HeritagePlanning SM Helping Yourself Helping Your Parents Helping Your Children Courtesy of: SM Medicare Supplemental Insurance Although Medicare is the basic federal health insurance for older people, it does not offer complete protection. Therefore, many people also buy private supplemental insurance, sometimes called Medigap insurance. Whether you need health insurance in addition to Medicare is a decision that only you can make. Medigap policies are a type of Medicare supplemental insurance designed specifically to fill in some of the gaps in Medicare coverage. By law, they must provide distinct benefits that pay some or all of the costs of services either not covered or not fully covered by Medicare. Enrollment If you are 65 or older, state and federal laws guarantee that for a period of six months from the date you enroll in Medicare Part B, you have a right to buy the Medigap policy of your choice regardless of your health condition. To determine whether you are in your Medigap open enrollment period, add six months to the effective date of your Part B coverage, which should be shown on your Medicare card. There is, however, one exception to this rule. If you are eligible for Part B but never signed up for it, you may buy Part B during Medicare s annual general enrollment period, which runs from January 1 to March 31. If you sign up during this general enrollment period, both your Part B coverage and Medigap open enrollment period begin July 1 of that year. During this six-month open enrollment period, which cannot be extended or repeated, you have the choice of any of the different Medigap policies sold by any insurer doing Medigap business in your state. The company cannot deny or restrict the policy or discriminate in the pricing of a policy because of your medical history, health status, or claims experience. The company can, in some cases, impose the same pre-existing condition restrictions that it applies to Medigap policies sold outside the open enrollment period. Mandatory Standardization To make it easier for consumers to comparison shop for Medigap insurance, regulations have been adopted that limit the maximum number of different Medigap policies that can be sold in the United States and its territories to ten standard benefit plans, labeled A through J. Plan A of the ten standard Medigap plans is the basic benefit package. Each of the other nine plans includes the basic package plus a different combination of benefits. The plans cover specific expenses either not covered or not fully covered by Medicare, with Plan A being the most basic policy and Plan J the most comprehensive. Insurers are not permitted to change the combination of benefits in any of the plans or to change the letter designations, and the policies must be guaranteed renewable for life. Each state must allow the sale of Plan A, and all Medigap insurance carriers must make at least Plan A available. Insurers are not required to offer any of the other nine plans, but most offer several plans, and some offer all ten. Insurers can independently decide This material is not intended to replace the advice of a qualified attorney, tax adviser, financial adviser, or insurance agent. Before making any financial commitment regarding the issues discussed here, consult with the appropriate professional adviser. This material was prepared by Ceridian Performance Partners; accordingly CPP (not MFS Fund Distributors, Inc.) is solely responsible for the accuracy of the content.
Medicare Supplemental Insurance/2 which of the nine optional plans they will sell as long 50% of approved charges for outpatient mental as the plans they select have been approved for sale health services) after a $100 deductible is met. in the state in which they are to be offered. Plans B through J offer all the basic benefits listed (Plans C, F, G, and H have not been approved for under Plan A, plus different combinations of additional sale in Delaware, while Vermont has not approved benefits. Remember, not every plan is available in Plans F, G, and I.) every state. These plans include the following: Note: Residents of Minnesota, Massachusetts, and Wisconsin will find that their Medigap plans are Plan B includes the basic benefits plus: different than those in other states. This is because those states had Medigap standardization programs in effect before the federal legislation standardizing Medigap was enacted. Because their Medigap plans Plan C includes the basic benefits plus: provide equivalent coverage, they were not required to conform. The Ten Standard Policies Plan A contains the basic benefit plan. All ten standard Medigap policies must contain the following basic benefits: 21-100 per benefit period Coverage for the Part A coinsurance amount Coverage for the Medicare Part B deductible ($190 per day in 1997) for days 61-90 of ($100 per calendar year hospitalization in each Medicare benefit period. Coverage for the Part A coinsurance amount ($380 per day 1997) for each of Medicare s 60 non-renewable lifetime hospital inpatient Plan D includes the basic benefits plus: reserve days used. After all Medicare hospital benefits are exhausted, coverage for 100% of the Medicare Part A eligible hospital expenses. Coverage is limited to a maximum of 365 days of additional inpatient hospital care during the policyholder s 21-100 per benefit period lifetime. This benefit is paid according to the approved rate Medicare pays hospitals or another appropriate standard of payment. Coverage under Medicare Parts A and B for the reasonable cost of the first three pints of blood recovery benefit pays up to $1,600 per year or equivalent in packed red blood cells per for short-term, at-home assistance with activities calendar year unless replaced in accordance of daily living (bathing, dressing, personal with federal regulations. hygiene, etc.) for those recovering from an Coverage for the coinsurance amount for Part B illness, injury, or surgery. There are various services (generally 20% of the approved amount; benefit requirements and limitations.
Medicare Supplemental Insurance/3 Plan E includes the basic benefits plus: 21-100 per benefit period Coverage for preventive medical care. The preventive medical care benefit pays up to $120 per year for such things as a physical examination, flu shot, serum cholesterol screening, hearing test, diabetes screenings, and thyroid function test. Plan F includes the basic benefits plus: 21-100 per benefit period Coverage for the Medicare Part B deductible ($100 per calendar year Coverage for 100% of Medicare Part B excess amount set by either Medicare or state law). Plan G includes the basic benefits plus: 21-100 per benefit period Coverage for 80% of Medicare Part B excess amount set by either Medicare or state law). recovery benefit pays up to $1,600 per year for short-term, at-home assistance with activities of daily living (bathing, dressing, personal hygiene, etc.) for those recovering from an illness, injury, or surgery. There are various benefit requirements and limitations. Plan H includes the basic benefits plus: 21-100 per benefit period Basic prescription drug coverage, which is 50% of the cost of prescription drugs up to a maximum annual benefit of $1,250 after the policyholder meets a $250 per year deductible. Plan I includes the basic benefits plus: 21-100 per benefit period
Medicare Supplemental Insurance/4 Coverage for 100% of Medicare Part B excess charge set by either Medicare or state law). recovery benefit pays up to $1,600 per year for short-term, at-home assistance with activities of daily living (bathing, dressing, personal hygiene, etc.) for those recovering from an illness, injury, or surgery. There are various benefit requirements and limitations. Basic prescription drug coverage, which is 50% of the cost of prescription drugs up to a maximum annual benefit of $1,250 after the policyholder meets a $250 per year deductible. Plan J includes the basic benefits plus: Coverage for the Medicare Part B deductible ($100 per calendar year 21-100 per benefit period Coverage for 100% of Medicare Part B excess charge set by either Medicare or state law). recovery benefit pays up to $1600 per year for short-term, at-home assistance with activities of daily living (bathing, dressing, personal hygiene, etc.) for those recovering from an illness, injury, or surgery. There are various benefit requirements and limitations. Extended prescription drug coverage, which is 50% of the cost of prescription drugs up to a maximum annual benefit of $3,000 after the policyholder meets a $250 per year deductible. Coverage for preventive medical care. The preventive medical care benefit pays up to $120 per year for such things as a physical examination, flu shot, serum cholesterol screening, hearing test, diabetes screenings, and thyroid function test. Comparing Medigap Plans To make it easier for consumers to compare plans and premiums, the same format, language, and definitions must be used in describing the benefits of each of the plans. A uniform chart and outline of coverage also must be used by the insurer to summarize those benefits for you. As you shop for a Medigap policy, keep in mind that each company s products are alike, so they are competing on service, reliability, and price. Look for the policy that best meets your needs. Compare benefits and premiums and be satisfied that the insurer is reputable before buying. For example, what specific benefits do you require? How much will the premiums cost? Are the benefits worth the cost? Should you keep an existing policy which is still renewable or purchase a new policy? Note: If you have a guaranteed renewable Medigap policy which was effective before the federal standardization requirements took effect in 1992, you may not be required to switch to one of the ten standard plans, depending on the state where you live. There may be pros and cons to keeping an existing policy or choosing a new one, so consider all issues carefully before making a decision. For example, an existing policy may have supplemental coverage which is not contained in the new standardized plans. Also, in some states, when a new policy is chosen, insurance companies can impose a waiting period as long as six months for coverage of pre-existing conditions.
Medicare Supplemental Insurance/5 As you compare the plans, use the chart below that outlines the benefits each provides. Ten Standard Medigap Plans Benefit A B C D E F G H I J Part A hospital coinsurance (days 61 90) X X X X X X X X X X Part A hospital lifetime reserve days (91 150) X X X X X X X X X X 100% for 365 lifetime hospitalization days X X X X X X X X X X Parts A and B blood X X X X X X X X X X Part B 20% coinsurance X X X X X X X X X X Part A inpatient hospital deductible X X X X X X X X X Part A skilled nursing facility care coinsurance X X X X X X X X (days 21 100) Foreign travel emergency X X X X X X X X At-home recovery X X X X Part B deductible X X X Part B excess charges 100% 80% 100% 100% Preventative medical care X X Prescription drugs Basic Basic Est.
Medicare Supplemental Insurance/6 Do You Need More Insurance? Financial assistance is also available for Medicare beneficiaries under the Specified Low-Income Before buying insurance to supplement Medicare, ask yourself whether you need private health insurance in addition to Medicare. In some instances, you may have duplicate coverage provided by another health insurance policy. To prevent this duplication, federal law prohibits insurers from selling Medicare supplement policies to anyone who has Medicaid or another health insurance policy that provides coverage for any of the same benefits. In other cases, you may not need an additional Medicare supplement policy because you qualify for assistance. For example: Low-income people who are eligible for Medicaid usually do not need additional insurance. They also qualify for certain health care benefits beyond those covered by Medicare, such as long-term nursing home care. If you become eligible for Medicaid, and you have Medigap insurance purchased on or after November 5, 1991, you can request that the Medigap benefits and premiums be suspended for up to two years while you are covered by Medicaid. Should you become ineligible for Medicaid benefits during the two years, your Medigap policy will be reinstated if you give proper notice and begin paying premiums again. You aren t required to suspend your Medigap policy, because suspension is not always to a Medicaid recipient s advantage. Limited financial assistance is available through Medicaid for paying Medicare premiums, deductibles, and coinsurance amounts for certain low-income elderly and disabled beneficiaries. If your annual income is at or below the national poverty level and your cash and savings are very limited, you may qualify for this state assistance which is called the Qualified Medicare Beneficiary (QMB) program. MFS Fund Distributors, Inc., 500 Boylston St., Boston, MA 02116 H0220598.pdf Medicare Beneficiary (SLMB) program. This program is for beneficiaries whose incomes exceed the poverty level by no more than 10% and who have other resource limitations. Resources for Further Information Contact the Health Care Financing Administration (HCFA) of the U.S. Department of Health and Human Services for a copy of the 1997 Guide to Health Insurance for People With Medicare. Call the Medicare Hotline, 1-800-638-6833, for answers to your questions about Medicare and Medigap or visit them on the world wide web at http://www. hcfa.gov. 1997 Medicare and Medigap Consumer Update. United Seniors Health Cooperative, 1997, 12 p., $3.50. Call 1-800-637-2604 to order. Consumers Checkbook Magazine Editors. Consumer s Guide to Health Plans. Center for the Study of Services, 1996, $12.00. Call 1-800-475-7283 to order. Oshiro, Carl, and Harry Snyder. Medicare/ Medigap. St. Martin s Press, 1994, 216 p., $13.95. Call 1-800-221-7954 to order. The American Association of Retired Persons (AARP) offers support and information for older persons and their caregivers. For details on available resources, call or write AARP, 601 E Street, NW, Washington, D.C., 20049, 1-800-424-3410. You can also visit the AARP on the world wide web at http://www.aarp.org. For more information or a list of other MFS Heritage Planning educational materials on helping your parents, your children, or yourself, contact your financial adviser.