Original Medicare and Medicare Supplemental (Medigaps ......• A client will have OM unless they...

Original Medicare and Medicare Supplement (Medigap) insurance

Created June 8, 2020

July 2020 continuing education

Today’s agenda• Learning objectives• Troubleshooting and sharing time

• Original Medicare• Medigaps• Case sharing and group discussions

• July learning aids and publications• Resources• Covid-19 • 2020 and 2021 continuing education topics• Continuing education evaluation• Optional training materials: Module 3, quizzes and scenarios

SHIBA advisor continuing education | July 2020 2

Learning objectivesAfter completing this training, you should be able to:

• Explain how people with Original Medicare (OM) will have costs that could be covered by a Medigap.

• Describe the three types of providers in the Medicare world and explain what assignment and non-assignment mean.

• Describe the implications of going to a doctor who does not accept Medicare assignment.

Continued


Learning objectives (continued)After completing this training, you should be able to:

• Explain how you would describe to a client what coverage of excess charges means in a Medigap Plan G.

• Demonstrate that you can use the What you need to know about Medigaps booklet to counsel clients about when they can switch plans or about other Medigap rules.

• Explain what the columns of the Approved Medigap chart mean.


Troubleshooting and sharing• Review June topics

o Medicare fraud and the Senior Medicare Patrol• Review publications from May training

o Medicare & Youo SMP Foundations Trainingo Tips to help you recover from scam callso STARS Beneficiary Contacts SMP instructions

• Local topic sharing• Other topics


Original Medicare


What’s your understanding?

Share your understanding of the following topics:

• Original Medicare:o Definition and description.o What does a client pay?o What’s assignment?

• Medigaps: o Definition and what are they also known as?o How do you compare policies?


Presenter

Presentation Notes

OM: See M&Y pages 51-54. Medigaps: See M&Y pages 69-72.

Original Medicare (OM)A quick review: How does OM work? M&Y page 51

• It’s one way to get Medicare. • A client will have OM unless they choose an MA plan or

other type of Medicare health plan.• A client will generally have to pay a portion of the cost

for each service covered by OM.


Presenter

Presentation Notes

Look at this page as a reminder about getting health care from any hospital, provider…yes with some exceptions. Review the chart. Note the five questions in the grid. There is room to discuss and review more detail if needed. Trainer discussion notes: There are other types of plans, like PACE. Demonstrate with volunteers who ask, that on page 51 of M & Y, "Medicare health plan" is in blue, in the definitions section you can look it up and find PACE, etc.

ContinuedSHIBA advisor continuing education | July 2020 9

Continued from previous slide


Original Medicare: AssignmentWhat’s assignment?M&Y pages 53-54

Doctor, provider or supplier agrees – or is required by law – to accept the Medicare-approved amount as full payment for covered services.

Participating and non-participating providers• Limiting charges: For example excess charges.

Private contracts and “opt out”• Certain doctors and other health care provides who don’t

want to engage with the Medicare program may “opt” out of Medicare.


Presenter

Presentation Notes

Page 53: Read this page and and have a discussion on assignment. Look in particular at excess charges as a point of discussion. Explain excess charges. Also look at private contracts and opted out. Relates closely to coverage under Medigaps. Discuss MSNs..

Assignment discussionParticipating, non-participating and opt-out providers

Spend some time as a group reviewing and summarizing the following web page (also presented on the following three slides):www.medicareinteractive.org/get-answers/medicare-covered-services/outpatient-provider-services/participating-non-participating-and-opt-out-providers

Continued

Medicare Interactive has free resources to learn more about Medicare.


http://www.medicareinteractive.org/get-answers/medicare-covered-services/outpatient-provider-services/participating-non-participating-and-opt-out-providers

Continued

Participating, non-participating, and opt-out providers: Slide 1 of 3






Knowledge check

Q1: Does a client need to choose a primary care doctor when on OM?

Q2: What is assignment?

Q3: What are some rules providers must follow if they choose to opt-out?


Presenter

Presentation Notes

Q1: Does a client need to choose a primary care doctor when on OM? Q1: No. M&Y page 51. Q2: What is assignment? A2: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. M&Y page 53. Q3: What are some rules providers must follow if they choose to opt-out? A3: Medicare will not pay for care you receive from an opt-out provider (except in emergencies). You are responsible for the entire cost of your care. The provider must give you a private contract describing their charges and confirming that you understand you are responsible for the full cost of your care and that Medicare will not reimburse you. Opt-out providers do not bill Medicare for services you receive.

Medigaps


What’s your knowledge?

Q1: What is a Medigap plan and why should a client buy one?

Q2: How does a person get a Medigap policy?

Q3: What do Medigap plans cover?

Q4: When can a client sign up or switch plans?

Q5: How can a client compare Medigap plans?


Presenter

Presentation Notes

WA has some slightly different rules. The group could have a brief discussion about how OIC regulates the Medigap plans and what the approval process looks like to acknowledge this process. Review it briefly, but move quickly from this section to the Medicare & You slides and then a deeper dive into the What you need to know about Medigap (Medicare Supplement) plans booklet covered later in this section. Q1: What is a Medigap plan and why should a client buy one? A1: A Medigap plan (also called a Medicare Supplement), sold by private companies, can help pay some of the health care costs Original Medicare doesn't cover, like copayments, coinsurance and deductibles. https://www.insurance.wa.gov/what-medigap-plan-and-why-should-i-buy-it Q2: How does a person obtain a Medigap policy? A2: Medicare Supplement Insurance (Medigap) policies are sold by private companies. These plans help pay some health care costs Original Medicare doesn't cover, such as copayments, coinsurance and deductibles. https://www.insurance.wa.gov/medigap-medicare-supplement-plans Q3: What do Medigap plans cover? A3: A Medigap plan pays some of the costs that Part A (hospital insurance) and Part B (medical insurance) don't cover. It fills in the gaps. These plans do not include prescription drug coverage. https://www.insurance.wa.gov/how-much-do-medigap-plans-cost-and-what-do-they-cover Q4: When can a client sign up or switch plans? A4: When can I sign up? To qualify for enrolling in a Medigap (also called Medicare Supplement) plan, you must first be enrolled in Original Medicare Parts A and B. The best time to sign up for a Medigap plan is during the first six months in which you are age 65 or older and also enrolled in Part B. To sign up, contact the private insurance company directly. See Approved Medicare Supplement plans (PDF, 229KB) for contact information. If you're under age 65, you might not be able to buy the Medigap plan you want - or any Medigap plan - until you turn 65. When can I switch plans? If you're already enrolled in a Medigap plan B through N, you can switch at any time to another Medigap plan B through N. If you have a Medigap plan A, you can switch to any other Medigap plan A. In either of these situations, you do not have to take a written health screening questionnaire. However, if you're switching from some other type of health insurance plan to a Medigap plan, rules can vary and insurers may require you pass a written health screening questionnaire. If you're not sure you need to take a written health screening, call our Insurance Consumer Hotline at 800-562-6900 and ask to speak with a health compliance analyst. https://www.insurance.wa.gov/when-can-i-sign-or-switch-medigap-plans Q5: How can a client compare Medigap plans? A5: Use the Comparing Medicare Supplement (Medigap) and Medicare Advantage plans chart which can be found on My SHIBA. https://www.insurance.wa.gov/sites/default/files/documents/ma-medigap-compare-chart_0.pdf

Medicare supplement insurancePolicies and how to compareM&Y, pages 69-70

• Also called Medigaps.• Polices are standardized.• Reminder: As of Jan. 1, 2020, Medigap plans sold to people

who are new to Medicare do not cover the Part B deductible. M&Y page 69.

On the next slide, review how to compare policies. Continued



Continued


Presenter

Presentation Notes

Point out that there is another version of this chart with the OIC publication titled Approved Medicare Supplement Plans.

Medigaps: What to knowImportant factsM&Y, page 71

Go through each of the bullets on this page as a group.• You must have Part A and Part B.• You must pay a monthly premium.• A policy covers one person.• You can’t have prescription drug coverage in both your

Medigap policy and a Medicare drug plan.• It’s important to compare.

Continued


Presenter

Presentation Notes

P.71. When to buy, only talks about the first six months The chart that shows guaranteed issue periods covers different scenarios where someone can buy without underwriting.. Maybe review this page bullet by bullet so volunteers can update their M&Y booklets. For example, the bottom bullet is where we talk about Plan G. Then maybe some info on how to get the Health Care Authority application. Talk about the work-arounds. Highlight where QA is different. For example, it’s good to know there are three types of rating systems but WA only has one. Some of the statements can be confusing. Volunteers need to know that everything in here does not apply to WA so if someone if moving be sure to refer them to the correct state SHIP. WA has some slightly different rules, so need to acknowledge that. Review it briefly, but move quickly from this section to a deeper dive into the What you need to know about Medigap (Medicare Supplement) plans booklet.

Medigaps: What to know (continued)When to buyM&Y, page 71

Go through each of the bullets on M&Y page 71 as a group.• The best time to buy is during what Medicare calls Medigap

Open Enrollment. o Carefully review the first bullet under When to Buy on page 71.

• If you delay enrolling in Part B due to group health coverage, your Medigap OEP won’t start until you sign up for Part B.

• Federal law generally doesn’t require insurance companies to sell Medigap policies to people under 65.

Continued


Presenter

Presentation Notes

Trainer notes: Discuss with volunteers that they need to know that the term “Medigap Open Enrollment” and the information in Medicare & You is what Medicare has in their materials. In Washington, we refer to MOE as Medigap guaranteed issuance. Reference to the Federal law is relevant and will be discussed later in this training where we cover under 65 options. P.71 When to buy, only talks about the first six months. The chart that shows guaranteed issue periods covers different scenarios where someone can buy without underwriting.. Maybe review this page bullet by bullet so they can update their M&Y booklets. For example the bottom bullet is where we talk about Plan G. Then maybe some info on how to get the Health Care Authority application. Talk about the work-arounds. Highlight where QA is different. For example, it’s good to know there are three types of rating systems but WA only has one. Some of the statements can be confusing. Volunteers need to know that everything in here does not apply to WA so if someone if moving be sure to refer them to the correct state SHIP. WA has some slightly different rules, so need to acknowledge that. Review it briefly, but move quickly from this section to a deeper dive into the What you need to know about Medigap (Medicare Supplement) plans booklet.

Medigaps: What to know (continued)Can a client have a Medigap policy and a Medicare Advantage plan?M&Y, page 72

If a client has an MA plan, it’s illegal for anyone to sell them a Medigap policy unless they are switching back to Original Medicare.

For more information:• Medicare.gov.• 1-800-MEDICARE.


Presenter

Presentation Notes

Discussion options: Address whether a client can have an MA plan and a Medigap? What if someone wants to go back and forth? Look at the switching chart and spend time on that. For optional discussion, spend time on shady business operations by agents. Emphasize it’s up to the client to notify their plan about cancelling their Medigap. May be more of a function of beneficiary not paying attention. This could be a good spot to share scenarios.

Medigaps: What you need to know

What you need to know about Medigap(Medicare Supplement) plans

www.insurance.wa.gov/media/873710 pages

Continued


Presenter

Presentation Notes

Review and prepare to discuss this document

http://www.insurance.wa.gov/media/8737

Medigaps: What you need to know (cont’d)Group activity

Discuss:• When to buy.• What Medigaps cover.• Costs.• Pre-existing conditions.• Snowbirds.• How to enroll.• Switching Medigap plans.

Continued


Presenter

Presentation Notes

Discuss as a group or use the Zoom breakout room option to discuss in smaller groups.

Medigaps: What you need to know (cont’d)Switching MedigapsWhat if someone wants to go back and forth between plans?

Look at the switching chart on pages 7-9 in the What you need to know about Medigaps plans booklet and spend some time reviewing and discussing.

Pages 7-9 from the booklet are presented on the next three slides.

Continued


Presenter

Presentation Notes

What you need to know abut Medigaps pages 7-9. OM: See M&Y pages 51-54. Medigaps: See M&Y pages 69-72.


What you need to know about Medigap (Medicare Supplement) plans

Switching Medigap plans, page 7

Continued


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Continued


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Presentation Notes


Approved Medicare Supplement plans

Approved Medicare Supplement (Medigap) plansSHIBA client publicationwww.insurance.wa.gov/media/18075 pages

Continued


Presenter

Presentation Notes

Pull out your Approved plans list client publication. Let’s go thru it together. Published/updated quarterly.


Approved Medicare Supplement plans (cont’d)• This content is VERY dense information. Spend time

reviewing and discussing all of this. Being familiar with the information helps you to explain it to clients

• The list is updated quarterly.• Read all info on bullets and notes on the first page.

• Note there’s a disclaimer that rates can change and to check with the plan.

• Grid column notes:• Company: Includes company name and phone number.• Pre X: See footnote on page 4 of the publication.• Health Screen: See footnote on page 4 of the publication.• Standardized plans: Refer to the chart at end of document.


Presenter

Presentation Notes

Pull out your Approved plans list. Let’s go through it together. Share how you explain these. Refer to the What you need to know about Medigap Plans booklet to explain more to clients.

Options for people under age 65

Medigaps or similar coverage are very limited.

We will talk about each one of these on the next three slides.• Washington State Health Care Authority Premera

Plan G.• United American Plan B.• Washington State Health Insurance Pool (WSHIP).



Options for people under age 65 (cont’d)Premera Blue CrossWashington State Health Care Authority Premera Plan G.

Approved Medicare Supplement (Medigap) plans, page 4Washington State Health Care Authority (HCA) Blue Cross Premera PlansUnder age 65 Medicare disabilitywww.insurance.wa.gov/media/1807

Presenter

Presentation Notes

Review of WHEN a person under age 65 can be sold a HCA Medigap plan G. We have a process to order an application to be sent to a client but we need to think they fit one of these bullets. Trainers can determine the best way to share this information with their volunteer groups.



Options for people under age 65 (cont’d)Premera Blue Cross (continued)Washington State Health Care Authority Premera Plan G.

Continued

Presenter

Presentation Notes

Review of WHEN a person under age 65 can be sold a HCA Medigap plan G. We have a process to order an application to be sent to a client but we need to think they fit one of these bullets. Trainers can determine the best way to share this information with their volunteer groups. Washington State HCA Premera Plan G, page 9 Source: www.hca.wa.gov/assets/pebb/premera-formb-2020.pdf

Options for under age 65 (continued)United American Plan B

Approved Medicare Supplement (Medigap) plans, page 3United American Insurance Co.Under age 65 Medicare disabilitywww.insurance.wa.gov/media/1807


Presenter

Presentation Notes

United American Medicare Supplements for Washington�https://medicare-washington.com/medsup/united_american.html


Options for under age 65 (continued)

WSHIP is our state's high-risk insurance pool. Created by the state legislature, it originally offered insurance to state residents who were rejected in the individual market due to health issues.www.insurance.wa.gov/washington-state-health-insurance-pool-wship


Presenter

Presentation Notes

Trainer notes: WSHIP Medical Supplement plan: Not technically a Medigap, but works in a similar way. Review limits and premiums. Not available or affordable for all, but can be very helpful with people facing very high health costs, such as kidney dialysis, cancer requiring a lot of treatment or other severe, chronic health problems.

http://www.insurance.wa.gov/washington-state-health-insurance-pool-wship

Knowledge checkYour trainer may lead a knowledge check.


Presenter

Presentation Notes

Trainers: There are options for questions at the end of this slide presentation. Either from SHIP TA Level 2 Course 4 Medigap Plans or from CMS NTP Module 3.

July 2020 learning aids Medicare & You 2020Partner publication Note: this is the national version.www.medicare.gov/Pubs/pdf/10050-medicare-and-you.pdf

What you need to know about Medigap (Medicare Supplement) plansSHIBA publicationwww.insurance.wa.gov/media/873710 pagesNote: This publication may be ordered from Fulfillment.


http://www.medicare.gov/Pubs/pdf/10050-medicare-and-you.pdf


https://prtonline.myprintdesk.net/DSF/storefront.aspx?6xni2of2cF1OAY5jHVvlUrUsqozrCjF3xgL/DdBBf+Sre9e470j4aMR+LcLIWmKS#!/Storefront

July 2020 learning aidsApproved Medicare Supplement (Medigap) plansSHIBA publicationwww.insurance.wa.gov/media/18075 pages



COVID-19 resources: VideosThe SMP Resource Center is excited to announce two new COVID-19 videos that are available as part of the SMP Consumer Fraud Alert: COVID-19 Fraud Resources.

Protect Yourself from COVID-19 Medicare scams videoYouTube: www.youtube.com/watch?v=ylkEREJcA-4&t=1sFacebook: www.facebook.com/SMPNationalResourceCenter/videos/1439792836219218/

Common COVID-19 Medicare Scam videoYouTube: www.youtube.com/watch?v=37O74z2jNxw

Prevent. Detect. Report. SHIBA advisor continuing education | July 2020 40

http://www.youtube.com/watch?v=ylkEREJcA-4&t=1s

https://www.facebook.com/SMPNationalResourceCenter/videos/1439792836219218/

http://www.youtube.com/watch?v=37O74z2jNxw

COVID-19: Scams and fraud alertsScammers are targeting older adults and those with serious long-term health conditions who appear to have a higher risk for serious illness from COVID-19.

Fraudsters are attempting to bill Medicare for sham tests or treatments related to the coronavirus and are targeting individuals to illegally obtain money or Medicare numbers.

If clients believe they’ve been scammed by a COVID-19 scam, they should contact SHIBA WA state’s Senior Medicare Patrol at 800-562-6900. #SMPwatchCOVID19

Prevent. Detect. Report. SHIBA advisor continuing education | July 2020 41

2020 continuing education topicsMonth Topic Medicare & YouAugust No trainingSeptember Getting ready for Open Enrollment and

comparing health and prescription drug plans in your area

Section 4

October Medicare Part D and Medicare Advantage Section 6

November No trainingDecember No training

2021January A look at what’s new for 2021 and a broad

overview of M&Y 2021All sections


Presenter

Presentation Notes

This is what we have planned for 2020 and 2021. Topics are subject to change.

EvaluationPlease take some time to send thoughts to [email protected], [email protected] or to your trainer.

We appreciate your feedback!


mailto:[email protected]

mailto:[email protected]

Optional expanded training materialsThe materials in this section are optional. They may be added to the slide

presentation by the trainer and/or studied separately by the volunteer.


Check your knowledge: Question 1

If you join an MA plan, you can buy a Medigap policy to pay for out-of-pocket costs.a. Trueb. False

Source: CMS NTP Module 3: Supplemental Insurance (Medigap) Policies

Optional expanded learningSHIBA advisor continuing education | July 2020 45

Presenter

Presentation Notes

Check Your Knowledge—Question 1 If you join an MA Plan, you can buy a Medigap policy to pay for out-of-pocket costs. True False ANSWER: b. False MA Plans don’t work with Medigap policies. If you join an MA Plan, you can’t use a Medigap policy to pay for out-of-pocket costs while you’re enrolled in an MA Plan. It’s also illegal for a company to sell you a Medigap policy if you belong to an MA Plan.


One Medigap policy can cover both you and your spouse.a. Trueb. False



Presenter

Presentation Notes

Check Your Knowledge—Question 2 One Medigap policy can cover both you and your spouse. True False ANSWER: b. False. Each Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you’ll need to buy separate Medigap policies.


Each standardized Medigap plan identified by the same letter (A-N) must offer the same basic benefits, no matter which insurance company sells it.a. Trueb. False



Presenter

Presentation Notes

Check Your Knowledge—Question 3 Each standardized Medigap plan (A-N) must offer the same basic benefits, no matter which insurance company sells it. True False ANSWER: a. True. All standardized Medigap plans offer the same basic benefits. Then, the additional benefits in any Medigap plan identified with the same letter are the same regardless of which insurance company you purchase your policy from.

If you’re 65 or older, your Medigap _____ starts when you enroll in Part B and it can’t be changed or repeated.

a. Initial Enrollment Period (IEP)b. General Enrollment Period (GEP)c. Open Enrollment Period (OEP)




Presenter

Presentation Notes

Check Your Knowledge—Question 6 If you’re 65 or older, your Medigap ______ begins when you enroll in Part B and it can’t be changed or repeated. Initial Enrollment Period (IEP) General Enrollment Period (GEP) Open Enrollment Period (OEP) ANSWER: c. Open Enrollment Period (OEP). Your OEP lasts for 6 months minimum, but may be longer in your state Notes: Volunteers need to know that the term “Medigap Open Enrollment” and the information in Medicare & You is what Medicare has in their materials. In Washington, we refer to MOE as Medigap guaranteed issuance.

Scenario 1Ted is 64. He’s had Medicare for four years due to a disability. He lives in a state that requires insurance companies to offer a Medigap policy to people with Medicare who are under age 65 and deemed disabled. He currently has a Medigap policy.

What might change when Ted turns 65 next year?



Presenter

Presentation Notes

Scenario 1 Ted is 64 and has had Medicare for 4 years due to a disability. He was able to purchase a Medigap policy because he lives in a state that requires insurance companies to offer a Medigap policy to people with Medicare who are under 65. What might change when Ted turns 65 next year?

Scenario 1: ConsiderationsTed will get a Medigap guaranteed issuance when he turns 65, he’ll have a:• Wider choice of Medigap policies.• Lower Medigap premium.If he signs up during his guaranteed issuance, insurance companies can’t: • Refuse to sell him any Medigap policy due to his disability.• Charge him a higher premium than they charge other people of the

same age.He can avoid the pre-existing condition waiting period since he had coverage for more than 6 months before he turned 65.



Presenter

Presentation Notes

Trainer notes: Discuss with volunteers that they need to know that the term “Medigap Open Enrollment” and the information in Medicare & You is what Medicare has in their materials. In Washington, we refer to Medigap Open Enrollment (MOE) as Medigap guaranteed issue. Review Scenario 1 Considerations What might change when Ted turns 65 next year? Ted will get a Medigap Open Enrollment Period (OEP) when he turns 65. He’ll have a wider choice of Medigap policies, and be able to get a lower Medigap premium. Since Ted is signing up during the Medigap OEP, insurance companies can’t refuse to sell him any Medigap policy due to his disability or charge him a higher premium than they charge other people of the same age. You can avoid waiting periods for pre-existing conditions if you’ve had continuous qualifying coverage, or haven’t gone without health care coverage more than 63 days prior to the effective date of the Medigap policy. Because Medicare (Part A and/or Part B) is qualified coverage, and Ted had Medicare for more than 6 months before he turned 65, he won’t have a pre-existing condition waiting period. Let’s say Ted only had Medicare for 4 months before he turned 65, no other health insurance for more than 63 days prior to getting Medicare, and got his Medigap policy in his Medigap OEP. In this instance, Ted might have a 3-month pre-existing condition waiting period. During this time the Medigap insurance company can refuse to cover Ted’s out-of-pocket costs for his pre-existing health problems. Medicare will still cover the Medicare-covered services associated with Ted’s condition, and Ted will be responsible for the deductibles, coinsurance and copayments. After the pre-existing condition waiting period ends, the Medigap policy will cover the condition that was excluded.

Scenario 2Sophie is 67 and healthy. She retired last month and ended her employer-sponsored health coverage. She was enrolled in Medicare Part A and just enrolled in Part B. She’s interested in buying a Medigap policy to help her with her out-of-pocket costs.

What does Sophie need to consider?



Presenter

Presentation Notes

Review Scenario 2 Sophie is 67 and healthy. She retired last month and ended her employer-sponsored health coverage. She was enrolled in Medicare Part A and just enrolled in Part B. She’s interested in buying a Medigap policy to help her with her out-of-pocket costs. What does Sophie need to consider?

Scenario 2: Considerations• Sophie should consider when she’ll buy a Medigap policy:

o The best time is during her 6-month OEP.o Starts with her Part B effective date.

• She’ll have guaranteed issue rights if she enrolls during her Medigap OEP.

• If she has guaranteed issue rights:o Insurance companies must sell her a Medigap policy.o All pre-existing conditions must be covered.o Insurance companies can’t charge her more.

• If she doesn’t enroll during her Medigap OEP, companies may use medical underwriting or refuse to sell her a policy.



Presenter

Presentation Notes

Trainer notes: Discuss with volunteers that they need to know that the term “Medigap Open Enrollment” and the information in Medicare & You is what Medicare has in their materials. In Washington, we refer to Medigap Open Enrollment (MOE) as Medigap guaranteed issue. Review Scenario 2 Considerations The best time for Sophie to buy a Medigap policy is during her Medigap OEP. This period lasts 6 months, and begins on the first day of the month in which she was both 65 or older and enrolled in Part B. During this period, Sophie has guaranteed issue rights. Insurance companies must sell her a Medigap policy, cover all of her pre-existing conditions, and can’t charge her more for a Medigap policy based upon her past or present health problems. What if Sophie waited a year to buy a Medigap policy? After her Medigap OEP, Medigap insurance companies are generally allowed to use medical underwriting to decide whether to accept an application and how much to charge. There’s no guarantee that an insurance company will sell Sophie a Medigap policy if she doesn’t enroll within the time allowed under federal or state laws.

Scenarios: Key points• You must have both Medicare Part A and Part B to get a

Medigap policy. • You still pay the Part B premium.• You pay a monthly premium for Medigap.• Medigap policies cover one person.• Each standardized Medigap policy offers the same basic

benefits, no matter which insurance company sells it.• Costs vary by plan and by company.

Continued



Presenter

Presentation Notes

There are some key points you should know about Medigaps: To buy a Medigap policy, you must have Part A and Part B. If you buy a Medigap policy, you must continue to pay your Part B premium. You pay the insurance company a monthly premium for your Medigap policy. Medigap policies only cover individuals. Your spouse wouldn’t be covered by your policy. If your spouse wants Medigap coverage, he or she would have to purchase his or her own individual policy. Medigap insurance companies in most states can only sell you a standardized Medigap policy. Each standardized Medigap policy must offer the same basic benefits, no matter which insurance company sells it. The costs for a Medigap policy can vary by the plan you choose, and by the company from which it’s purchased.

Scenarios: Key points (continued)• Medigap policies can only cover costs associated with

services covered by Original Medicare. Note: EXCEPT for foreign travel emergency.

• Medigap policies don’t work with Medicare Advantage plans.

• Insurance companies are prohibited from selling standardized Plans C or F to newly eligible people with Medicare: o Who turned 65 on Jan. 1, 2020, or later.o Getting premium-free Part A as of Jan. 1, 2020, or later.



Presenter

Presentation Notes

There are some key points you should know about Medigaps (continued). In general, Medigap policies can only cover costs associated with services covered by Original Medicare. Note the exception for foreign travel emergencies. Medigap policies don’t work with Medicare Advantage Plans. Insurance companies selling Medigap policies can't sell Plans C or F to people who turned 65 on January 1, 2020, or later, or to people who get premium-free Part A (due to a disability or ESRD) as of January 1, 2020, or later.

Resources: SHIP TA courseLevel 2: Medicare coverage rules Course 4: Medigaps

• This course reviews Medigap policies, a type of supplemental insurance that helps pay gaps in Original Medicare costs, like deductibles and coinsurances. In this course, you’ll learn what a Medigap plan is, what Medigap policies cover, and Medigap costs. We’ll also come to understand when someone with Medicare has the right to sign up for a Medigap plan.

• shipta.medicareinteractive.org/course/level-2-medicare-advance/course-4-medigap-plans-supplemental-insurance .

ContinuedOptional expanded learningSHIBA advisor continuing education | July 2020 55

https://shipta.medicareinteractive.org/course/level-2-medicare-advance/course-4-medigap-plans-supplemental-insurance

Knowledge checkLevel 2 Course 4: Medigap plans (Supplemental insurance)

• shipta.medicareinteractive.org/ship-certification-tool/exam-pdf/178

Note: If the link does not open, try copy/paste into the browser.


https://shipta.medicareinteractive.org/ship-certification-tool/exam-pdf/178

ResourcesChoosing a Medigap Policy: A guide to Health Insurance for People with MedicarePartner publicationwww.medicare.gov/Pubs/pdf/02110-medicare-medigap-guide.pdf50 pages

CMS Module 3: Supplemental Insurance (Medigap) Policies cmsnationaltrainingprogram.cms.gov/?q=global-search&combine=modulePartner publication, PowerPoint presentation55 slides


http://www.medicare.gov/Pubs/pdf/02110-medicare-medigap-guide.pdf

https://cmsnationaltrainingprogram.cms.gov/?q=global-search&combine=module

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Original Medicare and Medicare Supplemental (Medigaps ......• A client will have OM unless they...

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