2011

2011

MEDIGAP (MEDICARE SUPPLEMENT INSURANCE) POLICIES

What is a Medigap policy?

A Medigap policy (also called “Medicare Supplement Insurance”) is private health insurance that is designed to supplement Original Medicare. This means it helps pay some of the health care costs (“gaps”) that Original Medicare doesn’t cover (like copayments, coinsurance, and deductibles). If you have Original Medicare and a Medigap policy, Medicare will pay its share of the Medicare-approved amount 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 your Original Medicare benefits. NOTE: Medicare doesn’t pay any of the costs for you to get a Medigap policy.

Every Medigap policy must follow Federal and state laws designed to protect you, and the policy must be clearly identified as “Medicare Supplement Insurance”. Medigap insurance companies can sell you only 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.

What Medigap policies cover

The chart below gives you a quick look at the standardized Medigap Plans available.

Note:

· Insurance companies selling Medigap policies are required to make Plan A available. If they offer any other Medigap plan, they must also offer either Medigap Plan C or Plan F.

· Plans D and G – Plans D and G effective on or after June 1, 2010, have different benefits than D or G Plans bought before June 1, 2010.

· Plans No Longer for Sale – Plans E, H, I, and J are no longer sold, but, if you already have one, you can keep it. Contact your plan for more information.

Medigap Plans
How to read the chart:
If a check mark appears in a column of this chart, the Medigap policy covers 100% of the described benefit. If a row lists a percentage, the policy covers that percentage of the described benefit. If a row is blank, the policy doesn’t cover that benefit. Note: The Medigap policy covers coinsurance only after you have paid the deductible (unless the Medigap policy also covers the deductible).
	Medigap Plans Effective June 1, 2010
Medigap Benefits	A	B	C	D	F*	G	K	L	M	N
Medicare Part A Coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up	✓	✓	✓	✓	✓	✓	✓	✓	✓	✓
Medicare Part B Coinsurance or Copayment	✓	✓	✓	✓	✓	✓	50%	75%	✓	✓***
Blood (First 3 Pints)	✓	✓	✓	✓	✓	✓	50%	75%	✓	✓
Part A Hospice Care Coinsurance or Copayment	✓	✓	✓	✓	✓	✓	50%	75%	✓	✓
Skilled Nursing Facility Care Coinsurance			✓	✓	✓	✓	50%	75%	✓	✓
Medicare Part A Deductible		✓	✓	✓	✓	✓	50%	75%	50%	✓
Medicare Part B Deductible			✓		✓
Medicare Part B Excess Charges					✓	✓
Foreign Travel Emergency (Up to Plan Limits)			✓	✓	✓	✓			✓	✓
*Plan F also offers a high-deductible plan. If you choose this option, this means you must pay for Medicare-covered costs up to the deductible amount $2,000 in 2011 before your Medigap plan pays anything.							Out-of-Pocket Limit**
**After you meet your out-of-pocket yearly limit and your yearly Part B deductible ($162 in 2011), the Medigap plan pays 100% of covered services for the rest of the calendar year.							$4,640	$2,320
***Plan N pays 100% of the Part B coinsurance except for a copayment of up to $20 for some office visits and up to $50 copayment for emergency room visits that don’t result in an inpatient admission.

What do I need to know if I Want to Buy a Medigap Policy?

You must have Part A and Part B to buy a Medigap policy
If you have a Medicare Advantage Plan, you can apply for a Medigap policy, but make sure you can leave the Medicare Advantage Plan before your Medigap policy begins.
Plans E, H, I, and J are no longer for sale, but you can keep these plans if you already have one.
You pay the private insurance company a monthly premium for your Medigap policy in addition to the monthly Part B premium that 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.
You can buy a Medigap policy from any insurance company that’s licensed in our state to sell one.
Please contact SHIP for additional information on steps to buying a Medigap policy.
If you want to drop your Medigap policy, contact your insurance company to cancel the policy.
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 pay the premium.

Go to a list of insurance companies offering MEDIGAP policies in the State of Maryland. (This information is provided by the Maryland Insurance Administration in a table. It serves as a guideline and does not cover the full range of age groups. The rates are also subject to change. Please verify the current rates for your age by phoning the company of your choice.)