05.29.08
Top Ten Things You Need to Know Before Purchasing Medigap Insurance
1. Definition of Medigap Insurance: Medigap Insurance is a private health insurance policy commonly referred to as “Medicare Supplement Insurance.” It is designed to pay for the 8 gaps in physician and hospital coverage left by Medicare Parts A and B.
2. What Medicare Supplement Policies Cover: Medigap Policies cover medical procedures approved by Medicare at a Medicare Provider. Procedures not approved by Medicare are normally not covered by Medicare Supplement Insurance. Some policies offer limited benefits for expenses not covered by Medicare such as at home recovery.
3. Eligibility for Medicare Supplement Insurance: Anyone who is covered under both Medicare parts A and B are eligible for Medigap Coverage. Insurance Companies reserve the right to set further qualification criteria beyond Medicare Eligibility at their own discretion but can not exclude any person who is in an Open Enrollment or Guaranteed Issue situation.
4. Available Medicare Supplement Plans: Most states only allow standardized Medicare Plans A-L. Any company offering coverage is required to offer the base plan (Plan A) and any other combination of plans B-L at their discretion.
5. Plan Differences Between Companies: The coverage between companies for doctor and hospital visits is exactly the same for the same standardized policy. For instance, a Plan F with one insurance company will pay exactly the same as a plan F with any other company. Companies may choose which standardized Medicare Supplement Policies they wish to offer but all must at least offer Plan A.
6. Pre-Existing Conditions: Medicare Supplement Insurance Companies may put a pre-existing conditions clause that limits their liability on previous medical problems for up to 6 months after the issue date of the policy. Some companies will not exercise this option. All companies must waive this limitation for the time that you were covered under previous creditable coverage such as a private or employer sponsored health plan or another Medigap policy.
7. Pricing Differences: Medicare Supplement Insurance prices vary from company to company, from plan to plan and from area to area. There is no standardization of pricing for Medigap Insurance. Therefore, you could pay substantially more for the exact same coverage if you do not shop around for the best rate for your particular situation.
8. Choice of Doctors and Hospitals: Medicare Supplement Insurance does not limit you on the doctors or hospitals that you may choose. There are no networks. You simply choose any provider that accepts Medicare and your Medicare Supplement will pay that provider as stated in your policy.
9. Claims: Medicare Supplement Insurance has a very easy and mostly automated claims process. For Medicare Part B claims each Medicare Supplement Insurance company is linked directly to Medicare. Medicare will send the insurance company a copy of the claim and how they paid (known as a Medicare Explanation of Benefits or MEOB) to your Medicare Supplement provider each time they pay a claim. This is the claim that the insurance companies use to determine how to pay your claim. Because the claims come directly from Medicare, there is rarely a need for you or your doctor to file a claim for outpatient services.
10. Bottom Line: Medicare Supplement Insurance is very important and can provide you the peace of mind of knowing that you will not be burdened by the gaps in health coverage left by Medicare Parts A and B. However, it is important to compare plans and rates to make sure that you find the policy that is best for you. As Medicare Supplement Coverage is standardized in most states and the coverage is the same from company to company, it is very important to shop around to find the best available price.
Request a Personalized Price Analysis at: www.LowCostMedigap.com
“Welcome to Medicare” Physical Exam
Medicare will cover a one-time preventive physical exam within the first six months that you have Part B. The exam will include a thorough review of your health, education and counseling about the preventive services you need, like certain screenings and shots, and referrals for other care. The “Welcome to Medicare” physical exam is a great way to get up-to-date on important screenings and shots, and to talk with your doctor about your family history and how to stay healthy.
During the exam, your doctor will record your medical history and check your blood pressure, weight and height. Your doctor will also give you or order an Electrocardiogram (EKG) and a vision test. Your doctor will check to make sure that you are up-to-date with your shots. Depending on your general health and medical history, further tests may be ordered, if necessary. Your doctor will also give you advice to help you prevent disease, improve your health and stay well. You will also get a written plan (such as a checklist) when you leave letting you know which screenings and other preventive services you should get.
Remember
Once you enroll in Part B, it’s important to schedule your “Welcome to Medicare” Physical Exam / Initial Preventive Physical Examination (IPPE) right away. Medicare will only cover this physical exam if it occurs within the first six months that you have Part B. If your doctor thinks this six-month period has passed, he or she should give you a notice that says Medicare probably won’t pay for this service. If you still want to get the service, you will be asked to sign an agreement that you will pay for the service yourself if Medicare doesn’t pay for it. This is called an Advance Beneficiary Notice.
The IPPE is a preventive physical exam covered by Medicare. It may also be referred to as the “Welcome to Medicare Exam.” This exam consists of different parts that help the health care provider to identify risk factors that may be linked with various diseases and to detect diseases at earlier stages. There is usually a better outcome when diseases are detected early. The IPPE consists of an examination, an electrocardiogram (EKG), education, counseling, and referral to other screening and preventive services covered by Medicare. Clinical laboratory tests are not part of the IPPE.
Eligibility
Must have Medicare Part B
One time benefit/exam
The exam must be taken within the first months of Medicare Part B coverage.
The amount you need to pay – You pay 20% of the Medicare-approved amount for the one-time preventive physical exam.
Deductible and co-insurance apply.
For more information, you may call 1-800-MEDICARE (1-800-633-4227).
The part of Medicare that pays for this service or supply Part B Benefit
Medicare Contact for additional information at 1-800-MEDICARE
Important notes Actual amounts you must pay may be higher if a doctor, health care provider, or supplier does not accept assignment.
You must pay an annual $131 (in 2007) deductible for Part B services and supplies before Medicare begins to pay its share.
For assistance with the purchase of Medigap Insurance contact Golden Age Providers, LLC at: 1-800-495-1915 or www.LowCostMedigap.com
Advisors Need To Know Medicare Supplement Changes – Important Info for Agents and Seniors
NAIC recommendations are awaiting congressional approval
As the nation’s population ages and more and more of your clients near Medicare age, Medicare supplement is a product you should stay on top of.
Recent legislative events mean changes are on the horizon and more are likely in the near future. We are at a critical point with the Medicare system right now and modernization of Medicare supplement products, which are also known as “Medigap” products, is essential in order to keep pace with the future of Medicare. Throughout the industry, most feel that changes are overdue.
Last year, a congressional conference report accompanying the Medicare Modernization Act encouraged the National Association of Insurance Commissioners to modernize the Medicare supplement insurance market. As a result, the NAIC, Kansas City, Mo., developed a task force and subcommittee to develop recommendations to restructure the Medigap insurance market. Those recommendations were released in December 2006.
In March, the NAIC approved the following recommendations, which still must receive approval in Congress:
* Introduce two new plan options with higher cost-sharing responsibilities and lower premiums.
* Remove the at-home-recovery benefit from plans D, G, I and J.
* Create a new hospice benefit, which will be added as a basic benefit to all plans.
* Eliminate the preventive care benefit offered in plans E and J.
The benefit has been underutilized due to changes in the Medicare program to include more preventive care.
* Increase the Part B excess benefit in plan G from 80% to 100%, to mirror the benefit offered in Plan F.
* Eliminate plans H, I and J, which had provided prescription drug coverage before Medicare Part D.
* Eliminate plan E, as it will become identical to plan D once other changes are implemented.
At press time, Congress was still working on enacting these recommendations into law, so it’s unlikely that implementation will happen before 2008.
Regardless, the pending changes are still something that advisors should be aware of if they sell Medicare supplement insurance.
Once the proposed changes are approved, insurance companies will have to make the necessary changes by a certain date in order to sell the plans.
Companies will have an option of whether or not they will sell the new plans. Changes will include filing, rate adjustments and other system changes. Additionally, companies will be permitted to offer existing policyholders the opportunity to exchange their current policies for new policies.
For advisors, learning the new plans should not be a huge undertaking, because the recommended changes are fairly modest. However, it is safe to say that many current Medicare supplement policyholders will have questions about the changes. Advisors with senior clients should be prepared to answer those questions and help clients determine if their current Medicare supplement policies are still the best option for their particular situations.
For assistance with the purchase of Medigap Insurance contact Golden Age Providers, LLC at: 1-800-495-1915 or www.LowCostMedigap.com
How Medigap Plans Work
Medigap Policies
Medigap policies are health insurance policies sold by private insurance companies to fill “gaps” in Original Medicare Plan coverage. In general, with a Medigap policy:
You get help paying for some of the health care costs that the Original Medicare Plan doesn’t cover.
You also get benefits not covered by Original Medicare, like emergency health care outside the United States.
You pay a monthly premium to the private health insurance company that sells you the policy. Medicare and the Medigap policy both pay their shares of covered health care costs.
*For Assisitance researching Medicare Supplement Plans or obtaining a Medicare Supplement Quote contact Golden Age Providers, LLC at:
1-800-495-1915 or on the web at: www.LowCostMedigap.com
Medigap Plans Vary in Price
Are you looking to purchase a Medigap policy for yourself or a family member?
Based on TheStreet.com Ratings’ latest research of pricing data, we strongly recommend that you compare prices among the competing insurers.
In our annual study of premium rates of 154 insurers, we found there is a wide variation in prices for the same exact policies. The table at the bottom of the page highlights the broad range in premium rates for plans A through L across the nation.
Insurers adjust rates based on the state and the price method used, but even when we compared policies within a state using the same price method, we found there are still considerable pricing differences among insurers. Consider these examples for a 65-year-old female:
In California, plan F costs $1,333.54 with Mutual of Omaha Insurance Co., while Standard Life & Accident Co. issues the same policy for $2,189.73, representing a 64 percent difference in cost. In Texas, the same plan ranges from $1,466 with Constitution Life Insurance Co. to $3,589 with Oxford Life Insurance Co., a 144% difference.
In Iowa, premiums for plan C vary from a low of $939 with Sioux Valley Health Plan to a high of $2,169 with Bankers Life & Casualty Co., representing a 131% difference in cost, while rates in North Carolina run from $1,102 with Philadelphia American Life Insurance Co. to $2,115 with Continental General Insurance Co.
The differences in price are often a result of the different underwriting parameters, operating costs and marketing strategy of each insurer. You can look at your state here to find the top five lowest priced insurers for plan F (rate based on a 65-year-old female using attained-age pricing method).
Shopping around is your best weapon to save money on Medigap coverage, but other tools are available to you. Some employers provide insurance to retirees that would supplement a portion of what Medicare doesn’t cover. Be sure to check to see if your employer offers this.
If you or your parents are healthy and can’t afford to spend much, then you should give serious consideration to plans K and L, which provide less coverage, but also carry a reduced premium in comparison to the other plans.
Another option to consider if you are shopping for your parents is to chip in with the cost. It may seem extreme, but you could possibly save money in the long run if your parents have a catastrophic expense that is not covered by Medicare. Spending a little extra now for coverage can help prevent a possible financial disaster later.
*For Assistance Researching Medicare Supplement Insurance or Obtaining a Medicare Supplement Quote You May Contact:
Golden Age Providers, LLC at: 1-800-495-1915 or on the web at: www.LowCostMedigap.com
05.28.08
Six Mistakes to Avoid When Buying Medigap Insurance
It may come as no surprise that Medicare is estimated to cover only 50% of your health care costs. Many Medicare beneficiaries supplement Medicare either with a ‘Medigap’ policy that pays for what Medicare doesn’t cover, or they may enroll in a Medicare Health Maintenance Organization (HMO). Here’s what to watch out for:
Enroll in Medicare during your individual enrollment period, even if you receive employer-provided insurance. The individual enrollment period is the time running three months prior to your 65th birthday and three months after, during which you can enroll in Part B (doctors’ insurance) of Medicare. Make sure you are enrolled in both Medicare Part A (hospital insurance) and Part B. Why Part B? If you don’t purchase the Part B during your initial enrollment period when you turn 65, you have to wait until the next general enrollment period, and you pay a additional 10% premium for every year you wait.
Don’t settle for the first health plan you find. Certified Medigap insurance policies to supplement traditional fee-for-service Medicare are marketed in 10 standardized policies identified as Plans A through J. Shop around and compare prices because premiums vary tremendously. A study has found that a 65-year-old male living in Springfield Illinois, for example, would be charged $3,171 per year by a company in Missouri for its Plan J. He could get the same exact coverage from another company for only $1,699. You can compare certified policies on the basis of their premiums and select the one that offers the best value.
Don’t buy a policy that excludes pre-existing conditions, if at all possible. If you do, make sure the exclusion is limited to a six month waiting period at the most.
Don’t buy limited-purpose insurance such as cancer or accident insurance. Benefits in these polices are limited to certain diagnoses, and are generally full of other restrictions. Many are designed to never pay off.
Don’t buy a policy that has dollar limits on the total annual payments you receive or payments over your lifetime unless those limits are reasonably high. Some insurance policies, but not certified Medigap policies, pay less than the Medicare-approved amounts for hospital out-patient services and services provided from the doctor.
Don’t buy a policy without knowing exactly what your premium covers. For example, look carefully at the coverage offered for doctors’ fees above the Medicare-approved charge. The policy may only cover your 20% copayment, but may leave you responsible for the rest of the fee. Ask for a complete schedule of benefits and then ask your salesperson to mark the benefits your premium covers.
For assistance with the purchase of Medigap Insurance contact Golden Age Providers, LLC at: 1-800-495-1915 or www.LowCostMedigap.com
