Choosing a MediGap Policy 2010

8/8/2019 Choosing a MediGap Policy 2010

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2010

C E N T E R S F O R M E D I C A R E & M E D I C A I D S E R V I C E S

Choosing a Medigap Policy:A Guide to Health Insurance for People with Medicare

This of cial government guide has

important inormation about the

ollowing:

What a Medigap (Medicare

Supplement Insurance) policy is

Whats new in 2010

What Medigap policies cover Your rights to buy a Medigap policy

How to buy a Medigap policy

This guide can help if youre thinking about buying,

or already have, a Medigap policy.

Developed jointly by the Centers or Medicare & Medicaid Services (CMS)

and the National Association o Insurance Commissioners (NAIC)


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How to use this guide

Tere are two ways to fnd the inormation you need:

1. Te able o contents on pages 12 can help you fnd the sections youneed.

2. Te List o topics on pages 5558 lists topics in this guide and the pagenumber o where to fnd them.

Who should read this guide?

Tis guide helps people with Medicare understand Medigap (also calledMedicare Supplement Insurance) policies. A Medigap policy is a type

o private insurance that helps you pay or some o the costs that OriginalMedicare doesnt cover.

Whats new and important in 2010?

New laws have brought many changes to Medigap (Medicare SupplementInsurance) policies. Tese changes give you choices in health care coverage to fllgaps in services that Original Medicare doesnt cover.

Basic Benefts Starting with policies eective on or aer June 1, 2010,Hospice Part A coinsurance (outpatient prescription drug and inpatient

respite care coinsurance) will be covered as a basic beneft. Plan K will cover50%, and Plan L will cover 75% o these costs.

Part B Coinsurance Plans K, L, and N will require you to pay a portion oPart B coinsurance and copayments, which may result in lower premiums orthese plans. All other Medigap policies pay Part B coinsurance or copaymentsat 100%.

New Plans Oered Plans M and N are new choices.

Plans D and G Plans D and G bought on or aer June 1, 2010 have dierentbenefts than D or G plans bought beore June 1, 2010. But, i you bought Plan Dor G beore June 1, 2010, you can keep that plan and the benefts wont change.

Plans No Longer or Sale Plans E, H, I, and J will no longer be sold aerMay 31, 2010. But, i you already have or you buy Plan E, H, I, or J beoreJune 1, 2010, you can keep that plan.


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1Table of contents

Section 1: Medicare basics

A brie look at Medicare ........................................................................ 38

Section 2: Medigap basics

What is a Medigap policy? ......................................................................... 9

Medigap Plans with eective dates through May 31, 2010 .......... 1011

Medigap Plans eective on or ater June 1, 2010 ........................... 1213

What Medigap policies dont cover......................................................... 14

ypes o coverage that are NO Medigap policies ............................... 14

What types o Medigap policies can insurance companies sell? ... 1415

What do I need to know i I want to buy a Medigap policy? ....... 1516

When is the best time to buy a Medigap policy?.............................1617Why is it important to buy a Medigap policy when Im

irst eligible? .............................................................................................. 18

How insurance companies set prices or Medigap policies .......... 1920

Comparing Medigap costs ....................................................................... 21

What is Medicare SELEC? .................................................................... 22

How does Medigap pay your Medicare Part B bills? ............................ 22

Section 3: Your right to buy a Medigap policy

Guaranteed issue rights (Medigap protections) ............................. 2326(his section includes the situations when you have the rightto buy a Medigap policy ater your open enrollment period.)

Section 4: Steps to buying a Medigap policy

Step-by-step guide to buying a Medigap policy ............................. 2732

Section 5: For people who already have a Medigap policy

Switching Medigap policies ............................................................... 3437

Losing Medigap coverage.......................................................................... 38Medigap policies and Medicare prescription drug coverage .........3840

Continued on next page


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2 Table of contents

Section 6: Medigap policies for people with a disability or ESRD

Inormation or people under 65 ...................................................... 4142

Section 7: Medigap coverage in Massachusetts, Minnesota, andWisconsin

Medigap policies or Massachusetts ........................................................ 44

Medigap policies or Minnesota .............................................................. 45

Medigap policies or Wisconsin............................................................... 46

Section 8: For more information

Where to get more inormation ............................................................... 47

How to get help with Medicare and Medigap questions ..................... 48State Health Insurance Assistance Program and State Insurance

Department .........................................................................................4950(elephone numbers or each state)

Section 9: Definitions

Where words in blue are deined.......................................................5154

Section 10: List of topics

An alphabetical list o whats in this guide .......................................5558


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3

SECION

1Medicare basics

Tis guide helps people with Medicare understand Medigap(also called Medicare Supplement Insurance) policies.

A Medigap policy is health insurance sold by private insurancecompanies to fll gaps in Original Medicare coverage. Medigappolicies can help pay your share (coinsurance, copayments, ordeductibles) o the costs o Medicare-covered services. SomeMedigap policies also cover certain benefts Original Medicaredoesnt cover. Medigap policies dont cover your share o thecosts under other types o health coverage, including Medicare

Advantage Plans, stand-alone Medicare Prescription Drug Plans,employer/union group health coverage, Medicaid, VeteransAdministration (VA) benefts, or RICARE. Also, except orMedicare Prescription Drug Plans, while you have any o theseother types o health coverage, insurance companies generallyarent allowed to sell you a Medigap policy.

Beore you learn more about Medigap policies, the next ew pagesprovide a brie look at Medicare. I you already know the basics

about Medicare and want to learn about Medigap, turn to page 9.


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5Section 1:Medicare basics

Your Medicare Coverage Choices

With Medicare, you can choose how you get your health and prescription

drug coverage. Below are brie descriptions o your coverage choices.

Original Medicare

Run by the Federal government. Provides your Part A and Part B coverage. You can buy a Medigap (Medicare Supplement Insurance) policy (sold

by private insurance companies) to help fll the gaps in Part A and Part Bcoverage (like coinsurance, copayments, and deductibles).

You can join a Medicare Prescription Drug Plan to add drug coverage.

Medicare Advantage Plans (like an HMO or PPO)see page 6.

Run by private insurance companies approved by and under contractwith Medicare.

Provide your Part A and Part B coverage, but can charge dierentamounts or certain services. May oer extra coverage and prescriptiondrug coverage or an extra cost. Costs or items and services vary by plan.

I you want drug coverage, you must get it through your plan (in mostcases).

I youre enrolled in a Medicare Advantage Plan, you dont need and cant

use a Medigap policy.

Other Medicare Health Plans

Plans that arent Medicare Advantage Plans but are still part o Medicare. Include Medicare Cost Plans, Demonstration/Pilot Programs, and

Programs o All-Inclusive Care or the Elderly (PACE). Most plans provide Part A and Part B coverage, and some also provide

prescription drug coverage (Part D).

Note: I you have other health and/or prescription drug coverage rom a

ormer or current employer or union, you may have other coverage choices.Tis coverage may aect which Medicare coverage choice is best or you.

For more inormation about your Medicare coverage choices, call1-800-MEDICARE (1-800-633-4227), or visit www.medicare.gov. Y usersshould call 1-877-486-2048. You can also contact your State Health InsuranceAssistance Program (SHIP). See pages 4950 or the telephone number.

Words in blue

are defned on

pages 5154.
http://www.medicare.gov/


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6

Medicare Advantage Plans

Medicare Advantage Plans include the following: HealthMaintenance Organization (HMO) Plans Preerred Provider Organization (PPO) Plans PrivateFee-or-Service (PFFS) Plans MedicalSavings Account (MSA) Plans SpecialNeeds Plans (SNP)

Medicare Advantage Plans and Medigap Policies

I you have a Medigap policy and you are switching rom OriginalMedicare to a Medicare Advantage Plan, you dont need and cant use

the Medigap policy to cover deductibles, copayments, coinsurance, orpremiums under the Medicare Advantage Plan. You may choose to dropyour Medigap policy, but you should talk to your State Health InsuranceAssistance Program (see pages 4950) and your current Medigap insurancecompany frst because you may not be able to get your Medigap policyback. I you already have a Medicare Advantage Plan, its illegal or anyoneto sell you a Medigap policy unless youre disenrolling rom your MedicareAdvantage Plan to go back to Original Medicare.

Medicare Prescription Drug Coverage (Part D)

Medicare oers prescription drug coverage (Part D) or everyone with

Medicare. o get Medicare drug coverage, you must join a plan run byan insurance company or other private company approved by and undercontract with Medicare. Each plan can vary in cost and drugs covered.I you want Medicare drug coverage, you need to choose a plan that workswith your health coverage.

Tere are two ways to get Medicare prescription drug coverage:

1. Medicare Prescription Drug Plans. Tese plans (sometimes calledPDPs) add drug coverage to Original Medicare, some Medicare CostPlans, some Medicare Private Fee-or-Service Plans, and MedicareMedical Savings Account Plans.

2. Medicare Advantage Plans (like an HMO or PPO) or other Medicarehealth plans that have prescription drug coverage. You get all o yourPart A and Part B coverage and prescription drug coverage (Part D)through these plans. Medicare Advantage Plans with prescription drugcoverage are sometimes called MA-PDs.

Section 1:Medicare basics

Words in blue

are defned on

pages 5154.


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7Section 1:Medicare basics

Medicare Prescription Drug Coverage (continued)

Medicare Prescription Drug Coverage and Medigap Policies

I you bought your Medigap policy beore January 1, 2006, you mayhave a Medigap policy with prescription drug coverage. You can keepthe prescription drug coverage in that policy, or you can join a MedicarePrescription Drug Plan. I you join a Medicare Prescription Drug Plan,you must tell your Medigap insurance company. It will remove theprescription drug coverage rom your Medigap policy and adjust yourpremium. Tis is because you cant have both types o prescription drugcoverage at the same time. Once the drug coverage is removed, you cantget that coverage back even though you didnt change Medigap policies.

See pages 3840 i you have a Medigap policy with prescription drugcoverage that you bought beore January 1, 2006.

I you have Original Medicare and already have a Medigap policywithout prescription drug coverage, you can join a MedicarePrescription Drug Plan, and it wont aect your Medigap policy.

Can I buy a new Medigap policy that includes prescription drug

coverage?

No. As o January 1, 2006, Medicare oers prescription drug coverageto everyone with Medicare. For this reason, Medigap policies sold on oraer January 1, 2006, dont include prescription drug coverage. I youwant prescription drug coverage, you can get this coverage in one o thetwo ways described on page 6.

For more inormation

Remember, this guide is about Medigap policies. o learn more aboutMedicare, visit www.medicare.gov/Publications/Pub/pd/10050.pd to view

the Medicare & You handbook. You can also call 1-800-MEDICARE(1-800-633-4227). Y users should call 1-877-486-2048.
http://www.medicare.gov/Publications/Pub/pdf/10050.pdfhttp://www.medicare.gov/Publications/Pub/pdf/10050.pdf


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8 Section 1:Medicare basics

Notes

Use this page to writedown important notes orphone numbers.


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9

SECION

Medigap basics

2 What is a Medigap policy?A Medigap (also called Medicare Supplement Insurance) policyis private health insurance that is designed to supplement OriginalMedicare. Tis means it helps pay some o the health care costs(gaps) that Original Medicare doesnt cover (like copayments,coinsurance, and deductibles). I you are in Original Medicareand you have a Medigap policy, Medicare will pay its share o theMedicare-approved amounts or covered health care costs. Tenyour Medigap policy pays its share. (Note: Medicare doesnt payany o the costs or you to get a Medigap policy.) Also, a Medigappolicy is dierent than a Medicare Advantage Plan (like an HMO orPPO) because those plans are ways to get Medicare benefts, while aMedigap policy only supplements your Medicare benefts.

Every Medigap policy must ollow Federal and state laws designedto protect you, and the policy must be clearly identifed asMedicare Supplement Insurance. Medigap insurance companiesin most states can only sell you a standardized Medigap policyidentifed by letters A through N. Each standardized Medigappolicy must oer the same basic benefts, no matter whichinsurance company sells it. Cost is usually the only dierencebetween Medigap policies with the same letter sold by dierentinsurance companies.

In Massachusetts, Minnesota, and Wisconsin, Medigap policiesare standardized in a dierent way. See pages 4446. In somestates, you may be able to buy another type o Medigap policycalled Medicare SELEC. See page 22.


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10 Section 2:Medigap basics

Inormation about the chart on page 11

Te chart on the next page gives you a quick look at the standardized Medigap

Plans (including Medicare SELEC) available or purchase throughMay 31, 2010, and their benefts.

Insurance companies selling Medigap policies are required to make Plan Aavailable. Not all types o Medigap policies may be available in your state.See pages 4446 i you live in Massachusetts, Minnesota, or Wisconsin.I you need more inormation, call your State Insurance Department orState Health Insurance Assistance Program. See pages 4950 or your statestelephone number. See pages 1213 or an explanation o these changes and tosee plans with benefts eective June 1, 2010.

Important

New laws have brought many changes to Medigap policies. Tese changes willbe or plans with eective dates on or aer June 1, 2010, and will give youchoices in health care coverage to fll gaps in services that Original Medicaredoesnt cover. See pages 1213 or an explanation o these changes and theplans with benefts eective on or aer June 1, 2010.


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11Section 2:Medigap basics

M

edigapPlanswithef

ectivedatesthrough

May31

,2010

Howtoreadthecha

rt:

Iacheckmarkappearsin

acolumnothischart,theMediga

ppolicycovers100%othedescribedbeneft.Iacolumnlistsapercentage,t

he

policycoversthatpercentageothedescribedbeneft.Iacolumnisblank,thepolicydoesntco

verthatbeneft.

Note:TeMedigappolicy

coverscoinsuranceonlyaeryouhavepaidthedeductible(unlessth

eMedigappolicyalsocoversthedeductible).

TroughMay31,2

010youmaybuytheollowing

MedigapPlans:

MedigapPlansAthroughL

MedigapBenets

A

B

C

D

E

F*

G

H

I

J*

K

L

MedicarePartACoinsurancehospitalcostsuptoanadditional365daysaer

Medicarebeneftsareused

up

MedicarePartBCoinsuranceorCopayment(Exceptorprev

entiveservices)

50%

75%

Blood(First3Pints)

50%

75%

HospiceCareCoinsuranceorCopayment

50%

75%

SkilledNursingFacilityCareCoinsurance

50%

75%

MedicarePartADeductib

le

50%

75%

MedicarePartBDeductib

le

MedicarePartBExcessCharges

80%

ForeignravelEmergency

(UptoPlanLimits)

At-homeRecovery(Upto

PlanLimits)

MedicarePreventiveCare

PartBCoinsurance

PreventiveCarenotCoveredbyMedicare(upto$120)

Ou

t-of-Pocket

Limit**

$4,6

20

$2,310

*PlansFandJalsooerahigh-deductibleplan.TismeansyoumustpayorMedicare-coveredcosts

uptothe

deductibleamounto$2,000

in2010beoreyourMedigapplanp

aysanything.

**Aeryoumeetyourout-o-pocketyearlylimitandyouryearlyPartBdeductible($155in2010),theMedigap

planpays100%ocoveredservicesortherestothecalendarye

ar.Out-o-pocketlimitisthemaxim

umamount

youwouldpayorcoinsuran

ceandcopayments.


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Inormation about the chart on page 13

Te chart on the next page gives you a quick look at the standardized Medigap

Plans available with benefts eective June 1, 2010. See page 11 or MedigapPlans (including Medicare SELEC) available or purchase throughMay 31, 2010 and their benefts.

ImportantChanges Eective June 1, 2010

New laws have brought many changes to Medigap policies. Tese changes willbe eective June 1, 2010, and will give you choices in health care coverage tofll gaps in services that Original Medicare doesnt cover.

Basic Benefts Starting with policies eective on or aer June 1, 2010,

Hospice Part A coinsurance (outpatient prescription drug and inpatientrespite care coinsurance) will be covered. Plan K will cover 50% o thecosts and Plan L will cover 75% o these costs.

Part B Coinsurance Plans K, L, and N will require you to pay a portiono Part B coinsurance and copayments, which may result in lowerpremiums or these plans. All other Medigap policies pay them at 100%.

New Plans Oered Plans M and N are new choices. See the chart onpage 13 or details.

Plans D and G Plans D and G eective on or aer June 1, 2010 havedierent benefts than D or G Plans bought beore June 1, 2010.

Plans No Longer or Sale Plans E, H, I, and J will no longer be sold aerMay 31, 2010. But, i you already have or you buy Plan E, H, I, or J beoreJune 1, 2010, you can keep that plan.

Insurance companies selling Medigap policies are required to makePlan A available. I they oer any other Medigap plan, they must also oereither Medigap Plan C or Plan F. Not all types o Medigap policies maybe available in your state. See pages 4446 i you live in Massachusetts,

Minnesota, or Wisconsin. I you need more inormation, call your StateInsurance Department or State Health Insurance Assistance Program.See pages 4950 or your states telephone number.


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13

MedigapPlansEf

ectiveonoraterJune1

,2010

Howtoreadthe

chart:

Iacheckmarkappea

rsinacolumnothischart,theMedigappolicycovers100%othedescribedbeneft.Iacolumnlistsa

percentage,t

hepolicycoversthatpercentageothedesc

ribedbeneft.Iacolumnisblank,t

hepolicydoesntcoverthatbeneft.

Note:TeMedigapp

olicycoverscoinsuranceonlyaer

youhavepaidthedeductible(unlesstheMedigappolicyalsocoversthe

deductible).

YoumaybuytheollowingMedigapPlanswhichbecomeefectiveJune1,2010:

MedigapPlans

EfectiveJune1

,2010

MedigapBenets

A

B

C

D

F*

G

K

L

M

N

MedicarePartACoinsurancehospitalcostsuptoan

additional365daysa

erMedicarebeneftsareusedup

MedicarePartBCoin

suranceorCopayment

50%

75%

***

Blood(First3Pints)

50%

75%

PartAHospiceCareCoinsuranceorCopayment

50%

75%

SkilledNursingFacilityCareCoinsurance

50%

75%

MedicarePartADed

uctible

50%

75%

50%

MedicarePartBDeductible

MedicarePartBExce

ssCharges

ForeignravelEmergency(UptoPlanLimits)

MedicarePreventiveCarePartBCoinsurance

Section 2:Medigap basics

*PlanFalsooersahigh-deductibleplan.Tismeansyoum

ustpayorMedicare-covered

costsuptothedeductib

leamount$2,000in2010beoreyou

rMedigapplanpaysanything.

**Aeryoumeetyourout-o-pocketyearlylimitandyourye

arlyPartBdeductible($155in

2010),theMedigapplanpays100%ocoveredservicesort

herestothecalendaryear.

Out-o-pocketlimitisthemaximumamountyouwouldpayorcoinsuranceand

copayments.

***PlanNpays100%othePartBcoinsuranceexceptupto

$20copaymentorocevisits

andupto$50oremergencydepartmentvisits.

Out-of-PocketLimit**

$4,620

$2,310


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What Medigap policies dont cover

Medigap policies dont cover long-term care (like care in a nursing

home), vision or dental care, hearing aids, eyeglasses, and private-dutynursing.

Types o coverage that are NOT Medigap policies

Medicare Advantage Plans (Part C), like an HMO, PPO, orPrivate Fee-or-Service Plan

Medicare Prescription Drug Plans (Part D)

Medicaid

Employer or union plans, including Federal Employees HealthBenefts Program (FEHBP)

RICARE

Veterans benefts

Long-term care insurance policies

Indian Health Service, ribal, and Urban Indian Health plans

What types o Medigap policies can insurancecompanies sell?

In most cases, Medigap insurance companies can sell you only astandardized Medigap policy. All Medigap policies must have specifcbenefts so you can compare them easily. See pages 11 and 13. I youlive in Massachusetts, Minnesota, or Wisconsin, see pages 4446.

Insurance companies that sell Medigap policies dont have to oerevery Medigap policy (Medigap Plans A through N). However, they

must oer Medigap Plan A i they oer any other Medigap policy. Aso June 1, 2010, i they oer any other Medigap policy, they must alsooer either Plan C or Plan F. Each insurance company decides whichMedigap policies it wants to sell, although state laws might aect whichones they oer.

Words in blue

are defned on

pages 5154.


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What types o Medigap policies can insurance

companies sell? (continued)

In some cases, an insurance companymust sell you a Medigap policy, eveni you have health problems. Listed below are certain times that youreguaranteed the right to buy a Medigap policy:

When youre in your Medigap open enrollment period. See pages 1617.

I you have a guaranteed issue right. See pages 2325.

You may also buy a Medigap policy at other times, but the insurancecompany can deny you a Medigap policy based on your health. Also,in some cases it may be illegal or the insurance company to sell you

a Medigap policy (such as i you already have Medicaid or a MedicareAdvantage Plan).

What do I need to know i I want to buy a Medigap policy?

You must have Medicare Part A and Part B to buy a Medigap policy.

Plans E, H, I, and J will no longer be or sale aer May 31, 2010.

Eective June 1, 2010, there will be two new Medigap Plans oeredPlans Mand N. In addition, benefts or Plans A, B, C, D, F, and G will change.

You pay the private insurance company a monthlypremium or yourMedigap policy in addition to the monthly Part B premium that you payto Medicare.

A Medigap policy only covers one person. I you and your spouse bothwant Medigap coverage,you each will have to buy separate Medigappolicies.

You can buy a Medigap policy rom any insurance company thatslicensed in your state to sell one.

I you want to buy a Medigap policy, ollow the Steps to buying aMedigap policy. See pages 2732.

I you want to drop your Medigap policy, contact your insurancecompany to cancel the policy.

Any standardized Medigap policy is guaranteed renewable even i youhave health problems. Tis means the insurance company cant cancel yourMedigap policy as long as you pay the premium.


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What do I need to know if I want to buy a Medigap

policy? (continued)

Although some Medigap policies sold in the past cover prescription drugs,Medigap policies sold afer January 1, 2006, arent allowed to includeprescription drug coverage.

I you want prescription drug coverage, you can join a MedicarePrescription Drug Plan (Part D) oered by private companies approvedby Medicare. See page 6.

o learn about Medicare prescription drug coverage, visitwww.medicare.gov/Publications/Pubs/pd/11109.pd to view thebooklet Your Guide to Medicare Prescription Drug Coverage, or call

1-800-MEDICARE (1-800-633-4227). Y users should call1-877-486-2048.

When is the best time to buy a Medigap policy?

Te best time to buy a Medigap policy is during your Medigap openenrollment period. Tis period lasts or 6 months and begins on therst day o the month in which you are both 65 or older and enrolled inMedicare Part B. Some states have additional open enrollment periodsincluding those or people under 65. During this period, an insurance

company cant use medical underwriting. Tis means the insurancecompany cant do any o the ollowing: Reuse to sell you any Medigap policy it sells Make you wait or coverage to start (except as explained below) Charge you more or a Medigap policy because o your health problems

While the insurance company cant make you wait or your coverage to start,itmaybe able to make you wait or coverage o a pre-existing condition.A pre-existing condition is a health problem you have beore the date a newinsurance policy starts. In some cases, the Medigap insurance company

can reuse to cover your out-o-pocket costs or these pre-existing healthproblems or up to 6 months. Tis is called a pre-existing condition waitingperiod. Coverage or a pre-existing condition can only be excluded in aMedigap policy i the condition was treated or diagnosed within 6 monthsbeore the date the coverage starts under the Medigap policy. Afer this6-month period, the Medigap policy will cover the condition that wasexcluded. Remember, or Medicare-covered services, Original Medicarewill still cover the condition, even i the Medigap policy wont cover yourout-o-pocket costs.

Words in blue

are defned on

pages 5154.
http://www.medicare.gov/Publications/Pubs/pdf/11109.pdfhttp://www.medicare.gov/Publications/Pubs/pdf/11109.pdf


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When is the best time to buy a Medigap policy?

(continued)

Even i you have a pre-existing condition, i you buy a Medigap policyduring your Medigap open enrollment period and i you recentlyhad certain kinds o health coverage called creditable coverage,its possible to avoid or shorten waiting periods or pre-existingconditions. Prior creditable coverage is generally any other healthcoverage you recently had beore applying or a Medigap policy. I youhave had at least 6 months o continuous prior creditable coverage, theMedigap insurance company cant make you wait beore it covers yourpre-existing conditions.

Tere are many types o health care coverage that may count ascreditable coverage or Medigap policies, but they will only count iyou didnt have a break in coverage or more than 63 days. I therewas any time that you had no health coverage o any kind and werewithout coverage or more than 63 days, you can only count creditablecoverage you had aer that break in coverage.

alk to your Medigap insurance company. It will be able to tell youi your previous coverage will count as creditable coverage or this

purpose. You can also call your State Health Insurance AssistanceProgram. See pages 4950.

I you buy a Medigap policy when you have a guaranteed issue right(also called Medigap protection), the insurance company cant usea pre-existing condition waiting period. See pages 2325 or moreinormation about guaranteed issue rights.

Note: You can send in your application or a Medigap policy beoreyour Medigap open enrollment period starts. Tis may be important i

you currently have coverage that will end when you turn 65. Tis willallow you to have continuous coverage.


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Why is it important to buy a Medigap policy when

I am rst eligible?

Its very important to understand your Medigap open enrollment period.Medigap insurance companies are generally allowed to use medicalunderwriting to decide whether to accept your application and howmuch to charge you or the Medigap policy. However, i you applyduring your Medigap open enrollment period, you can buyanyMedigappolicy the company sells, even i you have health problems, or the sameprice as people with good health. I you apply or Medigap coverage aeryour open enrollment period, there is no guarantee that an insurancecompany will sell you a Medigap policy i you dont meet the medical

underwriting requirements, unless you are eligible because o one o thelimited situations listed on pages 2425.

Its also important to understand that your Medigap rights may dependon when you choose to enroll in Medicare Part B. I youre 65 or older,your Medigap open enrollment period begins when you enroll in Part B,and cant be changed or repeated. In most cases it makes sense to enrollwhen you are frst eligible or Part B, because you might otherwise haveto pay a Part B late enrollment penalty.

However, i you have group health coverage through an employer orunion, because either you or your spouse is currently working, you maywant to wait to enroll in Part B. Tis is because employer plans oenprovide coverage similar to Medigap, so you dont need a Medigappolicy. When your employer coverage ends, youll get a chance to enrollin Part B without a late enrollment penalty which means your Medigapopen enrollment period will start when youre ready to take advantageo it. I you enrolled in Part B while you still had the employer coverage,your Medigap open enrollment period would start, and unless youbought a Medigap policy beore you needed it, you would miss youropen enrollment period entirely.

Words in blue

are defned on

pages 5154.


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How insurance companies set prices or Medigap

policies

Each insurance company decides how it will set the price, or premium,or its Medigap policies. Its important to ask how an insurancecompany prices its policies. Te way they set the price aects howmuch you pay now and in the uture. Medigap policies can be pricedor rated in three ways:

1. Community-rated (also called no-age-rated)

2. Issue-age-rated (also called entry-age-rated)

3. Attained-age-rated

Each o these ways o pricing Medigap policies is described in thechart on the next page. Te examples show how your age aects yourpremiums, and why its important to look at how much the Medigappolicy will cost you now and in the uture. Te amounts in theexamples arent actual costs. Other actors such as geographical rating,medical underwriting, and discounts can also aect the amount oyour premiums.


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Type opricing

Community-

rated(also calledno-age-rated)

How itspriced

What this pricing may

mean or you

Examples

Generally the

same monthlypremium ischarged toeveryone whohas the Medigappolicy, regardlesso age.

Te premium is

based on the ageyou are whenyou buy (areissued) the

Medigap policy.

Te premium isbased on your

current age (theage you haveattained), soyour premiumgoes up as youget older.

Your premium isnt based on

your age. Premiums may goup because o ination andother actors but not becauseo your age.

Premiums are lower or people

who buy at a younger age andwont change as you get older.Premiums may go up becauseo ination and other actors

but not because o your age.

Premiums are low oryounger buyers but go up

as you get older. Tey maybe the least expensive atfrst, but they can eventuallybecome the most expensive.Premiums may also go upbecause o ination and

other actors.

Mr. Smith is 65. He buys a Medigap

policy and pays a $165 monthlypremium.

Mrs. Perez is 72. She buys the sameMedigap policy as Mr. Smith. Shealso pays a $165 monthly premiumbecause, with this type o Medigappolicy, everyone pays the same priceregardless o age.

Mr. Han is 65. He buys a Medigap

policy and pays a $145 monthlypremium.

Mrs. Wright is 72. She buys the sameMedigap policy as Mr. Han. Since sheis older when she buys it, her monthly

premium is $175.

Mrs. Anderson is 65. She buys aMedigap policy and pays a $120

monthly premium.At 66, her premium goes up to $126.

At 67, her premium goes up to $132.

At 72, her premium goes up to $165.

Mr. Dodd is 72. He buys the sameMedigap policy as Mrs. Anderson.He pays a $165 monthly premium.His premium is higher than Mrs.

Andersons because its based on hiscurrent age. Mr. Dodds premium willgo up every year.

At 73, his premium goes up to $171.

At 74, his premium goes up to $177.

Issue-age-

rated (alsocalled entryage-rated)

Attained-age-rated

How insurance companies set prices for Medigap policies (continued)


23/64


Comparing Medigap costs

As discussed on the previous pages, the cost o Medigap policies

can vary widely. Tere can be big diferences in the premiums thatdiferent insurance companies charge or exactly the same coverage.As you shop or a Medigap policy, be sure to compare the same type oMedigap policy, and consider the type o pricing used. See pages 1920.For example, compare a Medigap Plan C rom one insurance companywith a Medigap Plan C rom another insurance company. Althoughthis guide cant give actual costs o Medigap policies, you can get thisinormation by calling insurance companies or your State HealthInsurance Assistance Program. See pages 4950.

You can also fnd out which insurance companies sell Medigap policies inyour area by visiting www.medicare.gov and selecting Compare HealthPlans and Medigap Policies in Your Area.

Te cost o your Medigap policy may also depend on whether theinsurance company does any o the ollowing:

Oers discounts (such as discounts or women, non-smokers, orpeople who are married; discounts or paying annually; or discountsor paying your premiums using electronic unds transer).

Uses medical underwriting, or applies a dierent premium when youdont have a guaranteed issue right.

Sells Medicare SELEC policies that may require you to use certainproviders. I you buy this type o Medigap policy, your premium maybe less. See page 22.

Oers a high-deductible option or Medigap Plans F and J.Remember, Plan J will no longer be or sale aer May 31, 2010. I youbuy a Medigap Plan F or J high-deductible option, you must pay thefrst $2,000 (in 2010) in Medicare-covered costs beore the Medigappolicy pays anything. You must also pay a separate deductible ($250per year) or oreign travel emergency services. I you bought yourMedigap Plan J beore January 1, 2006, and it still covers prescriptiondrugs, you would also pay a separate deductible ($250 per year) orprescription drugs covered by the Medigap policy.
http://www.medicare.gov/http://www.medicare.gov/


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What is Medicare SELECT?

Medicare SELEC is a type o Medigap policysold in some states

that requires you to use hospitals and, in some cases, doctors withinits network to be eligible or ull insurance benefts (except in anemergency). Medicare SELEC can be any o the standardized MedigapPlans A through N. Medicare SELEC policies generally cost less thanother Medigap policies. However, i you dont use a Medicare SELEChospital or doctor or non-emergency services, youll have to paysome or all o what Medicare doesnt pay. Medicare will pay its share oapproved charges no matter which hospital or doctor you choose.

How does Medigap pay your Medicare Part B bills?

In most Medigap policies, when you sign the Medigap insurancecontract you agree to have the Medigap insurance company get yourMedicare Part B claim inormation directly rom Medicare and thenpay the doctor directly. Some Medigap insurance companies alsoprovide this service or Medicare Part A claims.

I your Medigap insurance companydoesnt provide this service,ask your doctors i they participate in Medicare. (Tis means thatthey accept assignment or all Medicare patients.) I your doctor

participates, the Medigap insurance company is required to pay thedoctor directly i you request.

I you have any questions about Medigap claim fling, call1-800-MEDICARE (1-800-633-4227). Y users should call1-877-486-2048.


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23

SECION

Your right to buy aMedigap policy

3 What are guaranteed issue rights?As explained on pages 1618, the best time to buy a Medigap policyis during your Medigap open enrollment period, when you have theright to buy any Medigap policy oered in your state. However, even iyou arent in your Medigap open enrollment period, there are severalsituations in which you may still have a guaranteed right to buy aMedigap policy.

Guaranteed issue rights (also called Medigap protections) are rightsyou have in certain situations when insurance companies are required bylaw to oer you certain Medigap policies even i you have health problemsand must cover anypre-existing conditions. See page 16. Tese situationsare described on pages 2425. In these situations, an insurance companymust do the ollowing:

Sell you a Medigap policy

Cover all your pre-existing health conditions

Cant charge you more or a Medigap policy because o past orpresent health problems

I you live in Massachusetts, Minnesota, or Wisconsin, you haveguaranteed issue rights to buy a Medigap policy, but the Medigap policiesare dierent. See pages 4446 or your Medigap policy choices.

When do I have guaranteed issue rights?In most cases, you have a guaranteed issue right when you have otherhealth care coverage that changes in some way, such as when youlose the other health care coverage. See pages 2425. In other cases,you have a trial right to try a Medicare Advantage Plan and stillbuy a Medigap policy i you change your mind. For trial rights, see

guaranteed issue rights, Situations #4 and #5 on page 25.


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24 Section 3:Your right to buy a Medigap policy

An insurance company cant reuse to sell you a Medigap policy in the

ollowing situations:

You have a guaranteed

issue right i...#1: You are in a MedicareAdvantage Plan, and your plan isleaving Medicare or stops givingcare in your area, or you move outo the plans service area.

#2: You have Original Medicareand an employer group healthplan (including retiree or COBRAcoverage) or union coverage thatpays aer Medicare pays and thatplan is ending.

Note: In this situation, you may haveadditional rights under state law.

#3: You have Original Medicareand a Medicare SELEC policy.You move out o the MedicareSELEC policys service area.

You can keep your Medigap policy,or you may want to switch toanother Medigap policy.

You have the right

to buy...Medigap Plan A, B, C, F, K, orL that is sold in your state by anyinsurance company.

You only have this right i youswitch to Original Medicarerather than joining anotherMedicare Advantage Plan.

Medigap Plan A, B, C, F, K, orL that is sold in your state by anyinsurance company.

I you have COBRA coverage,you can either buy a Medigappolicy right away or wait until

the COBRA coverage ends.

Medigap Plan A, B, C, F, K, orL that is sold by any insurancecompany in your state or thestate you are moving to.

You can/must apply or a

Medigap policy...As early as 60 calendar daysbeore the date your health carecoverage will end, but no laterthan 63 calendar days aeryour health care coverage ends.Medigap coverage cant start untilyour Medicare Advantage Plancoverage ends.

No later than 63 calendar daysaer the latest o these 3 dates:

Date the coverage ends1.

Date on the notice you get2.telling you that coverage isending (i you get one)

Date on a claim denial, i this3.is the only way you know thatyour coverage ended

As early as 60 calendar days beorethe date your health care coveragewill end, but no later than 63calendar days aer your healthcare coverage ends.


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25Section 3:Your right to buy a Medigap policy

You have a guaranteed

issue right if...#4: (Trial Right) You joined aMedicare Advantage Plan orPrograms o All-inclusive Care orthe Elderly (PACE) when you werefrst eligible or Medicare Part Aat 65, and within the frst year ojoining, you decide you want toswitch to Original Medicare.

#5: (rial Right) You dropped aMedigap policy to join a MedicareAdvantage Plan(or to switch to aMedicare SELEC policy) or thefrst time; you have been in theplan less than a year, and you wantto switch back.

#6: Your Medigap insurancecompany goes bankrupt andyou lose your coverage, or yourMedigap policy coverage otherwise

ends through no ault o your own.

#7: You leave a MedicareAdvantage Plan or drop a Medigappolicy because the company hasntollowed the rules, or it misled you.

You have the right

to buy...Any Medigap policy that is soldin your state by any insurancecompany.

Te Medigap policy you hadbeore you joined the MedicareAdvantage Plan or MedicareSELEC policy, i the sameinsurance company you hadbeore still sells it. I it includeddrug coverage, you can still getthat same policy, but without thedrug coverage.

I your ormer Medigap policyisnt available, you can buy aMedigap Plan A, B, C, F, K, orL that is sold in your state by anyinsurance company.



You can/must apply for a

Medigap policy...As early as 60 calendar days beorethe date your coverage will end,but no later than 63 calendar daysaer your coverage ends.

Note: Your rights may lastor an extra 12 monthsunder certain circumstances.

As early as 60 calendar days beorethe date your coverage will end,but no later than 63 calendar daysaer your coverage ends.

Note: Your rights may lastor an extra 12 monthsunder certain circumstances.

No later than 63 calendar daysrom the date your coverage ends.

No later than 63 calendar daysrom the date your coverage ends.

An insurance company cant reuse to sell you a Medigap policy in the

ollowing situations: (continued)


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26

Can I buy a Medigap policy i I lose my health care

coverage?Because you may have a guaranteed issue right (see pages 2325) to buy a Medigappolicy, make sure you keep the ollowing:

A copy o any letters, notices, e-mails, and/or claim denials that have your nameon them as proo o coverage

Te postmarked envelope these papers come in as proo o when it was mailed

You may need to send a copy o some or all o these papers with your Medigapapplication to prove you have a guaranteed issue right.

Its best to apply or a Medigap policybeore your current health coverage ends.You can apply or a Medigap policy while youre still in your health plan, but your

Medigap coverage can only start aer your health plan coverage ends. Tis willprevent breaks in your health coverage.

For more inormationI you have any questions or want to learn about any additional Medigap rights inyour state, you can do the ollowing:

Call your State Health Insurance Assistance Program to make sure that you qualiyor these guaranteed issue rights. See pages 4950.

Call your State Insurance Department i youre denied Medigap coverage in any othese situations. See pages 4950.

Important: Te guaranteed issue rights in this section are rom Federal law.Tese rights are or both Medigap and Medicare SELEC policies. Many statesprovide additional Medigap rights.

Tere may be times when more than one o the situations in the chart onpages 2425, applies to you. When this happens, you can choose the guaranteedissue right that gives you the best choice.

Some o the situations listed on pages 2425 include loss o coverage underPrograms o All-Inclusive Care or the Elderly (PACE). PACE combines medical,social, and long-term care services, and prescription drug coverage or rail people.o be eligible or PACE, you must meet certain conditions. PACE may be available instates that have chosen it as an optional Medicaid beneft. I you have Medicaid, aninsurance company can sell you a Medigap policyonlyin certain situations.For more inormation about PACE, call 1-800-MEDICARE (1-800-633-4227).Y users should call 1-877-486-2048.

Section 3:Your right to buy a Medigap policy


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27

SECION

Steps to buyinga Medigap policy

4 Buying a Medigappolicyis an important decision. Only youcan decide i a Medigap policy is the way or you to supplementOriginal Medicare coverage and which Medigap policy to choose.Shop careully. Compare available Medigap policies to see whichone meets your needs. As you shop or a Medigap policy, keepin mind that dierent insurance companies may charge dierentamounts or exactly the same Medigap policy, and not allinsurance companies oer all o the Medigap policies.

Below is a step-by-step guide to help you buy a Medigap policy.I you live in Massachusetts, Minnesota, or Wisconsin, seepages 4446.

STEP 1: Decide which benefts you want, then decide which othe Medigap Plans A through N meet your needs. See page 28.

STEP 2: Find out which insurance companies sell Medigappolicies in your state. See pages 2829.

STEP 3: Call the insurance companies that sell the Medigappolicies youre interested in and compare costs. See pages 3031.

STEP 4: Buy the Medigap policy. See page 32.


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28

STEP 1: Decide which benets you want, then

decide which o the Medigap Plans A

through N meet your needs.You should think about your current and uture health care needs whendeciding which benefts you want because you might not be able toswitch Medigap policies later. Decide which benefts you need, and selectthe Medigap policy that will work best or you. Te charts on pages 11and 13 provide an overview o the Medigap benefts.

STEP 2: Find out which insurance companies sell

Medigap policies in your state.

o fnd out which insurance companies sell Medigap policies in yourstate, you can do any o the ollowing:

Call your State Health Insurance Assistance Program. Seepages 4950. Ask i they have a Medigap rate comparison shoppingguide or your state. Tis type o guide usually lists companies thatsell Medigap policies in your state and their costs.

Call your State Insurance Department. See pages 4950.

Visit www.medicare.gov, and select Compare Health Plans andMedigap Policies in Your Area.

Tis website will help you fnd inormation on all your health planoptions, including the Medigap policies in your area. You can alsoget inormation on the ollowing:

How to contact the insurance companies that sell Medigappolicies in your state

What each Medigap policy covers

How insurance companies decide what to charge you or aMedigap policy premium

I you dont have a computer, your local library or senior centermay be able to help you look at this inormation. You can alsocall 1-800-MEDICARE (1-800-633-4227). A customer servicerepresentative will help you get inormation on all your health planoptions including the Medigap policies in your area. Y users shouldcall 1-877-486-2048.

Section 4:Steps to buying a Medigap policy

Words in blue

are defned on

pages 5154.


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29Section 4:Steps to buying a Medigap policy

STEP 2: (continued)

Since costs can vary between companies, you should plan to call more

than one insurance company that sells Medigap policies in your state.Beore you call, check the companies to be sure they are honest andreliable by using one o the resources listed below.

Call your State Insurance Department. See pages 4950. Ask ithey keep a record o complaints against insurance companies, andask whether these can be shared with you. When deciding whichMedigap policy is right or you, consider any complaints against theinsurance company.

Call your State Health Insurance Assistance Program.See pages 4950. Tese programs can give you ree help withchoosing a Medigap policy.

Go to your local public library or help with the ollowing:

Get inormation on an insurance companys fnancial strengthrom independent rating services such as Te Street.comRatings, A.M. Best, and Standard & Poors.

Look at inormation about the insurance company online.

alk to someone you trust, like a amily member, your insuranceagent, or a riend who has a Medigap policy rom the same Medigapinsurance company.


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30 Section 4:Steps to buying a Medigap policy

STEP 3: Call the insurance companies that sell the Medigap

policies youre interested in and compare costs.

Beore you call any insurance companies, fgure out i you are in your Medigap open enrollment

period or i you have a guaranteed issue right. Read pages 1617 and 2326 careully. I youhave questions, call your State Health Insurance Assistance Program. See pages 4950. Te chartbelow can help you keep track o the inormation you get.

CommunityIssue-ageAttained-age

CommunityIssue-ageAttained-age

Ask each insurance company

Are you licensed in ___? [Say the name o your state]Note: I the answer is NO, stop right here, and try another company.

Do you sell Medigap Plan ___? [Say the letter o the Medigap planyoure interested in.]

Note: Insurance companies usually oer some, but not all, Medigappolicies. Make sure the company sells the plan you want. Also, i youreinterested in a Medicare SELEC or high deductible Medigap policy, sayso.

Do you use medical underwriting or this Medigap policy?Note: I the answer is NO, go to step 4. I the answer is YES, but you knowyoure in your Medigap open enrollment period or have a guaranteedissue rightto buy that Medigap policy, go to step 4. Otherwise, you canask, Can you tell me whether I am likely to qualiy or the Medigappolicy?

Do you have a waiting period or pre-existing conditions?Note: I the answer is YES, ask how long the waiting period is, and write itin the box.

Do you price this Medigap policy by using community-rating,issue-age-rating, or attained-age-rating? See page 19.Note: Circle the one that applies or that insurance company.

I am ___ years old. What would my premium be under this Medigappolicy?Note: I it is attained-age, ask, How requently does the premium

increase due to my age?Has the premium or this Medigap policy increased in the last 3 yearsdue to ination or other reasons?Note: I the answer is YES, ask how much it has increased, and write it inthe box.

Do you oer any discounts or additional (innovative) benefts?See page 21.

Is there any extra charge to process my claims automatically?

Company 2Company 1


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31Section 4:Steps to buying a Medigap policy

STEP 3: (continued)

Watch out or illegal insurance practices

Its illegal or anyone to do the ollowing:

Pressure you into buying a Medigappolicy, or lie to or mislead you toswitch rom one company or policy to another.

Sell you a second Medigap policy when they know that you already haveone, unless you tell the insurance company in writing that you plan tocancel your existing Medigap policy.

Sell you a Medigap policy i they know you have Medicaid, except incertain situations.

Sell you a Medigap policy i they know you are in a Medicare AdvantagePlan (like an HMO, PPO, or Private Fee-or-Service Plan) unless yourcoverage under the Medicare Advantage Plan will end beore theeective date o the Medigap policy.

Claim that a Medigap policy is part o the Medicare Program or anyother Federal program. Medigap is private health insurance.

Claim that a Medicare Advantage Plan is a Medigap policy. Sell you a Medigap policy that cant legally be sold in your state. Check

with your State Insurance Department (see pages 4950) to make sure

that the Medigap policy you are interested in can be sold in your state. Misuse the names, letters, or symbols o the U.S. Department o Health &Human Services (HHS), Social Security Administration (SSA), Centers orMedicare & Medicaid Services (CMS), or any o their various programslike Medicare. (For example, they cant suggest the Medigap policy hasbeen approved or recommended by the Federal government.)

Claim to be a Medicare representative i they work or a Medigapinsurance company.

Sell you a Medicare Advantage Plan when you say you want to stay in

Original Medicare and buy a Medigap policy. A Medicare AdvantagePlan isnt the same as Original Medicare. See page 5. I you enroll ina Medicare Advantage Plan, you will be disenrolled rom OriginalMedicare and cant use a Medigap policy.

I you believe that a Federal law has been broken, call the Inspector Generalshotline at 1-800-HHS-IPS (1-800-447-8477). Y users should call1-800-377-4950. Your State Insurance Department can help you with otherinsurance-related problems.


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32

STEP 4: Buy the Medigap policy.Once you decide on the insurance company and the Medigap policy you want,you should apply and the insurance company must give you a clearly wordedsummary o your Medigap policy. Read it careully. I you dont understand it,ask questions. Remember the ollowing when you buy your Medigap policy:

Filling out your application. Fill out the application careully andcompletely. I the insurance agent flls out the application, make sure itscorrect. Te answers you give will determine your eligibility or openenrollment or guaranteed issue rights. Answer the medical questionscareully. I you buy a Medigap policy during your Medigap openenrollment period or provide evidence that youre entitled to a guaranteedissue right, the insurance company cant use any medical answers you give

to deny you a Medigap policy or change the price. Te insurance companycant ask you any questions about your genetic history or require you to takea genetic test.

Paying or your Medigap policy. Its best to pay or your Medigap policyby check, money order, or bank dra. Make it payable to the insurancecompany, not the agent. I buying rom an agent, get a receipt with theinsurance companys name, address, and telephone number or yourrecords. Some companies may oer electronic unds transer.

Starting your Medigap policy. Ask or your Medigap policy to become

eective when you want coverage to start. Generally, Medigap policiesbegin the frst o the month aer you apply. I, or any reason, the insurancecompany wont give you the eective date or the month you want, call yourState Insurance Department. See pages 4950.Note: I you already have a Medigap policy, ask or your new Medigap policyto become eective when your old Medigap policy coverage ends.

Getting your Medigap policy. I you dont get your Medigap policy in 30days, call your insurance company. I you dont get your Medigap policy in

60 days, call your State Insurance Department. See pages 4950.

I you already have a Medigap policy, its illegal or an insurance company tosell you a second policy unless you tell them in writing that you will cancelthe frst Medigap policy. However, dont cancel your old Medigap policy untilthe new one is in place, and you decide to keep it. See page 34. Once you getthe new Medigap policy, you have 30 days to decide i you want to keep thenew policy. Tis is called your ree look period. Te 30-day ree look periodbegins on the day you get your Medigap policy. You will need to pay bothpremiums or one month.

Section 4:Steps to buying a Medigap policy


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33

SECION

For people who already

have a Medigap policy

5 You should read this section i any o these situations apply toyou: Youre thinking about switching to a dierent Medigap

policy. See pages 3437.

Youre losing your Medigap coverage. See page 38.

You have a Medigap policy with Medicare prescriptiondrug coverage. See pages 3940.

(I you just want a reresher about Medigap insurance, turn

to page 9.)


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34

Switching Medigap policies

I youre satisied with your current Medigap policys cost and

coverage and the customer service you get, you dont need to doanything. I youre thinking about switching to a new Medigap policy,below and pages 3537 answer some common questions aboutswitching Medigap policies.

Can I switch to a dierent Medigap policy?

In most cases, you wont have a right under Federal law to switchMedigap policies, unless you are within your 6-month Medigapopen enrollment period or are eligible under a specifc circumstance

or guaranteed issue rights. But, i your state has more generousrequirements, or the insurance company is willing to sell you aMedigap policy, make sure you compare benefts and premiums beoreswitching. I you bought your Medigap policy beore 1992, it may oercoverage that isnt available in a newer Medigap policy. On the otherhand, older Medigap policies might not be guaranteed renewableand might have bigger premium increases than newer, standardizedMedigap policies currently being sold.

I you decide to switch, dont cancel your frst Medigap policy until you

have decided to keep the second Medigap policy. On the applicationor the new Medigap policy, you will have to promise that you willcancel your frst Medigap policy. You have 30 days to decide i youwant to keep the new Medigap policy. Tis is called your ree lookperiod. Te 30-day ree look period starts when you get your newMedigap policy. You will need to pay both premiums or one month.

Section 5:For people who already have a Medigap policy

Words in blue

are defned on

pages 5154.


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35Section 5:For people who already have a Medigap policy

Switching Medigap policies (continued)

Do I have to switch Medigap policies i I have an older Medigap

policy?No. I you buy a new Medigap policy, you have to give up your old policy(except or your 30-day ree look period, see page 34). Once you cancelthe policy, you cant get it back, and it can no longer be sold because itisnt a standardized policy.

Do I have to wait a certain length o time aer I buy my frstMedigap policy beore I can switch to a dierent Medigap policy?

No. You should be aware that i youve had your old Medigap policy

or less than 6 months, the Medigap insurance company may beable to make you wait up to 6 months or coverage o a pre-existingcondition. However, i your old Medigap policy had the same benefts,and you had it or 6 months or more, the new insurance company cantexclude your pre-existing condition. I youve had your Medigap policyless than 6 months, the number o months youve had your currentMedigap policy must be subtracted rom the time you must wait beoreyour new Medigap policy covers your pre-existing condition.

I the new Medigap policy has a beneft that isnt in your currentMedigap policy, you may still have to wait up to 6 months beore thatbeneft will be covered, regardless o how long you have had yourcurrent Medigap policy.

I youve had your current Medigap policy longer than 6 months andwant to replace it with a new one and the insurance company agreesto issue the new policy, they cant write pre-existing conditions,waiting periods, elimination periods, or probationary periods into thereplacement policy.


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36


Why would I want to switch to a dierent Medigap policy?

Some reasons or switching may include the ollowing:

Youre paying or benefts you dont need.

You need more benefts than you needed beore.

Your current Medigap policy has the right benefts, but you want tochange your insurance company.

Your current Medigap policy has the right benefts, but you want tofnd a policy that is less expensive.

Its important to compare the benefts in your current Medigap policyto the benefts listed on pages 11 and 13. I you live in Massachusetts,Minnesota, or Wisconsin, see pages 4446. o help you comparebenefts and decide which Medigap policy you want, ollow the Stepsto buying a Medigap policy on pages 2732. I you decide to changeinsurance companies, you can call the new insurance company andarrange to apply or your new Medigap policy. I your application isaccepted, call your current insurance company, and ask to have your

coverage ended. Te insurance company can tell you how to submit arequest to end your coverage.

As discussed on page 34, you should have your old Medigap policycoverage end aer you have the new Medigap policy or 30 days.Remember, this is your 30-day ree look period. You will need to payboth premiums or one month.



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Can I keep my current Medigap policy (or Medicare SELECT policy)

or switch to a dierent Medigap policy i I move out-o-state?You can keep your current Medigap policy regardless o where you liveas long as you still have Original Medicare. I you want to switch to adierent Medigap policy, youll have to check with the new insurancecompany to see i theyll oer you a dierent Medigap policy.You may have to pay more or your new Medigap policy and answersome medical questions i youre buying a Medigap policy outside oyour Medigap open enrollment period. See pages 1618.

I you have a Medicare SELEC policy and you move out o thepolicys area, you have the ollowing choices:

Buy a standardized Medigap policy rom your current Medigappolicy insurance company that oers the same or ewer benefts thanyour current Medicare SELEC policy. I youve had your MedicareSELEC policy or more than 6 months, you wont have to answerany medical questions.

You have a guaranteed issue right to buy Medigap Plan A, B, C, F, K,or L that is sold in most states by any insurance company.

What happens to my Medigap policy i I join a Medicare Advantage

Plan?

Medigap policies cant work with Medicare Advantage Plans. I you decide tokeep your Medigap policy, youll have to pay your Medigap policypremium,but the Medigap policy cant pay anydeductibles, copayments, coinsurance,or premiums under a Medicare Advantage Plan. So, i you want to join aMedicare Advantage Plan, you may want to drop your Medigap policy.Contact your Medigap Plan insurance company to fnd out how to disenroll.

However, i you leave the Medicare Advantage Plan you might not be ableto get the same Medigap policy back, or in some cases, any Medigap policyunless you have a trial right (see guaranteed issue right, Situation #4 and#5 on page 25). Your rights to buy a Medigap policy may vary by state. Youalways have a legal right to keep the Medigap policy aer you join a MedicareAdvantage Plan.

Words in blue

are defned on

pages 5154.


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38

Losing Medigap coverage

Can my Medigap insurance company drop me?

I you bought your Medigap policyaer 1992, in most cases theMedigap insurance company cant drop you because the Medigappolicy is guaranteed renewable. Tis means your insurance companycant drop you unless one o the ollowing happens:

You stop paying your premium.

You werent truthul on the Medigap policy application.

Te insurance company becomes bankrupt or insolvent.

However, i you bought your Medigap policybeore 1992, it mightnot be guaranteed renewable. At the time these Medigap policies weresold, state laws might not have required that these Medigap policies beguaranteed renewable. Tis means the Medigap insurance companycan reuse to renew the Medigap policy, as long as it gets the statesapproval to cancel your Medigap policy. However, i this does happen,you have the right to buy another Medigap policy. See the guaranteedissue right, (Situation #6) on page 25.

Medigap policies and Medicare prescription drugcoverage

I you bought a Medigap policybefore January 1, 2006, and it hascoverage or prescription drugs, see below and page 39.

Medicare oers prescription drug coverage (Part D) or everyone withMedicare. I you have a Medigap policy with prescription drug coverage,that means you chose not to join a Medicare Prescription Drug Planwhen you were frst eligible. However, you can still join a Medicare

Prescription Drug Plan. Your situation may have changed in ways thatmake a Medicare Prescription Drug Plan ft your needs better thanthe prescription drug coverage in your Medigap policy. Its a good ideato review your coverage each all, because you can join a MedicarePrescription Drug Plan between November 15December 31 each year.Your new coverage will begin on January 1 o the ollowing year.



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Medigap policies and Medicare prescription drug

coverage (continued)

Why would I change my mind and join a Medicare PrescriptionDrug Plan?

In a Medicare Prescription Drug Plan, you may have to pay a monthlypremium, but Medicare pays a large part o the cost. Teres nomaximum yearly amount. However, a Medicare Prescription DrugPlan might only cover certain prescription drugs (on its ormularyor drug list). Its important that you check whether your currentprescription drugs are on the Medicare Prescription Drug Plans list ocovered prescription drugs beore you join. I your Medigap premium

or your prescription drug needs were very low when you had yourfrst chance to join a Medicare Prescription Drug Plan, your Medigapprescription drug coverage may have met your needs. However, i yourMedigap premium or the amount o prescription drugs you use hasincreased recently, a Medicare Prescription Drug Plan might now be abetter choice or you.

Will I have to pay a late enrollment penalty i I join a Medicare

Prescription Drug Plan now?

Tis will depend on whether your Medigap policy includes creditableprescription drug coverage. Tis means that the Medigap policysdrug coverage pays, on average, at least as much as Medicares standardprescription drug coverage.

I it isnt creditable coverage, and you join a Medicare PrescriptionDrug Plan now, youll probably pay a higher premium (a penalty addedto your monthly premium) than i you had joined when you were frsteligible. You should also consider that your prescription drug needscould increase as you get older. Each month that you wait to joina Medicare Prescription Drug Plan will make your late enrollmentpenalty higher. Your Medigap carrier must send you a notice every yeartelling you i the prescription drug coverage in your Medigap policy iscreditable. You should keep these notices in case you decide later to joina Medicare Prescription Drug Plan.


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40

Medigap policies and Medicare prescription drug

coverage (continued)

Will I have to pay a late enrollment penalty i I join a MedicarePrescription Drug Plan now? (continued)

I your Medigap policy includes creditable coverage and i you decide to joina Medicare Prescription Drug Plan, you wont have to pay a late enrollmentpenalty as long as you dont drop your Medigap policybeore you join theMedicare Prescription Drug Plan. You can only join a Medicare PrescriptionDrug Plan between November 15December 31 each year unless you loseyour Medigap policy (or example, i it isnt guaranteed renewable, and your

company cancels it). In that case, you can join a Medicare Prescription DrugPlan at the time you lose your Medigap policy.

Can I join a Medicare Prescription Drug Plan and have a Medigap

policy with prescription drug coverage?

No. I your Medigap policy covers prescription drugs, you must tell yourMedigap insurance company i you join a Medicare Prescription DrugPlan so it can remove the prescription drug coverage rom your Medigappolicy and adjust your premium to reect the removal o your Medigap

prescription drug coverage. Once the drug coverage is removed, you cantget that coverage back even though you didnt change Medigap policies.

What i I decide to drop my entire Medigap policy (not just the

Medigap prescription drug coverage)?

I you decide to drop the entire Medigap policy, you need to be careulabout the timing. For example, you may want a completely dierentMedigap policy (not just your old Medigap policy without the prescriptiondrug coverage), or you might decide to switch to a Medicare Advantage

Plan (like an HMO or PPO) that oers prescription drug coverage. I youdrop your entire Medigap policy and the prescription drug coverage wasntcreditable or you go more than 63 days beore your new Medicare coveragebegins, you have to pay a late enrollment penalty or your MedicarePrescription Drug Plan, i you choose to join one. You can join a MedicarePrescription Drug Plan or Medicare Advantage Plan betweenNovember 15December 31 each year. Your coverage will begin onJanuary 1 o the ollowing year.



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41

SECION

Medigap policies or peoplewith a disability or ESRD

6 Medigap policies or people under 65 andeligible or Medicare because o a disability orEnd-Stage Renal Disease (ESRD)

You may have Medicare beore 65 due to a disability or ESRD(permanent kidney ailure requiring dialysis or a kidneytransplant).

I youre a person with Medicare under 65 and have a disabilityor ESRD, you might not be able to buy the Medigappolicy youwant, or any Medigap policy, until you turn 65. Federal lawdoesnt require insurance companies to sell Medigap policiesto people under 65. However, some states require Medigapinsurance companies to sell you a Medigap policy, even iyoure under 65. Tese states are listed on the next page.

Important: hese are the minimum Federal standards.For your state requirements, call your State Health InsuranceAssistance Program. See pages 4950.


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42

Medigap policies or people under 65 and eligible or

Medicare because o a disability or End-Stage Renal

Disease (ESRD) (continued)At the time o printing this guide, the ollowing states required insurancecompanies to oer at least one kind o Medigap policy to people withMedicare under 65:

Caliornia* Maryland Oklahoma Colorado Massachusetts* Oregon Connecticut Michigan Pennsylvania Delaware** Minnesota South Dakota Florida Mississippi exas

Hawaii Missouri Vermont* Illinois New Hampshire Wisconsin Kansas New Jersey Louisiana New York Maine North Carolina

* A Medigap policy isnt available to people with ESRD under 65.

** A Medigap policy is only available to people with ESRD.

Even i your state isnt on the list above, some insurance companies may

voluntarily sell Medigap policies to people under 65, although they willprobably cost you more than Medigap policies sold to people over 65, andthey can use medical underwriting. Check with your state about what rightsyou might have under state law.

Remember, i you are already enrolled in Medicare Part B, you will get aMedigap open enrollment period when you turn 65. You will probablyhave a wider choice o Medigap policies and be able to get a lowerpremium at that time. During the Medigap open enrollment period,

insurance companies cant reuse to sell you any Medigap policy due to adisability or other health problem, or charge you a higher premium (basedon health status) than they charge other people who are 65.

Because Medicare (Part A and/or Part B) is creditable coverage, i youhad Medicare or more than 6 months beore you turned 65, you maynot have a pre-existing condition waiting period. For more inormationabout the Medigap open enrollment period and pre-existing conditions,see pages 1617. I you have questions, call your State Health InsuranceAssistance Program. See pages 4950.

Section 6:Medigap policies or people with a disability or ESRD

Words in blue

are defned on

pages 5154.


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43

SECION

Medigap coverage in

Massachusetts, Minnesota,and Wisconsin7Medigap policies for Massachusetts . . . . . . . . . . . . . . . . . 44

Medigap policies for Minnesota . . . . . . . . . . . . . . . . . . . . . 45

Medigap policies for Wisconsin. . . . . . . . . . . . . . . . . . . . . . 46


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44 Section 7:Medigap coverage charts

MassachusettsChart o standardized Medigap policies

Basic benets included in Medigap policies available in

Massachusetts

Inpatient Hospital Care: Covers the Medicare Part A coinsurance pluscoverage or 365 additional days aer Medicare coverage ends

Medical Costs: Covers the Medicare Part B coinsurance (generally 20% o theMedicare-approved amount)

Blood: Covers the frst 3 pints o blood each year

Part AHospice coinsurance or copayment

Te checkmarks in this chart mean the beneft is covered.

Basic Beneits

Medicare Part A: InpatientHospital Deductible

Medicare Part A:Skilled NursingFacility Coinsurance

Medicare Part B: Deductible

Foreign ravel Emergency

Inpatient Days in MentalHealth Hospitals

State-Mandated Beneits(Annual Pap tests andmammograms. Check your planor other state-mandated beneits.)

60 days percalendar year

120 days perbeneit year

Medigap Beneits Supplement 1 PlanCore Plan

For more inormation on these Medigap policies, call your State InsuranceDepartment. See pages 4950. You can also visit www.medicare.gov, and selectCompare Health Plans and Medigap Policies in Your Area.


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45Section 7:Medigap coverage charts

a

MinnesotaChart o standardized Medigap policies

Basic benets included in Medigap policies available in Minnesot Inpatient Hospital Care: Covers the Medicare Part A coinsurance Medical Costs: Covers the Medicare Part B coinsurance (generally 20% o the

Medicare-approved amount) Blood: Covers the frst 3 pints o blood each year Part AHospice and respite cost sharing Parts Aand B home health services and supplies cost sharing


Basic BeneitsMedicarePart A: Inpatient

Hospital Deductible

MedicarePart A: Skilled

Nursing Facility (SNF) Coinsurance

MedicarePart B: Deductible

Foreign ravel Emergency

Outpatient Mental Health

Usual and Customary FeesMedicare-covered Preventive Care

Physical herapy

Coverage while in a

Foreign Country

State-mandated Beneits

(Diabetic equipment

and supplies, routine cancer

screening, reconstructive surgery,

and immunizations)

Medigap Benefits Basic Plan Extended

50% 50%

80%*

(Provides 120 days o

SNF care)

(Provides 100 days o

SNF care)

80%

80%*

20% 20%

80%*

Basic Plan

Mandatory Riders

Insurance companiescan oer our additional

riders that can be added

to a Basic Plan. You may

choose any one or all

o the riders to design

a Medigap policy that

meets your needs.

Medicare Part A:

Inpatient HospitalDeductible

MedicarePart B:

Deductible

Usual andCustomary Fees

Non-MedicarePreventive Care

* Pays 100% aer you spend $1,000 in out-o-pocket costs or a calendar year.

Minnesota version o Medigap Plans K and L are available, and Minnesota Plans M, N and high deductible F willbe oered eective June 1, 2010.

Important: Te Basic and Extended Basic benefts are available when you enroll in Part B, regardless o age orhealth problems. I you return to work and drop Part B to elect your employers health plan, you will get another6-month Medigap open enrollment period aer you retire rom that employer when you can elect Part B again.


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46 Section 7:Medigap coverage charts

WisconsinChart o standardized Medigap policies

Basic beneits included in Medigap policies available inWisconsin

Inpatient Hospital Care: Covers the Part A coinsurance Medical Costs: Covers the Part B coinsurance (generally 20% o the Medicare-

approved amount)

Blood: Covers the irst 3 pints o blood each year

Part AHospice coinsurance or copayment


Basic Benefts

Medicare Part A:Skilled Nursing FacilityCoinsurance

Inpatient MentalHealth Coverage

Home Health Care

Outpatient Mental Health

175 days per lietime inaddition to Medicaresbeneit

40 visits in addition tothose paid by Medicare

Medigap Benefits Basic Plan Optional Riders

Insurance companies areallowed to oer additionalriders to a Medigap policy.

Part A Deductible

Additional Home HealthCare (365 visits includingthose paid by Medicare)

Part B Deductible

Part B Excess Charges

Foreign ravel

For more inormation on these Medigap policies, call your State Insurance Department.See pages 4950. You can also visit www.medicare.gov, and select Compare Health Plansand Medigap Policies in Your Area.

Plans known as 50% and 25% Cost-sharing Plans are available. Tese plans are similar tostandardized Plans K (50%) and L (25%). A high deductible plan ($1,900 in 2010) also willbe available on and aer June 1, 2010.


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47

SECION

For more inormation

8 Where to get more inormationOn pages 4950, you will fnd telephone numbers or yourState Health Insurance Assistance Program and State InsuranceDepartment.

Call your State Health Insurance Assistance Program or helpwith any o the ollowing:

Buying a Medigap policy or long-term care insurance

Dealing with payment denials or appeals

Medicare rights and protections

Choosing a Medicare plan

Deciding whether to suspend your Medigap policy

Questions about Medicare bills

Call your State Insurance Department i you have questionsabout the Medigap policies sold in your area or any

insurance-related problems.


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48

How to get help with Medicare and Medigap

questions

I you have questions about Medicare, Medigap, or need updatedtelephone numbers or the contacts listed on pages 4950, you can dothe ollowing:

Visit www.medicare.gov:

For Medigap policies in your area, select Compare Health Plansand Medigap Policies in Your Area.

For updated telephone numbers, select Find Helpul PhoneNumbers and Websites.

Call 1-800-MEDICARE (1-800-633-4227):

Customer service representatives are available 24 hours a day,7 days a week. Y users should call 1-877-486-2048.

Section 8: For more inormation
http://www.medicare.gov/http://www.medicare.gov/http://www.medicare.gov/


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49Section 8:For more inormation

State State Health Insurance State InsuranceAssistance Program Department

Alabama 1-800-243-5463 1-800-433-3966

Alaska 1-800-478-6065 1-800-467-8725American Samoa Not Available 1-671-653-1835

Arizona 1-800-432-4040 1-800-325-2548

Arkansas 1-800-224-6330 1-800-224-6330

Caliornia 1-800-434-0222 1-800-927-4357

Colorado 1-888-696-7213 1-800-930-3745

Connecticut 1-800-994-9422 1-800-203-3447

Delaware 1-800-336-9500 1-800-282-8611

Florida 1-800-963-5337 1-877-693-5236

Georgia 1-800-669-8387 1-800-656-2298

Guam 1-671-735-7388 1-671-653-1835

Hawaii 1-888-875-9229 1-808-586-2790

Idaho 1-800-247-4422 1-800-721-3272

Illinois 1-800-548-9034 1-866-445-5364

Indiana 1-800-452-4800 1-800-622-4461

Iowa 1-800-351-4664 1-800-351-4664Kansas 1-800-860-5260 1-800-432-2484

Kentucky 1-877-293-7447 1-800-595-6053

Louisiana 1-800-259-5301 1-800-259-5300

Maine 1-877-353-3771 1-800-300-5000

Maryland 1-800-243-3425 1-800-492-6116

Massachusetts 1-800-243-4636 1-617-521-7794

Michigan 1-800-803-7174 1-877-999-6442

Minnesota 1-800-333-2433 1-800-657-3602

Mississippi 1-800-948-3090 1-800-562-2957

Missouri 1-800-390-3330 1-800-726-7390

Montana 1-800-551-3191 1-800-332-6148

Nebraska 1-800-234-7119 1-800-234-7119


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50 Section 8:For more inormation

State State Health Insurance State InsuranceAssistance Program Department

Nevada 1-800-307-4444 1-800-992-0900

New Hampshire 1-866-634-9412 1-800-852-3416New Jersey 1-800-792-8820 1-800-446-7467

New Mexico 1-800-432-2080 1-800-947-4722

New York 1-800-701-0501 1-800-342-3736

North Carolina 1-800-443-9354 1-800-546-5664

North Dakota 1-888-575-6611 1-800-247-0560

Northern Mariana Not Available 1-670-664-3064Islands

Ohio 1-800-686-1578 1-800-686-1526

Oklahoma 1-800-763-2828 1-800-522-0071

Oregon 1-800-722-4134 1-888-877-4894

Pennsylvania 1-800-783-7067 1-877-881-6388

Puerto Rico 1-877-725-4300 1-888-304-8686

Rhode Island 1-401-462-4444 1-401-222-2223

South Carolina 1-800-868-9095 1-800-768-3467

South Dakota 1-800-536-8197 1-800-310-6560ennessee 1-877-801-0044 1-800-342-4029

exas 1-800-252-9240 1-800-252-3439

Utah 1-800-541-7735 1-866-350-6242

Vermont 1-800-642-5119 1-800-631-7788

Virgin Islands 1-340-772-7368 1-340-774-71661-340-714-4354 (St.homas)

Virginia 1-804-662-9333 1-877-310-6560

Washington 1-800-562-6900 1-800-562-6900

Washington D.C. 1-202-739-0668 1-202-727-8000

West Virginia 1-877-987-4463 1-888-879-9842

Wisconsin 1-800-242-1060 1-800-236-8517

Wyoming 1-800-856-4398 1-800-438-5768


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51

SECION

Denitions

9CoinsuranceAn amount you may be required to payas your share o the costs or services aer you pay anydeductibles. Coinsurance is usually a percentage (orexample, 20%).

CopaymentAn amount you may be required to payas your share o the cost or a medical service or supply,like a doctors visit or a prescription. A copayment isusually a set amount, rather than a percentage. For

example, you might pay $10 or $20 or a doctors visitor prescription.

DeductibleTe amount you must pay or healthcare or prescriptions, beore Original Medicare, yourprescription drug plan, or your other insurance beginsto pay.

Excess ChargeI you have Original Medicare, andthe amount a doctor or other health care provider is

legally permitted to charge is higher than the Medicare-approved amount, the dierence is called the excesscharge.


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52 Section 9:Defnitions

Guaranteed Issue Rights (also calledMedigap Protections)Rights youhave in certain situations when insurancecompanies are required by law to sell or oer

you a Medigap policy. In these situations, aninsurance company cant deny you a Medigappolicy, or place conditions on a Medigappolicy, such as exclusions or pre-existingconditions, and cant charge you more or aMedigap policy because o a past or presenthealth problem.

Guaranteed RenewableAn insurancepolicy that cant be terminated by the insurance

company unless you make untrue statementsto the insurance company, commit raud, ordont pay your premiums. All Medigap policiesissued since 1992 are guaranteed renewable.

MedicaidA joint Federal and state programthat helps with medical costs or some peoplewith limited income and resources. Medicaidprograms vary rom state to state, but most

health care costs are covered i you qualiy orboth Medicare and Medicaid.

Medical UnderwritingTe process that aninsurance company uses to decide, based onyour medical history, whether or not to takeyour application or insurance, whether ornot to add a waiting period or pre-existingconditions (i your state law allows it), andhow much to charge you or that insurance.

Medicare Advantage Plan (Part C)A typeo Medicare health plan oered by a privatecompany that contracts with Medicare toprovide you with all your Medicare Part A and

Part B benefts. Medicare Advantage Plansinclude Health Maintenance Organizations,Preerred Provider Organizations, PrivateFee-or-Service Plans, Special Needs Plans,and Medicare Medical Savings Account Pla

Documents

Choosing a MediGap Policy 2010