Most Medicare-approved services today are covered primarily by original Medicare, which consists of Parts A and B. However, Medicare Parts A and B have “gaps” in coverage, leaving the burden of covering certain medical expenses to insured. These gaps include the Parts A and B deductibles and daily copayments for nursing home and hospital care. To make up for these gaps in Original Medicare coverage, the insurance industry created Medicare supplement policies or Medigap policies. Contact Crocker Life for your quote on Medicare Supplements South Carolina insurance.
Medigap insurance is another name for supplementary Medicare insurance. It is called Medigap because it makes up for the gaps in coverage left after normal Medicare has paid what it covers. The gaps are in the form of deductibles, copayments, and coinsurance and represent out-of-pocket expenses to insured. While Medicare supplement insurance pays for these charges, it is requires them to be medically necessary, just as Medicare does. In addition, the amounts paid are based on what Medicare would generally approve. Additional benefits, such as emergency care while overseas, are sometimes offered by certain plans.
Underwritten and sold by commercial insurance providers, Medicare supplement plans are designed exclusively to supplement Original Medicare. Please be aware that Medigap policies are not intended to supplement Medicare Advantage (Plan C) plans, since those plans already cover many of the gaps that Medigap policies were created to cover. Medigap policies may not duplicate coverage nor may they provide coverage that Medicare considers medically unnecessary. For example, Medigap policies cannot cover cosmetic surgery. However, some Medigap policies offer benefits that Medicare doesn’t, such as emergency medical care in a foreign country. Contact us for your quote on Medicare Supplements South Carolina insurance.
Federal law requires that people who qualify for Medicare are entitled to purchase a Medicare supplement policy without regard to health, as long as the applicant is at least age 65 and applies for a Medicare supplement policy within six months of enrolling in Medicare Part B. If the applicant meets these criteria, then he or she qualifies for the policy of their choice within their state. The insurance company cannot deny or condition the issue of a policy on the basis of medical history, health status, or claims experience.
The ten standard Medicare supplement plans are labeled “A” through “N.” Each plan consists of a different set of benefits, with benefits generally increasing from Plan A to Plan N. As of 2010 (the last time plan types were revised) the options are Plans A, B, C, D, F (with a high deductible option), G, K, L, M, and N. Four older plans labeled E, H, I, and J were discontinued in 2010, though those individuals who had these plans in effect at that time can continue them. Plans M and N became available in 2010. All insurance companies that sell Medicare supplement policies must offer Plan A and either Plan C or Plan F. They may choose to sell any or all of the other plans as well. To make it easier for consumers to understand their purchasing options, all Medicare supplement policies must meet federal standards for the ten standardized forms. For example, an insurer that sells Plan A must sell a product that exactly conforms to Plan A—no more, no less. In addition, insurers must include the plan code (A, B, C, etc.) in the product name. Whenever Medicare changes the standard deductibles and copayments, Medicare supplement policies must adjust their benefits to match the changes. Contact Crocker Life for your quote on Medicare Supplements South Carolina insurance.
To recap, the 10 standard Medigap plans are labeled A through N. Plan A coverage is mandatory for all companies that offer Medigap insurance. The other nine plans are optional. These standardized plans were first introduced in 1992, but policies purchased prior to that time are grandfathered in, so changing to one of the 10 standardized plans is not required. The federal government establishes the benefits and coverage under the plans but the South Carolina Department of Insurance regulates and licenses the private insurance companies that sell the plans. The Medigap policies are renewed automatically every year.
The table below shows the various benefits that Medicare supplement plans must provide as of June 1, 2010. NOTE: Since June 1, 2010, all Medigap plans must cover hospice care but no longer cover at home recovery or preventive medical care that is not covered by Medicare.
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| (“Yes” means covered at 100 percent; lower percentage is shown if applicable) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Standardized Medigap Plans as of June 1, 2010 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| (“Yes” means covered at 100 percent; lower percentage is shown if applicable) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Plan K and L premiums will be lower than premiums for other plans because coverage of the first three pints of blood, Part B coinsurance, and Part A hospice care cost-share is lower than with other plans, including the Plan A core plan.
States are not required to allow all 10 standardized Medigap plans to be sold in their jurisdictions. As a consequence, in some states insurers only offer something less than 10 standardized Medigap plans. However, all states are required to approve and allow insurers to market and sell at least Plan A, which offers the basic, or core, benefits. In other words, if an insurer wants to offer any Medigap plans at all, it must offer at least Plan A. In addition to Plan A, all Medigap insurers are required to offer, at a minimum, either Plan C or Plan F. Contact us for your quote on Medicare Supplements South Carolina insurance.
No Prescription Drug Coverage
Medicare supplement plans (except grandfathered plans) cannot include prescription drug coverage, which is available now through Medicare Part D. Before Medicare Part D was initiated, some Medicare supplement plans did include prescription drug coverage. These pre-Part D plans were grandfathered, and today anyone who still owns one may either continue the policy’s drug coverage (without having to buy a Part D policy) or discontinue the prescription drug coverage (and see a corresponding decrease in premium). If the policyholder chooses the latter option, a Part D policy may be funded with the premium savings. Crocker Life can help you with a quote for Medicare Supplements South Carolina insurance.
Guaranteed Renewable
All Medicare supplement policies must be issued as guaranteed renewable. A policy, once issued, cannot be canceled due to the insured’s health. The insurer may increase premiums, but only as long as premiums are increased for all such policies issued by the insurer.
Open Enrollment
If they are 65 and apply within six months (this is called the “open enrollment period”), applicants may purchase a Medicare supplement policy after enrolling in Medicare Part B. Insurers are obligated to sell any of the Medigap plans they offer to any eligible applicant during open enrollment. Contact Crocker Life for your quote on Medicare Supplements South Carolina insurance.
Is the Recommended Purchase Suitable?
An agent must make an effort to determine if the policy is suitable for the individual when recommending the purchase or replacement of a Medicare supplement policy. Selling a Medicare supplement policy that results in the policyholder having more than one Medicare supplement policy is not allowed. An insurer cannot issue a Medigap policy to a person already enrolled in Medicare Part C unless the effective date of the coverage is after the termination date of the person’s Part C coverage.
Medicare Select
Medicare Select is one example of a Medigap policy. Unlike standard Medigap policies, however, under Medicare Select you are required to use doctors and providers within a network for your care. Medicare Select is in essence what most people think of as a PPO. In all other ways it is just like standard Medigap policies because the same ten standard Medicare Supplement Plans, A through L, are offered. Out of network providers will not only cost more, but the benefits may not payable at all if a non-network provider is used in a non-emergency situation. The restrictions on providers only apply to the Medicare Select portion of your cover, since regular Medicare, will pay what it normally pays regardless of the provider. Because of arrangements with preferred providers, Medicare Select plans can generally offer lower premiums. You can choose to go back to a standard Medicare Supplement (Medigap) policy at any time as long as the Medigap policy you choose has equal or less coverage than your existing Medicare Select.
The Medicare SELECT plan is a more affordable alternative to Medicare supplement insurance. Whiles a Medigap policy is a traditional indemnity policy, a Medicare SELECT plan is a managed care plan. A Medicare SELECT plan requires seniors to receive care exclusively from the provider network established by the Medicare SELECT plan.
Medicare SELECT plans are typically sold through a managed care provider or an insurer that offers the policy’s benefits through a network of doctors, hospitals, and health care service providers. Each Medicare SELECT plan must be labeled with the type of Medigap plan that it is based on and must also include the word SELECT. For example, a plan that details the benefits of a Medigap Plan B policy must be labeled “Medicare SELECT Plan B.” A Medicare SELECT policy is usually less expensive because participants must obtain care through the plan’s network, yet it offers essentially the same benefits as a Medigap policy. Keep in mind, however, that although Medicare SELECT is a managed care alternative to the traditional Medicare supplement policy, it is still used only as a supplement to Medicare Parts A and B. Medicare SELECT cannot be used to supplement Medicare Advantage, which is a comprehensive approach to covering medical care.
