans A, B, C, D, E, H, J, K or L Medigap Plans A, B, C, D, E, H, J, K or L Blood Generally, YOU PAY for the first 3 pints of blood. Medigap Plans A, B, C, D, E, H, J, K or L Hospice Care Coinsurance or Copayment You may be required to pay up to $5 for each drug a hospice provides when you are getting hospice services in your home and 5% of the Medicare-approved amount for each day of inpatient respite care (up to certain limits). Medigap Plans K or L Skilled Nursing Facility Care Coinsurance For each benefit period, YOU PAY: Nothing for the first 20 days. Up to $133 per day for days For each benefit period, YOU PAY: $1,068 for days 1-60 of a hospital stay. Medigap Plans C, D, E, H, J, K or L Medicare Part A Deductible Medigap Plans B, C, D, E, H, J, K or L Medicare Part B Deductible YOU PAY the $135 yearly deductible. Medigap Plans C or J Medicare Part B Excess Charges Foreign Travel Emergency (Medicare coverage outside the U.S.) At-Home Recovery (Medicareapproved home health care to provide treatment ordered by your doctor for an illness or injury) Preventative Care Part B Coinsurance Preventive Care Not Covered by Medicare Medigap Plan J Generally, YOU PAY all costs. Medigap Plans C, D, E, H or J YOU PAY: $0 for Medicare-approved home health services. 100% for services not covered by Medicare. Generally, YOU PAY the $135 yearly Part B deductible and Part B coinsurance, but there are exceptions. YOU PAY all costs. Medigap Plans D or J Medigap Plans A, B, C, D, E, H, J, K or L Medigap Plans E or J According to Vermont law, hospitals and other health care professionals must accept the insurer s payment as payment in full and may not bill the insured for any balance. Remember, the Original Medicare Plan doesn t cover all of your health care costs. You may want to buy a Medigap policy to help pay these costs. 14

15 What Medigap Plans A through L Cover This chart gives you a quick look at the standardized Medigap Plans A through L and their benefits. Every insurance company must make Medigap Plan A available if they offer any other Medigap policy. How to read the chart: If a check mark appears in the column, this means that the Medigap policy covers that benefit up to 100% of the described benefit. If a column lists a percentage, this means the Medigap policy covers that benefit at that percentage of the described benefit. If no percentage appears or if the column is blank, this means the Medigap policy doesn t cover that benefit. Note: The Medigap policy covers coinsurance only after you have paid the deductible (unless the Medigap policy covers the deductible). Vermont Approved Medigap Plans A through L Medigap Benefits A B C D E H J* K L Medicare Part A Coinsurance and all costs after hospital benefits are exhausted. Medicare Part B Coinsurance or Copayment for other than preventive services 50% 75% Blood (First 3 Pints) 50% 75% Hospice Care Coinsurance or Copayment 50% 75% Skilled Nursing Facility Care Coinsurance 50% 75% Medicare Part A Deductible 50% 75% Medicare Part B Deductible Medicare Part B Excess Charges Foreign Travel Emergency (Up to Plan Limits)** At-Home Recovery (Up to Plan Limits) Medicare Preventive Care Part B Coinsurance Preventive Care not Covered by Medicare (up to $120) 2009 Out-of-Pocket Limit $4,620*** $2,310*** * Medigap Plan J offers a high-deductible option. You must pay for Medigap-covered costs up to the high-deductible amount ($2,000 in 2009) before the Medicare Supplement Insurance policy pays anything. ** You must also pay a separate deductible for foreign travel emergency ($250 per year). *** After you meet your out-of-pocket yearly limit and your yearly Part B deductible ($135 in 2009), the plan pays 100% of covered services for the rest of the calendar year. According to Vermont law, hospitals and other health care professionals must accept the insurer s payment as payment in full and may not bill the insured for any balance. 15

16 Section Seven: Shopping Hints Be careful about replacing coverage. Don t cancel an existing policy until a replacement policy is in effect. You may not be accepted by another company or your premium rates may increase significantly. Check for pre-existing condition exclusions and waiting periods. A preexisting condition is defined as a condition for which medical advice was given or treatment was recommended by or received from a physician within six (6) months before the effective date of coverage. Pre-existing condition waiting periods are the time during which a new policyholder must wait (up to six months) before treatment of pre-existing conditions is covered by a new insurance company. Once you have met the waiting period requirement, pre-existing conditions would be covered, subject to the terms and conditions of the Medicare Supplement policy. Do not over-buy Medicare Supplement insurance. One policy will meet your needs. Shop around for the best coverage combination that meets your needs. Be aware of maximum benefits. Ask questions about the maximum benefit coverage for: Inpatient and outpatient medical coverage Durable medical equipment Mental health coverage. If you are considering buying an insurance policy from an agent, ask to see his or her license. You may also call the Insurance Division of the Vermont Department of Banking, Insurance, Securities and Health Care Administration for information about agent licensing at Compare policies prices and coverage. Call several insurers and have them send information to you. For names and addresses of insurers offering approved Medicare Supplement policies in Vermont, see page 20 of this publication. Consider your options and shop carefully because prices for the same coverage can vary widely in the marketplace. 16

17 Section Eight: And Remember Take your time. Do not be pressured into buying a Medicare Supplement policy by an agent. You have six (6) months to apply if you become disabled before age 65 and qualify for Medicare or after you are age 65 or older and enroll in Medicare Part B. During this six-month period you must be accepted into any plan. After six months, you may be subject to some pre-existing condition benefit limitations or you may be refused coverage. Take advantage of the free look provision. Insurance companies are required to give people age 65 or older at least 30 days to review a Medicare Supplement policy. Your are entitled to a full refund if you return the policy and give written notice of cancellation within the 30-day period, which begins on the day that you receive the policy. If you are under age 65, you have 10 days in which to return and cancel the policy. Be sure to get an outline of coverage. You must be given a clearly worded written summary of the policy. Read it carefully. If you decide to buy, complete the application carefully. Omissions of medical conditions on your Medicare Supplement insurance policy application may result in termination of the policy. 17

18 Section Nine: Agencies that Provide Assistance Be sure you thoroughly understand the coverage and cost of the Original Medicare Plan and the Medicare Supplement policy that interests you. Consult free publications from Medicare, including Medicare and You and Choosing a Medigap Policy. These publications and other helpful information are available from: Centers for Medicare and Medicare Services Phone: 800-MEDICARE (toll free) or Website: Vermont Department of Aging & Disabilities Health Insurance Counseling and Assistance (HICA) Senior Help Line: (toll free) Website: Social Security Administration Phone: (toll free) Check your local listings for SSA offices in Burlington, Rutland and Montpelier The National Council on the Aging Website: Vermont Department of Banking, Insurance, Securities & Health Care Administration Division of Health Care Administration 89 Main Street Montpelier, VT Phone: (toll free) or Website: 18

19 Section Ten: State Health Insurance Counselors For additional help regarding Medicare Supplement insurance options, please contact your local Agency on Aging at (toll free) to speak with a trained state health insurance counselor. Visit their website at: A list of local area agencies is provided below: Area Agency on Aging for Northeastern Vermont 481 Summer Street, Suite 101 St. Johnsbury, VT (toll free) Central Vermont Council on Aging 30 Washington Street Barre, VT (toll free) or 109 Professional Drive Morrisville, VT (toll free) Champlain Valley Agency on Aging P.O. Box 158 Winooski, VT (toll free) Council on Aging for Southeastern Vermont 56 Main Street, Suite 304 Springfield, VT (toll free) Southwestern Vermont Council on Aging East Ridge Professional Building 1085 U.S. Route 4 East Unit B Rutland, VT (toll free) or 169 North Street Bennington, VT (toll free) Vermont Center for Independent Living 11 East State Street Montpelier, VT (toll free) 19

20 Section Eleven: Insurance Companies Selling Approved Medical Supplement Policies in Vermont American Family Life Assurance Company (AFLAC) 1932 Wynnton Road Columbus, GA (toll free) American Progressive of New York 6 International Drive, Suite 190 Rye Brook, NY (toll free) Bankers Life and Casualty Company 1085 U.S. Rte 4 East Rutland, VT (toll free) Blue Cross Blue Shield of Vermont P.O. Box 186 Montpelier, VT (toll free) Combined Insurance of America Medicare Supplement Department 5050 Broadway Chicago, IL (toll free) Conseco Health Insurance 222 Merchandise Mart Plaza Chicago, IL (toll free) Genworth Financial 6604 W. Broad Street Richmond, VA (toll free) Globe Life and Accident Globe Life Center Oklahoma City, OK (toll free) Guarantee Trust 1275 Milwaukee Avenue Glenview, IL (toll free) Life Investors Ins. Company of America 520 Park Avenue Baltimore, MD (toll free) Mutual of Omaha Insurance Company Mutual of Omaha Plaza Omaha, NE (toll free) Monumental General 111 North Charles Street Baltimore, MD (toll free) State Farm Insurance 1 State Farm Plaza Bloomington, IL Please contact your local State Farm Agent Transamerica Life Insurance Company Direct Response Division (Group only) 520 Park Avenue Baltimore, MD (toll free) United American Insurance Company 3700 Stonebridge Drive McKinney, TX (toll free) United Healthcare (AARP) AARP Healthcare Options P.O. Box 1017 Montgomery, PA (toll free) USAA Life 9800 Fredericksburg Rd San Antonio, TX (toll free) 20

21 Section Twelve: Medicare Supplement Plans Monthly Rates Ages 65 and Older COMPANY A B C Individual Insurance through Insurer Blue Cross Blue Shield of VT D E H J J HD* K L Group Insurance through Association Member Plans United American United Healthcare (AARP) Individual Insurance through Agents American Progressive Bankers Life & Casualty Combined Insurance Conseco Health Genworth Life & Annuity Guarantee Trust Mutual of Omaha State Farm Insurance United American USAA Life Group Insurance through Employers American Family Life Assurance (AFLAC) Bankers Life & Casualty Life Investors Monumental Life Transamerica Life Ins. Co United American * J HD This is a High Deductible Plan option. See Page 13 for more information. 21

22 Section Thirteen: Medicare Supplement Plans Monthly Rates Disabled Under Age 65 COMPANY Individual Insurance through Insurer A B C D E H J J HD* K L Blue Cross Blue Shield of VT Group Insurance through Association Member Plans United American United Healthcare (AARP) Individual Insurance through Agents American Progressive Bankers Life & Casualty Combined Insurance Conseco Health Genworth Life & Annuity Guarantee Trust Mutual of Omaha State Farm Insurance United American USAA Life Group Insurance through Employers American Family Life Assurance (AFLAC) Bankers Life & Casualty Life Investors Monumental Life Transamerica Life Ins. Co United American * J HD This is a High Deductible Plan option. See Page 13 for more information. 22

23 Division of Health Care Administration Department of Banking, Insurance, Securities and Health Care Administration 89 Main Street, Montpelier, VT Telephone: (toll free) or Website: