Home Office: Dallas, Texas • Medicare Supplement Administrative Office: PO BOX 10812, Clearwater, FL 33757-8812 • https://service.iasadmin.com/ac For Use in Oklahoma 15-138-17-OK (12/16) Thank you for your interest in purchasing an Americo Financial Life and Annuity Insurance Company Medicare Supplement insurance policy. Below are the forms your agent discussed with you during your application process. These forms are provided for your review. If you have questions, please contact your agent. Included in this disclosure packet: î Important Consumer Notices î Guaranteed Issue Eligibility Disclosure î Outline of Coverage î Rate Guide î Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare Medicare Disclosure Packet Americo Supplement
Transcript
Home Office: Dallas, Texas • Medicare Supplement Administrative Office: PO BOX 10812, Clearwater, FL 33757-8812 • https://service.iasadmin.com/acFor Use in Oklahoma15-138-17-OK (12/16)
Thank you for your interest in purchasing an Americo Financial Life and Annuity Insurance Company Medicare Supplement insurance policy. Below are the forms your agent discussed with you during your application process. These forms are provided for your review. If you have questions, please contact your agent.
Included in this disclosure packet:î Important Consumer Noticesî Guaranteed Issue Eligibility Disclosureî Outline of Coverageî Rate Guideî Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare
MedicareDisclosure Packet
Americo
Supplement
Home Office: Dallas, Texas • Medicare Supplement Administrative Office: PO Box 10812, Clearwater, FL 33757-8812 • https://service.iasadmin.com/ac AAA8394-MS (01/17) Leave with Applicant
Americo Financial Life and Annuity Insurance Company
Medicare Supplement Administrative Office: PO Box 10812, Clearwater, FL 33757-8812
INFORMATION PRACTICES NOTICE THIS NOTIFICATION MUST BE DELIVERED TO THE PROPOSED INSURED WHEN THE APPLICATION IS COMPLETED.
Thank you for your application. This notice is given to you at the time you apply for insurance to tell you about the kinds of information we may obtain in connection with your application. We rely primarily on information provided by you. We may also collect information from others, such as medical professionals who have treated you, hospitals, other insurance companies, and consumer reporting agencies. In certain limited situations, we are allowed by law to disclose necessary items of personal information to third parties without your specific authorization. You have a right of access and correction with respect to this information. You have the right to receive, in writing, the specific reason for an adverse underwriting decision. If you wish a more detailed explanation of our information practices, please write us at: Americo Financial Life and Annuity Insurance Company, PO BOX 410288, Kansas City, MO 64141-0288, Attention: Underwriting/New Business Department. Any requests to correct, amend or alter will be responded to within 30 days. Within a seven year timeframe, information that is corrected will be provided to any person who is designated by the requesting party and who may have received the information in the prior two years. Any statement of disagreement made by a requesting party will be filed and made available to those reviewing it in the future.
MIB, INC. PRE-NOTICE Information regarding your insurability will be treated as confidential. However, Americo Financial Life and Annuity Insurance Company or its reinsurers may make a brief report to the MIB, Inc. formerly known as Medical Information Bureau, a nonprofit membership organization of life insurance companies operating as an information exchange for its members. If you apply to another MIB member company for life or health insurance or a claim is submitted to such a company, upon request the MIB will supply the company with the information it has in its file. Upon receipt of a request from you, the MIB, Inc., will arrange disclosure of any information it has in your file. Please contact MIB at 866.692.6901 (TTY 866.346.3642). If you question the accuracy of information in the file, you may contact the MIB and seek a correction in accordance with the procedures in the Fair Credit Reporting Act. The MIB’s information office address is 50 Braintree Hill Park, Suite 400, Braintree, MA 02184-8734. The Company or its reinsurers may release information in its file to its reinsurers and to other life and health insurance companies to whom you apply for insurance or to whom a claim is submitted. Information for consumers about MIB may be obtained on its website at www.mib.com.
Important
Consumer Notices AAA8394-MS (01/17)
Home Office: Dallas, Texas • Medicare Supplement Administrative Office: PO Box 10812, Clearwater, FL 33757-8812 • https://service.iasadmin.com/ac AAA8564 Leave with Applicant
Disclosure Guaranteed Issue Eligibility AAA8564
Americo Financial Life and Annuity Insurance Company
The following are definitions of the categories of individuals who are eligible for Guaranteed Issue under the Balanced Budget Act of 1997: Enrolled under an employee welfare benefit plan that provides health benefits that supplement the benefits under Medicare; and
the plan terminates, or the plan ceases to provide all such supplemental health benefits to the individual, or the individual is enrolled under an employee welfare benefit plan that is primary to Medicare and the plan terminates, or the plan ceases to provide health benefits to the individual because the individual leaves the plan (eligible for Plans A or F); or
Enrolled in a Medicare Advantage plan or Program of All-Inclusive Care for the Elderly (PACE) and the organization’s certification or plan is terminated or specific circumstances permit discontinuance including, but not limited to, a change in residence of the individual, the plan is terminated within a residence area, the organization substantially violated a material policy provision, including the failure to provide an enrollee on a timely basis medically necessary care for which benefits are available under the plan or the failure to provide the covered care in accordance with applicable quality standards; or a material misrepresentation was made to the individual, or the person meets any other exceptional conditions as the secretary may provide (eligible for Plans A or F); or
Enrolled in a Medicare risk contract, health care prepayment plan, cost contract or Medicare Select plan, or similar organization, and the organization’s certification or plan is terminated or specific circumstances permit discontinuance including, but not limited to, a change in residence of the individual, the plan is terminated within a residence area, the organization substantially violated a material policy provision, or a material misrepresentation was made to the individual (eligible for Plans A or F); or
Enrolled in a Medicare Supplement policy and coverage discontinues due to insolvency, substantial violation of a material policy provision, or material misrepresentation (eligible for Plans A or F); or
Enrolled under a Medicare Supplement policy, terminates and enrolls for the first time in a Medicare Advantage, a risk or cost contract, or a Medicare Select plan, a PACE provider, and then terminates coverage within 12 months of enrollment (eligible for the same Plan you terminated with us, or, if that Plan is no longer available, Plans A or F); or Upon first becoming eligible for benefits under Part A at age 65, enrolls in a Medicare Advantage or PACE provider and then disenrolls within 12 months (eligible for all plans available from us); or
Enrolled in a Medicare Part D Plan during the initial Part D enrollment period while enrolled under a Medicare Supplement policy that covers outpatient prescription drugs and terminate the Medicare Supplement policy (eligible for Plans A or F).
Documentation of these events must be submitted with the Application.
You must apply within 63 days of the date of termination of previous coverage in order to qualify as an eligible person.
AM
ER
ICO
FIN
AN
CIA
L L
IFE
AN
D A
NN
UIT
Y IN
SU
RA
NC
E C
OM
PA
NY
Ou
tlin
e o
f C
ove
rage
Med
icar
e S
up
ple
men
t B
enef
it P
lan
s A
, F, H
igh
Ded
uct
ible
F, G
, an
d N
.
AO
K5
00-O
C (
09
/18)
Eff
ecti
ve:
10/0
1/2
018
Thi
s ch
art s
how
s th
e be
nefit
s in
clud
ed in
eac
h of
the
stan
dard
Med
icar
e S
uppl
emen
t pla
ns. E
very
insu
rer
mus
t mak
e av
aila
ble
Pla
n “A
.” S
ome
plan
s m
ay n
ot b
e
avai
labl
e in
you
r st
ate.
See
Out
line
of C
over
age
sect
ions
for
deta
ils a
bout
ALL
pla
ns. “
Bas
ic B
enef
its”
are
:
•H
osp
ital
izat
ion
– P
art A
coi
nsur
ance
plu
s co
vera
ge fo
r 36
5 ad
ditio
nal d
ays
afte
r M
edic
are
Ben
efits
end
.
•M
edic
al E
xpen
ses
– P
art B
coi
nsur
ance
(gen
eral
ly 2
0% o
f Med
icar
e ap
prov
ed a
mou
nts)
or
copa
ymen
ts fo
r hos
pita
l out
patie
nt s
ervi
ces.
Pla
ns K
, L, a
nd N
req
uire
insu
red’
s to
pay
a p
ortio
n of
Par
t B c
oins
uran
ce o
r co
paym
ents
.
•B
loo
d –
Firs
t thr
ee p
ints
of b
lood
eac
h ye
ar.
•H
osp
ice
– P
art A
coi
nsur
ance
•O
nly
Med
icar
e S
up
ple
men
t B
enef
it P
lan
s A
, F, H
igh
Ded
uct
ible
F, G
, an
d N
are
off
ered
by
Am
eric
o F
inan
cial
Lif
e an
d A
nn
uit
y In
sura
nce
Co
mp
any.
A
B
C
D
F /
F*
G
K
L
M
N
Bas
ic
incl
udin
g 10
0% P
art B
C
oins
uran
ce
Bas
ic in
clud
ing
100%
Par
t B
Coi
nsur
ance
Bas
ic in
clud
ing
100%
Par
t B
Coi
nsur
ance
Bas
ic in
clud
ing
100%
Par
t B
Coi
nsur
ance
Bas
ic in
clud
ing
100%
Par
t B
Coi
nsur
ance
Bas
ic in
clud
ing
100%
Par
t B
Coi
nsur
ance
Hos
pita
lizat
ion
and
prev
enta
tive
care
pai
d at
10
0%; o
ther
B
asic
Ben
efits
pa
id a
t 50%
Hos
pita
lizat
ion
and
prev
enta
tive
care
pai
d at
10
0%; o
ther
B
asic
Ben
efits
pa
id a
t 75%
Bas
ic in
clud
ing
100%
Par
t B
Coi
nsur
ance
Bas
ic in
clud
ing
100%
P
art B
Coi
nsur
ance
, ex
cept
up
to $
20
copa
ymen
t for
offi
ce
visi
t, an
d up
to $
50
copa
ymen
t for
E
mer
genc
y R
oom
th
at d
on’t
resu
lt in
in
patie
nt a
dmis
sion
. S
kille
d N
ursi
ng
Fac
ility
C
oins
uran
ce
Ski
lled
Nur
sing
F
acili
ty
Coi
nsur
ance
Ski
lled
Nur
sing
F
acili
ty
Coi
nsur
ance
Ski
lled
Nur
sing
F
acili
ty
Coi
nsur
ance
50%
Ski
lled
Nur
sing
Fac
ility
C
oins
uran
ce
75%
Ski
lled
Nur
sing
Fac
ility
C
oins
uran
ce
Ski
lled
Nur
sing
F
acili
ty
Coi
nsur
ance
Ski
lled
Nur
sing
F
acili
ty C
oins
uran
ce
Par
t A D
educ
tible
P
art A
Ded
uctib
le
Par
t A
Ded
uctib
le
Par
t A
Ded
uctib
le
Par
t A
Ded
uctib
le
50%
Par
t A
Ded
uctib
le
75%
Par
t A
Ded
uctib
le
50%
Par
t A
Ded
uctib
le
Par
t A D
educ
tible
Par
t B D
educ
tible
P
art B
D
educ
tible
P
art B
Exc
ess
100%
P
art B
Exc
ess
100%
F
orei
gn T
rave
l E
mer
genc
y F
orei
gn T
rave
l E
mer
genc
y F
orei
gn T
rave
l E
mer
genc
y F
orei
gn T
rave
l E
mer
genc
y F
orei
gn T
rave
l E
mer
genc
y F
orei
gn T
rave
l E
mer
genc
y O
ut-o
f-P
ocke
t lim
it $5
,240
; pai
d at
100
% a
fter
limit
reac
hed.
Out
-of-
Poc
ket
limit
$2,6
20;
paid
at 1
00%
af
ter
limit
reac
hed.
*Pla
n F
als
o ha
s an
opt
ion
calle
d a
high
Ded
uctib
le P
lan
F. T
his
high
Ded
uctib
le p
lan
pays
the
sam
e be
nefit
s as
Pla
n F
afte
r on
e ha
s pa
id a
cal
enda
r ye
ars
$2,2
40
Ded
uctib
le. B
enef
its fr
om h
igh
Ded
uctib
le P
lan
F w
ill n
ot b
egin
unt
il ou
t-of
-poc
ket e
xpen
ses
exce
ed $
2,24
0. O
ut-o
f-po
cket
exp
ense
s fo
r th
is D
educ
tible
are
exp
ense
s th
at
wou
ld h
ave
ordi
naril
y be
en p
aid
by th
e P
olic
y. T
hese
exp
ense
s in
clud
e th
e M
edic
are
Ded
uctib
les
for
Par
t A a
nd P
art B
, but
do
not i
nclu
de th
e pl
ans
sepa
rate
For
eign
Tra
vel E
mer
genc
y D
educ
tible
.
1 of 1
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Fem
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5.34
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2.36
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4.81
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For
Ann
ual P
rem
ium
mod
e, m
ultip
ly m
onth
ly r
ates
by
12.
For
Cla
ss 1
rat
es m
ultip
ly b
y 1.
15.
Att
ain
ed
Ag
e
Mo
nth
ly R
ates
by
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n -
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ma
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des
: A
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ith
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n F
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h D
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125.
0714
3.83
7617
5.33
201.
6319
3.38
222.
3956
.44
64.9
115
7.99
181.
6912
8.64
147.
9377
178.
5020
5.28
198.
1522
7.87
58.1
566
.88
162.
1518
6.48
132.
2415
2.08
7818
1.79
209.
0520
3.07
233.
5259
.89
68.8
716
6.44
191.
4013
5.94
156.
3379
185.
1021
2.87
208.
0323
9.23
61.6
570
.90
170.
7619
6.37
139.
6816
0.63
8018
8.55
216.
8321
3.15
245.
1263
.44
72.9
517
5.21
201.
5014
3.53
165.
0681
191.
3122
0.00
218.
2625
0.99
65.2
675
.05
179.
6620
6.61
147.
5716
9.70
8219
4.19
223.
3222
3.53
257.
0667
.11
77.1
818
4.24
211.
8815
1.73
174.
4883
197.
1022
6.66
228.
8626
3.19
68.9
979
.33
188.
8821
7.21
155.
9317
9.32
8420
0.04
230.
0523
4.25
269.
3970
.89
81.5
219
3.57
222.
6016
0.18
184.
2185
203.
0123
3.46
239.
7127
5.66
72.7
483
.65
198.
3122
8.06
164.
4818
9.16
8620
5.69
236.
5524
4.73
281.
4474
.32
85.4
620
2.63
233.
0316
8.40
193.
6687
208.
4023
9.66
249.
8228
7.29
75.9
187
.30
207.
0223
8.07
172.
3819
8.23
8821
1.15
242.
8225
4.99
293.
2377
.52
89.1
521
1.47
243.
1917
6.41
202.
8789
213.
8224
5.89
260.
0929
9.11
79.1
691
.03
215.
8724
8.25
180.
4120
7.47
9021
6.42
248.
8826
5.14
304.
9180
.81
92.9
322
0.22
253.
2618
4.38
212.
0491
218.
0425
0.74
269.
2230
9.61
82.3
194
.66
223.
7525
7.31
187.
6921
5.84
9221
9.67
252.
6227
3.35
314.
3583
.83
96.4
122
7.31
261.
4019
1.03
219.
6893
221.
0925
4.26
277.
2431
8.83
85.3
798
.18
230.
6726
5.27
194.
2122
3.34
9422
2.53
255.
9128
1.17
323.
3486
.93
99.9
723
4.07
269.
1819
7.42
227.
0495
223.
9725
7.57
285.
1332
7.90
88.5
010
1.78
237.
5027
3.12
200.
6723
0.77
9622
6.21
260.
1428
7.98
331.
1789
.12
102.
4923
9.87
275.
8520
2.67
233.
0797
228.
4726
2.74
290.
8633
4.49
89.7
510
3.21
242.
2727
8.61
204.
7023
5.41
9823
0.76
265.
3729
3.77
337.
8390
.37
103.
9324
4.69
281.
4020
6.75
237.
7699
233.
0626
8.02
296.
7034
1.21
91.0
110
4.66
247.
1428
4.21
208.
8224
0.14
For
Ann
ual P
rem
ium
mod
e, m
ultip
ly m
onth
ly r
ates
by
12.
For
Cla
ss 1
rat
es m
ultip
ly b
y 1.
15.
Pla
n F
Hig
h D
edu
ctib
le
Mo
nth
ly R
ates
by
Pla
n -
Okl
aho
ma
Zip
Co
des
: A
ll Z
ip C
od
es t
hat
sta
rt w
ith
730
-731
, 741
Pla
n F
Pla
n G
Pla
n N
Att
ain
ed
Ag
e
To
bac
co R
ates
Pla
n A
AO
K50
0-O
C R
AT
ES
(09
/18)
Effe
ctiv
e: 1
0/01
/201
8
RA
TE
S3 o
f 18
Fem
ale
Mal
eF
emal
eM
ale
Fem
ale
Mal
eF
emal
eM
ale
Fem
ale
Mal
e0-
6498
.50
113.
27n/
an/
an/
an/
an/
an/
an/
an/
a65
98.5
011
3.27
107.
2312
3.31
31.3
436
.04
85.1
897
.95
69.3
279
.72
6698
.50
113.
2710
7.23
123.
3131
.34
36.0
485
.18
97.9
569
.32
79.7
267
98.5
011
3.27
107.
2312
3.31
31.3
436
.04
85.1
897
.95
69.3
279
.72
6810
2.69
118.
0911
1.49
128.
2131
.34
36.0
488
.95
102.
3072
.34
83.1
969
106.
8112
2.83
115.
8613
3.24
32.3
537
.20
92.8
210
6.75
75.3
686
.66
7011
0.80
127.
4211
9.92
137.
9133
.94
39.0
396
.42
110.
8978
.21
89.9
471
114.
1113
1.23
123.
8414
2.42
35.1
440
.41
99.9
011
4.89
81.0
793
.23
7211
7.42
135.
0412
7.77
146.
9336
.34
41.8
010
3.38
118.
8983
.93
96.5
273
120.
7413
8.85
131.
6915
1.45
37.6
643
.31
106.
8612
2.89
86.7
999
.81
7412
4.05
142.
6613
5.62
155.
9638
.99
44.8
311
0.34
126.
8989
.65
103.
1075
127.
4314
6.55
139.
6116
0.55
40.5
246
.60
113.
8713
0.95
92.5
610
6.44
7612
9.76
149.
2214
3.11
164.
5841
.77
48.0
411
6.92
134.
4695
.20
109.
4877
132.
1015
1.92
146.
6416
8.64
43.0
449
.49
120.
0013
8.00
97.8
711
2.54
7813
4.53
154.
7115
0.28
172.
8244
.32
50.9
712
3.17
141.
6510
0.61
115.
7079
136.
9915
7.54
153.
9517
7.05
45.6
352
.47
126.
3714
5.33
103.
3711
8.88
8013
9.54
160.
4715
7.74
181.
4046
.95
53.9
912
9.67
149.
1210
6.22
122.
1581
141.
5816
2.81
161.
5218
5.75
48.3
055
.54
132.
9615
2.90
109.
2112
5.59
8214
3.71
165.
2716
5.42
190.
2449
.67
57.1
213
6.35
156.
8011
2.29
129.
1383
145.
8616
7.74
169.
3719
4.78
51.0
558
.71
139.
7816
0.75
115.
4013
2.71
8414
8.04
170.
2517
3.36
199.
3752
.46
60.3
314
3.25
164.
7411
8.54
136.
3385
150.
2417
2.78
177.
4020
4.01
53.8
361
.91
146.
7616
8.78
121.
7313
9.99
8615
2.22
175.
0618
1.11
208.
2855
.00
63.2
514
9.96
172.
4512
4.63
143.
3287
154.
2317
7.37
184.
8821
2.61
56.1
864
.61
153.
2117
6.19
127.
5714
6.70
8815
6.26
179.
7018
8.70
217.
0157
.37
65.9
815
6.50
179.
9713
0.55
150.
1489
158.
2418
1.98
192.
4822
1.36
58.5
867
.37
159.
7618
3.72
133.
5215
3.54
9016
0.16
184.
1819
6.22
225.
6559
.80
68.7
716
2.98
187.
4213
6.45
156.
9291
161.
3618
5.56
199.
2422
9.13
60.9
270
.05
165.
5919
0.42
138.
9015
9.73
9216
2.57
186.
9520
2.29
232.
6462
.04
71.3
516
8.22
193.
4514
1.37
162.
5893
163.
6218
8.16
205.
1723
5.95
63.1
872
.66
170.
7119
6.32
143.
7316
5.29
9416
4.68
189.
3920
8.08
239.
2964
.33
73.9
817
3.23
199.
2114
6.11
168.
0295
165.
7519
0.61
211.
0124
2.66
65.5
075
.32
175.
7620
2.13
148.
5117
0.78
9616
7.41
192.
5221
3.12
245.
0965
.96
75.8
517
7.52
204.
1514
9.99
172.
4997
169.
0819
4.45
215.
2524
7.54
66.4
276
.38
179.
2920
6.19
151.
4917
4.21
9817
0.77
196.
3921
7.40
250.
0166
.88
76.9
118
1.09
208.
2515
3.01
175.
9699
172.
4819
8.35
219.
5825
2.51
67.3
577
.45
182.
9021
0.33
154.
5317
7.72
For
Ann
ual P
rem
ium
mod
e, m
ultip
ly m
onth
ly r
ates
by
12.
For
Cla
ss 1
rat
es m
ultip
ly b
y 1.
15.
Pla
n F
Pla
n G
Pla
n N
Pla
n F
Hig
h D
edu
ctib
le
Mo
nth
ly R
ates
by
Pla
n -
Okl
aho
ma
Zip
Co
des
: A
ll Z
ip C
od
es t
hat
sta
rt w
ith
732
-740
, 742
-749
Att
ain
ed
Ag
e
No
n-T
ob
acco
Rat
es
Pla
n A
AO
K50
0-O
C R
AT
ES
(09
/18)
Effe
ctiv
e: 1
0/01
/201
8
RA
TE
S4 o
f 18
Fem
ale
Mal
eF
emal
eM
ale
Fem
ale
Mal
eF
emal
eM
ale
Fem
ale
Mal
e0-
6411
3.27
130.
26n/
an/
an/
an/
an/
an/
an/
an/
a65
113.
2713
0.26
123.
3114
1.81
36.0
441
.44
97.9
511
2.64
79.7
291
.68
6611
3.27
130.
2612
3.31
141.
8136
.04
41.4
497
.95
112.
6479
.72
91.6
867
113.
2713
0.26
123.
3114
1.81
36.0
441
.44
97.9
511
2.64
79.7
291
.68
6811
8.09
135.
8112
8.21
147.
4536
.04
41.4
410
2.30
117.
6483
.19
95.6
769
122.
8314
1.26
133.
2415
3.22
37.2
042
.78
106.
7512
2.76
86.6
699
.66
7012
7.42
146.
5313
7.91
158.
5939
.03
44.8
811
0.89
127.
5289
.94
103.
4371
131.
2315
0.91
142.
4216
3.78
40.4
146
.47
114.
8913
2.12
93.2
310
7.21
7213
5.04
155.
2914
6.93
168.
9741
.80
48.0
711
8.89
136.
7296
.52
110.
9973
138.
8515
9.68
151.
4517
4.16
43.3
149
.81
122.
8914
1.32
99.8
111
4.78
7414
2.66
164.
0615
5.96
179.
3544
.83
51.5
612
6.89
145.
9210
3.10
118.
5675
146.
5516
8.53
160.
5518
4.64
46.6
053
.59
130.
9515
0.59
106.
4412
2.41
7614
9.22
171.
6016
4.58
189.
2748
.04
55.2
413
4.46
154.
6310
9.48
125.
9077
151.
9217
4.70
168.
6419
3.93
49.4
956
.92
138.
0015
8.70
112.
5412
9.43
7815
4.71
177.
9217
2.82
198.
7450
.97
58.6
214
1.65
162.
8911
5.70
133.
0579
157.
5418
1.17
177.
0520
3.60
52.4
760
.34
145.
3316
7.13
118.
8813
6.71
8016
0.47
184.
5318
1.40
208.
6153
.99
62.0
914
9.12
171.
4912
2.15
140.
4881
162.
8118
7.24
185.
7521
3.61
55.5
463
.87
152.
9017
5.84
125.
5914
4.43
8216
5.27
190.
0619
0.24
218.
7757
.12
65.6
815
6.80
180.
3212
9.13
148.
5083
167.
7419
2.90
194.
7822
3.99
58.7
167
.52
160.
7518
4.86
132.
7115
2.61
8417
0.25
195.
7819
9.37
229.
2760
.33
69.3
816
4.74
189.
4513
6.33
156.
7785
172.
7819
8.69
204.
0123
4.61
61.9
171
.19
168.
7819
4.09
139.
9916
0.98
8617
5.06
201.
3220
8.28
239.
5263
.25
72.7
417
2.45
198.
3214
3.32
164.
8287
177.
3720
3.97
212.
6124
4.51
64.6
174
.30
176.
1920
2.61
146.
7016
8.71
8817
9.70
206.
6621
7.01
249.
5665
.98
75.8
717
9.97
206.
9715
0.14
172.
6689
181.
9820
9.27
221.
3625
4.56
67.3
777
.47
183.
7221
1.28
153.
5417
6.57
9018
4.18
211.
8122
5.65
259.
5068
.77
79.0
918
7.42
215.
5415
6.92
180.
4691
185.
5621
3.40
229.
1326
3.49
70.0
580
.56
190.
4221
8.99
159.
7318
3.69
9218
6.95
215.
0023
2.64
267.
5371
.35
82.0
519
3.45
222.
4716
2.58
186.
9693
188.
1621
6.39
235.
9527
1.34
72.6
683
.56
196.
3222
5.77
165.
2919
0.08
9418
9.39
217.
7923
9.29
275.
1873
.98
85.0
819
9.21
229.
0916
8.02
193.
2295
190.
6121
9.21
242.
6627
9.06
75.3
286
.62
202.
1323
2.45
170.
7819
6.40
9619
2.52
221.
4024
5.09
281.
8575
.85
87.2
320
4.15
234.
7717
2.49
198.
3697
194.
4522
3.61
247.
5428
4.67
76.3
887
.84
206.
1923
7.12
174.
2120
0.35
9819
6.39
225.
8525
0.01
287.
5276
.91
88.4
520
8.25
239.
4917
5.96
202.
3599
198.
3522
8.11
252.
5129
0.39
77.4
589
.07
210.
3324
1.88
177.
7220
4.37
For
Ann
ual P
rem
ium
mod
e, m
ultip
ly m
onth
ly r
ates
by
12.
For
Cla
ss 1
rat
es m
ultip
ly b
y 1.
15.
Pla
n A
Pla
n F
Hig
h D
edu
ctib
le
Mo
nth
ly R
ates
by
Pla
n -
Okl
aho
ma
Zip
Co
des
: A
ll Z
ip C
od
es t
hat
sta
rt w
ith
732
-740
, 742
-749
Pla
n F
Pla
n G
Pla
n N
Att
ain
ed
Ag
e
To
bac
co R
ates
AO
K50
0-O
C R
AT
ES
(09
/18)
Effe
ctiv
e: 1
0/01
/201
8
RA
TE
S5 o
f 18
AM
ER
ICO
FIN
AN
CIA
L L
IFE
AN
D A
NN
UIT
Y IN
SU
RA
NC
E C
OM
PA
NY
Ou
tlin
e o
f C
ove
rage
Med
icar
e S
up
ple
men
t B
enef
it P
lan
s A
, F, H
igh
Ded
uct
ible
F, G
, an
d N
.
AO
K5
00-O
C (
09
/18)
Eff
ecti
ve:
10/0
1/2
018
Dis
clo
sure
s. U
se th
is o
utlin
e to
com
pare
ben
efits
and
pre
miu
ms
amon
g po
licie
s.
Pre
miu
m In
form
atio
n. A
mer
ico
Fin
anci
al L
ife a
nd A
nnui
ty In
sura
nce
Com
pany
can
onl
y ra
ise
your
pre
miu
m if
we
rais
e th
e pr
emiu
m fo
r al
l pol
icie
s lik
e yo
urs
in th
e sa
me
geog
raph
ic a
rea
of th
e st
ate
whe
re y
ou li
ve. U
ntil
you
are
age
99, y
our
prem
ium
may
cha
nge
each
yea
r. T
his
chan
ge w
ill o
nly
be m
ade
on th
e fir
st r
enew
al d
ate
that
co
inci
des
with
or
follo
ws
each
ann
iver
sary
of t
he e
ffect
ive
date
. Sch
edul
es o
f rat
es m
ay v
ary
depe
ndin
g up
on y
our
effe
ctiv
e da
te.
Rea
d Y
ou
r P
olic
y V
ery
Car
efu
lly.
Th
is is
on
ly a
n o
utlin
e d
escr
ibin
g y
ou
r p
olic
y’s
mos
t im
po
rtan
t fe
atu
res.
Th
e p
olic
y is
yo
ur
insu
ran
ce c
on
trac
t. Y
ou
mu
st
read
th
e p
olic
y it
self
to
und
erst
and
all
of
the
rig
hts
an
d d
uti
es o
f b
oth
yo
u a
nd u
s.
Rig
ht
to R
etu
rn P
olic
y. If
you
find
that
you
are
not
sat
isfie
d w
ith y
our
polic
y, y
ou m
ay r
etur
n it
to u
s at
our
Med
icar
e S
uppl
emen
t Adm
inis
trat
ive
Offi
ces
PO
Box
108
12,
Cle
arw
ater
, FL
3325
7-88
12. I
f you
sen
d th
e po
licy
back
to u
s w
ithin
30
days
afte
r yo
u re
ceiv
e it,
we
will
trea
t the
pol
icy
as if
it h
ad n
ever
bee
n is
sued
and
ret
urn
all o
f you
r pa
ymen
ts.
Po
licy
Rep
lace
men
t. If
you
are
rep
laci
ng a
noth
er h
ealth
insu
ranc
e po
licy,
do
NO
T c
ance
l it u
ntil
you
have
act
ually
rec
eive
d yo
ur n
ew p
olic
y an
d ar
e su
re y
ou w
ant t
o ke
ep it
.
No
tice
. The
pol
icy
may
not
fully
cov
er a
ll of
you
r m
edic
al c
osts
. Nei
ther
we
nor o
ur a
gent
s ar
e co
nnec
ted
with
Med
icar
e. T
his
outli
ne d
oes
not g
ive
all t
he d
etai
ls o
f M
edic
are
cove
rage
. Con
tact
you
r lo
cal S
ocia
l Sec
urity
offi
ce o
r co
nsul
t “M
edic
are
& Y
ou” f
or m
ore
deta
ils.
Co
mp
lete
An
swer
s A
re V
ery
Imp
ort
ant.
Whe
n yo
u fil
l out
the
appl
icat
ion
for
the
new
pol
icy,
be
sure
to a
nsw
er tr
uthf
ully
and
com
plet
ely
all q
uest
ions
abo
ut y
our
med
ical
and
hea
lth h
isto
ry. W
e m
ay c
ance
l you
r pol
icy
and
refu
se to
pay
any
cla
ims
if yo
u le
ave
out o
r fa
lsify
impo
rtan
t med
ical
info
rmat
ion.
Rev
iew
th
e ap
plic
atio
n
care
fully
bef
ore
yo
u s
ign
it. B
e ce
rtai
n t
hat
all
info
rmat
ion
has
bee
n p
rop
erly
rec
ord
ed.
No
Hea
lth
Rev
iew
. No
heal
th r
evie
w is
req
uire
d if
you
enro
ll w
ithin
the
first
six
mon
ths
afte
r yo
u re
ach
age
65 a
nd e
nrol
l in
Med
icar
e P
art B
, or
in o
ther
situ
atio
ns a
s re
quire
d by
law
.
PL
EA
SE
RE
FE
R T
O Y
OU
R P
OL
ICY
FO
R D
ET
AIL
S.
6 of 1
8
AM
ER
ICO
FIN
AN
CIA
L L
IFE
AN
D A
NN
UIT
Y IN
SU
RA
NC
E C
OM
PA
NY
Ou
tlin
e o
f C
ove
rage
Med
icar
e S
up
ple
men
t B
enef
it P
lan
s A
, F, H
igh
Ded
uct
ible
F, G
, an
d N
.
AO
K5
00-O
C (
09
/18)
Eff
ecti
ve:
10/0
1/2
018
P
lan
A
Pla
n A
Med
icar
e P
art
A –
Ho
spit
al S
ervi
ces
Per
Ben
efit
Per
iod
*A b
enef
it pe
riod
begi
ns o
n th
e fir
st d
ay y
ou r
ecei
ve s
ervi
ce a
s an
inpa
tient
in a
hos
pita
l and
end
s af
ter
you
have
bee
n ou
t of t
he h
ospi
tal a
nd h
ave
not r
ecei
ved
skill
ed
care
in a
ny o
ther
faci
lity
for 6
0 da
ys in
a r
ow.
Ser
vice
s M
edic
are
Pay
s P
lan
A P
ays
Yo
u P
ay
Ho
spit
aliz
atio
n S
emip
rivat
e ro
om a
nd b
oard
, gen
eral
nur
sing
and
mis
cella
neou
s se
rvic
es a
nd s
uppl
ies.
F
irst 6
0 da
ys
All
but $
1,34
0 $0
$1
,340
Par
t A D
educ
tible
61
st th
ru 9
0th d
ay
All
but $
335
a da
y $3
35 a
day
$0
91
st d
ay a
nd a
fter
-W
hile
usi
ng 6
0 lif
etim
e re
serv
e da
ys-
Onc
e lif
etim
e re
serv
e da
ys a
re u
sed
�
Add
ition
al 3
65 d
ays
�
Bey
ond
the
addi
tiona
l 365
day
s
All
but $
670
a da
y
$0
$0
$670
a d
ay
100%
of M
edic
are
Elig
ible
Exp
ense
s $0
$0
$0**
A
ll C
osts
S
kille
d N
urs
ing
Fac
ility
Car
e Y
ou m
ust m
eet M
edic
are’
s re
quire
men
ts, i
nclu
ding
hav
ing
been
in a
ho
spita
l for
at l
east
3 d
ays
and
ente
red
a M
edic
are
appr
oved
faci
lity
with
in 3
0 da
ys a
fter
leav
ing
the
hosp
ital.
Firs
t 20
days
21
st th
ru 1
00th d
ays
101st
day
and
afte
r
All
appr
oved
am
ount
s A
ll bu
t $16
7.50
a d
ay
$0
$0
$0
$0
$0
Up
to $
167.
50 a
day
A
ll C
osts
B
loo
d
Firs
t 3 p
ints
A
dditi
onal
am
ount
s $0
10
0%
3 pi
nts
$0
$0
$0
Ho
spic
e C
are
You
mus
t mee
t Med
icar
e’s
requ
irem
ents
, inc
ludi
ng a
doc
tor’s
ce
rtifi
catio
n of
term
inal
illn
ess.
A
ll bu
t ver
y lim
ited
copa
ymen
t/coi
nsur
ance
fo
r ou
tpat
ient
dru
gs a
nd
inpa
tient
res
pite
car
e.
Med
icar
e co
paym
ent/c
oins
uran
ce
$0
* *W
hen
your
Med
icar
e P
art A
hos
pita
l ben
efits
are
exh
aust
ed, t
he in
sure
r st
ands
in th
e pl
ace
of M
edic
are
and
will
pay
wha
teve
r am
ount
Med
icar
e w
ould
hav
e pa
id fo
r up
to a
n ad
ditio
nal 3
65 d
ays
as p
rovi
ded
in th
e po
licy’
s “C
ore
Ben
efits
.” D
urin
g th
is ti
me,
the
hosp
ital i
s pr
ohib
ited
from
bill
ing
you
for
the
bala
nce
base
d on
any
diff
eren
ce
betw
een
its b
illed
cha
rges
and
the
amou
nt M
edic
are
wou
ld h
ave
paid
.
7 of 1
8
AM
ER
ICO
FIN
AN
CIA
L L
IFE
AN
D A
NN
UIT
Y IN
SU
RA
NC
E C
OM
PA
NY
Ou
tlin
e o
f C
ove
rage
Med
icar
e S
up
ple
men
t B
enef
it P
lan
s A
, F, H
igh
Ded
uct
ible
F, G
, an
d N
.
AO
K5
00-O
C (
09
/18)
Eff
ecti
ve:
10/0
1/2
018
P
lan
A
Pla
n A
Med
icar
e P
art
B –
Med
ical
Ser
vice
s p
er C
alen
dar
Yea
r
*Onc
e yo
u ha
ve b
een
bille
d $1
83 o
f Med
icar
e E
ligib
le E
xpen
ses
for
cove
red
serv
ices
, you
r M
edic
are
Par
t B D
educ
tible
will
hav
e be
en m
et fo
r th
e ca
lend
ar y
ear.
Ser
vice
s M
edic
are
Pay
s P
lan
A P
ays
Yo
u P
ay
Med
ical
Exp
ense
s In
or
out o
f the
hos
pita
l and
out
patie
nt h
ospi
tal t
reat
men
t, su
ch a
s P
hysi
cian
’s
serv
ices
, inp
atie
nt a
nd o
utpa
tient
med
ical
and
sur
gica
l ser
vice
s an
d su
pplie
s,
phys
ical
and
spe
ech
ther
apy,
dia
gnos
tic te
sts,
dur
able
med
ical
equ
ipm
ent
Firs
t $18
3 of
Med
icar
e ap
prov
ed a
mou
nts*
R
emai
nder
of M
edic
are
appr
oved
am
ount
s $0
G
ener
ally
80%
$0
G
ener
ally
20%
$1
83 P
art B
Ded
uctib
le
$0
Par
t B
Exc
ess
Ch
arge
s (a
bove
Med
icar
e ap
prov
ed a
mou
nts)
$0
$0
A
ll co
sts
Blo
od
F
irst 3
pin
ts
Nex
t $18
3 of
Med
icar
e ap
prov
ed a
mou
nts*
R
emai
nder
of M
edic
are
appr
oved
am
ount
s
$0
$0
80%
All
cost
s $0
20
%
$ 0
$183
Par
t B D
educ
tible
$0
C
linic
al L
abo
rato
ry S
ervi
ces
– T
ests
for
diag
nost
ic s
ervi
ces
100%
$0
$0
Par
ts A
& B
Ser
vice
s M
edic
are
Pay
s P
lan
A P
ays
Yo
u P
ay
Ho
me
Hea
lth
Car
e M
edic
are
Elig
ible
Ser
vice
s -
Med
ical
ly n
eces
sary
ski
lled
care
ser
vice
s an
d m
edic
al s
uppl
ies
-D
urab
le m
edic
al e
quip
men
t. F
irst $
183
of M
edic
are
appr
oved
am
ount
s*-
Rem
aind
er o
f Med
icar
e ap
prov
ed a
mou
nts
100%
$0
80
%
$0
$0
20%
$0
$183
Par
t B D
educ
tible
$0
8 of 1
8
AM
ER
ICO
FIN
AN
CIA
L L
IFE
AN
D A
NN
UIT
Y IN
SU
RA
NC
E C
OM
PA
NY
Ou
tlin
e o
f C
ove
rage
Med
icar
e S
up
ple
men
t B
enef
it P
lan
s A
, F, H
igh
Ded
uct
ible
F, G
, an
d N
.
AO
K5
00-O
C (
09
/18)
E
ffecti
ve:
10/0
1/2
018
Pla
n F
an
d H
igh
Ded
ucti
ble
Pla
n F
Pla
n F
an
d H
igh
Ded
uct
ible
Pla
n F
Med
icar
e P
art
A –
Ho
spit
al S
ervi
ces
Per
Ben
efit
Per
iod
*A b
enef
it pe
riod
begi
ns o
n th
e fir
st d
ay y
ou r
ecei
ve s
ervi
ce a
s an
inpa
tient
in a
hos
pita
l and
end
s af
ter
you
have
bee
n ou
t of t
he h
ospi
tal a
nd h
ave
not r
ecei
ved
skill
ed
care
in a
ny o
ther
faci
lity
for 6
0 da
ys in
a r
ow.
Ser
vice
s M
edic
are
Pay
s P
lan
F P
ays
Yo
u P
ay
Hig
h D
edu
ctib
le P
lan
F
Pay
s (a
fter
yo
u p
ay $
2,24
0 D
edu
ctib
le**
*
Yo
u P
ay
(In
ad
dit
ion
to
$2
,240
D
edu
ctib
le**
*)
Ho
spit
aliz
atio
n*
Sem
ipriv
ate
room
and
boa
rd, g
ener
al n
ursi
ng
and
mis
cella
neou
s se
rvic
es a
nd s
uppl
ies.
Firs
t 60
days
A
ll bu
t $1,
340
$1,3
40 P
art A
D
educ
tible
$0
$1
,340
Par
t A D
educ
tible
$0
61st th
ru 9
0th d
ay
All
but $
335
a da
y $3
35 a
day
$0
$3
35 a
day
$0
91
st d
ay a
nd a
fter
- W
hile
usi
ng 6
0 lif
etim
e re
serv
e da
ys
- O
nce
lifet
ime
rese
rve
days
are
use
d �
Add
ition
al 3
65 d
ays
�
Bey
ond
the
addi
tiona
l 365
day
s
All
but $
670
a da
y $0
$0
$670
a d
ay
100%
of M
edic
are
Elig
ible
Exp
ense
s
$0
$0
$0**
A
ll C
osts
$670
a d
ay
100%
of M
edic
are
Elig
ible
E
xpen
ses
$0
$0
$0**
A
ll C
osts
S
kille
d N
urs
ing
Fac
ility
Car
e*
You
mus
t mee
t Med
icar
e’s
requ
irem
ents
, in
clud
ing
havi
ng b
een
in a
hos
pita
l for
at l
east
3
days
and
ent
ered
a M
edic
are
appr
oved
faci
lity
with
in 3
0 da
ys a
fter
leav
ing
the
hosp
ital.
Firs
t 20
days
21
st th
ru 1
00th d
ays
101st
day
and
afte
r
All
appr
oved
am
ount
s A
ll bu
t $16
7.50
a
day
$0
$0
Up
to $
167.
50 a
da
y $0
$0
$0
All
Cos
ts
$0
Up
to $
167.
50 a
day
$0
$0
$0
All
Cos
ts
9 of 1
8
AM
ER
ICO
FIN
AN
CIA
L L
IFE
AN
D A
NN
UIT
Y IN
SU
RA
NC
E C
OM
PA
NY
Ou
tlin
e o
f C
ove
rage
Med
icar
e S
up
ple
men
t B
enef
it P
lan
s A
, F, H
igh
Ded
uct
ible
F, G
, an
d N
.
AO
K5
00-O
C (
09
/18)
E
ffecti
ve:
10/0
1/2
018
P
lan
F a
nd
Hig
h D
ed
ucti
ble
Pla
n F
Pla
n F
an
d H
igh
Ded
uct
ible
Pla
n F
Med
icar
e P
art
A –
Ho
spit
al S
ervi
ces
Per
Ben
efit
Per
iod
(C
on
tin
ued
)
Ser
vice
s M
edic
are
Pay
s P
lan
F P
ays
Yo
u P
ay
Hig
h D
edu
ctib
le P
lan
F
Pay
s (a
fter
yo
u p
ay $
2,24
0 D
edu
ctib
le**
*
Yo
u P
ay
(In
ad
dit
ion
to
$2
,240
D
edu
ctib
le**
*)
Blo
od
F
irst 3
pin
ts
Add
ition
al a
mou
nts
$0
100%
3
pint
s $0
$0
$0
3
pint
s $0
$0
$0
H
osp
ice
Car
e Y
ou m
ust m
eet M
edic
are’
s re
quire
men
ts,
incl
udin
g a
doct
or’s
cer
tific
atio
n of
term
inal
ill
ness
.
All
but v
ery
limite
d co
paym
ent/
coin
sura
nce
for
outp
atie
nt d
rugs
an
d in
patie
nt
resp
ite c
are.
Med
icar
e co
paym
ent/
coin
sura
nce
$0
Med
icar
e co
paym
ent/c
oins
uran
ce
$0
**W
hen
your
Med
icar
e P
art A
hos
pita
l ben
efits
are
exh
aust
ed, t
he in
sur e
r st
ands
in th
e pl
ace
of M
edic
are
and
will
pay
wha
teve
r am
ount
Med
icar
e w
ould
hav
e pa
id fo
r up
to a
n ad
ditio
nal 3
65 d
ays
as p
rovi
ded
in th
e po
licy’
s “C
ore
Ben
efits
.” D
urin
g th
is ti
me,
the
hosp
ital i
s pr
ohib
ited
from
bill
ing
you
for
the
bala
nce
base
d on
any
diff
eren
ce
betw
een
its b
illed
cha
rges
and
the
amou
nt M
edic
are
wou
ld h
ave
paid
. ***
Hig
h D
educ
tible
Pla
n F
pay
s th
e sa
me
bene
fits
as P
lan
F a
fter
one
has
paid
a c
alen
dar
year
$2
,240
ded
uctib
le. B
enef
its fr
om H
igh
Ded
uctib
le P
lan
F w
ill n
ot b
egin
unt
il ou
t -of
-poc
ket e
xpen
ses
exce
ed $
2,24
0. O
ut-o
f-po
cket
exp
ense
s fo
r th
is d
educ
tible
are
ex
pens
es th
at w
ould
ord
inar
ily b
e pa
id b
y th
e po
licy/
certi
ficat
e. T
hese
exp
ense
s in
clud
e th
e M
edic
are
dedu
ctib
les
for
Pay
A a
nd P
art B
, but
do
not i
nclu
de th
e pl
an’s
se
para
te F
orei
gn T
rave
l Em
erge
ncy
dedu
ctib
le.
10 of
18
AM
ER
ICO
FIN
AN
CIA
L L
IFE
AN
D A
NN
UIT
Y IN
SU
RA
NC
E C
OM
PA
NY
Ou
tlin
e o
f C
ove
rage
Med
icar
e S
up
ple
men
t B
enef
it P
lan
s A
, F, H
igh
Ded
uct
ible
F, G
, an
d N
.
AO
K5
00-O
C (
09
/18)
E
ffecti
ve:
10/0
1/2
018
Pla
n F
an
d H
igh
Ded
ucti
ble
Pla
n F
Pla
n F
an
d H
igh
Ded
uct
ible
Pla
n F
Med
icar
e P
art
B –
Med
ical
Ser
vice
s p
er C
alen
dar
Yea
r
*Onc
e yo
u ha
ve b
een
bille
d $1
83 o
f Med
icar
e A
ppro
ved
amou
nts
for
cove
red
serv
ices
, you
r M
edic
are
Par
t B D
educ
tible
will
hav
e be
en m
et fo
r th
e ca
lend
ar y
ear.
Ser
vice
s M
edic
are
Pay
s P
lan
F P
ays
Yo
u P
ay
Hig
h D
edu
ctib
le
Pla
n F
Pay
s (a
fter
yo
u p
ay $
2,24
0 D
edu
ctib
le**
*
Yo
u P
ay
(In
ad
dit
ion
to
$2
,240
D
edu
ctib
le**
*)
Med
ical
Exp
ense
s In
or
out o
f the
hos
pita
l and
out
patie
nt h
ospi
tal
trea
tmen
t, su
ch a
s P
hysi
cian
’s s
ervi
ces,
inpa
tient
and
ou
tpat
ient
med
ical
and
sur
gica
l ser
vice
s an
d su
pplie
s,
phys
ical
and
spe
ech
ther
apy,
dia
gnos
tic te
sts,
dur
able
m
edic
al e
quip
men
t
Firs
t $18
3 of
Med
icar
e ap
prov
ed a
mou
nts*
R
emai
nder
of M
edic
are
appr
oved
am
ount
s $0
G
ener
ally
80%
$1
83 P
art B
D
educ
tible
G
ener
ally
20%
$0
$0
$183
Par
t B
Ded
uctib
le
Gen
eral
ly 2
0%
$0
$0
Par
t B
Exc
ess
Ch
arge
s (a
bove
Med
icar
e ap
prov
ed
amou
nts)
$0
10
0%
$0
100%
$0
Blo
od
F
irst 3
pin
ts
Nex
t $18
3 of
Med
icar
e ap
prov
ed a
mou
nts*
R
emai
nder
of M
edic
are
appr
oved
am
ount
s
$0
$0
80%
All
cost
s $1
83 P
art B
D
educ
tible
20
%
$0
$0
$0
All
cost
s $1
83 P
art B
D
educ
tible
20
%
$0
$0
$0
Clin
ical
Lab
ora
tory
Ser
vice
s –
Tes
ts fo
r D
iagn
ostic
se
rvic
es
100%
$0
$0
$0
$0
***H
igh
Ded
uctib
le P
lan
F p
ays
the
sam
e be
nefit
s as
Pla
n F
afte
r one
has
pai
d a
cale
ndar
yea
r $2
,240
ded
uctib
le. B
enef
its fr
om H
igh
Ded
uctib
le P
lan
F w
ill n
ot b
egin
un
til o
ut-o
f-po
cket
exp
ense
s ex
ceed
$2,
240.
Out
-of-p
ocke
t exp
ense
s fo
r thi
s de
duct
ible
are
exp
ense
s th
at w
ould
ord
inar
ily b
e pa
id b
y th
e po
licy/
cert
ifica
te. T
hese
ex
pens
es in
clud
e th
e M
edic
are
dedu
ctib
les
for
Pay
A a
nd P
art B
, but
do
not i
nclu
de th
e pl
an’s
sep
arat
e F
orei
gn T
rave
l Em
erge
ncy
dedu
ctib
le.
11 of
18
AM
ER
ICO
FIN
AN
CIA
L L
IFE
AN
D A
NN
UIT
Y IN
SU
RA
NC
E C
OM
PA
NY
Ou
tlin
e o
f C
ove
rage
Med
icar
e S
up
ple
men
t B
enef
it P
lan
s A
, F, H
igh
Ded
uct
ible
F, G
, an
d N
.
AO
K5
00-O
C (
09
/18)
E
ffecti
ve:
10/0
1/2
018
P
lan
F a
nd
Hig
h D
ed
ucti
ble
Pla
n F
Pla
n F
an
d H
igh
Ded
uct
ible
Pla
n F
Par
ts A
& B
Ser
vice
s M
edic
are
Pay
s P
lan
F P
ays
Yo
u P
ay
Hig
h D
edu
ctib
le
Pla
n F
Pay
s (a
fter
yo
u p
ay $
2,24
0 D
edu
ctib
le**
*
Yo
u P
ay
(In
ad
dit
ion
to
$2,
240
Ded
uct
ible
***)
H
om
e H
ealt
h C
are
Med
icar
e E
ligib
le S
ervi
ces
-M
edic
ally
nec
essa
ry s
kille
d ca
re s
ervi
ces
and
med
ical
sup
plie
s-
Dur
able
med
ical
equ
ipm
ent.
Firs
t $18
3 of
Med
icar
e ap
prov
ed a
mou
nts*
-R
emai
nder
of M
edic
are
appr
oved
am
ount
s
100%
$0
80%
$0
$183
Par
t B
Ded
uctib
le
20%
$0
$0
$0
$0
$183
Par
t B
Ded
uctib
le
20%
$0
$0
$0
Oth
er B
enef
its
No
t C
ove
red
by
Med
icar
e
Ser
vice
s M
edic
are
Pay
s P
lan
F P
ays
Yo
u P
ay
Hig
h D
edu
ctib
le
Pla
n F
Pay
s (a
fter
yo
u p
ay $
2,24
0 D
edu
ctib
le**
*
Yo
u P
ay
(In
ad
dit
ion
to
$2,
240
Ded
uct
ible
***)
F
ore
ign
Tra
vel
Med
ical
ly n
eces
sary
em
erge
ncy
care
ser
vice
s be
ginn
ing
durin
g th
e fir
st 6
0 da
ys o
f eac
h tr
ip
outs
ide
the
US
A.
Firs
t $25
0 ea
ch c
alen
dar
year
R
emai
nder
of c
harg
es
$0
$0
$0
80%
to a
life
time
max
imum
ben
efit
of $
50,0
00.
$250
20
% a
nd a
mou
nts
over
the
$50,
000
lifet
ime
max
imum
.
$0
80%
to a
life
time
max
imum
ben
efit
of
$50,
000.
$250
20
% a
nd a
mou
nts
over
the
$50,
000
lifet
ime
max
imum
. **
Hig
h D
educ
tible
Pla
n F
pay
s th
e sa
me
bene
fits
as P
lan
F a
fter
one
has
paid
a c
alen
dar
year
$2,
240
dedu
ctib
le. B
enef
its fr
om H
igh
Ded
uctib
le P
lan
F w
ill n
ot b
egin
un
til o
ut-o
f poc
ket e
xpen
ses
exce
ed $
2,24
0. O
ut-o
f-po
cket
exp
ense
s fo
r thi
s de
duct
ible
are
exp
ense
s th
at w
ould
ord
inar
ily b
e pa
id b
y th
e po
licy/
cert
ifica
te. T
hese
ex
pens
es in
clud
e th
e M
edic
are
dedu
ctib
les
for
Pay
A a
nd P
art B
, but
do
not i
nclu
de th
e pl
an’s
sep
arat
e F
orei
gn T
rave
l Em
erge
ncy
dedu
ctib
le.
12 of
18
AM
ER
ICO
FIN
AN
CIA
L L
IFE
AN
D A
NN
UIT
Y IN
SU
RA
NC
E C
OM
PA
NY
Ou
tlin
e o
f C
ove
rage
Med
icar
e S
up
ple
men
t B
enef
it P
lan
s A
, F, H
igh
Ded
uct
ible
F, G
, an
d N
.
AO
K5
00-O
C (
09
/18)
Eff
ecti
ve:
10/0
1/2
018
P
lan
G
Pla
n G
Med
icar
e P
art
A –
Ho
spit
al S
ervi
ces
Per
Ben
efit
Per
iod
*A b
enef
it pe
riod
begi
ns o
n th
e fir
st d
ay y
ou r
ecei
ve s
ervi
ce a
s an
inpa
tient
in a
hos
pita
l and
end
s af
ter
you
have
bee
n ou
t of t
he h
ospi
tal a
nd h
ave
not r
ecei
ved
skill
edca
re in
any
oth
er fa
cilit
y fo
r 60
days
in a
row
.
Ser
vice
s M
edic
are
Pay
s P
lan
G P
ays
Yo
u P
ay
Ho
spit
aliz
atio
n*
Sem
ipriv
ate
room
and
boa
rd, g
ener
al n
ursi
ng a
nd m
isce
llane
ous
serv
ices
and
sup
plie
s.
Firs
t 60
days
A
ll bu
t $1,
340
$1,3
40 P
art A
Ded
uctib
le
$0
61st th
ru 9
0th d
ay
All
but $
335
a da
y $3
35 a
day
$0
91
st d
ay a
nd a
fter
-W
hile
usi
ng 6
0 lif
etim
e re
serv
e da
ys-
Onc
e lif
etim
e re
serv
e da
ys a
re u
sed
�
Add
ition
al 3
65 d
ays
�
Bey
ond
the
addi
tiona
l 365
day
s
All
but $
670
a da
y
$0
$0
$670
a d
ay
100%
of M
edic
are
Elig
ible
Exp
ense
s $0
$0
$0**
A
ll C
osts
S
kille
d N
urs
ing
Fac
ility
Car
e*
You
mus
t mee
t Med
icar
e’s
requ
irem
ents
, inc
ludi
ng h
avin
g be
en in
a
hosp
ital f
or a
t lea
st 3
day
s an
d en
tere
d a
Med
icar
e ap
prov
ed fa
cilit
y w
ithin
30
days
afte
r le
avin
g th
e ho
spita
l. F
irst 2
0 da
ys
21st th
ru 1
00 d
ays
101st
day
and
afte
r
All
appr
oved
am
ount
s A
ll bu
t $16
7.50
a d
ay
$0
$0
Up
to $
167.
50 a
day
$0
$0
$0
All
Cos
ts
Blo
od
F
irst 3
pin
ts
Add
ition
al a
mou
nts
$0
100%
3
pint
s $0
$0
$0
H
osp
ice
Car
e Y
ou m
ust m
eet M
edic
are’
s re
quire
men
ts, i
nclu
ding
a d
octo
r’s
cert
ifica
tion
of te
rmin
al il
lnes
s.
All
but v
ery
limite
d co
paym
ent/c
oins
uran
ce
for
outp
atie
nt d
rugs
and
in
patie
nt r
espi
te c
are.
Med
icar
e co
paym
ent/c
oins
uran
ce
$0
* *W
hen
your
Med
icar
e P
art A
hos
pita
l ben
efits
are
exh
aust
ed, t
he in
sure
r st
ands
in th
e pl
ace
of M
edic
are
and
will
pay
wha
teve
r am
ount
Med
icar
e w
ould
hav
e pa
id fo
r up
to a
n ad
ditio
nal 3
65 d
ays
as p
rovi
ded
in th
e po
licy’
s “C
ore
Ben
efits
.” D
urin
g th
is ti
me,
the
hosp
ital i
s pr
ohib
ited
from
bill
ing
you
for
the
bala
nce
base
d on
any
diff
eren
ce
betw
een
its b
illed
cha
rges
and
the
amou
nt M
edic
are
wou
ld h
ave
paid
.
13 of
18
AM
ER
ICO
FIN
AN
CIA
L L
IFE
AN
D A
NN
UIT
Y IN
SU
RA
NC
E C
OM
PA
NY
Ou
tlin
e o
f C
ove
rage
Med
icar
e S
up
ple
men
t B
enef
it P
lan
s A
, F, H
igh
Ded
uct
ible
F, G
, an
d N
.
AO
K5
00-O
C (
09
/18)
Eff
ecti
ve:
10/0
1/2
018
P
lan
G
Pla
n G
Med
icar
e P
art
B –
Med
ical
Ser
vice
s p
er C
alen
dar
Yea
r
*Onc
e yo
u ha
ve b
een
bille
d $1
83 o
f Med
icar
e ap
prov
ed a
mou
nts
for
cove
red
serv
ices
, you
r M
edic
are
Par
t B D
educ
tible
will
hav
e be
en m
et fo
r th
e ca
lend
ar y
ear.
Ser
vice
s M
edic
are
Pay
s P
lan
G P
ays
Yo
u P
ay
Med
ical
Exp
ense
s
In o
r ou
t of t
he h
ospi
tal a
nd o
utpa
tient
hos
pita
l tre
atm
ent,
such
as
Phy
sici
an’s
ser
vice
s, in
patie
nt a
nd o
utpa
tient
med
ical
and
sur
gica
l ser
vice
s an
d su
pplie
s, p
hysi
cal a
nd s
peec
h th
erap
y, d
iagn
ostic
test
s, d
urab
le
med
ical
equ
ipm
ent
Firs
t $18
3 of
Med
icar
e ap
prov
ed a
mou
nts*
R
emai
nder
of M
edic
are
appr
oved
am
ount
s $0
G
ener
ally
80%
$0
G
ener
ally
20%
$1
83 P
art B
Ded
uctib
le
$0
Par
t B
Exc
ess
Ch
arge
s (a
bove
Med
icar
e ap
prov
ed a
mou
nts)
$0
10
0%
$0
Blo
od
F
irst 3
pin
ts
Nex
t $18
3 of
Med
icar
e ap
prov
ed a
mou
nts*
R
emai
nder
of M
edic
are
appr
oved
am
ount
s
$0
$0
80%
All
cost
s $0
20
%
$ 0
$183
Par
t B D
educ
tible
$0
C
linic
al L
abo
rato
ry S
ervi
ces
– T
ests
for
Dia
gnos
tic s
ervi
ces
100%
$0
$0
Par
ts A
& B
Ser
vice
s M
edic
are
Pay
s P
lan
G P
ays
Yo
u P
ay
Ho
me
Hea
lth
Car
e M
edic
are
Elig
ible
Ser
vice
s -
Med
ical
ly n
eces
sary
ski
lled
care
ser
vice
s an
d m
edic
al s
uppl
ies
-D
urab
le m
edic
al e
quip
men
t. F
irst $
183
of M
edic
are
appr
oved
am
ount
s*-
Rem
aind
er o
f Med
icar
e ap
prov
ed a
mou
nts
100%
$0
80
%
$0
$0
20%
$0
$183
Par
t B D
educ
tible
$0
14 of
18
AM
ER
ICO
FIN
AN
CIA
L L
IFE
AN
D A
NN
UIT
Y IN
SU
RA
NC
E C
OM
PA
NY
Ou
tlin
e o
f C
ove
rage
Med
icar
e S
up
ple
men
t B
enef
it P
lan
s A
, F, H
igh
Ded
uct
ible
F, G
, an
d N
.
AO
K5
00-O
C (
09
/18)
Eff
ecti
ve:
10/0
1/2
018
P
lan
G
Pla
n G
Oth
er B
enef
its
No
t C
ove
red
by
Med
icar
e
Ser
vice
s M
edic
are
Pay
s P
lan
G P
ays
Yo
u P
ay
Fo
reig
n T
rave
l M
edic
ally
nec
essa
ry e
mer
genc
y ca
re s
ervi
ces
begi
nnin
g du
ring
the
first
60
day
s of
eac
h tr
ip o
utsi
de th
e U
SA
. F
irst $
250
each
cal
enda
r ye
ar
Rem
aind
er o
f Cha
rges
$0
$0
$0
80
% to
a li
fetim
e m
axim
um
bene
fit o
f $50
,000
.
$250
20
% a
nd a
mou
nts
over
the
$50,
000
lifet
ime
max
imum
.
15 of
18
AM
ER
ICO
FIN
AN
CIA
L L
IFE
AN
D A
NN
UIT
Y IN
SU
RA
NC
E C
OM
PA
NY
Ou
tlin
e o
f C
ove
rage
Med
icar
e S
up
ple
men
t B
enef
it P
lan
s A
, F, H
igh
Ded
uct
ible
F, G
, an
d N
.
AO
K5
00-O
C (
09
/18)
Eff
ecti
ve:
10/0
1/2
01
8P
lan
N
Pla
n N
Med
icar
e P
art
A –
Ho
spit
al S
ervi
ces
Per
Ben
efit
Per
iod
A b
enef
it pe
riod
begi
ns o
n th
e fir
st d
ay y
ou r
ecei
ve s
ervi
ce a
s an
inpa
tient
in a
hos
pita
l and
end
s af
ter
you
have
bee
n ou
t of t
he h
ospi
tal a
nd h
ave
not r
ecei
ved
skill
ed
care
in a
ny o
ther
faci
lity
for 6
0 da
ys in
a r
ow.
Ser
vice
s M
edic
are
Pay
s P
lan
N P
ays
Yo
u P
ay
Ho
spit
aliz
atio
n S
emip
rivat
e ro
om a
nd b
oard
, gen
eral
nur
sing
and
mis
cella
neou
s se
rvic
es a
nd s
uppl
ies.
F
irst 6
0 da
ys
All
but $
1,34
0 $1
,340
Par
t A D
educ
tible
$0
61
st th
ru 9
0th d
ay
All
but $
335
a da
y $3
35 a
day
$0
91
st d
ay a
nd a
fter
-W
hile
usi
ng 6
0 lif
etim
e re
serv
e da
ys-
Onc
e lif
etim
e re
serv
e da
ys a
re u
sed
�
Add
ition
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2018Choosing a Medigap Policy:
A Guide to Health Insurance for People with Medicare
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
This official government guide has important information about:
Developed jointly by the Centers for Medicare & Medicaid Services (CMS) and the National Association of Insurance Commissioners (NAIC)
Who should read this guide? This guide can help if you’re thinking about buying a Medigap policy or already have one. It'll help you understand Medicare Supplement Insurance policies (also called Medigap policies). A Medigap policy is a type of private insurance that helps you pay for some of the costs that Original Medicare doesn’t cover.
Important information about this guideThe information in this booklet describes the Medicare Program at the time this booklet was printed. Changes may occur after printing. Visit Medicare.gov, or call 1‑800‑MEDICARE (1‑800‑633‑4227) to get the most current information. TTY users can call 1‑877‑486‑2048.The “2018 Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare” isn’t a legal document. Official Medicare Program legal guidance is contained in the relevant statutes, regulations, and rulings.
New Medicare cards are in the mail!You asked, and we listened. You’re getting a new Medicare card! Your new card will have a new Medicare number instead of your Social Security Number. This will help keep your information more secure and help protect your identity.The new card won’t change your coverage or benefits. You’ll get more information from Medicare when your new card is mailed.
Paid for by the Department of Health & Human Services.
Where to get more information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45How to get help with Medicare and Medigap questions . . . . . . . . . . . . . . . . . . . . 46State Health Insurance Assistance Program and State Insurance Department. . 47
Definitions 49
Where words in BLUE are defined . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Section 6:
Section 7:
Section 8:
Section 9:
5
SECTION
1 Medicare Basics
A brief look at MedicareA Medicare Supplement Insurance (Medigap) policy is health insurance sold by private insurance companies which can help pay some of the health care costs that Original Medicare doesn't cover, like coinsurance, copayments, or deductibles. Some Medigap policies also cover certain benefits Original Medicare doesn’t cover, like emergency foreign travel expenses. Medigap policies don’t cover your share of the costs under other types of health coverage, including Medicare Advantage Plans (like HMOs or PPOs), stand‑alone Medicare Prescription Drug Plans, employer/union group health coverage, Medicaid, or TRICARE. Insurance companies generally can’t sell you a Medigap policy if you have coverage through Medicaid or a Medicare Advantage Plan.
Before you learn more about Medigap policies, the next few pages provide a brief look at Medicare. If you already know the basics about Medicare and only want to learn about Medigap, skip to page 9.
Words in blue are defined on pages 49–50.
6 Section 1: Medicare Basics
What's Medicare? Medicare is health insurance for:
• People 65 or older• People under 65 with certain disabilities • People of any age with End‑Stage Renal Disease (ESRD) (permanent kidney failure
requiring dialysis or a kidney transplant)
The different parts of Medicare The different parts of Medicare help cover specific services:
Medicare Part A (Hospital Insurance) helps cover
• Inpatient care in hospitals • Skilled nursing facility, hospice, and home health care
Medicare Part B (Medical Insurance) helps cover
• Services from doctors and other health care providers, hospital outpatient care, durable medical equipment, and home health care
• Preventive services to help maintain your health and to keep certain illnesses from getting worse
Medicare Part C (Medicare Advantage)
• Includes all benefits and services covered under Part A and Part B• Run by Medicare‑approved private insurance companies • Usually includes Medicare prescription drug coverage (Part D) as part of the plan • May include extra benefits and services for an extra cost
Medicare Part D (Medicare Prescription Drug Coverage)
• Helps cover the cost of outpatient prescription drugs • Run by Medicare‑approved private insurance companies• May help lower your prescription drug costs and help protect against higher costs in
the future
7Section 1: Medicare Basics
Your Medicare coverage choices at a glance There are 2 main ways to get your Medicare coverage — Original Medicare or a Medicare Advantage Plan. Use these steps to help you decide. See page 35 for information about Medicare Advantage Plans and Medigap policies.
Option1:
Original Medicare
You can add:
You can also add:
Option2:
Medicare Advantage (Part C)
This includes Part A and B
Part AHospital Insurance
Part BMedical Insurance
Part DMedicare Prescription Drug Coverage
MedigapMedicare Supplement Insurance
(Medigap policies help pay your out-of-pocket costs in Original Medicare.)
Part BMedical Insurance
Part DMedicare Prescription Drug Coverage
(most plans cover prescription drugs.)
Part AHospital Insurance
These plans are like HMOs or PPOs, and include Part A, B, and typically D.
8 Section 1: Medicare Basics
Medicare and the Health Insurance MarketplaceIf you have coverage through an individual Marketplace plan (not through an employer), you may want to end your Marketplace coverage and enroll in Medicare. You should do this during your Initial Enrollment Period to avoid a delay in future Medicare coverage and the possibility of a Medicare late enrollment penalty. Once you’re considered eligible for premium‑free Part A, you won’t qualify for help paying your Marketplace plan premiums or other medical costs. If you continue to get help paying your Marketplace plan premium after you have Medicare, you might have to pay back some or all of the help you got when you file your taxes. Visit HealthCare.gov to connect to the Marketplace in your state and learn more. Be sure not to end your Marketplace plan before your Medicare coverage begins. Otherwise, you may have a gap in coverage.Note: Medicare isn't part of the Marketplace. The Marketplace doesn’t offer Medicare Supplement Insurance (Medigap) policies, Medicare Advantage Plans, or Medicare drug plans (Part D).
For more information Remember, this guide is about Medigap policies. To learn more about Medicare, visit Medicare.gov, look at your “Medicare & You” handbook, or call 1‑800‑MEDICARE (1‑800‑633‑4227). TTY users can call 1‑877‑486‑2048.
Medigap Basics2 What's a Medigap policy? A Medigap policy is private health insurance that helps supplement Original Medicare. This means it helps pay some of the health care costs that Original Medicare doesn’t cover (like copayments, coinsurance, and deductibles). These are “gaps” in Medicare coverage. If you have Original Medicare and a Medigap policy, 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 is different from a Medicare Advantage Plan (like an HMO or PPO) because those plans are ways to get Medicare benefits, while a Medigap policy only supplements the costs of your Original Medicare benefits. Note: Medicare doesn’t pay any of your costs for a Medigap policy.All Medigap policies must follow federal and state laws designed to protect you, and policies must be clearly identified as “Medicare Supplement Insurance.” Medigap insurance companies in most states can only sell you a “standardized” Medigap policy identified by letters A through N. Each standardized Medigap policy must offer the same basic benefits, no matter which insurance company sells it. Cost is usually the only difference between Medigap policies with the same letter sold by different insurance companies.
In Massachusetts, Minnesota, and Wisconsin, Medigap policies are standardized in a different way. See pages 42–44. In some states, you may be able to buy another type of Medigap policy called Medicare SELECT. Medicare SELECT plans are standardized plans that may require you to see certain providers and may cost less than other plans. See page 20.
10 Section 2: Medigap Basics
What Medigap policies cover
The chart on page 11 gives you a quick look at the standardized Medigap Plans available. You'll need more details than this chart provides to compare and choose a policy. Call your State Health Insurance Assistance Program (SHIP) for help. See pages 47–48 for your state’s phone number.
Notes: • Insurance companies selling Medigap policies are required to make Plan A
available. If they offer any other Medigap policy, they must also offer either Plan C or Plan F. Not all types of Medigap policies may be available in your state. See pages 42– 44 if you live in Massachusetts, Minnesota, or Wisconsin.
• Plans D and G effective on or after June 1, 2010, have different benefits than Plans D or G bought before June 1, 2010.
• Plans E, H, I, and J are no longer sold, but, if you already have one, you can generally keep it.
• Starting January 1, 2020, Medigap plans sold to new people with Medicare won't be allowed to cover the Part B deductible. Because of this, Plans C and F will no longer be available to people new to Medicare starting on January 1, 2020. If you already have either of these two plans (or the high deductible version of Plan F) or are covered by one of these plans prior to January 1, 2020, you will be able to keep your plan. If you were eligible for Medicare before January 1, 2020 but not yet enrolled, you may be able to buy one of these plans.
11Section 2: Medigap Basics
Medicare Supplement Insurance (Medigap) Plans
Benefits A B C D F* G K L M NMedicare Part A coinsurance and hospital costs (up to an additional 365 days after Medicare benefits are used)
Blood (first 3 pints) 100% 100% 100% 100% 100% 100% 50% 75% 100% 100%Part A hospice care coinsurance or copayment
100% 100% 100% 100% 100% 100% 50% 75% 100% 100%
Skilled nursing facility care coinsurance
100% 100% 100% 100% 50% 75% 100% 100%
Part A deductible 100% 100% 100% 100% 100% 50% 75% 50% 100%Part B deductible 100% 100%Part B excess charges 100% 100%Foreign travel emergency (up to plan limits)
80% 80% 80% 80% 80% 80%
Out‑of‑pocket limit
in 2018**$5,240 $2,620
* Plan F is also offered as a high‑deductible plan by some insurance companies in some states. If you choose this option, this means you must pay for Medicare‑covered costs (coinsurance, copayments, deductibles) up to the deductible amount of $2,240 in 2018 before your policy pays anything. **For Plans K and L, after you meet your out‑of‑pocket yearly limit and your yearly Part B deductible ($183 in 2018), the Medigap plan pays 100% of covered services for the rest of the calendar year.*** Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don’t result in an inpatient admission.
This chart shows basic information about the different benefits that Medigap policies cover. If a percentage appears, the Medigap plan covers that percentage of the benefit, and you must pay the rest.
12 Section 2: Medigap Basics
What Medigap policies don’t coverGenerally, Medigap policies don’t cover long‑term care (like care in a nursing home), vision or dental care, hearing aids, eyeglasses, or private‑duty nursing.
Types of coverage that are NOT Medigap policies• Medicare Advantage Plans (Part C), like an HMO or PPO• Medicare Prescription Drug Plans (Part D)• Medicaid• Employer or union plans, including the Federal Employees Health
Benefits Program (FEHBP)• TRICARE • Veterans’ benefits • Long‑term care insurance policies • Indian Health Service, Tribal, and Urban Indian Health plans• Qualified Health Plans sold in the Health Insurance Marketplace
What types of Medigap policies can insurance companies sell?In most cases, Medigap insurance companies can sell you only a “standardized” Medigap policy. All Medigap policies must have specific benefits, so you can compare them easily. If you live in Massachusetts, Minnesota, or Wisconsin, see pages 42– 44.Insurance companies that sell Medigap policies don’t have to offer every Medigap plan. However, they must offer Plan A if they offer any Medigap policy. If they offer any plan in addition to Plan A, they must also offer Plan C or Plan F. Each insurance company decides which Medigap plan it wants to sell, although state laws might affect which ones they offer.In some cases, an insurance company must sell you a Medigap policy, even if you have health problems. Here are certain times that you’re guaranteed the right to buy a Medigap policy: • When you’re in your Medigap Open Enrollment Period. See pages 14 –15.• If you have a guaranteed issue right. See pages 21–23.
You may be able to buy a Medigap policy at other times, but the insurance company can deny you a Medigap policy based on your health. Also, in some cases it may be illegal for the insurance company to sell you a Medigap policy (like if you already have Medicaid or a Medicare Advantage Plan).
Words in blue are defined on pages 49–50.
13Section 2: Medigap Basics
What do I need to know if I want to buy a Medigap policy?• You must have Medicare Part A (Hospital Insurance) and Medicare Part B
(Medical Insurance) to buy a Medigap policy.
• If you have a Medicare Advantage Plan (like an HMO or PPO) but are planning to return to Original Medicare, you can apply for a Medigap policy before your coverage ends. The Medigap insurer can sell it to you as long as you’re leaving the Plan. Ask that the new Medigap policy start when your Medicare Advantage Plan enrollment ends, so you'll have continuous coverage.
• You pay the private insurance company a premium for your Medigap policy in addition to the monthly Part B premium you pay to Medicare.
• A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you each will have to buy separate Medigap policies.
• When you have your Medigap Open Enrollment Period, you can buy a Medigap policy from any insurance company that’s licensed in your state.
• If you want to buy a Medigap policy, see page 11 for an overview of the basic benefits covered by different Medigap policies to review the benefit choices. Then, follow the “Steps to Buying a Medigap Policy” on pages 25 –30.
• If you want to drop your Medigap policy, write your insurance company to cancel the policy and confirm it’s cancelled. Your agent can’t cancel the policy for you.
• Any standardized Medigap policy is guaranteed renewable even if you have health problems. This means the insurance company can’t cancel your Medigap policy as long as you stay enrolled and pay the premium.
• Different insurance companies may charge different premiums for the same exact policy. As you shop for a policy, be sure you’re comparing the same policy (for example, compare Plan A from one company with Plan A from another company).
• Some states may have laws that may give you additional protections.
14 Section 2: Medigap Basics
What do I need to know if I want to buy a Medigap policy? (continued)• Although some Medigap policies sold in the past covered prescription
drugs, Medigap policies sold after January 1, 2006, aren’t allowed to include prescription drug coverage.
• If you want prescription drug coverage, you can join a Medicare Prescription Drug Plan (Part D) offered by private companies approved by Medicare. See pages 6–7.
To learn about Medicare prescription drug coverage, visit Medicare.gov, or call 1‑800‑MEDICARE (1‑800‑633‑4227). TTY users can call 1‑877‑486‑2048.
When's the best time to buy a Medigap policy? The best time to buy a Medigap policy is during your Medigap Open Enrollment Period. This period lasts for 6 months and begins on the first day of the month in which you’re both 65 or older and enrolled in Medicare Part B. Some states have additional Open Enrollment Periods including those for people under 65. During this period, an insurance company can’t use medical underwriting. This means the insurance company can’t do any of these because of your health problems:• Refuse to sell you any Medigap policy it offers • Charge you more for a Medigap policy than they charge someone with no
health problems• Make you wait for coverage to start (except as explained below) While the insurance company can’t make you wait for your coverage to start, it may be able to make you wait for coverage related to a pre‑existing condition. A pre‑existing condition is a health problem you have before the date a new insurance policy starts. In some cases, the Medigap insurance company can refuse to cover your out‑of‑pocket costs for these pre‑existing health problems for up to 6 months. This is called a “pre‑existing condition waiting period.” After 6 months, the Medigap policy will cover the pre‑existing condition.
When's the best time to buy a Medigap policy? (continued) Coverage for a pre‑existing condition can only be excluded if the condition was treated or diagnosed within 6 months before the coverage starts under the Medigap policy. This is called the “look‑back period.” Remember, for Medicare‑covered services, Original Medicare will still cover the condition, even if the Medigap policy won’t, but you’re responsible for the Medicare coinsurance or copayment.
Creditable coverageIf you have a pre‑existing condition, you buy a Medigap policy during your Medigap Open Enrollment Period, and you’re replacing certain kinds of health coverage that count as “creditable coverage,” it’s possible to avoid or shorten waiting periods for pre‑existing conditions. Prior creditable coverage is generally any other health coverage you recently had before applying for a Medigap policy. If you've had at least 6 months of continuous prior creditable coverage, the Medigap insurance company can’t make you wait before it covers your pre‑existing conditions.There are many types of health care coverage that may count as creditable coverage for Medigap policies, but they'll only count if you didn’t have a break in coverage for more than 63 days.Your Medigap insurance company can tell you if your previous coverage will count as creditable coverage for this purpose. You can also call your State Health Insurance Assistance Program. See pages 47– 48.If you buy a Medigap policy when you have a guaranteed issue right (also called “Medigap protection”), the insurance company can’t use a pre‑existing condition waiting period. See pages 21–23 for more information about guaranteed issue rights.Note: If you’re under 65 and have Medicare because of a disability or End‑Stage Renal Disease (ESRD), you might not be able to buy the Medigap policy you want, or any Medigap policy, until you turn 65. Federal law generally doesn’t require insurance companies to sell Medigap policies to people under 65. However, some states require Medigap insurance companies to sell you a Medigap policy, even if you’re under 65. See page 39 for more information.
16 Section 2: Medigap Basics
Why is it important to buy a Medigap policy when I'm first eligible? When you're first eligible, you have the right to buy any Medigap policy offered in your state. In addition, you generally will get better prices and more choices among policies. It’s very important to understand your Medigap Open Enrollment Period. Medigap insurance companies are generally allowed to use medical underwriting to decide whether to accept your application and how much to charge you for the Medigap policy. However, if you apply during your Medigap Open Enrollment Period, you can buy any Medigap policy the company sells, even if you have health problems, for the same price as people with good health. If you apply for Medigap coverage after your Open Enrollment Period, there’s no guarantee that an insurance company will sell you a Medigap policy if you don’t meet the medical underwriting requirements, unless you’re eligible for guaranteed issue rights (Medigap protections) because of one of the limited situations listed on pages 22–23.It’s also important to understand that your Medigap rights may depend on when you choose to enroll in Medicare Part B. If you’re 65 or older, your Medigap Open Enrollment Period begins when you enroll in Part B and can’t be changed or repeated. In most cases, it makes sense to enroll in Part B and purchase a Medigap policy when you’re first eligible for Medicare, because you might otherwise have to pay a Part B late enrollment penalty and might miss your Medigap Open Enrollment Period. However, there are exceptions if you have employer coverage.
Employer coverageIf you have group health coverage through an employer or union, because either you or your spouse is currently working, you may want to wait to enroll in Part B. This is because benefits based on current employment often provide coverage similar to Part B, so you would be paying for Part B before you need it, and your Medigap Open Enrollment Period might expire before a Medigap policy would be useful. When the employer coverage ends, you’ll get a chance to enroll in Part B without a late enrollment penalty which means your Medigap Open Enrollment Period will start when you’re ready to take advantage of it. If you or your spouse is still working and you have coverage through an employer, contact your employer or union benefits administrator to find out how your insurance works with Medicare. See page 24 for more information.
Words in blue are defined on pages 49–50.
17Section 2: Medigap Basics
How do insurance companies set prices for Medigap policies? Each insurance company decides how it’ll set the price, or premium, for its Medigap policies. The way they set the price affects how much you pay now and in the future. Medigap policies can be priced or “rated” in 3 ways: 1. Community‑rated (also called “no‑age‑rated”)
2. Issue‑age‑rated (also called “entry‑age‑rated”)
3. Attained‑age‑rated
Each of these ways of pricing Medigap policies is described in the chart on the next page. The examples show how your age affects your premiums, and why it’s important to look at how much the Medigap policy will cost you now and in the future. The amounts in the examples aren’t actual costs. Other factors like where you live, medical underwriting, and discounts can also affect the amount of your premium.
18 Section 2: Medigap Basics
How do insurance companies set prices for Medigap policies? (continued)
Type of pricing
Community-rated (also called “no-age-rated”)
How it’s priced
What this pricing may mean for you
Examples
Generally the same premium is charged to everyone who has the Medigap policy, regardless of age or gender.
The premium is based on the age you are when you buy (are “issued”) the Medigap policy.
The premium is based on your current age (the age you've “attained”), so your premium goes up as you get older.
Your premium isn’t based on your age. Premiums may go up because of inflation and other factors but not because of your age.
Premiums are lower for people who buy at a younger age and won’t change as you get older. Premiums may go up because of inflation and other factors but not because of your age.
Premiums are low for younger buyers but go up as you get older. They may be the least expensive at first, but they can eventually become the most expensive. Premiums may also go up because of inflation and other factors.
Mr. Smith is 65. He buys a Medigap policy and pays a $165 monthly premium.
Mrs. Perez is 72. She buys the same Medigap policy as Mr. Smith. She also pays a $165 monthly premium.
Mr. Han is 65. He buys a Medigap policy and pays a $145 monthly premium.
Mrs. Wright is 72. She buys the same Medigap policy as Mr. Han. Since she is older when she buys it, her monthly premium is $175.
Mrs. Anderson is 65. She buys a Medigap policy and pays a $120 monthly premium. Her premium will go up each year: • 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 same Medigap policy as Mrs. Anderson. He pays a $165 monthly premium. His premium is higher than Mrs. Anderson’s because it’s based on his current age. Mr. Dodd’s premium will go up each year:• At 73, his premium goes up to $171. • At 74, his premium goes up to $177.
Issue-age-rated (also called “entry age-rated”)
Attained-age-rated
19Section 2: Medigap Basics
Comparing Medigap costs As discussed on the previous pages, the cost of Medigap policies can vary widely. There can be big differences in the premiums that different insurance companies charge for exactly the same coverage. As you shop for a Medigap policy, be sure to compare the same type of Medigap policy, and consider the type of pricing used. See pages 17–18. For example, compare a Plan C from one insurance company with a Plan C from another insurance company. Although this guide can’t give actual costs of Medigap policies, you can get this information by calling insurance companies or your State Health Insurance Assistance Program. See pages 47– 48.You can also find out which insurance companies sell Medigap policies in your area by visiting Medicare.gov.The cost of your Medigap policy may also depend on whether the insurance company:
• Offers discounts (like discounts for women, non‑smokers, or people who are married; discounts for paying yearly; discounts for paying your premiums using electronic funds transfer; or discounts for multiple policies).
• Uses medical underwriting, or applies a different premium when you don’t have a guaranteed issue right or aren’t in a Medigap Open Enrollment Period.
• Sells Medicare SELECT policies that may require you to use certain providers. If you buy this type of Medigap policy, your premium may be less. See page 20.
• Offers a “high‑deductible option” for Plan F. If you buy Plan F with a high‑deductible option, you must pay the first $2,240 of deductibles, copayments, and coinsurance (in 2018) for covered services not paid by Medicare before the Medigap policy pays anything. You must also pay a separate deductible ($250 per year) for foreign travel emergency services.
If you bought Medigap Plan J before January 1, 2006, and it still covers prescription drugs, you would also pay a separate deductible ($250 per year) for prescription drugs covered by the Medigap policy. And, if you have a Plan J with a high deductible option, you must also pay a $2,240 deductible (in 2018) before the policy pays anything for medical benefits.
What's Medicare SELECT? Medicare SELECT is a type of Medigap policy sold in some states that requires you to use hospitals and, in some cases, doctors within its network to be eligible for full insurance benefits (except in an emergency). Medicare SELECT can be any of the standardized Medigap plans (see page 11). These policies generally cost less than other Medigap policies. However, if you don’t use a Medicare SELECT hospital or doctor for non‑emergency services, you’ll have to pay some or all of what Medicare doesn’t pay. Medicare will pay its share of approved charges no matter which hospital or doctor you choose.
How does Medigap help pay my Medicare Part B bills? In most Medigap policies, when you sign the Medigap insurance contract you agree to have the Medigap insurance company get your Medicare Part B claim information directly from Medicare, and then they pay the doctor directly whatever amount is owed under your policy. Some Medigap insurance companies also provide this service for Medicare Part A claims.If your Medigap insurance company doesn’t provide this service, ask your doctors if they participate in Medicare. Participating providers have signed an arrangement to accept assignment for all Medicare‑covered services. If your doctor participates, the Medigap insurance company is required to pay the doctor directly if you request. If your doctor doesn't participate but still accepts Medicare, you may be asked to pay the coinsurance amount at the time of service. In these cases, your Medigap insurance company will pay you directly according to policy limits.If you have any questions about Medigap claim filing, call 1‑800‑MEDICARE (1‑800‑633‑4227). TTY users can call 1‑877‑486‑2048.
21
SECTION
Your Right to Buy a Medigap Policy3 What are guaranteed issue rights?
Guaranteed issue rights are rights you have in certain situations when insurance companies must offer you certain Medigap policies when you aren't in your Medigap Open Enrollment Period. In these situations, an insurance company must: • Sell you a Medigap policy • Cover all your pre‑existing health conditions • Can’t charge you more for a Medigap policy regardless of past or present
health problems If you live in Massachusetts, Minnesota, or Wisconsin, you have guaranteed issue rights to buy a Medigap policy, but the Medigap policies are different. See pages 42– 44 for your Medigap policy choices.
When do I have guaranteed issue rights? In most cases, you have a guaranteed issue right when you have certain types of other health care coverage that changes in some way, like when you lose the other health care coverage. In other cases, you have a “trial right” to try a Medicare Advantage Plan and still buy a Medigap policy if you change your mind. For information on trial rights, see page 23.
22 Section 3: Your Right to Buy a Medigap Policy
This chart describes the most common situations, under federal law, that give you a right to buy a policy, the kind of policy you can buy, and when you can or must apply for it. States may provide additional Medigap guaranteed issue rights.
You have a guaranteed issue right if...
You’re in a Medicare Advantage Plan (like an HMO or PPO), and your plan is leaving Medicare or stops giving care in your area, or you move out of the plan’s service area.
You have Original Medicare and an employer group health plan (including retiree or COBRA coverage) or union coverage that pays after Medicare pays and that plan is ending.
Note: In this situation, you may have additional rights under state law.
You have Original Medicare and a Medicare SELECT policy. You move out of the Medicare SELECT policy’s service area.
Call the Medicare SELECT insurer for more information about your options.
You have the right to buy...
Medigap Plan A, B, C, F, K, or L that’s sold in your state by any insurance company.
You only have this right if you switch to Original Medicare rather than join another Medicare Advantage Plan.
Medigap Plan A, B, C, F, K, or L that’s sold in your state by any insurance company.
If you have COBRA coverage, you can either buy a Medigap policy right away or wait until the COBRA coverage ends.
Medigap Plan A, B, C, F, K, or L that’s sold by any insurance company in your state or the state you’re moving to.
You can/must apply for a Medigap policy...
As early as 60 calendar days before the date your health care coverage will end, but no later than 63 calendar days after your health care coverage ends. Medigap coverage can’t start until your Medicare Advantage Plan coverage ends.
No later than 63 calendar days after the latest of these 3 dates:
1. Date the coverage ends
2. Date on the notice you get telling you that coverage is ending (if you get one)
3. Date on a claim denial, if this is the only way you know that your coverage ended
As early as 60 calendar days before the date your Medicare SELECT coverage will end, but no later than 63 calendar days after your Medicare SELECT coverage ends.
23Section 3: Your Right to Buy a Medigap Policy
You have a guaranteed issue right if...
(Trial right) You joined a Medicare Advantage Plan (like an HMO or PPO) or Programs of All‑inclusive Care for the Elderly (PACE) when you were first eligible for Medicare Part A at 65, and within the first year of joining, you decide you want to switch to Original Medicare.
(Trial right) You dropped a Medigap policy to join a Medicare Advantage Plan (or to switch to a Medicare SELECT policy) for the first time, you’ve been in the plan less than a year, and you want to switch back.
Your Medigap insurance company goes bankrupt and you lose your coverage, or your Medigap policy coverage otherwise ends through no fault of your own.
You leave a Medicare Advantage Plan or drop a Medigap policy because the company hasn’t followed the rules, or it misled you.
You have the right to buy...
Any Medigap policy that’s sold in your state by any insurance company.
The Medigap policy you had before you joined the Medicare Advantage Plan or Medicare SELECT policy, if the same insurance company you had before still sells it. If your former Medigap policy isn’t available, you can buy Medigap Plan A, B, C, F, K, or L that’s sold in your state by any insurance company.
Medigap Plan A, B, C, F, K, or L that’s sold in your state by any insurance company.
Medigap Plan A, B, C, F, K, or L that’s sold in your state by any insurance company.
You can/must apply for a Medigap policy...
As early as 60 calendar days before the date your coverage will end, but no later than 63 calendar days after your coverage ends.
Note: Your rights may last for an extra 12 months under certain circumstances.
As early as 60 calendar days before the date your coverage will end, but no later than 63 calendar days after your coverage ends. Note: Your rights may last for an extra 12 months under certain circumstances.
No later than 63 calendar days from the date your coverage ends.
No later than 63 calendar days from the date your coverage ends.
This chart describes the most common situations, under federal law, that give you a right to buy a policy, the kind of policy you can buy, and when you can or must apply for it. States may provide additional Medigap guaranteed issue rights. (continued)
24
Can I buy a Medigap policy if I lose my health care coverage? Yes, you may be able to buy a Medigap policy. Because you may have a guaranteed issue right to buy a Medigap policy, make sure you keep these: • A copy of any letters, notices, emails, and/or claim denials that have your name on
them as proof of your coverage being terminated.
• The postmarked envelope these papers come in as proof of when it was mailed. You may need to send a copy of some or all of these papers with your Medigap application to prove you have a guaranteed issue right. If you have a Medicare Advantage Plan (like an HMO or PPO) but you’re planning to return to Original Medicare, you can apply for a Medigap policy before your coverage ends. The Medigap insurer can sell it to you as long as you’re leaving the plan. Ask that the new policy take effect when your Medicare Advantage enrollment ends, so you’ll have continuous coverage.
For more information If you have any questions or want to learn about any additional Medigap rights in your state, you can: • Call your State Health Insurance Assistance Program to make sure that you qualify
for these guaranteed issue rights. See pages 47– 48. • Call your State Insurance Department if you’re denied Medigap coverage in any of
these situations. See pages 47– 48.
Important: The guaranteed issue rights in this section are from federal law. These rights are for both Medigap and Medicare SELECT policies. Many states provide additional Medigap rights.
There may be times when more than one of the situations in the chart on pages 22–23 applies to you. When this happens, you can choose the guaranteed issue right that gives you the best choice. Some of the situations listed include loss of coverage under Programs of All‑inclusive Care for the Elderly (PACE). PACE combines medical, social, and long‑term care services, and prescription drug coverage for frail people. To be eligible for PACE, you must meet certain conditions. PACE may be available in states that have chosen it as an optional Medicaid benefit. If you have Medicaid, an insurance company can sell you a Medigap policy only in certain situations. For more information about PACE, visit Medicare.gov, or call 1‑800‑MEDICARE (1‑800‑633‑4227). TTY users can call 1‑877‑486‑2048.
Steps to Buying a Medigap Policy4 Step-by-step guide to buying a Medigap policy
Buying a Medigap policy is an important decision. Only you can decide if a Medigap policy is the way for you to supplement Original Medicare coverage and which Medigap policy to choose. Shop carefully. Compare available Medigap policies to see which one meets your needs. As you shop for a Medigap policy, keep in mind that different insurance companies may charge different amounts for exactly the same Medigap policy, and not all insurance companies offer all of the Medigap policies. Below is a step‑by‑step guide to help you buy a Medigap policy. If you live in Massachusetts, Minnesota, or Wisconsin, see pages 42– 44.
STEP 1: Decide which benefits you want, then decide which of the standardized Medigap policies meet your needs.
STEP 2: Find out which insurance companies sell Medigap policies in your state.
STEP 3: Call the insurance companies that sell the Medigap policies you’re interested in and compare costs.
STEP 4: Buy the Medigap policy.
26
STEP 1: Decide which benefits you want, then decide which of the Medigap policy meets your needs. Think about your current and future health care needs when deciding which benefits you want because you might not be able to switch Medigap policies later. Decide which benefits you need, and select the Medigap policy that will work best for you. The chart on page 11 provides an overview of Medigap benefits.
STEP 2: Find out which insurance companies sell Medigap policies in your state.
To find out which insurance companies sell Medigap policies in your state: • Call your State Health Insurance Assistance Program. See pages 47– 48.
Ask if they have a “Medigap rate comparison shopping guide” for your state. This guide usually lists companies that sell Medigap policies in your state and their costs.
• Call your State Insurance Department. See pages 47– 48. • Visit Medicare.gov/find‑a‑plan:
This website will help you find information on your health plan options, including the Medigap policies in your area. You can also get information on: 4 How to contact the insurance companies that sell Medigap policies in your state.4 What each Medigap policy covers.4 How insurance companies decide what to charge you for a Medigap policy premium.
If you don’t have a computer, your local library or senior center may be able to help you look at this information. You can also call 1‑800‑MEDICARE (1‑800‑633‑4227). A customer service representative will help you get information on all your health plan options including the Medigap policies in your area. TTY users can call 1‑877‑486‑2048.
Since costs can vary between companies, plan to call more than one insurance company that sells Medigap policies in your state. Before you call, check the companies to be sure they’re honest and reliable by using one of these resources: • Call your State Insurance Department. Ask if they keep a record of
complaints against insurance companies that can be shared with you. When deciding which Medigap policy is right for you, consider these complaints, if any.
• Call your State Health Insurance Assistance Program. These programs can give you help at no cost to you with choosing a Medigap policy.
• Go to your local public library for help with: – Getting information on an insurance company’s financial strength
from independent rating services like weissratings.com, A.M. Best, and Standard & Poor’s.
– Looking at information about the insurance company online. • Talk to someone you trust, like a family member, your insurance agent,
or a friend who has a Medigap policy from the same Medigap insurance company.
28 Section 4: Steps to Buying a Medigap Policy
Before you call any insurance companies, figure out if you’re in your Medigap Open Enrollment Period or if you have a guaranteed issue right. Read pages 14 –15 and 22–23 carefully. If you have questions, call your State Health Insurance Assistance Program. See pages 47– 48. This chart can help you keep track of the information you get.
STEP 3: Call the insurance companies that sell the Medigap policies you’re interested in and compare costs.
Community Issue‑age Attained‑age
Community Issue‑age Attained‑age
Ask each insurance company…
“Are you licensed in ___?” (Say the name of your state.) Note: If the answer is NO, STOP here, and try another company. “Do you sell Medigap Plan ___?” (Say the letter of the Medigap Plan you’re interested in.) Note: Insurance companies usually offer some, but not all, Medigap policies. Make sure the company sells the plan you want. Also, if you’re interested in a Medicare SELECT or high‑deductible Medigap policy, tell them.
“Do you use medical underwriting for this Medigap policy?” Note: If the answer is NO, go to step 4 on page 30. If the answer is YES, but you know you’re in your Medigap Open Enrollment Period or have a guaranteed issue right to buy that Medigap policy, go to step 4. Otherwise, you can ask, “Can you tell me whether I'm likely to qualify for the Medigap policy?”
“Do you have a waiting period for pre‑existing conditions?” Note: If the answer is YES, ask how long the waiting period is and write it in the box.
“Do you price this Medigap policy by using community‑rating, issue‑age‑rating, or attained‑age‑rating?” See page 18. Note: Circle the one that applies for that insurance company.
“I'm ___ years old. What would my premium be under this Medigap policy?” Note: If it’s attained‑age, ask, “How frequently does the premium increase due to my age?”
“Has the premium for this Medigap policy increased in the last 3 years due to inflation or other reasons?” Note: If the answer is YES, ask how much it has increased, and write it in the box.
“Do you offer any discounts or additional benefits?” See page 19.
Company 2 Company 1
29Section 4: Steps to Buying a Medigap Policy
STEP 3: (continued)
Watch out for illegal practices. It’s illegal for anyone to:
• Pressure you into buying a Medigap policy, or lie to or mislead you to switch from one company or policy to another.
• Sell you a second Medigap policy when they know that you already have one, unless you tell the insurance company in writing that you plan to cancel your existing Medigap policy.
• Sell you a Medigap policy if they know you have Medicaid, except in certain situations.
• Sell you a Medigap policy if they know you’re in a Medicare Advantage Plan (like an HMO or PPO) unless your coverage under the Medicare Advantage Plan will end before the effective date of the Medigap policy.
• Claim that a Medigap policy is a part of Medicare or any other federal program. Medigap is private health insurance.
• Claim that a Medicare Advantage Plan is a Medigap policy. • Sell you a Medigap policy that can’t legally be sold in your state. Check with
your State Insurance Department (see pages 47– 48) to make sure that the Medigap policy you’re interested in can be sold in your state.
• Misuse the names, letters, or symbols of the U.S. Department of Health & Human Services (HHS), Social Security Administration (SSA), Centers for Medicare & Medicaid Services (CMS), or any of their various programs like Medicare. (For example, they can’t suggest the Medigap policy has been approved or recommended by the federal government.)
• Claim to be a Medicare representative if they work for a Medigap insurance company.
• Sell you a Medicare Advantage Plan when you say you want to stay in Original Medicare and buy a Medigap policy. A Medicare Advantage Plan isn’t the same as Original Medicare. See page 5. If you enroll in a Medicare Advantage Plan, you can’t use a Medigap policy.
If you believe that a federal law has been broken, call the Inspector General’s hotline at 1‑800‑HHS‑TIPS (1‑800‑447‑8477). TTY users can call 1‑800‑377‑4950. Your State Insurance Department can help you with other insurance‑related problems.
30
STEP 4: Buy the Medigap policy. Once you decide on the insurance company and the Medigap policy you want, apply. The insurance company must give you a clearly worded summary of your Medigap policy. Read it carefully. If you don’t understand it, ask questions. Remember these when you buy your Medigap policy: • Filling out your application. Fill out the application carefully and completely,
including medical questions. The answers you give will determine your eligibility for an Open Enrollment Period or guaranteed issue rights. If the insurance agent fills out the application, make sure it’s correct. If you buy a Medigap policy during your Medigap Open Enrollment Period or provide evidence that you’re entitled to a guaranteed issue right, the insurance company can’t use any medical answers you give to deny you a Medigap policy or change the price. The insurance company can’t ask you any questions about your family history or require you to take a genetic test.
• Paying for your Medigap policy. You can pay for your Medigap policy by check, money order, or bank draft. Make it payable to the insurance company, not the agent. If buying from an agent, get a receipt with the insurance company’s name, address, and phone number for your records. Some companies may offer electronic funds transfer.
• Starting your Medigap policy. Ask for your Medigap policy to become effective when you want coverage to start. Generally, Medigap policies begin the first of the month after you apply. If, for any reason, the insurance company won’t give you the effective date for the month you want, call your State Insurance Department. See pages 47– 48. Note: If you already have a Medigap policy, ask for your new Medigap policy to become effective when your old Medigap policy coverage ends.
• Getting your Medigap policy. If you don’t get your Medigap policy in 30 days, call your insurance company. If you don’t get your Medigap policy in 60 days, call your State Insurance Department.
Section 4: Steps to Buying a Medigap Policy
31
SECTION
If You Already Have a Medigap Policy5 Read this section to see if any of these situations apply to you:
• You’re thinking about switching to a different Medigap policy. See pages 32–35.
• You’re losing your Medigap coverage. See page 36.
• You have a Medigap policy with Medicare prescription drug coverage. See pages 36–38.
If you just want a refresher about Medigap insurance, turn to page 11.
32
Switching Medigap policies If you’re thinking about switching to a new Medigap policy, see below and pages 33–35 to answer some common questions.
Can I switch to a different Medigap policy?
In most cases, you won’t have a right under federal law to switch Medigap policies, unless you’re within your 6‑month Medigap Open Enrollment Period or are eligible under a specific circumstance for guaranteed issue rights. But, if your state has more generous requirements, or the insurance company is willing to sell you a Medigap policy, make sure you compare benefits and premiums before switching. If you bought your Medigap policy before 2010, it may offer coverage that isn’t available in a newer Medigap policy. On the other hand, Medigap policies bought before 1992 might not be guaranteed renewable and might have bigger premium increases than newer, standardized Medigap policies currently being sold.If you decide to switch, don’t cancel your first Medigap policy until you’ve decided to keep the second Medigap policy. On the application for the new Medigap policy, you’ll have to promise that you’ll cancel your first Medigap policy. You have 30 days to decide if you want to keep the new Medigap policy. This is called your “free look period.” The 30‑day free look period starts when you get your new Medigap policy. You’ll need to pay both premiums for one month.
Section 5: If You Already Have a Medigap Policy
Words in blue are defined on pages 49–50.
33Section 5: If You Already Have a Medigap Policy
Switching Medigap policies (continued)
Do I have to switch Medigap policies if I have a Medigap policy that's no longer sold?
No. But you can’t have more than one Medigap policy, so if you buy a new Medigap policy, you have to give up your old policy (except for your 30‑day “free look period,” described on page 32). Once you cancel the old policy, you can’t get it back.
Do I have to wait a certain length of time after I buy my first Medigap policy before I can switch to a different Medigap policy?
No. If you’ve had your old Medigap policy for less than 6 months, the Medigap insurance company may be able to make you wait up to 6 months for coverage of a pre‑existing condition. However, if your old Medigap policy had the same benefits, and you had it for 6 months or more, the new insurance company can’t exclude your pre‑existing condition. If you’ve had your Medigap policy less than 6 months, the number of months you’ve had your current Medigap policy must be subtracted from the time you must wait before your new Medigap policy covers your pre‑existing condition.If the new Medigap policy has a benefit that isn’t in your current Medigap policy, you may still have to wait up to 6 months before that benefit will be covered, regardless of how long you’ve had your current Medigap policy.If you’ve had your current Medigap policy longer than 6 months and want to replace it with a new one with the same benefits and the insurance company agrees to issue the new policy, they can’t write pre‑existing conditions, waiting periods, elimination periods, or probationary periods into the replacement policy.
34
Switching Medigap policies (continued)Why would I want to switch to a different Medigap policy?
Some reasons for switching may include: • You’re paying for benefits you don’t need. • You need more benefits than you needed before. • Your current Medigap policy has the right benefits, but you want to
change your insurance company. • Your current Medigap policy has the right benefits, but you want to find a
policy that’s less expensive.
It’s important to compare the benefits in your current Medigap policy to the benefits listed on page 11. If you live in Massachusetts, Minnesota, or Wisconsin, see pages 42– 44. To help you compare benefits and decide which Medigap policy you want, follow the “Steps to Buying a Medigap Policy” in Section 4. If you decide to change insurance companies, you can call the new insurance company and arrange to apply for your new Medigap policy. If your application is accepted, call your current insurance company, and ask to have your coverage end. The insurance company can tell you how to submit a request to end your coverage.As discussed on page 32, you should have your old Medigap policy coverage end after you have the new Medigap policy for 30 days. Remember, this is your 30‑day free look period. You’ll need to pay both premiums for one month.
Section 5: If You Already Have a Medigap Policy
35Section 5: If You Already Have a Medigap Policy
Switching Medigap policies (continued)
Can I keep my current Medigap policy (or Medicare SELECT policy) or switch to a different Medigap policy if I move out-of-state?
In general, you can keep your current Medigap policy regardless of where you live as long as you still have Original Medicare. If you want to switch to a different Medigap policy, you’ll have to check with your current or the new insurance company to see if they’ll offer you a different Medigap policy.You may have to pay more for your new Medigap policy and answer some medical questions if you’re buying a Medigap policy outside of your Medigap Open Enrollment Period. See pages 14–16.If you have a Medicare SELECT policy and you move out of the policy’s area, you can:• Buy a standardized Medigap policy from your current Medigap policy
insurance company that offers the same or fewer benefits than your current Medicare SELECT policy. If you’ve had your Medicare SELECT policy for more than 6 months, you won’t have to answer any medical questions.
• Use your guaranteed issue right to buy any Plan A, B, C, F, K, or L that’s sold in most states by any insurance company.
Your state may provide additional Medigap rights. Call your State Health Insurance Assistance Program or State Department of Insurance for more information. See pages 47–78 for their phone numbers.
What happens to my Medigap policy if I join a Medicare Advantage Plan?
Medigap policies can’t work with Medicare Advantage Plans. If you decide to keep your Medigap policy, you’ll have to pay your Medigap policy premium, but the Medigap policy can’t pay any deductibles, copayments, coinsurance, or premiums under a Medicare Advantage Plan. So, if you join a Medicare Advantage Plan, you may want to drop your Medigap policy. Contact your Medigap insurance company to find out how to disenroll. However, if you leave the Medicare Advantage Plan you might not be able to get the same Medigap policy back, or in some cases, any Medigap policy unless you have a “trial right.” See page 23. Your rights to buy a Medigap policy may vary by state. You always have a legal right to keep the Medigap policy after you join a Medicare Advantage Plan. However, because you have a Medicare Advantage Plan, the Medigap policy would no longer provide benefits that supplement Medicare.
Words in blue are defined on pages 49–50.
36
Losing Medigap coverage Can my Medigap insurance company drop me?
If you bought your Medigap policy after 1992, in most cases the Medigap insurance company can’t drop you because the Medigap policy is guaranteed renewable. This means your insurance company can’t drop you unless one of these happens: • You stop paying your premium. • You weren’t truthful on the Medigap policy application. • The insurance company becomes bankrupt or insolvent.
If you bought your Medigap policy before 1992, it might not be guaranteed renewable. This means the Medigap insurance company can refuse to renew the Medigap policy, as long as it gets the state’s approval to cancel your Medigap policy. However, if this does happen, you have the right to buy another Medigap policy. See the guaranteed issue right on page 23.
Medigap policies and Medicare prescription drug coverage If you bought a Medigap policy before January 1, 2006, and it has coverage for prescription drugs, see below and page 37.
Medicare offers prescription drug coverage (Part D) for everyone with Medicare. If you have a Medigap policy with prescription drug coverage, that means you chose not to join a Medicare Prescription Drug Plan when you were first eligible. However, you can still join a Medicare drug plan. Your situation may have changed in ways that make a Medicare Prescription Drug Plan fit your needs better than the prescription drug coverage in your Medigap policy. It’s a good idea to review your coverage each fall, because you can join a Medicare Prescription Drug Plan between October 15–December 7. Your new coverage will begin on January 1.
Section 5: If You Already Have a Medigap Policy
37Section 5: If You Already Have a Medigap Policy
Medigap policies and Medicare prescription drug coverage (continued)
Why would I change my mind and join a Medicare Prescription Drug Plan?
In a Medicare Prescription Drug Plan, you may have to pay a monthly premium, but Medicare pays a large part of the cost. There’s no maximum yearly amount as with Medigap prescription drug benefits in old Plans H, I, and J (these plans are no longer sold). However, a Medicare Prescription Drug Plan might only cover certain prescription drugs (on its “formulary” or “drug list”). It’s important that you check whether your current prescription drugs are on the Medicare drug plan’s list of covered prescription drugs before you join. If your Medigap premium or your prescription drug needs were very low when you had your first chance to join a Medicare Prescription Drug Plan, your Medigap prescription drug coverage may have met your needs. However, if your Medigap premium or the amount of prescription drugs you use has increased recently, a Medicare Prescription Drug Plan might now be a better choice for you.
Will I have to pay a late enrollment penalty if I join a Medicare Prescription Drug Plan now?
If you qualify for Extra Help, you won’t pay a late enrollment penalty. If you don’t qualify for Extra Help, it will depend on whether your Medigap policy includes “creditable prescription drug coverage.” This means that the Medigap policy’s drug coverage pays, on average, at least as much as Medicare’s standard prescription drug coverage. If your Medigap policy's drug coverage isn’t creditable coverage, and you join a Medicare Prescription Drug Plan now, you’ll probably pay a higher premium (a penalty added to your monthly premium) than if you had joined when you were first eligible. Each month that you wait to join a Medicare Prescription Drug Plan will make your late enrollment penalty higher. Your Medigap carrier must send you a notice each year telling you if the prescription drug coverage in your Medigap policy is creditable. Keep these notices in case you decide later to join a Medicare Prescription Drug Plan. Also consider that your prescription drug needs could increase as you get older.
38
Will I have to pay a late enrollment penalty if I join a Medicare Prescription Drug Plan now? (continued)
If your Medigap policy includes creditable prescription drug coverage and you decide to join a Medicare Prescription Drug Plan, you won’t have to pay a late enrollment penalty as long as you don’t go 63 or more days in a row without creditable prescription drug coverage. So, don’t drop your Medigap policy before you join the Medicare drug plan and the coverage starts. In general, you can only join a Medicare drug plan between October 15 –December 7. However, if you lose your Medigap policy (for example, if it isn’t guaranteed renewable, and your company cancels it), you may be able to join a Medicare drug plan 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. If your Medigap policy covers prescription drugs, you must tell your Medigap insurance company if you join a Medicare drug plan so it can remove the prescription drug coverage from your Medigap policy and adjust your premium. Once the drug coverage is removed, you can’t get that coverage back even though you didn’t change Medigap policies.
What if I decide to drop my entire Medigap policy (not just the Medigap prescription drug coverage) and join a Medicare Advantage Plan that offers prescription drug coverage?
You need to be careful about the timing because in general, you can only join a Medicare Prescription Drug Plan or Medicare Advantage Plan (like an HMO or PPO) during the Medicare Open Enrollment Period between October 15 –December 7. If you join during Medicare Open Enrollment Period, your coverage will begin on January 1 as long as the plan gets your enrollment request by December 7.
Section 5: If You Already Have a Medigap Policy
39
SECTION
Medigap Policies for People with a Disability or ESRD6 Information for people under 65Medigap policies for people under 65 and eligible for Medicare because of a disability or End-Stage Renal Disease (ESRD) You may have Medicare before turning 65 due to a disability or ESRD (permanent kidney failure requiring dialysis or a kidney transplant).If you're under 65 and have Medicare because of a disability or ESRD, you might not be able to buy the Medigap policy you want, or any Medigap policy, until you turn 65. Federal law generally doesn’t require insurance companies to sell Medigap policies to people under 65. However, some states require Medigap insurance companies to sell you a Medigap policy, even if you’re under 65. These states are listed on the next page.
Important: This section provides information on the minimum federal standards. For your state requirements, call your State Health Insurance Assistance Program. See pages 47– 48.
40
Medigap policies for people under 65 and eligible for Medicare because of a disability or End-Stage Renal Disease (ESRD) (continued)At the time of printing this guide, these states required insurance companies to offer at least one kind of Medigap policy to people with Medicare under 65:
Section 6: Medigap Policies for People with a Disability or ESRD
• California • Colorado • Connecticut • Delaware• Florida• Georgia• Hawaii • Illinois• Idaho • Kansas• Kentucky
• Louisiana • Maine • Maryland • Massachusetts • Michigan • Minnesota • Mississippi • Missouri• Montana• New Hampshire • New Jersey
• New York • North Carolina • Oklahoma • Oregon • Pennsylvania • South Dakota• Tennessee • Texas • Vermont • Wisconsin
Note: Some states provide these rights to all people with Medicare under 65, while others only extend them to people eligible for Medicare because of disability or only to people with ESRD. Check with your State Insurance Department about what rights you might have under state law.
Even if your state isn’t on the list above, some insurance companies may voluntarily sell Medigap policies to people under 65, although they’ll probably cost you more than Medigap policies sold to people over 65, and they can probably use medical underwriting. Also, some of the federal guaranteed rights are available to people with Medicare under 65, see pages 21–24. Check with your State Insurance Department about what additional rights you might have under state law.Remember, if you’re already enrolled in Medicare Part B, you’ll get a Medigap Open Enrollment Period when you turn 65. You'll probably have a wider choice of Medigap policies and be able to get a lower premium at that time. During the Medigap Open Enrollment Period, insurance companies can’t refuse to sell you any Medigap policy due to a disability or other health problem, or charge you a higher premium (based on health status) than they charge other people who are 65.Because Medicare (Part A and/or Part B) is creditable coverage, if you had Medicare for more than 6 months before you turned 65, you may not have a pre‑existing condition waiting period imposed for coverage bought during the Medigap Open Enrollment Period. For more information about the Medigap Open Enrollment Period and pre‑existing conditions, see pages 16 –17. If you have questions, call your State Health Insurance Assistance Program. See pages 47–48.
Massachusetts benefits • Inpatient hospital care: covers the Medicare Part A coinsurance plus coverage for 365
additional days after Medicare coverage ends • Medical costs: covers the Medicare Part B coinsurance (generally 20% of the
Medicare‑approved amount) • Blood: covers the first 3 pints of blood each year• Part A hospice coinsurance or copaymentThe check marks in this chart mean the benefit is covered.
Massachusetts—Chart of standardized Medigap policies
Basic benefits
Part A: inpatient hospital deductible
Part A: skilled nursing facility (SNF) coinsurance
Part B: deductible
Foreign travel emergency
Inpatient days in mental health hospitals
State‑mandated benefits (annual Pap tests and mammograms—check your plan for other state‑mandated benefits)
60 days per calendar year
120 days per benefit year
3 3
3 3
3
3
3
3
Medigap benefits
Supplement 1 Plan Core plan
For more information on these Medigap policies, visit Medicare.gov/find‑a‑plan, or call your State Insurance Department. See pages 47– 48.
Minnesota benefits • Inpatient hospital care: covers the Part A coinsurance • Medical costs: covers the Part B coinsurance (generally 20% of the Medicare‑approved amount)• Blood: covers the first 3 pints of blood each year• Part A hospice and respite cost sharing• Parts A and B home health services and supplies cost sharingThe check marks in this chart mean the benefit is covered.
Minnesota—Chart of standardized Medigap policies
Basic benefits
Part A: inpatient hospital deductible
Part A: skilled nursing facility (SNF) coinsurance
Part B: deductible
Foreign travel emergency
Outpatient mental health
Usual and customary fees
Medicare‑covered preventive care
Physical therapy
Coverage while in a foreign country
State‑mandated benefits (diabetic equipment and supplies, routine cancer screening, reconstructive surgery, and immunizations)
Medigap benefits Basic plan Extended
20% 20%
3 3
3 3
80%*
3
3(Provides 120 days of
SNF care)
3
3(Provides 100 days of
SNF care)
80%
80%*
20% 20%
80%*
basic plan
3 3
Mandatory riders
Insurance companies can offer 4 additional riders that can be added to a basic plan. You may choose any one or all of these riders to design a Medigap policy that meets your needs:
1. Part A: inpatient hospital deductible
2. Part B: deductible 3. Usual and
customary fees 4. Non‑Medicare
preventive care
* Pays 100% after you spend $1,000 in out-of-pocket costs for a calendar year. Minnesota versions of Medigap Plans K, L, M, N, and high-deductible F are available.
Important: The basic and extended basic benefits are available when you enroll in Part B, regardless of age or health problems. If you are under 65, return to work and drop Part B to elect your employer’s health plan, you’ll get a 6‑month Medigap Open Enrollment Period after you turn 65 and retire from that employer when you can join Part B again.
44 Section 7: Medigap Coverage Charts
Basic benefits
Part A: skilled nursing facility (SNF) coinsurance
Inpatient mental health coverage
Home health care
State‑mandated benefits
Wisconsin benefits • Inpatient hospital care: covers the Part A coinsurance • Medical costs: covers the Part B coinsurance (generally 20% of the
Medicare‑approved amount) • Blood: covers the first 3 pints of blood each year• Part A hospice coinsurance or copayment
The check marks in this chart mean the benefit is covered.
For more information on these Medigap policies, visit Medicare.gov/find‑a‑plan or call your State Insurance Department. See pages 47– 48.
Plans known as “50% and 25% cost‑sharing plans” are available. These plans are similar to standardized Plans K (50%) and L (25%). A high‑deductible plan ($2,240 deductible for 2018) is also available.
175 days per lifetime in addition to Medicare’s benefit
3
3
3
40 visits per year in addition to those paid by Medicare
Wisconsin — Chart of standardized Medigap policies
Medigap benefits Basic plan Optional riders
Insurance companies are allowed to offer these 7 additional riders to a Medigap policy:1. Part A deductible 2. Additional home health
care (365 visits including those paid by Medicare)
3. Part B deductible 4. Part B excess charges5. Foreign travel emergency6. 50% Part A deductible7. Part B copayment or coinsurance
For More Information8 Where to get more information On pages 47– 48, you’ll find phone numbers for your State Health Insurance Assistance Program (SHIP) and State Insurance Department.
• Call your SHIP for help with:
– 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 if you have questions about the Medigap policies sold in your area or any insurance‑related problems.
46
How to get help with Medicare and Medigap questions If you have questions about Medicare, Medigap, or need updated phone numbers for the contacts listed on pages 47– 48:
Visit Medicare.gov: • For Medigap policies in your area, visit Medicare.gov/find‑a‑plan.• For updated phone numbers, visit Medicare.gov/contacts.
Call 1-800-MEDICARE (1-800-633-4227): Customer service representatives are available 24 hours a day, 7 days a week. TTY users can call 1‑877‑486‑2048. If you need help in a language other than English or Spanish, let the customer service representative know the language.
State Health Insurance Assistance Program and State Insurance Department
48 Section 8: For More Information
Nevada 1‑800‑307‑4444 1‑800‑992‑0900 New Hampshire 1‑866‑634‑9412 1‑800‑852‑3416 New Jersey 1‑800‑792‑8820 1‑800‑446‑7467 New Mexico 1‑800‑432‑2080 1‑888‑727‑5772 New York 1‑800‑701‑0501 1‑800‑342‑3736 North Carolina 1‑855‑408‑1212 1‑800‑546‑5664 North Dakota 1‑888‑575‑6611 1‑800‑247‑0560 Northern Mariana Not available 1‑670‑664‑3064 Islands 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 1‑888‑722‑8686 Rhode Island 1‑888‑884‑8721 1‑401‑462‑9500 South Carolina 1‑800‑868‑9095 1‑803‑737‑6160 South Dakota 1‑800‑536‑8197 1‑605‑773‑3563 Tennessee 1‑877‑801‑0044 1‑800‑342‑4029 Texas 1‑800‑252‑9240 1‑800‑252‑3439 Utah 1‑800‑541‑7735 1‑800‑439‑3805 Vermont 1‑800‑642‑5119 1‑800‑964‑1784 Virgin Islands 1‑340‑772‑7368 1‑340‑774‑7166 1‑340‑714‑4354 (St. Thomas) Virginia 1‑800‑552‑3402 1‑877‑310‑6560 Washington 1‑800‑562‑6900 1‑800‑562‑6900 Washington D.C. 1‑202‑994‑6272 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
State Insurance Department
State State Health Insurance Assistance Program
49
SECTION
Definitions9 Assignment—An agreement by your doctor, provider, or supplier to be paid directly by Medicare, to accept the payment amount Medicare approves for the service, and not to bill you for any more than the Medicare deductible and coinsurance.
Coinsurance—An amount you may be required to pay as your share of the costs for services after you pay any deductibles. Coinsurance is usually a percentage (for example, 20%).
Copayment—An amount you may be required to pay as your share of the cost for a medical service or supply, like a doctor’s visit, hospital outpatient visit, or a prescription drug. A copayment is usually a set amount, rather than a percentage. For example, you might pay $10 or $20 for a doctor’s visit or prescription drug.
Deductible—The amount you must pay for health care or prescriptions before Original Medicare, your prescription drug plan, or your other insurance begins to pay.
Excess charge—If you have Original Medicare, and the amount a doctor or other health care provider is legally permitted to charge is higher than the Medicare‑approved amount, the difference is called the excess charge.
Guaranteed issue rights —Rights you have in certain situations when insurance companies are required by law to sell or offer you a Medigap policy. In these situations, an insurance company can’t deny you a Medigap policy, or place conditions on a Medigap policy, such as exclusions for pre‑existing conditions, and can’t charge you more for a Medigap policy because of a past or present health problem.
Where words in BLUE are defined
50 Section 9: Definitions
Guaranteed renewable policy—An insurance policy that can’t be terminated by the insurance company unless you make untrue statements to the insurance company, commit fraud, or don’t pay your premiums. All Medigap policies issued since 1992 are guaranteed renewable.
Medicaid—A joint federal and state program that helps with medical costs for some people with limited income and resources. Medicaid programs vary from state to state, but most health care costs are covered if you qualify for both Medicare and Medicaid.
Medical underwriting—The process that an insurance company uses to decide, based on your medical history, whether or not to take your application for insurance, whether or not to add a waiting period for pre‑existing conditions (if your state law allows it), and how much to charge you for that insurance.
Medicare Advantage Plan (Part C)—A type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Medicare Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee‑for‑Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you’re enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan and aren’t paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage.
Medicare-approved amount—In Original Medicare, this is the amount a doctor or supplier that accepts assignment can be paid. It may be less than the actual amount a doctor or supplier charges. Medicare pays part of this amount and you're responsible for the difference.
Medicare prescription drug plan (Part D)— Part D adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private‑Fee‑for‑Service Plans, and Medicare Medical Savings Account Plans. These plans are offered by insurance companies and other private companies approved by Medicare. Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans.
Medicare SELECT—A type of Medigap policy that may require you to use hospitals and, in some cases, doctors within its network to be eligible for full benefits.
Medigap Open Enrollment Period—A one‑time‑only, 6‑month period when federal law allows you to buy any Medigap policy you want that’s sold in your state. It starts in the first month that you’re covered under Medicare Part B, and you’re 65 or older. During this period, you can’t be denied a Medigap policy or charged more due to past or present health problems. Some states may have additional Open Enrollment rights under state law.
Premium—The periodic payment to Medicare, an insurance company, or a health care plan for health care or prescription drug coverage.
State Health Insurance Assistance Program (SHIP)—A state program that gets money from the federal government to give free local health insurance counseling to people with Medicare.
State Insurance Department—A state agency that regulates insurance and can provide information about Medigap policies and other private health insurance.
Notice of Accessible CommunicationsTo help ensure people with disabilities have an equal opportunity to participate in our services, activities, programs, and other benefits, we provide communications in accessible formats. The Centers for Medicare & Medicaid Services (CMS) provides auxiliary aids and services, like publications, documents and communications, in Braille, large print, data/audio CD, relay services and TTY communications.CMS provides free auxiliary aids and services to help us better communicate with people with disabilities. Auxiliary aids include materials in Braille, audio/data CD or other accessible formats.Note: You can get the Choosing a Medigap Policy electronically in standard print, large print, or as an eBook.For Medicare publications, call us at 1‑800‑MEDICARE (1‑800‑633‑4227). TTY: 1‑877‑486‑2048.For all other CMS publications and documents, you can contact our Customer Accessibility Resource Staff:Call 1‑844‑ALT‑FORM (1‑844‑258‑3676). TTY: 1‑844‑716‑3676.Send a fax to 1‑844‑530‑3676.Send an email to [email protected] a letter to: Centers for Medicare & Medicaid Services Offices of Hearings and Inquiries (OHI) 7500 Security Boulevard, Mail Stop S1‑13‑25 Baltimore, MD 21244‑1850 Attn: Customer Accessibility Resource Staff
You can also contact the Customer Accessibility Resource staff:• To follow up on a previous accessibility request• If you have questions about the quality or timeliness of your previous requestNote: Your request for a CMS publication or document should include:• Your name, phone number, and the mailing address where we should send the publications or documents.• The publication title and CMS Product No., if known.• The format you need, like Braille, large print, or data/audio CD.Note: If you’re enrolled in a Medicare Advantage or Prescription Drug Plan, you can contact your plan to request their documents in an accessible format.
Nondiscrimination NoticeCMS doesn’t exclude, deny benefits to, or otherwise discriminate against any person on the basis of race, color, national origin, disability, sex, or age in admission to, participation in, or receipt of the services and benefits under any of its programs and activities, whether carried out by CMS directly or through a contractor or any other entity with which CMS arranges to carry out its programs and activities.
How to file a complaintIf you believe you’ve been subjected to discrimination in a CMS program or activity, there are 3 ways to file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights:1. Online at hhs.gov/civil‑rights/filing‑a‑complaint/complaint‑process/index.html.2. By phone: Call 1‑800‑368‑1019. TDD user can call 1‑800‑537‑7697.3. In writing: Send information about your complaint to:
Office for Civil Rights U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201
To get this publication in Braille, Spanish, or large print (English), visit Medicare.gov, or call 1‑800‑MEDICARE (1‑800‑633‑4227). TTY users can call 1‑877‑486‑2048.
¿Necesita una copia en español? Visite Medicare.gov en el sitio Web. Para saber si esta publicación esta impresa y disponible (en español), llame GRATIS al 1‑800‑MEDICARE (1‑800‑633‑4227). Los usuarios de TTY deben llamar al 1‑877‑486‑2048.
