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The
Federal Medicare health insurance program …… only pays part of the bill!
Medicare is a federal health insurance
program for people 65 years of age or older, and certain younger people with disabilities
or End-Stage Renal Disease (permanent kidney failure). It pays for much of your health
care, but not all of it. You have to pay some costs yourself, unless you buy more
insurance. This is where buying a Medicare Supplement comes in. Also, with a Medigap
policy you can buy as little or as much extra coverage as you want.
Don’t be caught short. The bill you receive for the
balance after Medicare pays their portion often times is the largest part of the bill.
Medicare Supplements, sometimes called Medigap policies,
are available to pay for expenses, which the Federal Medicare plans do not pay for. A
Medigap policy is sold by private insurance companies to fill the "gaps" in
original Medicare Plan coverage. In all but three states (Minnesota, Massachusetts, and
Wisconsin), there are 10 standardized Medigap plans called plans "A" through
"J". Each plan has a different set of standard benefits. You can purchase a Medicare supplement at any time after you turn age 65,
however the first six months after you turn 65 is referred to Your Open Enrollment
Period.
Open Enrollment Period:
Your Medigap open enrollment period lasts for six months
after the first day of the month in which you are both age 65 or older and
enrolled in Medicare Part B. Once the six month Medigap open enrollment period
starts, it cannot be changed. During this time, you have the right to buy the Medigap
policy of your choice and the insurance company cannot deny you insurance coverage, place
conditions on a policy (like making you wait for coverage to start), or change the price
of the policy because of past or present health problems. If you buy a policy during your
Medigap open enrollment period, the insurance company must shorten the waiting period for
pre-existing conditions by the amount of previous health coverage you have. (This is
called creditable coverage).
Will my Pre-Existing Conditions be covered if I buy a
Medigap policy?
If you buy a policy during your Medigap open enrollment
period, the insurance company can refuse to cover care for pre-existing conditions for up
to six months. This only applies to conditions that were diagnosed or treated during the 6
months immediately before the start of your Medigap policy. This 6-month period is called
the pre-existing condition waiting period. However, they cannot refuse to cover
pre-existing conditions if you have at least 6 months of creditable coverage. Any new
health problem would be covered immediately, regardless of whether you had creditable
coverage. (We can provide you with a list of what is classified as creditable coverage).
Medicare Supplements policies only help pay health care
costs if you have the in force part A & B of Medicare.
What is a
Medicare Advantage Plan?
A Medicare Advantage plan is a low cost insurance policy that pays in addition to
the expenses standard Medicare already pays for medical and
prescription drug coverage. Although this plan supplements Federal Medicare benefits it may not be offered in all zip codes.
Features of Medicare Advantage plans
include:
- HMO and PPO plan designs
- Offer the lowest premiums even with RX benefits included
- HMO plans premiums are as low as zero, with prescription card
- PPO plan premiums between $45 - $125, with prescription card
- Some plans have out of pocket maximums
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