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Medicare, Medicare Supplement Insurance and your health care coverage options.
MedSuppInfo.com provides Medicare, Medicaid, and Medicare Supplement information for our current insureds.
Whether you are just entering into Medicare, are preparing for your future or exploring
your health care coverage options, our website was designed to help.
We invite you to take a look around - Learn more About Medicare
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Insurance benefits are underwritten by members of the AEGON Insurance Group including: Life Investors Insurance Company of America, Bankers United Life Assurance Company, Monumental Life Insurance Company, AUSA Life Insurance Company, Inc. and Transamerica Life Insurance Company
More information on Members of the AEGON Insurance Group
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Results from search: http://www.medsuppinfo.com/medicare.asp
Medicare, Medicare Supplement Insurance and your health care coverage options.
Medicare at a glance .
Medicare was started in 1966 to help with medical expenses. It's a national
health insurance program designed to help people age 65 and over with medical expenses. It
also assists certain younger disabled people and people who have kidney failure.
There are two parts of Medicare, Hospital Insurance (referred to as Part A) and Medical
Insurance (referred to as Part B). Part A helps to pay for your in-hospital
expenses, care in a skilled nursing facility, and provides limited benefits for home
health care and hospice care. Part B helps to pay doctor bills, outpatient hospital care
and other medical services not covered by Part A.
Medicare Supplement insurance plans were developed to help fill the gaps in Medicare.
Medicare Supplement can only be sold in 10 standardized plans. The ten
standard plans, labeled A - J are outlined in the chart below.
CLICK ON THE PLAN LETTER FOR MORE DETAILS ON THE BENEFITS IN THIS CHART...
Medical Supplement Benefits By Plan
Plan Letter
Basic
Benefits
Part A
Deductible
Skilled
Nursing
Coinsurance
Part B
Deductible
Part B
Excess
Foreign
Travel
Emergency
At Home
Recovery
Drug
Benefit
Preventive
Care
A
B
C
D
E
F *
100%
G
80%
H
$1,250
I
100%
$1,250
J *
100%
$3,000
Notes
States may allow only some of the ten standard benefit plans.
States may approve innovative additional benefit plans under certain circumstances.
These standard benefit plans do not apply to policies sold in MA, MN and WI.
Availability of plans varies from company to company.
Beneficiaries must keep good records of prescription drug expenses as they must file the
claims themselves.
*Plans F and J also have an option called a high deductible Plan F and a high
deductible Plan J. These high deductible plans pay the same benefits as Plans F and
J after you pay a calendar year $1,620 deductible. Benefits from high deductible
Plans F and J will not begin until out-of-pocket expenses total $1,620.
Out-of-pocket expenses for this deductible are expenses that would normally be paid by the
policy. These expenses include the Medicare deductibles for Part A and Part
B. These expenses do not include the prescription drug deductible of $250 in Plan
J. They also do not include the $250 foreign travel emergency deductible in Plan F
and Plan J.
Click here for a free Guide
Home | About Medicare | Frequently Asked Questions Special Articles | Latest News | Test Yourself | Contact Us Site Map | About Us | Your Privacy | Copyright and Legal Information
Insurance benefits are underwritten by members of the AEGON Insurance Group including: Life Investors Insurance Company of America, Bankers United Life Assurance Company, Monumental Life Insurance Company, AUSA Life Insurance Company, Inc. and Transamerica Life Insurance Company
More information on Members of the AEGON Insurance Group
This information is brought to you by: AEGON Special Markets Group, Inc. Copyright © 1999
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Medicare Supplement Insurance Handbook & Rate Guide
(Revised September 2001)
Table of Contents
Medicare and Medicare Supplement Insurance
Medicare Basics
Your Rights as a Medicare Supplement Consumer
Shopping Wisely for Medicare Supplement Insurance
How to Use the Guide
Appendix - Summary of Medicare supplement benefits
Click on the letter to view rates for that particular plan.
A
B
C
D
E
F
G
H
I
J
Disability Under Age 65
Medicare and Medicare Supplement Insurance
Medicare is a federal health insurance program for people 65 or older, some people under 65 with disabilities, and people with end-stage renal disease. If you are on Medicare, it will pay for much - but not all - of your health care. Medicare supplement insurance can help you fill in some of the "gaps" that Medicare alone won´t pay for. Therefore, it´s often referred to as "Medigap" insurance. There are 10 standardized Medicare supplement insurance plans, labeled "A" through "J." Each plan offers a different level of benefits. Two plans, F and J, offer a high-deductible option.
Not everyone needs a Medicare supplement policy. If you are enrolled in certain other types of health plans, the gaps in your Medicare coverage may already be covered.
You may not need Medicare supplement insurance if
you receive Medicaid
you belong to a Medicare+Choice plan
you are a Qualified Medicare Beneficiary (QMB)
you have group health insurance through an employer or former employer.
For More Information about Medicare, Medicare Supplement Insurance, and Medicaid
Call the Texas Department on Aging´s State Health Insurance Assistance Program (SHIP)
1-800-252-9240
1-800-252-9108 (TDD)
For information about your rights and public assistance benefits, call the Legal Hot Line for Older Texans
1-800-622-2520
1-877-526-9953 (TDD)
Call the Centers for Medicare and Medicaid Services (CMS) Dallas regional office
214-767-6401
For information about Medicare+Choice plans available by county or ZIP code, visit the CMS Web site
www.medicare.gov
For information about Medicaid, call the Texas Department of Human Services
1-888-834-7406
1-888-425-6889 (TDD)
For information about Medicare supplement insurance sold in Texas, call the Texas Department of Insurance (TDI) Consumer Help Line
1-800-252-3439
1-800-735-2989 (Relay Texas)
Call TrailBlazer Health Enterprises or visit the TrailBlazer Web site. TrailBlazer is the Medicare carrier for Texas.
1-800-442-2620
www.the-medicare.com
PART I - TEXAS MEDICARE SUPPLEMENT HANDBOOK
Return to Table of Contents
Medicare Basics
Medicare Part A (hospital) pays for in-patient hospital services, skilled nursing facility care after a hospital stay, home health care, and hospice care. Medicare Part A also pays for all but the first three pints of blood in a calendar year. See the Centers for Medicare and Medicaid Service´s Medicare and You handbook for information on Medicare Part A deductibles and copayments. This handbook is mailed to Medicare beneficiaries each year.
Medicare Part B (medical) pays for medical expenses, clinical laboratory services, and outpatient hospital treatment. In most cases, Medicare pays 80 percent of the cost of covered services. You must pay a $100 annual deductible and the remaining 20 percent of the cost of services. The portion you pay is called coinsurance. Covered medical expenses include physicians´ services and supplies. Some Medicare Part B services are paid as a fixed copayment under the new outpatient prospective payment system (PPS). Depending on which services you receive and where you get the service, your out-of-pocket costs may be higher or lower than they were previously for the same service. Medicare also pays for some preventive services. Ask your physician whether Medicare will pay for the preventive services you´re considering.
Services Not Covered by Medicare
Custodial care, such as help in walking, getting in and out of bed, dressing, bathing, toileting, shopping, eating, and taking medicine
More than 100 days of skilled nursing facility care during a benefit period following a hospital stay (the Medicare Part A benefit period begins the first day you receive a Medicare-covered service and ends when you have been out of the hospital or a skilled nursing facility for 60 consecutive days)
Private duty nursing care
Most outpatient prescription drugs
Homemakers´ services
Most dental care and dentures
Health care you receive while traveling outside the United States (except under limited circumstances)
Cosmetic surgery and routine foot care
Routine eye care, eyeglasses (except after cataract surgery), and hearing aids.
Provider Fees and Assignment
Health care providers who accept "assignment" receive the amount Medicare approves for a service or supply as payment in full. You are responsible for paying any deductibles, coinsurance, and copayments. Part B Medicare pays 80 percent of the approved charge after you´ve met your annual deductible; you or a Medicare supplement policy pay the coinsurance or copayment.
Providers who do not accept assignment may charge 15 percent above the Medicare-approved amount when treating Medicare patients. You must pay the excess 15 percent. The amount you owe is shown on the Explanation of Medicare Benefits or Medicare Summary Notice, which you receive from Medicare. If you were charged more than the 15 percent and paid it, your provider must refund the excess charges to you within 30 days. If you believe a provider has overcharged you, question the bill before you pay it and contact TrailBlazer Health Enterprises, the Medicare carrier for Texas.
TrailBlazer maintains the Medicare Participating Physician/Supplier Directory, which lists physicians and other providers who accept assignment on all Medicare claims. For a list of providers who accept assignment in your area, call TrailBlazer or visit the TrailBlazer Web site.
Medicare Supplement Insurance
Medicare supplement insurance fills the gaps between Medicare benefits and what you must pay out-of-pocket for deductibles, coinsurance, and copayments. A deductible is the amount you must pay each year for covered medical expenses before Medicare or Medigap insurance begins to pay benefits. Both Medicare Part A and Part B have deductibles. A copayment is a fixed charge for a medical service. Coinsurance is the percentage of the cost of a covered service that you or a Medigap policy pay after Medicare pays its portion of the cost.
Medicare only pays for services that it deems are "medically necessary." Medigap policies only pay for Medicare-approved services, and payments are generally based on the Medicare-approved charge.
Medigap Benefits
There are 10 standardized plans of Medigap benefits. These plans are labeled "A" through "J." Each company must use these same identifying letters. All companies that sell Medigap insurance must offer Plan A, but do not have to offer the other nine plans. The benefits provided by these policies are described on the inside back cover of this handbook.
If you bought a Medigap policy before the 10 standardized plans were first required in 1992, you may keep your existing policy. You do not have to switch to one of the 10 standardized plans.
Medigap policies cover deductibles, copayments, and coinsurance for Medicare Part A and Part B. Some Medicare supplement policies offer benefits that Medicare doesn´t, such as prescription drug coverage, emergency care while in a foreign country, and preventive health care services. Medigap benefits are set by the federal government.
Medicare Select
Medicare Select is a type of Medigap policy that may give you a lower price in return for using only the providers on your insurance company´s "network providers" list. Medicare Select coverage can be issued by an insurance company or a Medicare health maintenance organization (HMO). If you leave a Medicare Select plan, the company must make available any non-Medicare Select policy it has on the market with comparable or lesser benefits.
Alternatives to Medicare Supplement Insurance
Before you buy a Medigap policy, consider these other options. If you are part of an employee group plan, a member of a Medicare+Choice plan, on Medicaid, or are a Qualified Medicare Beneficiary, you may not need Medicare supplement insurance.
Employee Group Plans
If you remain employed after your 65th birthday, you may continue your group health insurance where you work. If so, you may not need Medicare Part B or Medigap insurance. Likewise, if you are the spouse of a worker over 65 and you remain on your spouse´s policy at work, you may not need a Medigap policy. You also may not need Medigap coverage if you have health care coverage through a union or fraternal organization.
Retirees who remain on their employers´ health plans also might not need Medigap coverage. Because health plans work differently, talk to your employer's benefits coordinator before making a decision about Medigap insurance.
Additional information about delaying Part B enrollment is available in the Guide to Health Insurance for People with Medicare booklet.
Medicare+Choice Plans
If you are in a Medicare+Choice plan, you don´t need a Medigap policy. There are two different types of Medicare+Choice plans:
managed care plans, which include HMOs, preferred provider organizations (PPOs), provider-sponsored organizations (PSOs), and religious fraternal benefit society pans (RFBs)
private fee-for-service plans.
Medicare pays a monthly premium to the Medicare+Choice plan to provide your health care. In addition, the plan may require you to pay an additional premium and may charge a copayment each time you use a covered service. To be a member of a Medicare+Choice plan, you must have both Medicare Part A and Part B and live in an area that has a plan. Not all plans are available in all areas of the state.
Medicare HMOs require you, in most instances, to use only physicians and hospitals in the HMO's network. The Medicare HMO with a point-of-service option allows you the flexibility to choose your own doctors, but you must pay extra. You can generally go to any doctor or provider you want with a private fee-for-service plan, and may receive care anywhere in the United States, as long as the doctor and provider agree to treat you and accept the plan´s payment terms.
If your Medicare+Choice plan terminates its contract in your service area, you are guaranteed the option to purchase any Medigap plan A, B, C, or F offered in Texas. Companies may not place any restrictions, such as pre-existing conditions exclusions, on these policies. This is called "guaranteed issue." However, to ensure your guaranteed issue rights, you must apply for a policy within 63 days after your Medicare+Choice plan´s coverage ends.
Medicaid
If your income and assets are below a certain level, you might be eligible for Medicaid. You do not need a Medigap policy if you receive Medicaid because Medicaid pays eligible expenses in full. For information about Medicaid, call the Texas Department of Human Services (DHS).
Medical Savings Programs
Medicaid-sponsored Medical Savings Programs may pay Medicare premiums, deductibles, and coinsurance amounts for eligible Medicare beneficiaries. These programs allow Medicare beneficiaries to better direct their savings to cover other expenses.
The Qualified Medicare Beneficiary (QMB) program, the Specified Low-Income Medicare Beneficiary (SLMB) program, the Qualified Individuals (QI-1 and QI-2), and the Qualified Disabled Working Individuals (QDWI) are all Medical Savings Programs.
The federal QMB program pays the Medicare Part B premium and covers all Medicare deductibles and copayments for people with incomes below a certain level. You do not need Medicare supplement insurance if you are in the QMB Program. QDWI pays Medicare Part A premiums. The other plans pay all or part of your Medicare Part B premium.
For information on eligibility requirements for these programs, call the Texas Department of Health. You also may call your local Social Security office for assistance. Check your phone book for the office nearest you.
Return to Table of Contents
Your Rights as a Medicare Supplement Consumer
Open Enrollment
Seniors: Companies must sell you a Medigap policy - even if you have health problems - if you are at least 65 and apply within six months after enrolling in Medicare Part B. These six months are called your "open enrollment" period. During open enrollment, a company must allow you free choice among all the Medicare supplement policies it offers. You can use your open enrollment rights more than once during this six-month period. For instance, you may change your mind about a policy you bought, cancel it, and still have the right to buy any other Medigap policy, so long as the sale takes place during the six months after you enroll in Medicare Part B.
Even though a company must sell you a policy during your open enrollment period, it may require a waiting period of up to six months before covering your pre-existing conditions. Pre-existing conditions are conditions for which you received treatment or medical advice or recommendations from a physician within the previous six months.
Your right to open enrollment is absolute, even if you wait for several years after you become 65 to enroll in Medicare Part B because of continued employment or other reasons.
Texans with disabilities: In Texas, people under age 65 who receive Medicare because of disabilities have a six-month open enrollment period beginning the day they enroll in Medicare Part B. This open enrollment right is only applicable to Medigap Plan A. Companies selling Medicare supplement insurance in Texas may not deny you a Plan A policy because you have pre-existing conditions. Companies are not required to offer Plans B-J to Texans with disabilities, but they may do so if they wish.
If you need more than basic Medigap Plan A, you may be able to expand your coverage by
contacting a company that offers more than Plan A for people with disabilities
purchasing a Medicare supplement policy when you turn 65. Even if you are already receiving Medicare because of a disability, you have a six-month open enrollment period to purchase any Medigap plan a company offers when you turn 65.
Special Enrollment
You may have the right to buy a Medigap policy outside of your open enrollment period if you lose certain types of health care coverage. In general, your right to purchase Medigap coverage is limited to plans A, B, C, or F. Special enrollment periods are time sensitive and require proof of the loss of your health care coverage. Texans with disabilities also have special enrollment rights in Texas.
30-Day "Free Look"
You can return your Medigap policy within 30 days after receiving it and get your money back - with no questions asked. Be sure to keep a record of the date you received the policy. Read the policy as soon as you get it. Don't wait until the last minute. If you return the policy to the company, use certified mail with a return receipt to ensure that it's returned within the 30-day time limit.
Renewability
All Medicare supplement policies are guaranteed renewable. A company cannot cancel your policy or refuse to renew it unless you made intentional material false statements on your application or failed to pay your premium. However, the amount of the premium is not guaranteed. An insurance company may raise your premium, but may do so only once each year. If you have an "attained-age policy," a company may also raise your premium on your birthday.
Medicare Supplement Claims
Your doctor and other health care providers must submit Medicare claims to TrailBlazer for you. In most cases, TrailBlazer will then send your Medigap claim directly to your insurance company.
Medigap policies won´t pay for services that Medicare does not deem medically necessary. Therefore, if TrailBlazer denies your claim as medically unnecessary, your Medigap company won´t pay it. You have the right to appeal TrailBlazer´s decision to deny a claim. The appeal process is described in your Medicare Summary Notice. Call your local State Health Insurance Assistance Program office if you need help with an appeal.
If your Medigap company refuses to pay a claim for a Medicare-approved charge or delays payment of your claims, call TDI.
Group Medicare Supplement Insurance
Your rights with a group Medicare supplement policy are essentially the same as with an individual policy. Because the group might make decisions that are out of your control, you have the following protections:
If the group changes insurance companies, the new company must offer coverage to everyone previously covered. The new policy must cover pre-existing conditions that were covered by the old policy.
If you leave the group, the insurance company must offer to provide unbroken Medicare supplement coverage with an individual policy or continuation of your group insurance.
If the group cancels its coverage, the insurance company must offer you either an individual policy continuing the benefits you had before or a different policy meeting Texas requirements.
Unfair Practices
Agents and companies may not engage in any of the following illegal activities:
Knowingly making any misleading statement that causes someone to drop a policy and buy a replacement from another company. This is called "twisting."
Using high-pressure tactics, including the use of force, fright, or threat to pressure someone into buying a policy.
Obtaining sales leads by using advertising that hides the fact that an agent or company may try to sell you insurance. This is called "cold lead advertising."
Posing as a representative of Medicare or a government agency.
Selling you a Medigap policy that duplicates Medicare benefits or health insurance coverage you already have. An agent is required to ask if you have other health policies.
Suggesting that you falsify an application.
Using misleading advertisements made to look like mail from a government agency by including eagles or similar graphics or official-sounding government bureaus on the return address.
Return to Table of Contents
Shopping Wisely for Medicare Supplement Insurance
Key Points to Remember when Shopping
Medicare coverage: You must have both Medicare Part A and Part B to buy a Medicare supplement policy.
Open enrollment: Insurance companies must sell you a Medicare supplement policy - despite any health problems you have - during the first six months after you turn 65 and enroll in Medicare Part B. This is called "open enrollment." People under 65 with disabilities also are entitled to open enrollment for Medicare supplement Plan A for six months after enrolling in Medicare Part B. However, a company may impose a waiting period of up to six months before paying for health care related to a pre-existing medical condition.
Special enrollment: If you lose health coverage that supplements Medicare, you may be eligible to buy certain Medigap policies outside of open enrollment. This protection extends to persons under age 65 on Medicare.
Free look: You can return a policy within 30 days of the date you receive it for a full refund. Use this "free look" period to review the policy carefully.
Switching policies: Before buying any new policy, read your existing policy and the new policy. Don't switch policies just to get a lower price. Premiums can increase.
Group coverage: Group insurance through an employer or former employer often is cheaper and more comprehensive than Medicare supplement insurance. Ask before your retirement if you can keep your employee health insurance or convert it to suitable Medicare supplement coverage after you turn 65.
Money-Saving Tips
Shop around. Standardized benefit plans make price shopping easy. Use the rate guide section of this handbook to compare the prices of the plans that interest you.
Consider other factors. Price should not be your only consideration. You can learn a company's complaint record and A.M. Best financial strength rating by calling TDI's Consumer Help Line . Both are important indicators of the service you can expect from a company. Your family and friends are other sources of information about a company´s customer service. Ask them if they have had any experiences with the companies you are considering.
Consider your needs. Although it is illegal to sell you more than one Medigap policy, insurers may offer other policies with benefits that may overlap Medigap coverage. These include cancer, specified disease, hospital indemnity, and long-term care policies. Any duplication of benefits must be disclosed in writing. In general, duplicate coverage wastes money. Before buying, consider your budget and your health care needs.
Find out whether your provider accepts assignment. Providers who accept assignment of Medicare claims agree to charge the amount approved by Medicare for a particular treatment or service. Some providers do not agree to assignment. These providers may charge up to 15 percent more than the Medicare-approved charge. You must pay this excess amount. If your provider does not accept assignment of Medicare benefits, discuss the provider's charges ahead of time. This could help you avoid charges that Medicare or your Medigap insurance will not pay.
Protect Yourself
Read what you are asked to sign before you sign it. Never sign a blank application form.
If an agent tries to rush you, be suspicious!
Buy from an agent you know and trust. If you buy insurance by mail, ask if the company has a local agent or a toll-free number that you can call for answers to questions or help in filing claims.
Ask questions and take notes when you talk to an agent. These could help you later if there is a dispute over what you were told about a policy.
Make sure the agent and company are licensed. You can verify company and agent licenses by calling TDI´s Consumer Help Line
1-800-252-3439
Don´t buy insurance on the agent´s first visit. Invite someone you trust to be present during the second visit. An agent shouldn´t object.
Answer all questions on the application accurately. Don´t let the agent fill it out for you. If an agent helps you complete the application, make sure the information is correct and complete before you sign. Omitting or falsifying information could cause the company to deny your claims or cancel your policy.
Do not pay cash or make a check out to an individual agent. Always pay by check or money order so you have a clear record of payment. Make checks payable only to the insurance company or insurance agency. Insist on a receipt signed by the agent on the company´s letterhead.
Be sure you have the names and addresses of the agent and the insurance company. Know how to contact the agent and the company if you need help.
PART II - TEXAS MEDICARE SUPPLEMENT RATE GUIDE
Return to Table of Contents
How to Use the Guide
The companies listed are licensed to sell their plans throughout Texas. Companies selling Medicare Select will sell by specific areas of the state. For information about a company´s plans, call the company at the toll-free number listed in the guide or call one of the company´s agents. Check your phone book for the phone numbers of agents in your area. If a company has a Web site, the address is included in the guide.
The premiums listed vary according to area, benefits, and other factors. To learn the exact premium you would pay, call your agent or the company.
Appendix
The Appendix describes the basic benefits offered in plans A through J and the additional benefits offered in plans B through J.
Organization of the Rate Information
All the companies that sell Plan A are listed together in alphabetical order. The company's rates for ages 65, 70, and 75 are shown. After the list of companies offering Plan A is an alphabetical list of companies that sell Plan B policies. Separate lists follow for companies that sell plans C through J. The number of companies selling each plan varies. All companies must offer Plan A, but they do not have to offer any of the other plans. The guide identifies companies that offer a high-deductible option for plans F and J. Following the tables for the 10 standardized plans is a table with information about Plan A rates for people under age 65 with disabilities. Group policies are listed at the end of each individual plan list.
Key to the Rate Tables
Benefits: The chart on the inside back cover summarizes the benefits provided in each of the 10 plans. An explanation of the standard benefit plans is provided in the appendix.
Rates: The rates shown are the annual premiums you would pay in one lump sum for a year. Rates are given for the lowest annual premium the company charges and the highest annual premium. The exact premium you will pay is based on a variety of factors. Rates vary if you pay monthly or quarterly. If you have an issue-age policy, your premiums are based on your age at the time you buy. Companies may increase issue-age policy premiums once during your first year of coverage. After that, the company may not increase the premium for 12 months. If you have an attained-age policy, your premium will increase on your birthday, in addition to any rate increase during the first 12 months. Premiums usually change in January. Medigap rates are set by insurance companies, and are subject to approval by the Texas Department of Insurance.
Age: Rates are shown for people buying at ages 65, 70, and 75. You should compare costs at different ages over time. For people under 65 with disabilities, one price is shown.
Pre-existing conditions: If you move from one Medicare supplement policy to another, you get credit for the time you were covered under your prior policy. If you have had a policy for at least six months, your new policy will not have a waiting period for pre-existing medical conditions. If you are age 65 or over, have had a employer health insurance plan for at least six months, and if you purchase a Medicare supplement policy within 63 days of leaving your employer plan, you should not have a waiting period for pre-existing medical conditions. If you are not replacing a policy and a company accepts you, the company may impose a waiting period of up to six months before covering pre-existing medical conditions. The amount of time you must wait before pre-existing conditions are covered by a policy is shown in the column labeled "Pre-Ex-Wait" in the rate tables.
Group policies: You must be a member of a particular group, association, or organization to get group insurance coverage. In general, rates for group coverage are lower than rates for individual policies. Group policies are listed by plan after the individual policies.
Disability Under Age 65 - Other Plans: This table lists companies that offer additional plans to people under age 65 with disabilities. Since Texas law requires companies only to offer Plan A, people with disabilities must meet a company´s guidelines to be eligible for any of the additional plans the company offers.
Notes: Rates and policies vary according to several factors. Each one is given a different symbol in the guide:
AA
Attained Age: The AA symbol means the price of this policy will automatically increase as you get older. This increase will be in addition to any general premium increase by the company.
GI
Guaranteed Issue: The GI symbol means you will not be required to answer health questions or take a medical exam to qualify for coverage. If you do not qualify for a policy because of your health history, and your open enrollment period has passed, you should be able to buy a guaranteed issue policy from one of these companies.
MS
Medicare Select: The MS symbol means the policy is a Medicare Select policy. Medicare Select is a cost-control program in which services are provided only through a specific list of network providers. Medicare Select policies are offered by area.
AR
Area: The AR symbol means the company has different rates for different areas of the state. Call the company or ask the agent to find out what premium is charged in your area.
FM
Female/Male: The FM symbol means the company charges different rates for females and males.
NS
Nonsmoker: The NS symbol means the company charges higher prices for smokers than for nonsmokers, except during the open enrollment period.
Links to Rate Tables
Return to Table of Contents
APPENDIX - SUMMARY OF MEDICARE SUPPLEMENT BENEFITS
Medicare supplement plans A-J all provide these basic benefits to cover gaps in Medicare:
Your daily copayments for hospitalization expenses from the 61st through the 90th day of any Medicare benefit period.
Medicare Part A copayments for any hospital confinement beyond the 90th day in a benefit period, up to an additional 60 days during your lifetime. (These are your inpatient "reserve days." You may use these days when you require more than 90 days in the hospital during a benefit period. When you use a reserve day, it is subtracted from your lifetime total and cannot be used again.)
All Medicare-eligible hospital charges for a period of up to 365 additional days during your lifetime after you have exhausted all your Medicare hospital benefits.
The reasonable cost of the first three pints of blood, or their equivalent, under Medicare Parts A and B, unless replaced.
Your 20 percent Part B copayment for Medicare-eligible expenses for medical services - including doctor bills, hospital or home health care, and outpatient hospital treatment - after you have met your Part B deductible.
Additional Benefits in Plans B through J
Plans B through J offer the following additional benefits:
Skilled nursing facility care: Covers actual billed charges up to your coinsurance amount from the 21st day through the 100th day in a benefit period for post-hospital skilled nursing facility care eligible under Medicare Part A. This is not custodial care. (Available on plans C through J.)
Part A deductible: Pays the entire Medicare Part A deductible amount per benefit period. (Available on plans B through J.)
Part B deductible: Pays the entire Medicare Part B deductible amount per calendar year, regardless of whether you were hospitalized. (Available on plans C, F, and J.)
Medicare Part B excess doctor charges: Pays 80 percent or 100 percent of the excess fees, which are limited by law to 15 percent above the Medicare approved amount. If most of your doctors take Medicare assignment, you may not need this benefit. (100 percent coverage in plans F, I, and J; 80 percent coverage in plan G)
Foreign travel emergency: Pays 80 percent of the billed charges for foreign emergency care that Medicare would have covered if provided in the United States. Care must begin during your first 60 days outside the United States. Calendar year deductible is $250. Lifetime maximum benefit is $50,000. (Available on plans C through J.)
At-home recovery: Pays for doctor-approved, short-term, at-home assistance with activities of daily living while recovering from an illness, injury, or surgery. Limited to seven visits per week by a qualified care provider. Pays actual charges up to $40 per visit, with a maximum of $1,600 per year. (Available on plans D, G, I, and J.)
Preventive medical care: Includes an annual physical examination, certain lab tests, and other preventive measures deemed appropriate by your physician. Maximum benefit is $120 per year. (Available on plans E and J.)
Prescription drug benefits:
Basic: Pays 50 percent of your outpatient prescription drug charges after you meet a deductible of $250 per calendar year. To receive the maximum benefit of $1,250 per calendar year, your prescriptions would have to cost $2,750. (Available on plans H and I.)
Extended: Same as the basic prescription benefit but with a maximum benefit of $3,000 per calendar year. Your prescription costs must be at least $6,250 for you to get the maximum benefit. People with high prescription or medical costs will probably not be able to get this plan unless they apply during their six-month open enrollment period. (Available on Plan J.)
High deductibles: Offers the same benefits, but you pay a lower premium in exchange for paying a higher deductible. A deductible is the amount you pay out of pocket before the policy pays. With a high-deductible option on a Medicare supplement policy, you must pay $1,580 out of pocket before the policy pays for covered services. The deductible amount can change each year. (Available on plans F and J.)
The 10 Standard Medicare Supplement Insurance Plans
There are 10 standardized Medicare supplement insurance plans, labeled "A" through "J." Each plan offers different levels of benefits. This chart summarizes the benefits offered with each plan. Every company must offer Plan A.
These basic benefits are included in all 10 plans:
Hospitalization: Part A coinsurance plus coverage for 365 additional days after Medicare benefits end.
Medical expenses: Part B coinsurance (generally 20 percent of the Medicare-approved charge).
Blood: First three pints of blood each year.
Click on the letter to view rates for that particular plan.
A
B
C
D
E
Basic benefits
Basic benefits
Basic benefits
Basic benefits
Basic benefits
Skilled nursing coinsurance
Skilled nursing coinsurance
Skilled nursing coinsurance
Part A deductible
Part A deductible
Part A deductible
Part A deductible
Part B deductible
Foreign travel emergency
Foreign travel emergency
Foreign travel emergency
At home recovery
Preventive care
F*
G
H
I
J*
Basic benefits
Basic benefits
Basic benefits
Basic benefits
Basic benefits
Skilled nursing coinsurance
Skilled nursing coinsurance
Skilled nursing coinsurance
Skilled nursing coinsurance
Skilled nursing coinsurance
Part A deductible
Part A deductible
Part A deductible
Part A deductible
Part A deductible
Part B deductible
Part B deductible
Part B excess (100%)
Part B excess (80%)
Part B excess (100%)
Part B excess (100%)
Foreign travel emergency
Foreign travel emergency
Foreign travel emergency
Foreign travel emergency
Foreign travel emergency
At home recovery
At home recovery
At home recovery
Basic drug benefit ($1,250 limit)
Basic drug benefit ($1,250 limit)
Extended drug benefit ($3,000 limit)
Preventive care
* Plans F and J also have a high-deductible option. Although your deductible is higher, you have a lower premium. The high-deductible plans have the same benefits as the regular plans F and J.
Texas Department of Insurance
Created/Updated 10-02-2001
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If Medicare doesn't cover all your medical bills, you may want to supplement that coverage with Medicare supplement insurance. It
can help you keep
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Results from search: http://www.state.nd.us/ndins/consinfo/medicare.html
ND Department of Insurance | Medicare Supplement Insurance
North Dakota Department of
Insurance
Medicare Supplement Insurance
What Is Medicare Supplement
Insurance
Standard Medicare Supplement Plans and Premium Comparison
What Is
Medicare Supplement Insurance
Medicare supplement insurance (also referred to as
Med Sup or Medigap insurance) is private insurance that helps pay health care expenses
that Medicare covers in part or not at all. Medicare supplement insurance can provide
coverage for Medicare deductibles, co-insurance amounts and even some expenses not
eligible under Medicare.
Types of Plans Available
In North Dakota, consumers can currently purchase one of 10 different standardized
Medicare supplement plans. These plans are offered by private insurers. The plans have
letter designations ranging from "A" through "J". A is the basic
benefit package and J contains the most extensive benefits.
Plan A pays the Medicare hospital and physician coinsurance, the first three pints of
blood, and 365 days of hospitalization beyond Medicare. Plans B through J provide these
basic benefits and add further benefits such as coverage for Medicare deductibles, excess
charges and limited preventive care, foreign travel emergency care, and limited
prescription drugs.
Opportunities To Enroll For Coverage
You should only buy one Medicare supplement plan. No one should try to sell you an
additional Medicare supplement plan unless you decide you need to switch policies. If you
decide to switch, do not cancel the old policy until you have received the new one.
Federal law requires coverage to be made available to individuals without medical
underwriting during a six month open enrollment period and also during certain limited
situations involving health coverage changes. The six month open enrollment period begins
when you are age 65 or older and are enrolled in Part B of Medicare. Existing health
problems are not considered in determining your eligibility when you enroll during that
six month period. This means insurance companies are required to guaranteed issue any
Medicare supplement plan when you apply during this period and pay the required premiums.
After this six month open enrollment period, you can still apply for Medicare supplement
coverage but may be subject to underwriting. Underwriting means the company may choose to
accept or deny your application based on your health status or other risk selection
criteria.
A few companies may offer coverage on a guaranteed issue basis, outside of the open
enrollment period. This means you have the right to purchase a Medicare supplement plan at
any time, regardless of any health problem.
Medigap Protections
Some situations involving health coverage
changes may give you a guaranteed issue right to buy a Medicare supplement policy even
when you are not in your Medicare supplement open enrollment period. These are the most
likely situations to occur in North Dakota:
1. You have employer group health plan coverage
which supplements or is primary to Medicare and the employer group health plan ends.
2. You are covered by a Medicare + Choice plan
in another state and move to North Dakota which is out of the plan's service area.
There may be other circumstances that give you a
guaranteed issue right to buy a Medicare supplement plan. Please refer to pages 16 and 17
in the "2000 Guide to Heatlh Insurance for People with Medicare." You may call
the North Dakota Insurance Department (1-800-247-0560) to requeset the Medicare Guide or
to ask further questions.
Medicare Supplement Premiums
Benefits are identical for all Medicare supplement plans of the same type. Premiums may
vary greatly from one company to another and from area to area. Insurance companies use
three methods to calculate premiums: issue age, attained age and no age rating.
If your company uses the issue age method, and you were 65 when you bought the policy you
will always pay the same premiums the company charges people who are 65 regardless of your
age. The attained age method means the premium is based on your current age and will
increase as you grow older. Under the no age rating, everyone pays the same premium
regardless of age.
The Insurance Department must approve the rates charged for all Medicare supplement
policies. The insurance company can raise your premiums only when it has approval to raise
the premiums for everyone else with the same policy.
Standard
Medicare Supplement Plans and Premium Comparison
Medigap can only be sold in 10 standardized
plans. This chart shows the benefits included in each plan. Every company offers Plan A.
Companies may have some, all, or none of the other plans. Some plans may not be available.
Premium
comparison for under 65 and disabled
Basic Benefits: Included in all plans.
Hospitalization: Part A coinsurance plus coverage for 365 additional days during your
lifetime after Medicare benefits end.
Medical Expenses: Part B coinsurance (generally 20% of Medicare-approved expenses).
Blood: First 3 pints of blood each year.
(Click the letter
at the top of the chart to access a brief description of the plan's benefits and a premium
comparison.)
Medigap Benefits
A *
B *
C *
D *
E
F *
G
H
I
J *
Basic Benefits
X
X
X
X
X
X
X
X
X
X
Part A: Inpatient Hospital
Deductible
X
X
X
X
X
X
X
X
X
Part A: Skilled-Nursing
Facility Co-Insurance
X
X
X
X
X
X
X
X
Part B: Deductible
X
X
X
Foreign Travel Emergency
X
X
X
X
X
X
X
X
At-Home Recovery
X
X
X
X
Part B: Excess Charges
100%
80%
100%
100%
Preventive Care
X
X
Prescription Drugs
X
X
X
* PLAN OPTIONS
High deductible options are available for plans F and J .
Medicare Select options are available for plans A , B , C , D and F .
If you have additional questions, please call 1-800-247-0560 or email us at: ndshic@state.nd.us
© Copyright 1998-2001 North Dakota Department of Insurance || Disclaimer
|| Links
North Dakota Department of Insurance, 600 E Boulevard, Dept. 401, Bismarck, ND
58505-0320
(701) 328-2440 - phone || (701) 328-4880 - fax || insuranc@state.nd.us
May 16 2001 || www.state.nd.us/ndins/consinfo/medicare.html
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QUOTE - Abuse & Molestation (Assault & Battery Protection)
QUOTE - Professional E & O (All Professions)
QUOTE - Foster Homes (Including Adult Care)
QUOTE - Aircraft (Helicopters, Gliders, Balloon, etc)
QUOTE - Amusement Parks (Fairgrounds, Rides & Attractions)
QUOTE - Inland Marine
(Jewelry, Art Collections)
QUOTE - Dealerships
(New & Used Car, Truck, Boat)
QUOTE - Bowling Alleys
(Building, Liability, Premise)
QUOTE - Welfare Facilities
(Child & Adult)
QUOTE - Camps
(Summer, Winter, Child & Adult)
QUOTE - Clubs (Golf, Rotary, Health, etc)
QUOTE - Malpractice (Dentist, Doctor, Chiropractor, etc)
QUOTE - Farms (Ranches, Dairy, Cattle, etc)
QUOTE - Schools
(Private, Dance, Self-Defense)
QUOTE - Mobile Home Parks (Large & Small, All Types)
QUOTE - Motel
(Hotel, Franchise, Private)
QUOTE - Nursing Home (Health Care, Adult & Child)
QUOTE - Animal Shelter
(Pet Salons & Kennel Operations)
QUOTE - Police
(Security Guard, Body Guard)
QUOTE - Self Storage (Large & Small)
QUOTE - Gas Stations
(Franchise, Private, Large & Small)
QUOTE - Shopping Centers (Malls, Food
Centers)
QUOTE -
Commercial Umbrella (Commercial to 50 Million)
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Results from search: http://www.mercyhealthsystem.org/insure.htm
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MercyCare HMO
MercyCare Select
MercyCare Senior
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MercyCare TM Health Plan
Providing A System For Life to such a broad range of people means making it accessible to everyone. MercyCare Insurance Company ties the entire Mercy Health System together by making our complete health care services readily accessible to the people who need them.
Because both employers and employees in our communities need affordable care under the MercyCare label, MercyCare Insurance Company offers a choice of the following product lines:
Health maintenance organization - MercyCare HMO
Point of service (POS) - MercyCare Select
Medicaid HMO programs - MercyCare MVP
Medicare supplement - MercyCare Senior
Since its inception in 1994, MercyCare Health Plans have grown to more than 26,000 members. MercyCare plans are accepted by medical providers in Rock, Green, Jefferson, and Walworth counties in Wisconsin. MercyCare plan members can choose from more than 200 physicians in more than 70 facilities throughout southern Wisconsin. MercyCare health plans are currently available to Wisconsin employer groups only.
MercyCare Insurance Company
MercyCare Health Plan
Post Office Box 2770
Janesville, WI 53547-2770
Phone:
(800) 752-3431
Customer Service:
(800) 895-2421
MercyCare HMO
(coverage for 2+ employees)
MercyCare HMO offers its members the easy administration and full coverage of an HMO, with the quality health care of Mercy Health System and other providers. Plans for both large and small groups are available.
MercyCare HMO offers:
100% coverage
No deductible
No claim forms
Competitive rates
Wellness/Stay Healthy benefits
Preventive medicine
Coverage for routine office visits, physicals, eye and hearing exams
MercyCare Select (Point of Service)
(coverage for 2+ employees)
With MercyCare Select, members get the full benefits they need, plus the freedom to choose their own doctor and hospital.
MercyCare Select offers:
Freedom to choose doctor and hospital
100% coverage for participating providers
No claim forms
Wellness/Stay Healthy benefits
Competitive rates
No deductible in-plan
MercyCare Senior
For seniors who need supplemental insurance, MercyCare Senior offers coverage that enhances benefits paid by Medicare Parts A and B. With no bills or paperwork, MercyCare offers the security of knowing you're covered if you should need medical care.
MercyCare Senior offers:
Supplemental insurance for Medicare Parts A and B
100% coverage for routine office visits, physicals, eye and hearing exams
Wellness/Stay Healthy benefits
PCS Prescription Drug discount and mail order service
No bills or paperwork
MercyCare Senior is only available to residents in Rock, Green, Jefferson, and Walworth counties in Wisconsin.
For more information about plan options, call MercyCare Insurance Company at (800) 752-3431. Or, e-mail us at MercyCare Insurance Company .
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