What is Medicare Supplement Insurance?

Medicare Supplement Insurance is a private health insurance policy designed to help pay some or all of the costs that are not covered by Medicare Parts A and B.

Who is eligible for Medicare Supplement Insurance?

Anyone who is covered under both Medicare parts A and B is eligible for Medigap Coverage.

When can I apply for Medicare Supplement Insurance?

You can apply for Medicare Supplement Insurance during open enrollment. Open enrollment includes a six-month period from the date you enrolled in Medicare Part B if age 65 or older, or up to six-month after you turn 65 if you were eligible for Part B benefits before age 65. If you become eligible for Medicare Part B benefits before age 65 because of disability or ESRD (permanent kidney failure), you are guaranteed the Medicare Supplement policy of your choice during the first six months you are age 65 and enrolled in Part B.

Does Medicare Supplement coverage include prescription drug benefits?

No, Medicare Supplement is designed to fill in the “gaps” with Medicare Plans such as Part A (which covers hospital and skilled nursing facility care) and Part B (which covers doctor bills and other medical expenses). For prescription drug coverage, you can select a separate Medicare Part D Prescription Drug Plan.

Can I enroll if I do not have Medicare Parts A or B?

No, you must be entitled to Medicare Part A and/or enrolled in Medicare Part B to be eligible for a Medicare prescription drug coverage.

To learn how to get Medicare Part A and/or Part B, please call Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day/7 days a week. For the hearing or speech impaired, please call 1-877-486-2048.

You may also contact your State Medicaid Office or the Social Security Administration at 1-800-772-1213, Monday – Friday, 7 a.m. – 7 p.m. CST. For the hearing or speech impaired, please call 1-800-325-0778.

Does Everyone Need a Medicare Supplement Policy?

Not everyone needs a Medicare supplement policy. If you have certain other types of health coverage, the gaps in your Medicare coverage may already be covered. You probably don’t need Medicare supplement insurance if

• you belong to a Medicare Advantage plan
• Medicaid or the Qualified Medicare Beneficiary (QMB) Program pays your Medicare premiums and other out-of-pocket costs.
• You are covered under an employer group health plan

What if I (or my spouse) plan to work after age 65 and continue receiving group health care benefits?

Check with your group plan administrator. You may be able to choose either your group plan or Medicare plus Medicare Supplement coverage. If you stay with your group health care plan, a Special Enrollment Period lets you delay purchasing Part B until you need it.

Will I need to switch doctors if I enroll in a Medicare Supplement plan?

No, you may continue to see your own doctor. Medicare Supplement plans are convenient and flexible, giving you freedom of choice.

Can I see a specialist whenever I want?

Yes. Just remember that your out-of-pocket costs will be less if you choose a physician who accepts Medicare assignment.

Medicare does not cover all health care costs. Medicare coverage consists of Part A (which covers hospital and skilled nursing facility care), and Part B (which covers doctor bills and other medical expenses).

Even with Medicare Part A and Part B coverage, you’re responsible for some out-of-pocket expenses including:

• Part A hospital deductible ($1,316)
• Part B deductible ($183)
• Copayments for hospital stays over 60 days
• Care in a skilled nursing facility after 20 days
• Twenty percent coinsurance for doctor bills and other medical expenses

To qualify for a Medicare Supplement policy, you must be age 65 or older (may vary by state), enrolled in Medicare parts A and B, and you must reside in the state in which you are applying for supplemental coverage.

When to Enroll

Your open enrollment period is the best time to buy a Medicare Supplement policy because companies must sell you any plan they offer regardless of your pre-existing health conditions. Your open enrollment period lasts for 6 months and begins on the first day of the month in which you are age 65 or older and enrolled in Part A and B of Medicare.

Late Enrollment

To help control rising costs, carriers apply the pre-existing condition clause to newly issued Medicare Supplement plans in most states if you enroll after the open enrollment period. Expenses resulting from a condition existing six months prior to the supplemental policy effective date are not covered unless they are incurred three months after the supplemental policy effective date.

If the supplemental policy replaces another creditable individual or group insurance coverage due to a person’s eligibility for Medicare, this Pre-Existing Conditions Limitation will be reduced by the number of months that coverage was in force. If this supplemental policy replaces another Medicare Supplement policy, this Pre-Existing Conditions Limitation will be reduced by the number of months that the coverage was in force.