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Medicare Supplement Insurance
2017 SHIP Fall Conference
Senior Health Insurance Program
800-548-9034 [email protected]/23/2017 Medicare Supplements 1
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What is SHIPSenior Health Insurance Program• Established in 1988 • Free Medicare Counseling Program• Sponsored by the State of Illinois
o Illinois Department on Aging• Do not sell or solicit insurance• Dedicated to educating people with Medicare• SHIP trains volunteer counselors throughout Illinois • Provide one-on-one counseling
o With Medicare Beneficiaries, family members and caregivers• Enroll beneficiaries into various Medicare programs
o Medicare Prescription Drug Coverage, SSA “Extra Help”, …etc.• Through community based sites
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Does anyone ever feel like this?
Medicare Supplement Insurance
Medicare Supplement Insurance
Often called Medigap or MedSup• Private health insurance• Supplements the financial gaps in Original Medicare
o Does not work with Medicare Advantage (MA)
Helps pay some health care costs that Original Medicare doesn’t cover (coverage “gaps”)
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Medicare Supplement Insurance
Medicare will pay its share of the Medicare-approved amounts for covered health care costs• Then your Medigap policy pays its share
A Medigap policy covers one person
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About Medigap Policies
You must have both Medicare Part A and Part B to get a Medigap policy
You pay a monthly premium for the Medigap policy
You pay your Medicare Part B premium
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Medigap Plans
Standardized plans identified by a letter• Plans A, B, C, D, F, G, K, L, M, and N are currently sold
• Companies don’t have to sell all plans
• Plans with the same letter must offer the same basic benefits
“An A is an A”, no matter who you buy from and what they charge
• Only the policy cost will vary between companies
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Medicare SELECT Policies
A type of Medigap policy with a network
To get full benefits (except in emergency)
• Must use specific hospitals, and
• May have to see specific doctors
Can be any of the standardized policies
Generally cost less than non-network policies
Not all companies sell
Can switch to plan with equal or lesser value at any time10/23/2017 Medicare Supplements 11
Medigap Costs
Premiums may vary greatly for same Medigap plan
Cost (monthly premium) can depend on • Your age (in some states)• Where you live (e.g., urban, rural, or ZIP Code)• Company selling the policy• Discounts (women, non-smokers, married couples)
Medicare SELECT policies generally have lower premiums
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Medigap Pricing Based on AgeType of Rating Description
No-age-rated(community-rated)
Everyone pays same regardless of age if 65 or older Generally least expensive over lifetime
Issue-age-rated Based on age when purchased Doesn’t go up automatically as you get older
Note: No companies in Illinois currently use the issue age method.
Attained-age-rated Premium based on current age Costs less when you’re 65 Cost goes up each year as you get older
Note: The only company using this rating methodology in Illinois is AARP/United Healthcare (UHC).
Premiums may go up due to inflation and other factors.10/23/2017 Medicare Supplements 13
The Best Time to Buy a Medigap Policy
Medigap Open Enrollment Period (OEP) for beneficiary turning age 65
• A 6 month guaranteed issue period, beginning when you’re first enrolled in Part B
• During that time, an insurance company must sell you a plan
Can’t be changed or repeated If miss Medigap Open Enrollment and are on Medicare due to age 65, you
may be able to buy a Medigap policy any time an insurance company will sell you one subject to underwriting (denial)
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Open Enrollment for the Disabled Under Age 65
In Illinois, those on Medicare due to disability and are under age 65 have the same rights as those 65 and older.
• 6 month guaranty to get any policy, from any company
• Will pay that company’s highest rate
• At age 65, you will get an additional 6 month OEP without underwriting
Note: Some States do not have guaranteed issue for disability eligible Medicareenrollees10/23/2017 Medicare Supplements 15
Two Guaranteed Issue Companies
In Illinois, only two companies offer guaranteed issue Medigap plans for those on Medicare due to disability and not in the OEP or guaranteed issue period Blue Cross Blue Shield Health Alliance
IMPORTANT: This is only offered during the Annual Open Enrollment period from October 15 – December 710/23/2017 Medicare Supplements 16
Delayed Medigap Open Enrollment Period (OEP)
If you defer enrolling in Medicare Part B• Because you or your spouse is still working, and• You have group health coverage
Medigap OEP is delayed• Until you’re 65 or older and enroll in Part B• No late enrollment penalty
Notify Social Security to delay Part B10/23/2017 Medicare Supplements 17
Pre-existing Conditions and Medigap
Health problem(s) you had before the new insurance policy starts • Treated or diagnosed 6 months before coverage start date
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Pre-existing Conditions and Medigap
Pre-existing Condition Waiting Period• Insurance companies can refuse to cover costs for excluded
conditions for up to 6 months from policy start date (“look-back period”)
• Occurs when no prior creditable coverage and no break in coverage more than 63 days, for the six months prior to application
Note: Some plans have no pre-existing condition waiting period (0, 3 or 6 month)
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Medicare and the Marketplace
The Affordable Care Act does not
impact the pre-existing condition waiting period for
Medigap coverage.
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Can I Switch Medigap Policies?
You might switch policies if you
• Are paying for benefits you don’t need• Need more benefits now• Want to change your insurance company• Find a cheaper policy
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Switching Medigap Policies?
If not in your Medigap Open Enrollment Period• You may pay more for the new policy
• There might be medical underwriting (Can be denied)
• Could have a delay in coverage for pre-existing condition
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When Can You Switch Medigap Policies?
A guaranteed right under federal law allows you to switch only: • During your Medigap Open Enrollment Period or• If you have a guaranteed issue right
You can buy anytime insurance company will sell to you
When you buy a new Medigap policy• You’ll have a 30-day “free-look period”
Don’t cancel policy until new one is fully in effect May need to pay premiums on both policies while in
transition.10/23/2017 Medicare Supplements 23
Guaranteed Issue Rights
Federal protections in certain situations• Companies must sell you a Medigap policy• All pre-existing conditions must be covered• Can’t be charged more• Must apply within 63 days of date other coverage ends
See the next two slides for all situations
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Guaranteed Issue RightsThis chart describes the situations, under federal law, that give you a right to buya policy, the kind of policy you can buy, and when you can or must apply for it. All situations have no pre-existing wait periods.
Chart is on Page 11-12 of the SHIP Medicare Supplement Guide
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Guaranteed Issue RightsThis chart describes the situations, under federal law, that give you a right to buya policy, the kind of policy you can buy, and when you can or must apply for it. All situations have no pre-existing wait periods.
Chart is on Page 11-12 of the SHIP Medicare Supplement Guide
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Guaranteed Renewable
Medigap policies purchased after 1992 are guaranteed renewable
Your insurance company can’t drop you unless one of the following happens:• You stop paying your premium • You weren’t truthful on the Medigap application• The insurance company becomes bankrupt or insolvent
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Right to Suspend Medigap for People With Medicaid
If you have both Medicare and Medicaid• You generally can’t buy a Medigap policy (duplication of
coverage per insurance law)
You can suspend your Medigap policy • Within 90 days of getting Medicaid
For up to 2 years
You can start it up again• No new medical underwriting or waiting periods10/23/2017 Medicare Supplements 28
Right to Suspend Medigap
If you suspend your Medigap policy• You don't pay Medigap premiums• The Medigap policy won’t pay benefits
You may not want to suspend your policy if you see doctors who don’t accept Medicaid
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New Information on Plans C and F
Plans C and F will no longer be available as of 2020
This applies only to newly eligible beneficiaries• Defined as those individuals who: (a) have attained age 65 on or after
January 1, 2020; or (b) first become eligible for Medicare due to age, disability or end-stage renal disease, on or after January 1, 2020.
If you were “eligible” for Medicare prior to 2020, you can still buy either plan after 2020, or switch your current Med Supp for a Plan C or F
If you already have a Plan C or F, you can keep it!10/23/2017 Medicare Supplements 30
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For plans sold to “newly eligible”, on or after January 1, 2020:
Plan G will be offered as the high deductible option
2020 High Deductible Option
FYI: New Innovative Benefits
Medicare Supplemental insurers can now add innovative benefits to a standardized supplemental policy Innovative benefits may include vision and dental benefits,
comparable to many managed care plans
Currently, Humana is the only company in Illinois offering these benefits, calling these plans “Healthy Living” plans
Contact Humana for more details (listed in SHIP MedSup Guide)
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How can I find out more about Medigap plans?
Illinois Department Aging, SHIP800-252-8966www.illinois.gov/aging/SHIPOr email SHIP at [email protected]
MedicareMedicare & You 2017 handbook800-633-4227 (24 hours a day, 7 days a week)www.medicare.govwww.mymedicare.govTTY 1-877-486-2048
SHIP Medicare Supplement Comparison GuideWeb site: http://www.illinois.gov/aging/ship/Download the Medicare Supplement Comparison Guide
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Are There Any Questions?
Thank you
Senior Health Insurance Program
800-548-9034 [email protected]
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