Medicare Supplement Coverage

Transcription

1 Guide to Choosing Medicare Supplement Coverage Medicare Health Care A User Guide for Medicare Supplement Coverage (03/02) - PDF Front Cover

2 p1 First Things First Why Buy Medicare Supplement Coverage The Other Considerations Table of Contents Medicare Supplement Coverage A Word About Medicare Are You Eligible for Medicare? How to Apply Why Buy Medicare Supplement Coverage How Does Medicare Supplement Insurance Work? What Does Standardized Mean? Choosing a Plan Facility Coverage Excess Coverage At-Home Recovery Preventive Care Prescription Drugs What is Medicare Select? What Else You Should Consider Plan Comparison Tool Important Numbers and References (03/02) - PDF Page 1 of 10

3 Trigon Blue Cross Blue Shield p2 Medicare Supplement Coverage With all the changes in Medicare and health care these days, choosing the right health coverage can be a frustrating, puzzling experience. That s true whether you re just about to turn 65, or if you ve been enrolled with Medicare for a number of years and now are reconsidering your current coverage. If you feel Medicare doesn t cover everything you need in a health plan, making the right choice about supplementing your basic Medicare coverage doesn t have to be a mystery. By taking a few minutes to review this guide, you ll be a much more informed consumer both about Medicare and the options available to you to bridge the gaps that Medicare doesn t cover. You ll learn: What Medicare covers and just as important what it doesn t. What the 10 standardized Medicare Supplement plans cover. The difference between Medicare Supplement plans and Medicare Select plans. Important questions to ask yourself and health insurers. In other words, this fact-filled, straight-talk guide is a great tool to help you select a Medicare supplement policy that is right for you both now and in the future. And whether or not one of our policies is right for you, we want to help you make the right decision. That s why we ve prepared this guide. Want even more help? If you need advice or have questions, just call your Trigon Sales Representative. First Things First A word about Medicare Medicare is divided into two parts. Medicare, which is often called hospital coverage, helps pay for things like hospital care and skilled nursing facility care. Medicare, which is often called physician coverage, helps pay for things like doctor s bills, diagnostic tests, some screening tests and durable medical equipment, like walkers and wheelchairs. Medicare, however, does not pay for such things as routine physicals and outpatient prescription drugs. Also, in some cases it doesn t fully pay for the services that it does cover. That s why most Medicare beneficiaries find that they want some type of coverage to supplement Medicare. Medicare Supplement policies do just that they supplement, or help pay for, the portion of the costs that Medicare does not fund. Also, keep in mind that in most cases Medicare Supplement policies only help cover your portion of services that Medicare covers not services that Medicare does not allow. But in order for you to be eligible for a Medicare Supplement policy, you first must be eligible for Medicare (03/02) - PDF Page 2 of 10

4 p3 First Things First Why Buy Medicare Supplement Coverage The Other Considerations Who can I call? If you need to find out how to apply for Medicare, call the Social Security Administration s free hotline: (7 days a week, 7 a.m. - 7 p.m., EST). If you have any questions about Medicare, or to request your free copy of the Medicare & You handbook, call the CMS (Centers for Medicare and Medicaid Services) toll-free Medicare hotline: MEDICARE ( ) 24 hours a day, 7 days a week. The handbook is also available via the Internet at Are you eligible for Medicare? To be eligible for Medicare, you must be at least 65 years old and a permanent resident of the United States. You or your spouse must have worked at least 10 years in Medicare-covered employment. You could also be eligible if you are younger than 65 but have a disability or chronic kidney disease. How to apply You must apply for Medicare and through either the: Social Security Administration (SSA); or Railroad Retirement Board (if you are a Railroad annuitant). In many cases, the SSA will contact you by mail. If you don t receive anything from them, you should call to apply three months before you turn 65. If you wait to apply more than four months after you turn 65, you will have to wait for the next general enrollment period: between January 1 and March 31 each year. Already getting Social Security or Railroad Retirement benefits when you turn 65? If so, your Medicare card will be mailed to you about three months before your 65th birthday. You won t have to do anything to enroll. Note: If you don t want (physician coverage), follow the instructions that come with your Medicare card. If you intend to continue working past age 65, it may be to your benefit to delay enrollment in, since enrollment in Medicare automatically begins your six-month open-enrollment window when you are guaranteed the Medicare Supplement plan of your choice without having to answer health questions. Why buy Medicare Supplement Coverage? You might be thinking that once you reach 65, Medicare has you covered. It does, but not completely. Each year gaps in Medicare coverage your out-of-pocket costs continue to grow. For example, the deductible that Medicare requires you to pay if you are hospitalized this year is $812. In other words, you must pay $812 before Medicare starts covering your care. Beyond that, there is coinsurance to consider. If you were hospitalized more than 60 days, you d also have to pay $203 a day and $406 a day after your 90th day. Need care in a skilled nursing facility? Medicare would require you to pay $ per day after the first 20 days. And what if you need to see a doctor? Each year, Medicare requires you to pay an initial deductible of $100. That means you must pay the first $100 of bills for such things as doctors services, lab tests or therapy. After that, Medicare only covers 80% of such charges you are responsible for the other 20% of Medicare s approved fees. How does Medicare Supplement insurance work? Medicare Supplement insurance does just that it supplements the coverage Medicare provides by helping to pay the deductibles, coinsurance and copayment costs that are not paid by Medicare or B. In some cases, Medicare Supplement coverage also offers additional services and supplies that Medicare does not. In Virginia, two main types of Medicare Supplement insurance are available: 1) Federally standardized, or standard, Medicare Supplement plans, and 2) Medicare Select plans, which are also a type of Federally standardized Medicare Supplement plan (03/02) - PDF Page 3 of 10

5 Trigon Blue Cross Blue Shield p4 What does standardized mean? Health insurers used to offer so many different plans that it was often difficult to compare benefits and costs. To help consumers make the best choice for themselves, the federal government, state insurance commissioners and insurers agreed on 10 standardized plans. The 10 different plans are designed to appeal to folks with different needs and budgets. With Federally standardized Medicare Supplement and Medicare Select coverage, the policy benefits are the same from company to company. Likewise all policies have exclusions and limitations. This means that with any Medicare Supplement carrier that you consider, you should find the same basic set of exclusions and limitations described along with their benefits. If you do not find that information, be sure to ask the insurance carrier for more details. Thanks to standardization, it s much easier to choose the standardized plan with the best benefit package for you. Then you can compare various insurers on a number of factors (that are not standardized), including: cost, service, quality, experience and financial strength. Considering Medicare Supplement Coverage? Don t Wait! The best time to buy Medicare Supplement coverage is during your open enrollment period. This period lasts for six months, beginning when you turn 65 and first enroll in Medicare. Most people enroll in when they enroll in at age 65. However, some people delay their enrollment until they retire. During this six-month period after you turn 65 and enroll in Medicare, you are entitled to buy the Medicare Supplement policy of your choice. You cannot be turned down for coverage, or charged higher premiums, due to health conditions. That s an important point. After this open enrollment period, you may still be able to get Medicare Supplement coverage at a later date. But depending on the insurer you may: have to answer health questions, not be able to choose the exact policy you want, or have to pay higher premiums. So don t wait! Enroll in a Medicare Supplement Plan during your open enrollment period. Choosing a Plan All insurers can give you an outline of coverage that explains the 10 plans we ll look at in this guide. But most insurers do not offer all 10 plans. Make sure the insurer has the plan you want, and make sure the plan you want is the plan you buy. But deciding on the plan that s right for you is easier said than done. Like all insurance, when you buy a Medicare Supplement insurance policy you are investing in future protection. Particularly if you are healthy now, it s hard to predict exactly what your health needs will be five, 10 or 15 years from now. Our health is our most important asset, and as we live longer, the chances of needing substantial health care continues to increase. So Medicare Supplement coverage is worth thinking about (03/02) - PDF Page 4 of 10

6 p5 First Things First Why Buy Medicare Supplement Coverage The Other Considerations Let s look at the benefits The 10 standardized Medicare Supplement plans are lettered A through J. Building upon the basic benefits contained in Plan A, the benefits increase as you go higher up the alphabet. Here s a look at what each Federally standardized benefit offers: All plans include a basic benefit package. The basic benefit package covers: The $203 hospital expense a day for days in the hospital which can add up to $6,090 for an extended inpatient stay. The expense of $406 a day for 60 nonrenewable, lifetime hospital inpatient reserve days. That can total $24, % of eligible hospital expenses for an additional 365 days during your lifetime, after your Medicare benefits stop completely. Your 20% coinsurance for physician and medical services, or for hospital outpatient services, applicable copayments, after you satisfy Medicare s annual $100 deductible. Finally, under Medicare Parts A and B, you re covered for the cost of the first three pints of blood or equivalent quantities of packed red blood cells per calendar year. Available with: Plans A through J. Covers your hospital services deductible for each benefit period,* up to six times in a 12-month period. In 2002, the deductible is at an all-time high of $812. Available with: Plans B through J. Facility Coverage Coverage for your share of skilled nursing facility care $ a day for days 21 though 100 in 2002, after at least three days in a hospital. Some skilled nursing facilities provide long-term or custodial care, such as help with daily needs like bathing, dressing and eating. However Medicare and this supplement benefit generally does not cover such care if that s all the care you need. Available with: Plans C through J. Coverage for your yearly $100 Medicare deductible. Available with: Plans C, F and J. Excess Coverage for 80% or 100% of Medicare excess charges (up to limitations set by either Medicare or state law). You might not need this coverage, because about 85 percent** of Virginia doctors accept Medicare assignment, which means they accept the charges Medicare allows for all services as payment in full. You can find out if your doctor accepts Medicare assignment by asking him or her, or by calling Medicare customer service at * A benefit period begins the first day you are hospitalized and ends after you have been out of the hospital, a skilled nursing facility or rehabilitation facility for 60 days in a row. After these 60 days, if you are again hospitalized you would start a new benefit period and would be liable again for the $812 deductible. ** United Health Care, Medicare carrier for most of Virginia (03/02) - PDF Page 5 of 10

7 Trigon Blue Cross Blue Shield p6 If your doctor does not accept Medicare assignment, he or she can charge you up to 15% more than the Medicare allowance. This coverage would pay for those excess charges. Available with: Plans F, I and J (100% coverage) and Plan G (80%). Coverage 80% coverage for medically necessary emergency care in a foreign country (beginning during the first 60 days of trip), after a $250 calendar year deductible, up to a $50,000 lifetime maximum. What are your travel plans? If you are planning a trip abroad, or even think that s a future possibility, this benefit may be a good option for you. If you have no intentions of visiting a foreign country, then you may not need this benefit. Available with: Plans C through J. At-Home Recovery Up to $40 a day (up to $1,600 per year) for short-term, at-home assistance with activities of daily living (such as bathing and dressing) for those recovering from an illness, injury or surgery. If you were confined to your home and needed personal care, would you have someone who could care for you? If not, would you have the income to pay for such care? If not, this coverage might be a good choice for you. Available with: Plans D, G, I and J. Preventive Care Coverage for up to $120 per year for preventive medical care, including annual physicals, routine checkups and tests to keep you healthy or prevent illness. While Medicare now covers more preventive services than in the past, additional screenings recommended by your doctor might not be covered. This benefit can be used to cover those screenings not covered by Medicare. Available with: Plans E and J. Prescription Drugs There are two types of prescription drug benefits: prescription drug coverage: 50% of your outpatient prescription drug costs after you satisfy a $250 calendar year deductible up to $1,250 per year; Extended prescription drug coverage: 50% of your outpatient prescription drug costs after you satisfy a $250 calendar year deductible up to $3,000 a year. This is an important consideration. Unless you currently have a chronic condition, it is hard to predict your future drug needs. And if you follow preventive care guidelines and lead a healthy lifestyle, you might not need a lot of medications. But keep in mind that the overwhelming majority of seniors eventually are prescribed multiple drugs. The question comes down to this: Does the increased cost of a prescription drug plan seem like a good value when you consider: how much do you spend annually on prescription drugs, we are all living longer, and the cost of prescription drugs increases every year? In other words, do you see yourself needing and/or being able to afford more than $1,250, or more than $3,000, worth of prescription drugs? If you are trying to decide among the three plans that offer drug coverage, consider the other benefits these three plans offer. For example, of the three, only Plan J offers deductible and preventive care coverage. Both Plan I and Plan J offer at-home recovery benefits and coverage for 100% of excess charges. prescription drug coverage: Available with: Plans H and I. Extended prescription drug coverage: Available with: Plan J (03/02) - PDF Page 6 of 10

8 p7 First Things First Why Buy Medicare Supplement Coverage The Other Considerations What You Should Consider If you choose to use a non-participating hospital for non-emergency care, you will still be covered by Medicare, but your out-of-pocket expenses will be greater with a Medicare Select policy. So basically you need to ask yourself: 1. Are the hospitals I use or anticipating using part of the Medicare Select network? If not, is the savings in premium enough for me to seek care at a Select hospital? 2. Does my doctor have admitting privileges at the Select hospitals? 3. Am I willing to pay more out-of-pocket costs if I choose a non-participating hospital for non-emergency care in return for lower premiums? If you answered yes to one or more of these questions, a Medicare Select plan could work for you. What is Medicare Select? Medicare Select is a form of Medicare Supplement that helps cover what isn t covered by Medicare and. The plans range from A through J with each policy offering the same benefits that its corresponding standardized Medicare Supplement policy offers. What is the difference between Medicare Supplement and Medicare Select? 1. Your premiums for Medicare Select are lower. 2. In order to take full advantage of your Medicare Select benefits, you need to use hospitals and/or physicians from a specified group or network of preferred providers. Under Medicare Select, you can also visit a hospital that is not part of the network in an emergency, or if the service you need is not offered by a network hospital. What Else You Should Consider After I buy my policy, how will my future premiums be determined? Health insurers can rate, or set your Medicare Supplement premiums in several different ways. 1. Issue Age (also known as Entry Age): This means your premium is always based on the age you were when you first purchased the policy. Any future premium changes will be based solely on increases in medical costs and inflation, changes in Medicare or changes in state and Federal regulations there are no additional increases because you get older. For example, if you purchase a policy at age 65, when you re 70, you will pay the same premium as a 65 year old with the same plan. 2. Attained Age: This means each year your premium could change based on medical costs, inflation, changes in Medicare or changes in state or Federal regulations, and changes in your age. So even if medical costs and inflation remain stable, your premiums automatically increase just because you are another year older. While attained age policies often are initially less expensive, over time the total cost of attained-age premiums generally exceeds the total cost of entry-age rated policy premiums. Based on Plan F premiums filed with the Virginia Bureau of Insurance between 1994 and 1999, for people age 65 through 75, Trigon Blue Cross Blue Shield estimates these policies, on average, become more expensive by age (03/02) - PDF Page 7 of 10

9 Trigon Blue Cross Blue Shield p8 3. Community Rating: This means that, regardless of age, everyone in a particular plan (and sometimes, geographical region) will pay the same rate based on, among other factors, the typical medical costs among that entire group of people, and in that area. This rating method is designed so that the younger, healthier customers offset claims of the older or less healthy customers. However, if the company does not attract enough new, younger customers, premiums for new customers can be higher than entry age or attained age plans, because everyone in a community rated plan pays for the medical costs of the entire group. In addition to one of these rating methods, some insurers base their rates on whether you are male or female and/or on the area in which you live. Make sure you know whether this type of rating affects you. How should I evaluate the benefits of discount plans? Since Medicare Supplement plans are standardized, many insurers offer discount programs to differentiate themselves. For example, many offer discounts on prescription drugs and hearing and vision care. Some also give you discounted access to alternative medicine services, such as chiropractic treatments, massage therapy and acupuncture. In evaluating these discount programs, you need to ask: How much will I take advantage of these services? How much value do they add beyond the benefits Medicare and Medicare Supplement policies offer? How long has the insurer provided these discount features? If the value-added services, or discounts, are provided by outside vendors (not the insurer itself), are these vendors optical shops, for example reputable and easy for me to deal with and get to? What Other Factors Should be Considered? and premiums are obvious considerations. However, there are other important factors to consider as well. The company s experience and how well it can service your needs can both make a big difference in how satisfied you are with your choice. So you should also ask these questions when you are shopping: Will there be a waiting period for past or present health conditions? Does the company offer automatic claims filing for Medicare and? And if so, is there an additional cost for this service? How long has the company been in business? How long has it operated in Virginia? And how long has it offered Medicare Supplement insurance? What is the company s latest financial rating from such independent organizations as A.M. Best or Standard and Poor s? Is the company easy to reach? Is it located in Virginia or at least the Eastern time zone? If not, is it reachable during hours convenient to you? Is the organization selling the policy the same company that answers the phone? Who in other words is the actual insurer? Who will be insuring you and servicing your policy? As we said at the beginning of this guide, understanding Medicare and selecting the best Medicare Supplement or Medicare Select policy to supplement Medicare can be confusing. But by asking a lot of questions of yourself and the companies you are considering you ll be armed with the information you need to make the right choice for you, your pocketbook and your health care needs (03/02) - PDF Page 8 of 10

10 p9 First Things First Why Buy Medicare Supplement Coverage The Other Considerations A Tool to Help You Choose a Medicare Supplement Plan Check which plan has the benefits most important to you. A TYPE OF PLAN B C D E F F G H I J J Excess 100% Excess 80% Excess 100% Excess 100% At-Home Recovery At-Home Recovery At-Home Recovery At-Home Recovery Drugs ($1,250 Limit) Drugs ($1,250 Limit) Extended Drugs ($3,000 Limit) Preventive Care Preventive Care If they choose, Medicare Supplement insurers can offer Plan F and/or J with a high-deductible option. These high deductible plans have a $1,620 calendar year deductible, which means that your benefits do not begin until your out-of-pocket expenses for a calendar year exceed $1,620. Out of pocket expenses are those that would ordinarily be paid by the policy, including Medicare and B deductibles. However, they do not include the separate prescription drug deductible for Plan J or the separate foreign travel emergency deductible for Plans F & J (03/02) - PDF Page 9 of 10

11 Trigon Blue Cross Blue Shield p10 Important Numbers and References How to get more help if you need it. Important phone numbers The Social Security Administration Hotline: (Open 7 days a week, 7 a.m. 7 p.m., EST) For help applying to Medicare Virginia Health Quality Center Review Organization: (Open Monday Friday, 8 a.m. 8 p.m., EST) For questions about the quality of care in a Medicare-certified facility Medicare Hotline: MEDICARE ( ), TTD for the hearing impaired (Open 24 hours a day, 7 days a week) For general questions, or to receive the following free publications: The Medicare & You Handbook Summary of Medicare benefits, rights and obligations. Guide To Health Insurance For People With Medicare Help choosing a Medicare supplement plan. What Everyone Should Know About Facilities Under Medicare Information on skilled nursing facilities. Guide To Choosing A Home Step-by-step help in selecting a nursing home. Savings for Qualified Beneficiaries Programs that can help pay your Medicare expenses. Medicare and Home Healthcare Home health care services that Medicare covers and how to qualify for them. Consumer Fraud Pamphlet: Medicare & Home Medical Equipment How you can get medical equipment for your home and how to report suspected fraud. Know Your Rights Medicare Beneficiary Bulletin Information about Health Maintenance Organizations (HMOs). Internet Sources Trigon Blue Cross Blue Shield Medicare for much of the above information, and other information such as: Medicare Compare (comparison of Medicare health plans in your area); and Home Compare (information on nursing homes in your area) (03/02) - PDF Page 10 of 10

12 Registered Marks of the Blue Cross and Blue Shield Association ' Registered Mark of Trigon Insurance Company Trigon Blue Cross Blue Shield is the trade name of Trigon Insurance Company An Independent Licensee of the Blue Cross and Blue Shield Association (03/02) - PDF Back Cover