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Mary Johnson was considering the purchase of Medicare Supplement Insurance. Many of her friends had
purchased Medigap Plans. Bill and Sally have Medigap Plans and Dick and Jane have Medigap Plans as
well. I don't think the Harris family owns Medigap Plans. Medicare Coverage is required to purchase
Medigap Plans. You must have Medicare coverage or Medigap Plans are out of the question. The first
thing you need to do is to sign up for Medicare Coverage, because if you don't have Medicare Coverage
with Medicare then you won't be able to purchase Medigap Plans. Medicare Supplement Plans are
another option Mary Johnson was considering to go with her Medicare. Medicare Supplement Plans are
nice to own. Maybe the Harris family has Medicare Supplement Plans since they don't have Medigap
Plans to go with their Medicare Coverage. I have heard that Medicare Supplement Plans are nice to have
to go with your Medicare Benefits. I think Medicare Supplement Plans are the same thing as Medigap
Plans and Medicare Supplement Insurance. How would one even contemplate living without Medicare
Benefits. Mary Johnson thought Medigap Coverage was the same thing as Medicare Benefits, Medicare
Supplement Plans, Medicare Supplement Insurance and that they go well with Medicare Benefits. Blue
Cross Blue Shield offers Medigap Coverage to go with your Medicare benefits. Some people love Blue
Cross Blue Shield but other people prefer AARP Medicare Supplement Insurance. I like both Blue Cross
Blue Shield and AARP Medicare Supplement Insurance. My favorite plan is Mutual of Omaha Medicare
Supplement. I don't think it really matters if you buy Mutual of Omaha Medicare Supplement, AARP
Medicare Supplement Insurance or Blue Cross Blue Shield. Between your Medicare Benefits, Medigap
Coverage, Medicare Supplement Insurance and either AARP Medicare Supplement Insurance, Blue
Cross Blue Shield and Mutual of Omaha Medicare Supplement, you will be just fine. The first step in
Mary's search was to request a Medigap Quotes. To get her Medigap Quotes Mary went to Google and
Yahoo and did research on AARP Medicare Supplement Insurance, Blue Cross Blue Shield and Mutual of
Omaha Medicare Supplement. Mary loved her Medigap Quotes. Now Mary has Medicare Supplement
Insurance, also known as Medigap Plans. So, I would suggest that you get yourself a Medigap Quotes
right now. Medigap Quotes are allot of fun. So hurry and get some Medigap Quotes now..
purchased Medigap Plans. Bill and Sally have Medigap Plans and Dick and Jane have Medigap Plans as
well. I don't think the Harris family owns Medigap Plans. Medicare Coverage is required to purchase
Medigap Plans. You must have Medicare coverage or Medigap Plans are out of the question. The first
thing you need to do is to sign up for Medicare Coverage, because if you don't have Medicare Coverage
with Medicare then you won't be able to purchase Medigap Plans. Medicare Supplement Plans are
another option Mary Johnson was considering to go with her Medicare. Medicare Supplement Plans are
nice to own. Maybe the Harris family has Medicare Supplement Plans since they don't have Medigap
Plans to go with their Medicare Coverage. I have heard that Medicare Supplement Plans are nice to have
to go with your Medicare Benefits. I think Medicare Supplement Plans are the same thing as Medigap
Plans and Medicare Supplement Insurance. How would one even contemplate living without Medicare
Benefits. Mary Johnson thought Medigap Coverage was the same thing as Medicare Benefits, Medicare
Supplement Plans, Medicare Supplement Insurance and that they go well with Medicare Benefits. Blue
Cross Blue Shield offers Medigap Coverage to go with your Medicare benefits. Some people love Blue
Cross Blue Shield but other people prefer AARP Medicare Supplement Insurance. I like both Blue Cross
Blue Shield and AARP Medicare Supplement Insurance. My favorite plan is Mutual of Omaha Medicare
Supplement. I don't think it really matters if you buy Mutual of Omaha Medicare Supplement, AARP
Medicare Supplement Insurance or Blue Cross Blue Shield. Between your Medicare Benefits, Medigap
Coverage, Medicare Supplement Insurance and either AARP Medicare Supplement Insurance, Blue
Cross Blue Shield and Mutual of Omaha Medicare Supplement, you will be just fine. The first step in
Mary's search was to request a Medigap Quotes. To get her Medigap Quotes Mary went to Google and
Yahoo and did research on AARP Medicare Supplement Insurance, Blue Cross Blue Shield and Mutual of
Omaha Medicare Supplement. Mary loved her Medigap Quotes. Now Mary has Medicare Supplement
Insurance, also known as Medigap Plans. So, I would suggest that you get yourself a Medigap Quotes
right now. Medigap Quotes are allot of fun. So hurry and get some Medigap Quotes now..
Medicare Supplement Insurance, also known as "Medigap" insurance, provides supplemental health
insurance coverage for Medicare beneficiaries. Individuals in the "original" Medicare program may want
to obtain Medicare Supplement ("Medigap") insurance because Medicare often covers less than the total
cost of the beneficiary's health care.
Medicare is divided into two coverage components, Part A and Part B. Both programs have gaps in
coverage that may be covered by supplemental insurance.
GAPS IN COVERAGE
Medicare Part A Gaps
Medicare Part A (also known as Hospital Insurance) covers inpatient hospital, inpatient skilled nursing
facility, home health, and hospice services. The following is a partial list of gaps in coverage that are not
reimbursed by Medicare:
Hospital deductible per spell of illness ($992 for 2007);
Hospital coinsurance payments (Medicare covers the first 60 days in full after the deductible has been
met; the daily coinsurance payment for days 61 to 90 is $248 per day in 2007, and for days 91 to 150,
the "lifetime reserve days," $496);
Hospital services beyond 150 days per spell of illness;
Skilled nursing facility coinsurance payments (Medicare covers the first 20 days in full; the daily
coinsurance payment for days 21 to 100 is $124 per day in 2007);
Skilled nursing facility services beyond 100 days per spell of illness;
Home health aide services that are provided on more than a part-time or intermittent basis;
Home health nursing and aide services when there is no longer a skilled care component;
Medicare Part B Gaps
Medicare Part B (also known as Supplementary Medicare Insurance) provides coverage for a variety of
outpatient and physician services. It also pays for durable medical equipment, prosthetic devices,
supplies incident to physician's services, and ambulance transportation. The following is a list of gaps in
coverage that are not reimbursed by Medicare:
Part B deductible (an annual deductible - $131 in 2007- must be met before Medicare will make payment
for covered services);
Part B 20% coinsurance payment (Medicare pays 80% of the approved charge for all Part B services
and items, an amount that varies according to the services and items provided);
Balance billing above the Medicare-approved charge (many physicians and providers charge more than
the amount Medicare approves);
WHO NEEDS MEDICARE SUPPLEMENT INSURANCE
Medicare beneficiaries fill in Medicare's coverage gaps in a number of different ways, including:
Government Programs (Medicaid/QMB/SLMB);
Group Retirement Policies (Non-Standardized);
Non-Standardized Individual Medigap Policies (Issued Prior to July 31, 1992);
Standardized Individual Medigap Policies (Issued After July 31, 1992).
Medicare beneficiaries who are also eligible for Medicaid (Title 19) do not need Medigap insurance since
Medicaid will cover the cost of their health care expenses. People who do not qualify for Medicaid but
are within 100% of the federal poverty level are eligible for coverage under a program known as the
Qualified Medicare Beneficiary Program (QMB). QMB program benefits include:
Payment of Medicare premiums.
Payment of Medicare annual deductibles.
Payment of Medicare coinsurance amounts.
Thus individuals who qualify for the QMB program generally also do not need, and should not pay for,
Medicare Supplement Insurance. Individuals living in Connecticut with monthly incomes of $1,024.00
and assets up to $4,000, and couples with monthly incomes of $1,514.00 and assets up to $6,000 are
eligible for QMB coverage through March, 2006. (These income figures change in April each year.)
Contact the Connecticut Department of Social Services office in your area to find out more about Title 19
and QMB eligibility and enrollment.
Individuals who do not qualify for QMB because of excess income may qualify for the Specified
Low-Income Medicare Beneficiary Program (SLMB) or Qualified Individual Program (QI). People who
have incomes within 120% - 135% of the federal poverty level are eligible for SLMB or QI coverage.
However, SLMB and QI only pay for the Medicare Part B monthly premium. Therefore, SLMB and QI
individuals may still want to purchase Medigap insurance if they can afford to do so. Individuals with
monthly incomes of $1,187.40 and assets up to $4,000, couples with monthly incomes of $1,734.00 and
assets up to $6,000 are eligible for SLMB coverage through March, 2007. Individuals with monthly
incomes up to $1309.95 and couples with monthly incomes up to $1899.00 are eligible for QI through
March, 2007. There is no asset limit for the QI program in Connecticut. Like QMB, these income figures
change in April each year and the programs are administered by the Connecticut Department of Social
Services.
Some employers offer health insurance coverage to their retirees. Retirees who are covered by such
group plans may not need to purchase an individual policy. While a retiree may choose to switch to an
individual plan, this may not be a good choice because group retiree plans usually do not cost anything
to the individual and the group coverage is often as good or better than most individual Medigap
policies. Thus the individual should compare his company's policy costs and coverage with the ten
Medigap policies. The retiree should also consider the stability of his company. If it is conceivable that
the company will falter, that his costs will rise, or that coverage will diminish, the individual may wish to
purchase an independent policy. Remember, however, that if a new policy is purchased the old policy
must be dropped.
Most Medicare beneficiaries are not eligible for Medicaid or QMB, however, and may want to obtain
Medigap insurance. Approximately two-thirds purchase Medigap policies. As of July 31, 1992, Medigap
policies were standardized throughout the United States. This mandatory standardization was a result of
legislation passed by Congress through the Omnibus Budget Reconciliation Act of 1990. There are ten
specific benefit plans which federal law permits to be sold as Medigap policies. Two new plans were
added in 2006. States may allow all or some of these plans to be marketed. Insurance companies may
sell all or some of the plans which the individual state allows them to market. However, there is a basic
benefit package, known as the "core benefit" plan, which must be allowed in all states and which must be
offered by any company which sells Medigap insurance.
Although individual Medigap policies have been standardized since 1992, some seniors are still covered
by previously issued non-standardized plans. These policies are no longer available for purchase.
However, individuals may continue to keep their old policies and many people have chosen to do so.
Individuals covered by an old policy should consider changing to a new "standardized" plan, and should
compare the benefits and costs of each of the policies. Then an informed decision can be made. An
individual who purchases a new standardized policy can only have one Medigap policy and must
therefore drop the old, non-standardized plan. This protects people from the unnecessary costs of
duplicate coverage.
THE STANDARD MEDICARE SUPPLEMENT POLICIES
The twelve standardized benefit policies are labeled A through L. Policy A contains the basic or "core"
benefits. The other eleven policies contain the core benefits plus one or more additional benefits. The
following is a list of the benefits that are contained in the core policy and that must be contained in all
new Medigap policies sold beginning July 31, 1992:
Part A Hospital Coinsurance for Days 61-90 ($248/2007);
Part A Hospital Lifetime Reserve Coinsurance for Days 91-150 ($496/2007);
365 Lifetime Hospital Days Beyond Medicare Coverage;
Parts A and B Three Pint Blood Deductible;
Part B 20% Coinsurance.
Additional benefits are offered in policies B through L. Each plan offers a different combination of these
benefits in addition to the core benefits. Additional benefits are:
Part A Skilled Nursing Facility Coinsurance for Days 21-100 ($124/2007);
Part A Hospital Deductible ($992/2007);
Part B Deductible ($131);
Part B Charges above the Medicare Approved Amount (if provider does not accept assignment);
Foreign Travel Emergency Coverage;
At-Home Recovery (Home Health Aid Services);
Preventive Medical Care.
Policies B through L vary considerably. Beneficiaries should review the policy packages carefully and
decide which coverages are appropriate for them. The chart at the end of these materials illustrates the
various coverages for Medigap policies A through L.
There are many issues which must be considered before purchasing Medigap insurance. For example,
what specific benefits does the individual require? How much will the premiums cost?
Are the benefits worth the cost? Will the individual be able to afford the premiums in the future? What if
he/she decides to switch to a Medicare Advantage plan and then wants to, or has to, switch back?
Certain consumer protections are provided pursuant to federal law and protect Medicare beneficiaries
across the country. Connecticut provides additional protections. Some of those protections are
described below.
CONSUMER PROTECTIONS UNDER FEDERAL LAW
Guaranteed Issue
Guaranteed issue means that an insurance company is required to sell a policy and may not force an
individual to prove "insurability" by making the person pass an insurance physical examination.
All newly entitled Medicare beneficiaries have a right to guaranteed issue of any Medigap policy which is
offered for sale for the first six months after their Medicare entitlement begins. This right only applies to
Medicare beneficiaries who are 65 years of age or older. Insurance companies are not required by
federal law to offer the same range of Medigap policies to Medicare beneficiaries with disabilities that
they offer for sale to Medicare beneficiaries over age 65. Some states require insurance companies to
sell designated Medigap policies to Medicare beneficiaries with disabilities. Connecticut requires
insurance companies to offer Plans A, B and C to Medicare beneficiaries with disabilities, if they offer
these policies for sale to older Medicare beneficiaries. Connecticut also requires that insurance
companies which offer plans A-L sell these plans at all times to Medicare beneficiaries who are over age
65.
Since 1997, pursuant to the Balanced Budget Act of 1997, Medicare beneficiaries who are at least 65
years old are also guaranteed issuance of certain Medigap policies if they apply within 63 days after
disenrollment from a Medicare managed care plan. The circumstances under which these rights exist
are as follows:
A Medicare beneficiary who enrolled in a Medicare managed care plan upon first becoming eligible for
Medicare who subsequently disenrolled within 12 months is guaranteed issue of any Medigap policy
offered for sale in her state.
If such a beneficiary enrolled in a Medicare managed care plan which withdrew from the geographic area
within the first 12 months of the individual's enrollment and the individual enrolled in another Medicare
managed care plan, the time in which the beneficiary may disenroll and purchase any Medigap plan is
extended for a second 12 month period, for a total of 24 months.
A Medicare beneficiary who dropped a Medigap policy upon enrolling for the first time in a Medicare
managed care plan but who subsequently disenrolled from the managed care plan within 12 months is
guaranteed issuance of the same Medigap policy from the same insurance company if that policy is still
being offered for sale. Otherwise, such an individual is entitled to guaranteed issuance of Medigap
Plans A, B, C or F.
If such an individual enrolled for the first time in a Medicare managed care plan which withdrew from the
geographic area within the first 12 months of the individual's enrollment, the time in which these special
Medigap rights apply is extended for a second 12 month period, for a total of 24 months.
A Medicare beneficiary who moved out of the area or whose Medicare managed care plan terminated
service to her area, became bankrupt or violated or misrepresented a provision of the plan is
guaranteed issuance of Medigap Plans A, B, C or F. These same rights apply to Medicare beneficiaries
whose employer stops providing retiree health insurance coverage.
NOTE: Connecticut beneficiaries over age 65 have the right to purchase Policies A - L from any
company selling those policies in Connecticut.
IMPORTANT NOTE: The Centers for Medicare and Medicaid Services (CMS) has stated that the above
Balanced Budget Act provisions do NOT apply to Medicare beneficiaries whose Medicare entitlement is
based on their disability or upon End Stage Renal Disease. According to CMS, these provisions apply
only to Medicare beneficiaries who are at least 65 years old.
Upon purchasing a Medigap policy, a Medicare beneficiary has 30 days in which to change her mind,
cancel the policy and receive a refund of the previously paid premium.
Pre-Existing Conditions
A pre-existing condition exclusion means that health insurance may not cover the costs incurred as a
result of a medical condition a person had prior to obtaining the health insurance coverage. The ability
of insurance companies to impose pre-existing condition exclusions has been severely constricted since
the enactment of a federal law called "HIPAA." Under HIPAA, if an individual had health insurance
coverage for a period of at least 6 months prior to their initial open enrollment period for Medicare, no
pre-existing condition exclusion may be imposed. Most types of health coverage offer this "creditable
coverage," including employee or union group health insurance, retiree health insurance, Medicare
Parts A and B and Medicaid (Title 19).
For Medigap purposes, creditable coverage is conferred for the number of months an individual was
covered by another Medigap policy or was enrolled in a Medicare HMO. Thus, if an individual was
previously in another Medigap plan or Medicare managed care plan for at least six months, no
pre-existing condition limit can be imposed by a new Medigap plan.
Prohibition on Duplicate Policies
Another important provision of the law is that insurance companies and agents are prohibited from
selling a beneficiary a second Medigap policy. An insurance agent is required to disclose this provision
to Medicare beneficiaries and must obtain a written acknowledgment. A new policy may be sold to
replace an existing policy, but this fact must also be acknowledged in writing. However, an individual may
keep or purchase another medical insurance policy which is not a Medigap policy. Such policies include
hospital indemnification coverage which only provide benefits for hospitalization and nothing else. When
an insurance company or independent insurance agency sells such a policy, they must disclose to the
purchaser the specific coverage and certify that the policy is not a Medigap policy.
Agents must also ask if the beneficiary is eligible for Medicaid coverage. A policy holder who becomes
eligible for Medicaid may have premiums suspended for up to two years. If Medicaid eligibility is
terminated during this period, the individual will be able to return to his prior Medigap policy.
ADDITIONAL CONSUMER PROTECTIONS FOR POLICIES SOLD IN CONNECTICUT
In Connecticut, any insurance company which sells Medigap plans A through L must sell them to any
Medicare beneficiary over the age of 65 at any time, regardless of age, gender, medical condition or
previous health insurance claims history. Insurance companies are prohibited from refusing coverage
under these plans based upon a person's medical conditions or medical history. This means that
insurance companies are not allowed to medically underwrite plans A through L for any Medicare
beneficiary over the age of 65. Thus, no health insurance company may require a health insurance
examination of an older Medicare beneficiary prior to authorizing the sale of these Medigap plans.
RECENT CHANGES TO MEDIGAP INSURANCE
The Medicare Prescription Drug, Modernization and Improvement Act (MMA) contains provisions which
affected Medigap insurance. This new law, which went into effect on January 1, 2006, changed
coverage under Medigap plans H, I, and J and created two additional Medigap plans, designated K and
L.
Changes to Medigap Plans H, I, & J
Federal law now prohibits the sale of Medigap plans H, I, or J with prescription coverage. These plans
may continue to be sold without prescription drug coverage and the premiums will be adjusted to reflect
this change.
Beneficiaries already enrolled in Medigap plans H, I, or J on December 31, 2005 may renew their
enrollment in these plans as long as they do not enroll in Medicare Part D's prescription drug coverage.
If such a beneficiary does enroll in a Part D prescription drug plan, his or her Medigap plan's coverage
will be modified to eliminate prescription drug coverage as of the effective date of the Part D plan.
A beneficiary who delays enrollment in a Part D plan in favor of keeping a Medigap plan which covers
prescription drugs faces late enrollment penalties for Part D if that Medigap plan is not considered to be
as good as Part D's standard benefit (creditable coverage). Medigap insurance issuers were required to
send notice to their enrollees between September 15, 2005 and November 15, 2005 advising them if the
Medigap insurance they have is creditable. Most Medigap plans will not be considered creditable
coverage because their coverage is not as good as the standard Part D benefit.
Medigap Plans K & L
Beginning January 1, 2006, two new Medigap plans will be offered. Plan K will fully cover the cost
sharing for Part B preventive services, the Part A hospital co-insurance and an additional 365 days of
hospital coverage. It will also cover 50% of the Part A and Part B blood deductibles, the Part B
co-insurance, the skilled nursing facility co-insurance, the cost sharing associated with the hospice
benefit, and the Part A hospital deductible. Plan K will cover 100% of all cost sharing under Medicare
Parts A and B for the rest of the calendar year once a beneficiary reaches an out-of-pocket limit of
$4000 in 2006.
Plan L will fully cover the cost sharing for Part B preventive services, the Part A hospital co-insurance
and an additional 365 days of hospital coverage. It will also cover 75% of the Part A and Part B blood
deductibles, the Part B co-insurance, the skilled nursing facility co-insurance, the cost sharing
associated with the hospice benefit, and the Part A hospital deductible. Plan L will cover 100% of all cost
sharing under Medicare Parts A and B for the rest of the calendar year once a beneficiary reaches an
out-of-pocket limit of $2000 in 2006.
WHAT TO CONSIDER WHEN PURCHASING MEDIGAP INSURANCE
There are many considerations when purchasing Medigap insurance. The most important considerations
are the person's medical needs and financial abilities. The individual should look at his or her current
needs and abilities and also try to anticipate future concerns.
Obtaining Coverage and Switching Policies
Remember that under federal law an individual age 65 or older may enroll in any of the twelve policies
during the six-month period after first being covered by Part B. Connecticut beneficiaries over age 65
are guaranteed the ability to purchase Medigap plans A-L beyond this six-month period.
Remember that prior coverage under another Medigap policy or Medicare Managed care plan counts
toward the six-month waiting period for coverage of pre-existing conditions. Finally, some companies
have liberal rules about letting a person switch from one policy to another policy offered by that company.
Cost
The next major consideration in selecting a Medigap policy is cost. A person must be able to afford the
particular policy he or she desires. There is a great deal of price difference from policy to policy.
There is also a big difference in price from company to company for the same policy. For example,
monthly premiums for companies selling Policy C in Connecticut range from $138.50 to $310.00 yet all
the policies offer the exact same benefits. Thus, before purchasing one of the higher priced policies, the
buyer should be certain that he desires something else about the company besides the policy's benefits
(for example, a reputation for timely claims processing).
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