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2015Choosing 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:

• Medicare Supplement Insurance

(Medigap) policies

• What Medigap policies cover

• Your rights to buy a Medigap policy

• How to buy a Medigap policy

This guide can help if you’re thinking about buying

a Medigap policy or already have one.

Developed jointly by the Centers or Medicare & Medicaid Services (CMS)

and the National Association o Insurance Commissioners (NAIC)


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Who should read this guide?Tis guide helps people with Medicare understand Medicare Supplement Insurancepolicies (also called Medigap policies). A Medigap policy is a type o private insurancethat helps you pay or some o the costs that Original Medicare doesn’t cover.

Important information about this guide

Te inormation in this booklet describes the Medicare program at the time thisbooklet was printed. Changes may occur afer printing. Visit Medicare.gov, or call1-800-MEDICARE (1-800-633-4227) to get the most current inormation. Y users

should call 1-877-486-2048.Te “2015 Choosing a Medigap Policy: A Guide to Health Insurance orPeople with Medicare” isn’t a legal document. Official Medicare Programlegal guidance is contained in the relevant statutes, regulations, and rulings.


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3Table of Contents

Section 1: Medicare Basics 5

A brie look at Medicare. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

What's Medicare? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Te different parts o Medicare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Your Medicare coverage choices at a glance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Medigap Basics 9

What's a Medigap policy? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

What Medigap policies cover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

What Medigap policies don’t cover. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

ypes o coverage that are NO Medigap policies . . . . . . . . . . . . . . . . . . . . . . . . . 12

What types o Medigap policies can insurancecompanies sell? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

What do I need to know i I want to buy a Medigap policy?. . . . . . . . . . . . . . . . . 13

When's the best time to buy a Medigap policy? . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Why is it important to buy a Medigap policy when I'm first eligible? . . . . . . . . 16

How do insurance companies set prices or Medigap policies? . . . . . . . . . . . . . . 17

What this pricing may mean or you . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Comparing Medigap costs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

What's Medicare SELEC? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20How does Medigap help pay my Medicare Part B bills? . . . . . . . . . . . . . . . . . . . . 20

Your Right to Buy a Medigap Policy 21

What are guaranteed issue rights? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

When do I have guaranteed issue rights? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Can I buy a Medigap policy i I lose my health care coverage? . . . . . . . . . . . . . . 24

Steps to Buying a Medigap Policy 25

Step-by-step guide to buying a Medigap policy . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

If You Already Have a Medigap Policy 31

Switching Medigap policies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Losing Medigap coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

Medigap policies and Medicare prescription drug coverage . . . . . . . . . . . . . . . . 36

Section 4:

Section 5:

Section 2:

Section 3:


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4 Table of Contents

Section 6: Medigap Policies for People with a Disability or ESRD 39

Inormation or people under 65 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

Medigap Coverage in Massachusetts, Minnesota, and Wisconsin 41

Massachusetts benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Minnesota benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

Wisconsin benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

For More Information 45

Where to get more inormation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

How to get help with Medicare and Medigap questions . . . . . . . . . . . . . . . . . . . . 46

State Health Insurance Assistance Program and State Insurance Department. . 47

Definitions 49

Where words in BLUE are defined . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

Section 7:

Section 8:

Section 9:


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5

SECTION

1Medicare Basics

A brief look at Medicare

A Medigap policy is health insurance sold by private insurancecompanies to fill gaps in Original Medicare coverage. Medigap policiescan help pay your share (like coinsurance, copayments, or deductibles)o the costs o Medicare-covered services. Some Medigap policies alsocover certain benefits Original Medicare doesn’t cover like emergencyoreign travel expenses. Medigap policies don’t cover your share othe costs under other types o health coverage, including MedicareAdvantage Plans, stand-alone Medicare Prescription Drug Plans,

employer/union group health coverage, Medicaid, Department oVeterans Affairs (VA) benefits, or RICARE. Insurance companiesgenerally can’t sell you a Medigap policy i you have coverage throughMedicaid or a Medicare Advantage Plan.

Beore you learn more about Medigap policies, the next ew pagesprovide a brie look at Medicare. I you already know the basics aboutMedicare and only want to learn about Medigap, skip to page 9.

Words in blue

are defined on

pages 49–50.


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6 Section 1: Medicare Basics

What's Medicare?

Medicare is health insurance or:

• People 65 or older

• People under 65 with certain disabilities

• People o any age with End-Stage Renal Disease (ESRD) (permanent kidney ailurerequiring dialysis or a kidney transplant)

The different parts of Medicare

Te different parts o Medicare help cover specific services:

Medicare Part A (Hospital Insurance) helps cover

• Inpatient care in hospitals• Skilled nursing acility, hospice, and home health care

Medicare Part B (Medical Insurance) helps cover

• Services rom 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 romgetting 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 o the plan

• May include extra benefits and services or an extra cost

Medicare Part D (Medicare Prescription Drug Coverage)

• Helps cover the cost o outpatient prescription drugs

• Run by Medicare-approved private insurance companies

• May help lower your prescription drug costs and help protect against higher costs inthe uture


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7Section 1: Medicare Basics

Your Medicare coverage choices at a glance

Tere are 2 main ways to get your Medicare coverage — Original Medicare or aMedicare Advantage Plan. Use these steps to help you decide which way to get yourcoverage. See page 35 or inormation about Medicare Advantage Plans and Medigappolicies.

Part AHospitalInsurance

Part BMedicalInsurance

MedicareSupplementInsurance(Medigap) policy

Part DPrescriptionDrug Coverage

Part CCombines Part A,Part B, and usually Part D

ORIGINAL MEDICARE MEDICARE ADVANTAGE PLANPart C (like an HMO or PPO)

Step 2: Decide if you needto add drug coverage.

STEP 3: Decide if you need to add supplemental coverage.

END

END

STEP 1: Decide how you want to get your coverage.

Part D Prescription DrugCoverage (MostMedicare AdvantagePlans coverprescription drugs.You may be able toadd drug coverage insome plan types i notalready included.)

or

START

I you join a Medicare Advantage Plan,

you can’t use and can’t be sold a Medigappolicy. See page 35.

STEP 2: Decide if you need toadd drug coverage.

STEP 2: Decide if you need toadd drug coverage.


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8 Section 1: Medicare Basics

Medicare and the Health Insurance Marketplace

Te Health Insurance Marketplace is a way or qualified individuals, amilies, andemployees o small businesses to get health coverage. Medicare isn’t part o theMarketplace.

I I have Medicare, do I need to do anything?

As long as you have Medicare Part A coverage, you’re considered covered and youdon’t have to get any additional coverage. I you only have Medicare Part B, youaren’t considered to have minimum essential coverage. Tis means you may have topay a ee or not having coverage.

Can I get a Marketplace plan instead o Medicare, or can I get a

Marketplace plan in addition to Medicare?

Generally, no. In most cases, it’s against the law or someone who knows youhave Medicare to sell you a Marketplace plan, because that would duplicate yourcoverage. However, i you’re employed and your employer offers employer-basedcoverage through the Marketplace, you may be eligible to get that type o coverage.

Note: Te 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. o learn more about Medicare, visitMedicare.gov, look at your “Medicare & You” handbook, or call 1-800-MEDICARE(1-800-633-4227). Y users should call 1-877-486-2048.

https://medicare.gov/https://medicare.gov/


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9

SECTION

Medigap Basics

2 What's a Medigap policy?A Medigap policy is private health insurance that helps supplementOriginal Medicare. Tis means it helps pay some o the healthcare costs that Original Medicare doesn’t cover (like copayments,coinsurance, and deductibles). Tese are “gaps” in Medicare coverage.

I you have Original Medicare and a Medigap policy, Medicare willpay its share o the Medicare-approved amounts or covered healthcare costs. Ten your Medigap policy pays its share. A Medigap policyis different rom a Medicare Advantage Plan (like an HMO or PPO)because those plans are ways to get Medicare benefits, while a Medigappolicy only supplements the costs o your Original Medicare benefits.

Note: Medicare doesn’t pay any o your costs or a Medigap policy.

All Medigap policies must ollow ederal and state laws designedto protect you, and policies must be clearly identified as “MedicareSupplement Insurance.” Medigap insurance companies in moststates can only sell you a “standardized” Medigap policy identified byletters A through N. Each standardized Medigap policy must offerthe 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 arestandardized in a different way. See pages 42–44. In some states, youmay be able to buy another type o Medigap policy called MedicareSELEC. Medicare SELEC plans are standardized plans that mayrequire you to see certain providers and may cost less than other plans.See page 20.


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10 Section 2: Medigap Basics

What Medigap policies cover

Te chart on page 11 gives you a quick look at the standardized MedigapPlans available. You'll need more details than this chart provides to compare andchoose a policy. Call your State Health Insurance Assistance Program (SHIP) orhelp. See pages 47–48 or your state’s phone number.

You’ll need more details than this chart provides to compare and choose a policy.Call your State Health Insurance Assistance Program or help. See pages 47– 48 oryour state’s phone number.

Notes:

• Insurance companies selling Medigap policies are required to make Plan A

available. I they offer any other Medigap policy, they must also offer eitherMedigap Plan C or Plan F. Not all types o Medigap policies may be availablein your state. See pages 42– 44 i you live in Massachusetts, Minnesota, orWisconsin.

• Plans D and G effective on or afer June 1, 2010, have different benefits thanplans D or G bought beore June 1, 2010.

• Plans E, H, I, and J are no longer sold, but, i you already have one, you cangenerally keep it.

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11Section 2: Medigap Basics

Tis chart shows basic inormation about the different benefits that Medigap policies

cover. I a percentage appears, the Medigap plan covers that percentage o the benefit,

and you must pay the rest.

Medicare Supplement Insurance (Medigap) Plans

Benefits A B C D F* G K L M N

Medicare Part Acoinsurance and hospitalcosts (up to an additional365 days afer Medicarebenefits are used)

100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

Medicare Part B

coinsurance or copayment

100% 100% 100% 100% 100% 100% 50% 75% 100% 100%

***Blood (first 3 pints) 100% 100% 100% 100% 100% 100% 50% 75% 100% 100%

Part A hospice carecoinsurance or copayment

100% 100% 100% 100% 100% 100% 50% 75% 100% 100%

Skilled nursing acility carecoinsurance

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 o - -pocket limit

in 2015**

$4,940 $2,470

* Plan F is also offered as a high-deductible plan by some insurance companies in some states. I youchoose this option, this means you must pay or Medicare-covered costs (coinsurance, copayments,deductibles) up to the deductible amount o $2,180 in 2015 beore your policy pays anything.

**For Plans K and L, afer you meet your out-o-pocket yearly limit and your yearly

Part B deductible ($147 in 2015), the Medigap plan pays 100% o covered services or the rest o thecalendar year.

*** Plan N pays 100% o the Part B coinsurance, except or a copayment o up to $20 or some office visitsand up to a $50 copayment or emergency room visits that don’t result in an inpatient admission.


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What Medigap policies don’t cover

Generally, 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, PPO, orPrivate Fee-or-Service Plan

• Medicare Prescription Drug Plans (Part D)

• Medicaid

• Employer or union plans, including the Federal Employees Health

Benefits Program (FEHBP)• RICARE

• Veterans’ benefits

• Long-term care insurance policies

• Indian Health Service, ribal, 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 cancompare them easily. I you live in Massachusetts, Minnesota, or Wisconsin, seepages 42– 44.

Insurance companies that sell Medigap policies don’t have to offer every Medigapplan. However, they must offer Medigap Plan A i they offer any Medigap policy.I they offer any plan in addition to Plan A, they must also offer Plan C or Plan F. Eachinsurance company decides which Medigap plan it wants to sell, although state lawsmight affect which ones they offer.

In some cases, an insurance company must sell you a Medigap policy, even i youhave health problems. Here are certain times that you’re guaranteed the right to buya Medigap policy:

• When you’re in your Medigap Open Enrollment Period. See pages 14 –15.

• I 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 companycan deny you a Medigap policy based on your health. Also, in some cases it may beillegal or the insurance company to sell you a Medigap policy (like i you alreadyhave Medicaid or a Medicare Advantage Plan).

Words in blue

are defined on

pages 49–50.


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What do I need to know if I want to buy a Medigap policy?

• You must have Medicare Part A and Part B to buy a Medigap policy.

• I you have a Medicare Advantage Plan (like an HMO or PPO) but are planningto return to Original Medicare, you can apply or a Medigap policy beore yourcoverage ends. Te Medigap insurer can sell it to you as long as you’re leaving thePlan. Ask that the new Medigap policy start no later than when your MedicareAdvantage Plan enrollment ends, so you'll have continuous coverage.

• Plans E, H, I, and J are no longer or sale, but you can generally keep these plansi you already have one.

• You pay the private insurance company a monthly premium or your Medigap

policy in addition to the monthly Part B premium you pay to Medicare.

• A Medigap policy only covers one person. I you and your spouse both wantMedigap coverage, you each will have to buy separate Medigap policies.

• When you have your Medigap Open Enrollment Period, you can buy a Medigappolicy rom any insurance company that’s licensed in your state.

• I you want to buy a Medigap policy, see page 11 or an overview o the basicbenefits covered by different Medigap policies to review the benefit choices. Ten,ollow the “Steps to Buying a Medigap Policy ” on pages 25 –30.

• I you want to drop your Medigap policy, write your insurance company to cancelthe policy and confirm it’s cancelled. Your agent can’t cancel the policy or you.

• Any standardized Medigap policy is guaranteed renewable even i you havehealth problems. Tis means the insurance company can’t cancel your Medigappolicy as long as you pay the premium.

• Different insurance companies may charge different premiums or the sameexact policy. As you shop or a policy, be sure you’re comparing the same policy(or example, compare Plan A rom one company with Plan A rom another

company).

• Some states may have laws that may give you additional protections.

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What do I need to know if I want to buy a Medigap

policy? (continued)

• Although some Medigap policies sold in the past covered prescriptiondrugs, Medigap policies sold afer January 1, 2006, aren’t allowed to includeprescription drug coverage.

• I you want prescription drug coverage, you can join a Medicare PrescriptionDrug Plan (Part D) offered by private companies approved by Medicare.See pages 6–7.

o learn about Medicare prescription drug coverage, visit Medicare.gov, or call1-800-MEDICARE (1-800-633-4227). Y users should call 1-877-486-2048.

When's the best time to buy a Medigap policy?

Te best time to buy a Medigap policy is during your Medigap Open EnrollmentPeriod. Tis period lasts or 6 months and begins on the first day o the monthin which you’re both 65 or older and enrolled in Medicare Part B. Some stateshave additional Open Enrollment Periods including those or people under65. During this period, an insurance company can’t use medical underwriting.Tis means the insurance company can’t do any o these because o your healthproblems:

• Reuse to sell you any Medigap policy it offers• Charge you more or a Medigap policy than they charge someone with no

health problems

• Make you wait or coverage to start (except as explained below)

While the insurance company can’t make you wait or your coverage to start, it maybe able to make you wait or coverage related to a pre-existing condition.A pre-existing condition is a health problem you have beore the date a newinsurance policy starts. In some cases, the Medigap insurance company canreuse to cover your out-o-pocket costs or these pre-existing health problems

or up to 6 months. Tis is called a “pre-existing condition waiting period.”Afer 6 months, the Medigap policy will cover the pre-existing condition.

Words in blue

are defined on

pages 49–50.

https://medicare.gov/https://medicare.gov/


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When's the best time to buy a Medigap policy? (continued)

Coverage or a pre-existing condition can only be excluded i the condition

was treated or diagnosed within 6 months beore the coverage starts underthe Medigap policy. Tis is called the “look-back period.” Afer the 6-monthpre-existing condition waiting period, the Medigap policy will cover thecondition that was excluded. Remember, or Medicare-covered services,Original Medicare will still cover the condition, even i the Medigap policywon’t, but you’re responsible or the Medicare coinsurance or copayment.

Creditable coverage

I you have a pre-existing condition, you buy a Medigap policy duringyour Medigap Open Enrollment Period, and you’re replacing certain

kinds o health coverage that count as “creditable coverage,” it’s possibleto avoid or shorten waiting periods or pre-existing conditions. Priorcreditable coverage is generally any other health coverage you recently hadbeore applying or a Medigap policy. I you have had at least 6 months ocontinuous prior creditable coverage, the Medigap insurance company can’tmake you wait beore it covers your pre-existing conditions.

Tere are many types o health care coverage that may count as creditablecoverage or Medigap policies, but they'll only count i you didn’t have abreak in coverage or more than 63 days.

Your Medigap insurance company can tell you i your previous coverage willcount as creditable coverage or this purpose. You can also call your StateHealth Insurance Assistance Program. See pages 47– 48.

I you buy a Medigap policy when you have a guaranteed issue right (alsocalled “Medigap protection”), the insurance company can’t use a pre-existingcondition waiting period. See pages 21–23 or more inormation aboutguaranteed issue rights.

Note: I you’re under 65 and have Medicare because o a disability orEnd-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 lawdoesn’t require insurance companies to sell Medigap policies to peopleunder 65. However, some states require Medigap insurance companies tosell you a Medigap policy, even i you’re under 65. See page 39 or moreinormation.

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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 policyoffered in your state. In addition, you generally will get better prices andmore choices among policies. It’s very important to understand your Medigap Open Enrollment Period. Medigap insurance companies are generally allowedto use medical underwriting to decide whether to accept your applicationand how much to charge you or the Medigap policy. However, i you applyduring your Medigap Open Enrollment Period, you can buy any Medigappolicy the company sells, even i you have health problems, or the same priceas people with good health. I you apply or Medigap coverage afer your

Open Enrollment Period, there’s no guarantee that an insurance companywill sell you a Medigap policy i you don’t meet the medical underwritingrequirements, unless you’re eligible because o one o the limited situationslisted on pages 22–23.

It’s also important to understand that your Medigap rights may depend onwhen you choose to enroll in Medicare Part B. I you’re 65 or older, yourMedigap Open Enrollment Period begins when you enroll in Part B andit can’t be changed or repeated. In most cases, it makes sense to enroll inPart B and purchase a Medigap policy when you’re first eligible or Medicare,because you might otherwise have to pay a Part B late enrollment penalty and

you might miss your Medigap Open Enrollment Period. However, there areexceptions i you have employer coverage.

Employer coverage

I you have group health coverage through an employer or union, becauseeither you or your spouse is currently working, you may want to wait to enrollin Part B. Tis is because benefits based on current employment ofen providecoverage similar to Part B, so you would be paying or Part B beore you needit, and your Medigap Open Enrollment might expire beore a Medigap policywould be useul. When the employer coverage ends, you’ll get a chance to

enroll in Part B without a late enrollment penalty which means your MedigapOpen Enrollment Period will start when you’re ready to take advantage o it.I you enrolled in Part B while you still had employer coverage, your MedigapOpen Enrollment Period would start, and unless you bought a Medigap policybeore you needed it, you would miss your Open Enrollment Period entirely.I you or your spouse is still working and you have coverage through anemployer, contact your employer or union benefits administrator to find outhow your insurance works with Medicare. See page 24 or more inormation.

Words in blue

are defined on

pages 49–50.


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How do insurance companies set prices for Medigap

policies?

Each insurance company decides how it’ll set the price, or premium, or itsMedigap policies. It’s important to ask how an insurance company prices itspolicies. Te way they set the price affects how much you pay now and inthe uture. 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 o these ways o pricing Medigap policies is described in the chart onthe next page. Te examples show how your age affects your premiums,and why it’s important to look at how much the Medigap policy will costyou now and in the uture. Te amounts in the examples aren’t actual costs.Other actors like where you live, medical underwriting, and discounts canalso affect the amount o your premium.

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How do insurance companies set prices for Medigap policies? (continued)

Type ofpricing

Community-rated(also called“no-age-rated”)

How it’spriced

What this pricing may

mean for you

Examples

Generally thesame monthlypremium ischarged toeveryone whohas the Medigappolicy, regardlesso age.

Te premium isbased on the ageyou are whenyou buy (are“issued”) the

Medigap policy.

Te premium isbased on yourcurrent age(the age you've“attained”), soyour premiumgoes up as youget older.

Your premium isn’t based onyour age. Premiums may goup because o inflation andother actors but not becauseo your age.

Premiums are lower or peoplewho buy at a younger age andwon’t change as you get older.Premiums may go up becauseo inflation and other actors

but not because o your age.

Premiums are low oryounger buyers but go upas you get older. Tey maybe the least expensive atfirst, but they can eventuallybecome the most expensive.Premiums may also go upbecause o inflation and

other actors.

Mr. Smith is 65. He buys a Medigappolicy and pays a $165 monthly

premium.

Mrs. Perez is 72. She buys the sameMedigap policy as Mr. Smith. Shealso pays a $165 monthly premiumbecause, with this type o Medigappricing, everyone pays the same priceregardless o age.

Mr. Han is 65. He buys a Medigappolicy and pays a $145 monthly

premium.

Mrs. Wright is 72. She buys the sameMedigap policy as Mr. Han. Since sheis older when she buys it, her monthly

premium is $175.

Mrs. Anderson is 65. She buys aMedigap policy and pays a $120monthly premium. Her premium willgo up each year.

• At 66, her premium goes up to $126.



Mr. Dodd is 72. He buys the sameMedigap policy as Mrs. Anderson.He pays a $165 monthly premium.

His premium is higher than Mrs.Anderson’s because it’s based on hiscurrent age. Mr. Dodd’s premium willgo up each year.

• At 73, his premium goes up to $171.

• At 74, his premium goes up to $177.

Issue-age-rated (alsocalled “entryage-rated”)

Attained-age-rated

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Comparing Medigap costs

As discussed on the previous pages, the cost o Medigap policies can vary

widely. Tere can be big differences in the premiums that differentinsurance companies charge or exactly the same coverage. As you shopor a Medigap policy, be sure to compare the same type o Medigap policy,and consider the type o pricing used. See pages 17–18. For example,compare a Plan C rom one insurance company with a Plan C rom anotherinsurance company. Although this guide can’t give actual costs o Medigappolicies, you can get this inormation by calling insurance companies or yourState 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 .Te cost o your Medigap policy may also depend on whether the insurancecompany:

• Offers discounts (like discounts or women, non-smokers, or peoplewho are married; discounts or paying yearly; discounts or paying yourpremiums using electronic unds transer; or discounts or multiplepolicies).

• Uses medical underwriting, or applies a different premium when you don’thave a guaranteed issue right or aren’t in a Medigap Open Enrollment

Period.

• Sells Medicare SELEC policies that may require you to use certainproviders. I you buy this type o Medigap policy, your premium may beless. See page 20.

• Offers a “high-deductible option” or Plan F. I you buy Plan F with a high-deductible option, you must pay the first $2,180 o deductibles, copayments,and coinsurance (in 2015) not paid by Medicare beore the Medigap policypays anything. You must also pay a separate deductible ($250 per year) ororeign travel emergency services.

I you bought your Medigap Plan J beore January 1, 2006, and it still coversprescription drugs, you would also pay a separate deductible ($250 per year)or prescription drugs covered by the Medigap policy. And, i you have a Plan Jwith a high deductible option, you must pay a $2,180 deductible (in 2015)beore the policy pays anything.

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What's Medicare SELECT?

Medicare SELEC is a type o Medigap policy sold in some states that

requires you to use hospitals and, in some cases, doctors within its networkto be eligible or ull insurance benefits (except in an emergency). MedicareSELEC can be any o the standardized Medigap plans (see page 11.) Tesepolicies generally cost less than other Medigap policies. However, i you don’tuse a Medicare SELEC hospital or doctor or non-emergency services, you’llhave to pay some or all o what Medicare doesn’t pay. Medicare will pay itsshare o 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 contractyou agree to have the Medigap insurance company get your MedicarePart B claim inormation directly rom Medicare, and then they pay thedoctor directly whatever amount is owed under your policy. Some Medigapinsurance companies also provide this service or Medicare Part A claims.

I your Medigap insurance company doesn’t provide this service, ask yourdoctors i they participate in Medicare. Participating providers have signedan arrangement to accept assignment or all Medicare-covered services.I your doctor participates, the Medigap insurance company is required topay the doctor directly i you request. I your doctor doesn't participate butstill accepts Medicare, you may be asked to pay the coinsurance amount atthe time o service. Your Medigap insurance company will pay you directlyaccording to policy limits.

I you have any questions about Medigap claim filing, call 1-800-MEDICARE(1-800-633-4227). Y users should call 1-877-486-2048.


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21

SECION

Your Right to Buy aMedigap Policy

3 What are guaranteed issue rights?As explained on pages 14–16, the best time to buy a Medigap policy isduring your Medigap Open Enrollment Period, when you have the right tobuy any Medigap policy offered in your state. However, even i you aren’t inyour Open Enrollment Period, there are several situations in which you maystill have a guaranteed right to buy a Medigap policy.

Guaranteed issue rights are rights you have in certain situations wheninsurance companies must offer you certain Medigap policies. In thesesituations, an insurance company must:

• Sell you a Medigap policy

• Cover all your pre-existing health conditions

• Can’t charge you more or a Medigap policy regardless o past or presenthealth problems

I you live in Massachusetts, Minnesota, or Wisconsin, you have guaranteedissue rights to buy a Medigap policy, but the Medigap policies are different.See pages 42– 44 or your Medigap policy choices.

When do I have guaranteed issue rights?

In most cases, you have a guaranteed issue right when you have certaintypes o other health care coverage that changes in some way, like whenyou lose the other health care coverage. In other cases, you have a “trialright” to try a Medicare Advantage Plan and still buy a Medigap policy iyou change your mind. For inormation on trial rights, see page 23.


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22 Section 3: Your Right to Buy a Medigap Policy

This chart describes the 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 AdvantagePlan (like an HMO or PPO), andyour plan is leaving Medicare orstops giving care in your area, oryou move out o the plan’s servicearea.

You have Original Medicare andan employer group health plan(including retiree or COBRAcoverage) or union coverage thatpays afer Medicare pays and thatplan is ending.

Note: In this situation, you mayhave additional rights under statelaw.

You have Original Medicare anda Medicare SELEC policy. Youmove out o the Medicare SELECpolicy’s service area.

Call the Medicare SELEC insureror more inormation about youroptions.

You have the right

to buy...

Medigap Plan A, B, C, F, K, orL that’s sold in your state by anyinsurance company.

You only have this right i youswitch to Original Medicarerather than join anotherMedicare Advantage Plan.


I you have COBRA coverage,you can either buy a Medigappolicy right away or wait until

the COBRA coverage ends.

Medigap Plan A, B, C, F, K, orL that’s sold by any insurancecompany in your state or thestate you’re moving to.

You can/must apply for a

Medigap policy...

As early as 60 calendar daysbeore the date your health carecoverage will end, but no laterthan 63 calendar days aferyour health care coverage ends.Medigap coverage can’t start untilyour Medicare Advantage Plan

coverage ends.

No later than 63 calendar daysafer the latest o these 3 dates:

1. Date the coverage ends

2. Date on the notice you gettelling you that coverage is

ending (i you get one)3. Date on a claim denial, i this

is the only way you know thatyour coverage ended

As early as 60 calendar days beorethe date your Medicare SELECcoverage will end, but no laterthan 63 calendar days afer your

Medicare SELEC coverage ends.


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23Section 3: Your Right to Buy a Medigap Policy

You have a guaranteedissue right if...

(rial right) You joined a Medicare Advantage Plan (like an HMO orPPO) or Programs o All-inclusiveCare or the Elderly (PACE)when you were first eligible orMedicare Part A at 65, and withinthe first year o joining, you decide

you want to switch to OriginalMedicare.

(Trial right) You dropped aMedigap policy to join a MedicareAdvantage Plan (or to switch to aMedicare SELEC policy) or the

first time, you’ ve been in the planless than a year, and you want toswitch back.

Your Medigap insurance companygoes bankrupt and you lose yourcoverage, or your Medigap policycoverage otherwise ends throughno ault o your own.

You leave a Medicare AdvantagePlan or drop a Medigap policybecause the company hasn’tollowed the rules, or it misled you.

You have the rightto buy...

Any Medigap policy that’s soldin your state by any insurancecompany.

Te Medigap policy you hadbeore you joined the MedicareAdvantage Plan or MedicareSELEC policy, i the sameinsurance company you hadbeore still sells it.

I your ormer Medigap policy

isn’t available, you can buyMedigap Plan A, B, C, F, K, orL that’s sold in your state by anyinsurance company.



You can/must apply for aMedigap policy...

As early as 60 calendar days beorethe date your coverage will end,but no later than 63 calendar daysafer your coverage ends.

Note: Your rights may lastor an extra 12 monthsunder certain circumstances.

As early as 60 calendar days beorethe date your coverage will end,but no later than 63 calendar daysafer your coverage ends.

Note: Your rights may lastor an extra 12 monthsunder certain circumstances.

No later than 63 calendar daysrom the date your coverage ends.

No later than 63 calendar daysrom the date your coverage ends.

This chart describes the 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)


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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 guaranteedissue right to buy a Medigap policy, make sure you keep these:

• A copy o any letters, notices, emails, and/or claim denials that have your name onthem as proo o your coverage being terminated

• Te postmarked envelope these papers come in as proo o when it was mailed

You may need to send a copy o some or all o these papers with your Medigapapplication to prove you have a guaranteed issue right.

I you have a Medicare Advantage Plan (like an HMO or PPO) but you’re planningto return to Original Medicare, you can apply or a Medigap policy beore yourcoverage ends. Te Medigap insurer can sell it to you as long as you’re leaving

the plan. Ask that the new policy take effect no later than when your MedicareAdvantage enrollment ends, so you’ll have continuous coverage.

For more information

I you have any questions or want to learn about any additional Medigap rights inyour state, you can:

• Call your State Health Insurance Assistance Program to make sure that you qualiyor these guaranteed issue rights. See pages 47– 48.

• Call your State Insurance Department i you’re denied Medigap coverage in any o

these situations. See pages 47– 48.

Important: Te guaranteed issue rights in this section are rom ederal law.Tese rights are or both Medigap and Medicare SELEC policies. Many statesprovide additional Medigap rights.

Tere may be times when more than one o the situations in the chart onpages 22–23 applies to you. When this happens, you can choose the guaranteedissue right that gives you the best choice.

Some o the situations listed include loss o coverage under Programs o All-inclusive

Care or the Elderly (PACE). PACE combines medical, social, and long-term careservices, and prescription drug coverage or rail people. o be eligible or PACE, youmust meet certain conditions. PACE may be available in states that have chosen it asan optional Medicaid benefit. I you have Medicaid, an insurance company can sellyou a Medigap policy only in certain situations. For more inormation about PACE,

visit Medicare.gov , or call 1-800-MEDICARE (1-800-633-4227). Y users shouldcall 1-877-486-2048.

Section 3: Your Right to Buy a Medigap Policy

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25

SECTION

Steps to Buyinga Medigap Policy

4 Step-by-step guide to buying a Medigap policyBuying a Medigap policy is an important decision. Only you candecide i a Medigap policy is the way or you to supplement OriginalMedicare coverage and which Medigap policy to choose. Shopcareully. Compare available Medigap policies to see which onemeets your needs. As you shop or a Medigap policy, keep in mindthat different insurance companies may charge different amounts orexactly the same Medigap policy, and not all insurance companies offerall o the Medigap policies.

Below is a step-by-step guide to help you buy a Medigap policy. I youlive in Massachusetts, Minnesota, or Wisconsin, see pages 42– 44.

STEP 1: Decide which benefits you want, then decide which o thestandardized Medigap policies meet your needs.

STEP 2: Find out which insurance companies sell Medigap policies inyour state.

STEP 3: Call the insurance companies that sell the Medigap policiesyou’re interested in and compare costs.

STEP 4: Buy the Medigap policy.


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26

STEP 1: Decide which benefits you want, then

decide which of the Medigap policy meets

your needs.

You should think about your current and uture health care needs whendeciding which benefits you want because you might not be able to switchMedigap policies later. Decide which benefits you need, and select theMedigap policy that will work best or you. Te chart on page 11 providesan overview o Medigap benefits.

STEP 2: Find out which insurance companies sell

Medigap policies in your state.

o find out which insurance companies sell Medigap policies in your state:

• Call your State Health Insurance Assistance Program. See pages 47– 48.Ask i they have a “Medigap rate comparison shopping guide” or yourstate. Tis guide usually lists companies that sell Medigap policies in yourstate and their costs.

• Call your State Insurance Department. See pages 47– 48.

• Visit Medicare.gov/find-a-plan:

Tis website will help you find inormation on all your health planoptions, including the Medigap policies in your area. You can also getinormation on:

4 How to contact the insurance companies that sell Medigap policies inyour state

4 What each Medigap policy covers

4 How insurance companies decide what to charge you or a Medigappolicy premium

I you don’t have a computer, your local library or senior center may be able

to help you look at this inormation. You can also call 1-800-MEDICARE(1-800-633-4227). A customer service representative will help you getinormation on all your health plan options including the Medigap policiesin your area. Y users should call 1-877-486-2048.

Section 4: Steps to Buying a Medigap Policy

Words in blue

are defined on

pages 49–50.

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27Section 4: Steps to Buying a Medigap Policy

STEP 2: (continued)

Since costs can vary between companies, you should plan to call more thanone insurance company that sells Medigap policies in your state. Beoreyou call, check the companies to be sure they’re honest and reliable byusing one o these resources:

• Call your State Insurance Department. Ask i they keep a record ocomplaints against insurance companies that can be shared with you.When deciding which Medigap policy is right or you, consider thesecomplaints, i any.

• Call your State Health Insurance Assistance Program. Tese programscan give you help with choosing a Medigap policy at no cost to you.

• Go to your local public library or help with:

Getting inormation on an insurance company’s financial strengthrom independent rating services like weissratings.com, A.M. Best,and Standard & Poor’s.

Looking at inormation about the insurance company online.

• alk to someone you trust, like a amily member, your insurance agent,or a riend who has a Medigap policy rom the same Medigap insurancecompany.



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28 Section 4: Steps to Buying a Medigap Policy

STEP 3: Call the insurance companies that sell the Medigap

policies you’re interested in and compare costs.

Beore you call any insurance companies, figure out i you’re in your Medigap Open Enrollment Period

or i you have a guaranteed issue right. Read pages 14 –15 and 22–23 careully. I you have questions,call your State Health Insurance Assistance Program. See pages 47– 48. Tis chart can help you keeptrack o the inormation you get.

Ask each insurance company…

“Are you licensed in ___?” (Say the name o your state.)Note: I the answer is NO, SOP right here, and try another company.

“Do you sell Medigap Plan ___?” (Say the letter o the Medigap Planyou’re interested in.)

Note: Insurance companies usually offer some, but not all, Medigap policies.Make sure the company sells the plan you want. Also, i you’re interested in aMedicare SELEC or high-deductible Medigap policy, tell them.

“Do you use medical underwriting or this Medigap policy?”Note: I theanswer is NO, go to step 4 on page 30. I 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 am likely to qualiy or the Medigap policy?”

“Do you have a waiting period or pre-existing conditions?”

Note: I the answer is YES, ask how long the waiting period is and write itin 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 or that insurance company.

“I'm ___ years old. What would my premium be under this Medigappolicy?”Note: I it’s attained-age, ask, “How requently does the premium increasedue to my age?”

“Has the premium or this Medigap policy increased in the last 3 yearsdue to inflation or other reasons?”Note: I the answer is YES, ask how much it has increased, and write it inthe box.

“Do you offer any discounts or additional benefits?” See page 19.

Company 1 Company 2

CommunityIssue-ageAttained-age

CommunityIssue-ageAttained-age

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29Section 4: Steps to Buying a Medigap Policy

STEP 3: (continued)

Watch out for illegal practices.It’s illegal or anyone to:

• Pressure you into buying a Medigap policy, or lie to or mislead you to switchrom 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 yourexisting Medigap policy.

• Sell you a Medigap policy i they know you have Medicaid, except in certainsituations.

• Sell you a Medigap policy i they know you’re in a Medicare Advantage Plan (like an HMO or PPO) unless your coverage under the Medicare AdvantagePlan will end beore the effective date o the Medigap policy.

• Claim that a Medigap policy is a part o Medicare or any other ederal 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 withyour 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 o the U.S. Department o Health &

Human Services (HHS), Social Security Administration (SSA), Centers orMedicare & Medicaid Services (CMS), or any o their various programs likeMedicare. (For example, they can’t suggest the Medigap policy has beenapproved or recommended by the ederal government.)

• Claim to be a Medicare representative i they work or a Medigap insurancecompany.

• 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 sameas Original Medicare. See page 5. I you enroll in a Medicare Advantage Plan,you can’t use a Medigap policy.

I you believe that a ederal law has been broken, call the Inspector General’shotline at 1-800-HHS-IPS (1-800-447-8477). Y users should call1-800-377-4950. Your State Insurance Department can help you with otherinsurance-related problems.

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30

STEP 4: Buy the Medigap policy.

Once you decide on the insurance company and the Medigap policy you want,you should apply. Te insurance company must give you a clearly wordedsummary o your Medigap policy. Read it careully. I you don’t understand it,ask questions. Remember these when you buy your Medigap policy:

• Filling out your application. Fill out the application careully and completely,including medical questions. Te answers you give will determine youreligibility or an Open Enrollment Period or guaranteed issue rights. I theinsurance agent fills out the application, make sure it’s correct. I you buy aMedigap policy during your Medigap Open Enrollment Period or provideevidence 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 policyor change the price. Te insurance company can’t ask you any questions aboutyour amily history or require you to take a genetic test.

• Paying or your Medigap policy. You can pay or your Medigap policyby check, money order, or bank draf. Make it payable to the insurancecompany, not the agent. I buying rom an agent, get a receipt with theinsurance company’s name, address, and phone number or your records.Some companies may offer electronic unds transer.

• Starting your Medigap policy. Ask or your Medigap policy to become

effective when you want coverage to start. Generally, Medigap policiesbegin the first o the month afer you apply. I, or any reason, the insurancecompany won’t give you the effective date or the month you want, call yourState Insurance Department. See pages 47– 48.

Note: I you already have a Medigap policy, ask or your new Medigap policyto become effective when your old Medigap policy coverage ends.

• Getting your Medigap policy. I you don’t get your Medigap policy in 30days, call your insurance company. I you don’t get your Medigap policy in60 days, call your State Insurance Department.

I you already have a Medigap policy, it’s illegal or an insurance company tosell you a second policy unless you tell them in writing that you’ll cancel thefirst Medigap policy. However, don’t cancel your old Medigap policy until thenew one is in place, and you decide to keep it. See pages 29 and 32.

Section 4: Steps to Buying a Medigap Policy

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31

SECTION

If You AlreadyHave a Medigap Policy

5 You should read this section i any o 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 drugcoverage. See pages 36–38.

I you just want a reresher about Medigap insurance, turn to page 11.


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32

Switching Medigap policies

I you’re satisfied with your current Medigap policy’s cost, coverage, and

customer service, you don’t need to do anything. I you’re thinking aboutswitching to a new Medigap policy, see below and pages 33–35 to answersome common questions about switching Medigap policies.

Can I switch to a different Medigap policy?

In most cases, you won’t have a right under ederal law to switch Medigappolicies, unless you’re within your 6-month Medigap Open EnrollmentPeriod or are eligible under a specific circumstance or guaranteed issuerights. But, i your state has more generous requirements, or the insurance

company is willing to sell you a Medigap policy, make sure you comparebenefits and premiums beore switching. I you bought your Medigap policybeore 2010, it may offer coverage that isn’t available in a newer Medigappolicy. On the other hand, Medigap policies bought beore 1992 might notbe guaranteed renewable and might have bigger premium increases thannewer, standardized Medigap policies currently being sold.

I you decide to switch, don’t cancel your first Medigap policy until you’vedecided to keep the second Medigap policy. On the application or the newMedigap policy, you’ll have to promise that you’ll cancel your first Medigappolicy. You have 30 days to decide i you want to keep the new Medigap

policy. Tis is called your “ree look period.” Te 30-day ree look periodstarts when you get your new Medigap policy. You’ll need to pay bothpremiums or one month.

Section 5: If You Already Have a Medigap Policy

Words in blue

are defined on

pages 49–50.

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33Section 5: If You Already Have a Medigap Policy

Switching Medigap policies (continued)

Do I have to switch Medigap policies i I have a Medigap policy that's nolonger sold?

No. But you can’t have more than one Medigap policy, so i you buy a newMedigap policy, you have to give up your old policy (except or your 30-day“ree look period,” described on page 32). Once you cancel the policy, youcan’t get it back.

Do I have to wait a certain length o time afer I buy my first

Medigap policy beore I can switch to a different Medigap policy?

No. I you’ve had your old Medigap policy or less than 6 months, theMedigap insurance company may be able to make you wait up to 6 monthsor coverage o a pre-existing condition. However, i your old Medigappolicy had the same benefits, and you had it or 6 months or more, the newinsurance company can’t exclude your pre-existing condition. I you’ve hadyour Medigap policy less than 6 months, the number o months you’ve hadyour current Medigap policy must be subtracted rom the time you mustwait beore your new Medigap policy covers your pre-existing condition.

I 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 beore that benefit will becovered, regardless o how long you’ve had your current Medigap policy.

I you’ve had your current Medigap policy longer than 6 months and wantto replace it with a new one with the same benefits and the insurancecompany agrees to issue the new policy, they can’t write pre-existingconditions, waiting periods, elimination periods, or probationary periodsinto the replacement policy.


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34


Why would I want to switch to a different Medigap policy?

Some reasons or switching may include:

• You’re paying or benefits you don’t need.

• You need more benefits than you needed beore.

• Your current Medigap policy has the right benefits, but you want tochange your insurance company.

• Your current Medigap policy has the right benefits, but you want to find apolicy that’s less expensive.

It’s important to compare the benefits in your current Medigap policy tothe benefits listed on page 11. I you live in Massachusetts, Minnesota,or Wisconsin, see pages 42– 44. o help you compare benefits and decidewhich Medigap policy you want, ollow the “Steps to Buying a MedigapPolicy ” in Section 4. I you decide to change insurance companies, you cancall the new insurance company and arrange to apply or your new Medigappolicy. I your application is accepted, call your current insurance company,and ask to have your coverage end. Te insurance company can tell you howto submit a request to end your coverage.

As discussed on page 32, you should have your old Medigap policy coverage

end afer you have the new Medigap policy or 30 days. Remember, thisis your 30-day ree look period. You’ll need to pay both premiums or onemonth.


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Can I keep my current Medigap policy (or Medicare SELEC policy) orswitch to a different Medigap policy i I move out-o-state?

In general, you can keep your current Medigap policy regardless o whereyou live as long as you still have Original Medicare. I you want to switch toa different Medigap policy, you’ll have to check with your current or the newinsurance company to see i they’ll offer you a different Medigap policy.

You may have to pay more or your new Medigap policy and answer somemedical questions i you’re buying a Medigap policy outside o your Medigap Open Enrollment Period. See pages 14–16.

I you have a Medicare SELEC policy and you move out o the policy’s area,you can:

• Buy a standardized Medigap policy rom your current Medigap policyinsurance company that offers the same or ewer benefits than your currentMedicare SELEC policy. I you’ve had your Medicare SELEC policy ormore 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 soldin most states by any insurance company.

Your state may provide additional Medigap rights. Call your State Health

Insurance Assistance Program or State Department o Insurance or moreinormation. See pages 47–78 or their phone numbers.

What happens to my Medigap policy i I join a Medicare Advantage Plan?

Medigap policies can’t work with Medicare Advantage Plans. I you decide tokeep 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, i you join a MedicareAdvantage Plan, you may want to drop your Medigap policy. Contact your

Medigap insurance company to find out how to disenroll. However, i youleave the Medicare Advantage Plan you might not be able to get the sameMedigap policy back, or in some cases, any Medigap policy unless you havea “trial right.” See page 23. Your rights to buy a Medigap policy may vary bystate. You always have a legal right to keep the Medigap policy afer you join aMedicare Advantage Plan. However, because you have a Medicare AdvantagePlan, the Medigap policy would no longer provide benefits that supplementMedicare.

Words in blue

are defined on

pages 49–50.

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36

Losing Medigap coverage

Can my Medigap insurance company drop me?

I you bought your Medigap policy afer 1992, in most cases the Medigapinsurance company can’t drop you because the Medigap policy is guaranteed renewable. Tis means your insurance company can’t drop you unless one othese happens:

• You stop paying your premium.

• You weren’t truthul on the Medigap policy application.

• Te insurance company becomes bankrupt or insolvent.

I you bought your Medigap policy beore 1992, it might not be guaranteedrenewable. Tis means the Medigap insurance company can reuse to renewthe Medigap policy, as long as it gets the state’s approval to cancel yourMedigap policy. However, i this does happen, you have the right to buyanother Medigap policy. See the guaranteed issue right on page 23.

Medigap policies and Medicare prescription drug

coverage

I you bought a Medigap policy beore January 1, 2006, and it has coverageor prescription drugs, see below and page 37.

Medicare offers prescription drug coverage (Part D) or everyone withMedicare. I you have a Medigap policy with prescription drug coverage,that means you chose not to join a Medicare Prescription Drug Plan whenyou were first eligible. However, you can still join a Medicare drug plan.Your situation may have changed in ways that make a Medicare drug planfit your needs better than the prescription drug coverage in your Medigappolicy. It’s a good idea to review your coverage each all, because you can

join a Medicare drug plan between October 15–December 7. Your new

coverage will begin on January 1.


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Medigap policies and Medicare prescription drug coverage

(continued)

Why would I change my mind and join a Medicare drug plan?

In a Medicare Prescription Drug Plan, you may have to pay a monthlypremium, but Medicare pays a large part o the cost. Tere’s no maximumyearly amount as with Medigap prescription drug benefits in old Plans H, I,and J (these plans are no longer sold.) However, a Medicare drug plan mightonly cover certain prescription drugs (on its “ormulary” or “drug list”). It’simportant that you check whether your current prescription drugs are on theMedicare drug plan’s list o covered prescription drugs beore you join.

I your Medigap premium or your prescription drug needs were very lowwhen you had your first chance to join a Medicare drug plan, your Medigapprescription drug coverage may have met your needs. However, i yourMedigap premium or the amount o prescription drugs you use has increasedrecently, a Medicare drug plan might now be a better choice or you.

Will I have to pay a late enrollment penalty i I join a Medicare drug plan

now?

I you qualiy or Extra Help, you won’t pay a late enrollment penalty.

I you don’t qualiy or Extra Help, it will depend on whether your Medigappolicy includes “creditable prescription drug coverage.” Tis means thatthe Medigap policy’s drug coverage pays, on average, at least as much asMedicare’s standard prescription drug coverage. I you qualiy or Extra Help,you won’ t pay a late enrollment penalty.

I your Medigap policy's drug coverage isn’t creditable coverage, and you join a Medicare drug plan now, you’ll probably pay a higher premium (apenalty added to your monthly premium) than i you had joined when youwere first eligible. Each month that you wait to join a Medicare drug planwill make your late enrollment penalty higher. Your Medigap carrier mustsend you a notice each year telling you i the prescription drug coverage inyour Medigap policy is creditable. You should keep these notices in case youdecide later to join a Medicare drug plan. You should also consider that yourprescription drug needs could increase as you get older.

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38

Will I have to pay a late enrollment penalty i I join a Medicare drug plan

now? (continued)

I your Medigap policy includes creditable prescription drug coverage and youdecide to join a Medicare Prescription Drug Plan, you won’t have to pay a lateenrollment penalty as long as you don’t go 63 or more days in a row withoutcreditable prescription drug coverage. So, don’t drop your Medigap policy beore you join the Medicare drug plan and the coverage starts. You can only join aMedicare drug plan between October 15 –December 7 unless you lose yourMedigap policy (or example, i it isn’t guaranteed renewable, and your companycancels it.) In that case, you may be able to join a Medicare drug plan at the timeyou lose your Medigap policy.

Can I join a Medicare drug plan and have a Medigap policy with

prescription drug coverage?

No. I your Medigap policy covers prescription drugs, you must tell yourMedigap insurance company i you join a Medicare drug plan so it can removethe prescription drug coverage rom your Medigap policy and adjust yourpremium. Once the drug coverage is removed, you can’t get that coverage backeven though you didn’t change Medigap policies.

What i I decide to drop my entire Medigap policy (not just the Medigapprescription drug coverage) and join a Medicare Advantage Plan that offers

prescription drug coverage?

You need to be careul about the timing because in general, you can only join aMedicare Prescription Drug Plan or Medicare Advantage Plan (like an HMOor PPO) during the Open Enrollment Period between October 15 –December 7.Your coverage will begin on January 1 as long as the plan gets your enrollmentrequest by December 7.


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39

SECTION

Medigap Policies for Peoplewith a Disability or ESRD

6 Information for people under 65Medigap policies or people under 65 and eligible or Medicarebecause o a disability or End-Stage Renal Disease (ESRD)

You may have Medicare beore turning 65 due to a disability orESRD (permanent kidney ailure requiring dialysis or a kidneytransplant).

I you’re a person with Medicare under 65 and have a disabilityor ESRD, you might not be able to buy the Medigap policy youwant, or any Medigap policy, until you turn 65. Federal law

doesn’t require insurance companies to sell Medigap policies topeople under 65. However, some states require Medigap insurancecompanies to sell you a Medigap policy, even i you’re under 65.Tese states are listed on the next page.

Important: Tese are the minimum ederal standards.For your state requirements, call your State Health InsuranceAssistance Program. See pages 47– 48.



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40

Medigap policies or people under 65 and eligible or Medicare because o a

disability or End-Stage Renal Disease (ESRD) (continued)

At the time o printing this guide, these states required insurance companies tooffer at least one kind o 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• Kansas• 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 onlyextend them to people eligible or Medicare because o disability or only to people with ESRD.Check with your State Insurance Department about what rights you might have under state law.

Even i 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 usemedical underwriting. Check with your State Insurance Department about whatrights you might have under state law.

Remember, i 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 oMedigap policies and be able to get a lower premium at that time. During the OpenEnrollment Period, insurance companies can’t reuse to sell you any Medigap policydue to a disability or other health problem, or charge you a higher premium (basedon health status) than they charge other people who are 65.

Because Medicare (Part A and/or Part B) is creditable coverage, i you hadMedicare or more than 6 months beore you turned 65, you may not have apre-existing condition waiting period. For more inormation about the MedigapOpen Enrollment Period and pre-existing conditions, see pages 16 –17. I you havequestions, call your State Health Insurance Assistance Program. See pages 47–48.

Words in blue

are defined on

pages 49–50.

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41

SECTION

Medigap Coverage inMassachusetts, Minnesota,

and Wisconsin7Massachusetts benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42Minnesota benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

Wisconsin benefits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44


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42 Section 7: Medigap Coverage Charts

Massachusetts—Chart of standardized Medigap policies

3 3

3 3

3

3

3

3

Massachusetts benefits

• Inpatient hospital care: covers the Medicare Part A coinsurance plus coverage or 365additional days afer Medicare coverage ends

• Medical costs: covers the Medicare Part B coinsurance (generally 20% o theMedicare-approved amount)

• Blood: covers the first 3 pints o blood each year

• Part A hospice coinsurance or copayment

Te check marks in this chart mean the benefit is covered.

Medigap benefits Core plan Supplement 1 Plan

Basic beneits

Part A: inpatient hospitaldeductible

Part A: skilled nursingacility (SNF) coinsurance

Part B: deductible


Inpatient days in mentalhealth hospitals

State-mandated beneits(annual Pap tests andmammograms. Check your plan

or other state-mandated beneits.)

60 days percalendar year

120 days perbeneit year

For more inormation on these Medigap policies, visit Medicare.gov/find-a-plan, orcall your State Insurance Department. See pages 47– 48.

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43Section 7: Medigap Coverage Charts

Minnesota benefits

• Inpatient hospital care: covers the Part A coinsurance • Medical costs: covers the Part B coinsurance (generally 20% o the

Medicare-approved amount)• Blood: covers the first 3 pints o blood each year• Part A hospice and respite cost sharing• Parts A and B home health services and supplies cost sharing


Minnesota—Chart of standardized Medigap policies

Basic beneits

Part A: inpatient

hospital deductible

Part A: skilled nursing acility

(SNF) coinsurance

Part B: deductible


Outpatient mental health

Usual and customary ees

Medicare-covered preventive care

Physical therapy

Coverage while in a

oreign country

State-mandated beneits

(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 o

SNF care)

3

3(Provides 100 days o

SNF care)

80%

80%*

20% 20%

80%*

basic plan

3 3

Mandatory riders

Insurance companies

can oer 4 additional

riders that can be added

to a basic plan. You may

choose any one or all o

these riders to design

a Medigap policy that

meets your needs:

1. Part A: inpatient

hospital deductible

2. Part B: deductible

3. Usual andcustomary ees

4. Non-medicarepreventive care

* Pays 100% afer you spend $1,000 in out-o-pocket costs or a calendar year.

Minnesota versions o Medigap Plans K, L, M, N, andhigh-deductible F are available.

Important: Te basic and extended basic benefits are available when you enroll in Part B, regardless o age or health

problems. I you return to work and drop Part B to elect your employer’s health plan, you ’ll get another 6-monthMedigap Open Enrollment Period afer you retire rom that employer when you can elect Part B again.


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44 Section 7: Medigap Coverage Charts

3

3

3

Wisconsin — Chart of standardized Medigap policies

Optional riders

Insurance companies are

allowed to offer these 7 additional

riders to a Medigap policy:

1. Part A deductible

2. Additional home healthcare (365 visits includingthose paid by Medicare)

3. Part B deductible

4. Part B excess charges

5. Foreign travel emergency

6. 50% Part A deductible

7. Part B copayment or coinsurance

Wisconsin benefits

• Inpatient hospital care: covers the Part A coinsurance

• Medical costs: covers the Part B coinsurance (generally 20% o theMedicare-approved amount)

• Blood: covers the first 3 pints o blood each year

• Part A hospice coinsurance or copayment


Medigap benefits Basic plan

Basic benefits

Part A: skilled nursingacility (SNF) coinsurance

Inpatient mentalhealth coverage

Home health care

State-mandated benefits

175 days per lietime in

addition to Medicare’s

beneit

40 visits per year in

addition to those paid

by Medicare

For more inormation 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. Tese plans are similar tostandardized Plans K (50%) and L (25%). A high-deductible plan ($2,180 deductible or 2015) isalso available.

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45

SECTION

For More Information

8 Where to get more informationOn pages 47– 48, you’ll find phone numbers or your State HealthInsurance Assistance Program (SHIP) and State InsuranceDepartment.

• Call your SHIP or 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 i you have questions aboutthe Medigap policies sold in your area or any insurance-relatedproblems.



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46

How to get help with Medicare and Medigap questions

I you have questions about Medicare, Medigap, or need updated phone

numbers or 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.Y users should call 1-877-486-2048. I you need help in a language other

than English or Spanish, let the customer service representative know thelanguage.

Section 8: For More Information

https://medicare.gov/https://medicare.gov/find-a-plan/questions/home.aspxhttps://medicare.gov/contacts/https://medicare.gov/contacts/https://medicare.gov/find-a-plan/questions/home.aspxhttps://medicare.gov/


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47Section 8: For More Information

State Health Insurance Assistance Program and State

Insurance Department

State State Health Insurance

Assistance Program

State Insurance

Department Alabama 1-800-243-5463 1-800-433-3966

Alaska 1-800-478-6065 1-800-467-8725

American Samoa Not available 1-684-633-4116

Arizona 1-800-432-4040 1-800-325-2548

Arkansas 1-800-224-6330 1-800-224-6330

Caliornia 1-800-434-0222 1-800-927-4357

Colorado 1-888-696-7213 1-800-930-3745

Connecticut 1-800-994-9422 1-800-203-3447

Delaware 1-800-336-9500 1-800-282-8611

Florida 1-800-963-5337 1-877-693-5236

Georgia 1-866-552-4464 1-800-656-2298

Guam 1-671-735-7421 1-671-635-1835

Hawaii 1-888-875-9229 1-808-586-2790

Idaho 1-800-247-4422 1-800-721-4422

Illinois 1-217-524-6911 1-888-473-4858Indiana 1-800-452-4800 1-800-622-4461

Iowa 1-800-351-4664 1-877-955-1212

Kansas 1-800-860-5260 1-800-432-2484

Kentucky 1-877-293-7447 1-800-595-6053

Louisiana 1-800-259-5300 1-800-259-5301

Maine 1-877-353-3771 1-800-300-5000

Maryland 1-800-243-3425 1-800-492-6116

Massachusetts 1-800-243-4636 1-877-563-4467

Michigan 1-800-803-7174 1-877-999-6442

Minnesota 1-800-333-2433 1-800-657-3602

Mississippi 1-800-948-3090 1-800-562-2957

Missouri 1-800-390-3330 1-800-726-7390

Montana 1-800-551-3191 1-800-332-6148

Nebraska 1-800-234-7119 1-800-234-7119



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48 Section 8: For More Information

State State Health InsuranceAssistance Program

State Insurance

Department

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 1-800-443-9354 1-800-546-5664

North Dakota 1-800-247-0560 1-800-247-0560

Northern Mariana Not available 1-670-664-3064

IslandsOhio 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 1-401-462-0510 1-401-462-9500

South Carolina 1-800-868-9095 1-803-737-6160

South Dakota 1-800-536-8197 1-605-773-3563

ennessee 1-877-801-0044 1-800-342-4029

exas 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 1-340-774-71661-340-714-4354 (St. homas)

Virginia 1-800-552-3402 1-877-310-6560Washington 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



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49

SECTION

Definitions

9 Assignment—An agreement by your doctor, provider, or supplierto be paid directly by Medicare, to accept the payment amountMedicare approves or the service, and not to bill you or any morethan the Medicare deductible and coinsurance.

Coinsurance—An amount you may be required to pay as yourshare o the costs or services afer you pay any deductibles.Coinsurance is usually a percentage (or example, 20%).

Copayment—An amount you may be required to pay as yourshare o the cost or a medical service or supply, like a doctor’s visit,

hospital outpatient visit, or a prescription. A copayment is usuallya set amount, rather than a percentage. For example, you might pay$10 or $20 or a doctor’s visit or prescription.

Deductible—Te amount you must pay or health care orprescriptions, beore Original Medicare, your prescription drug plan,or your other insurance begins to pay.

Excess charge—I you have Original Medicare, and the amount adoctor or other health care provider is legally permitted to charge ishigher than the Medicare-approved amount, the difference is called

the excess charge.

Guaranteed issue rights—Rights you have in certain situationswhen insurance companies are required by law to sell or offer youa Medigap policy. In these situations, an insurance company can’tdeny you a Medigap policy, or place conditions on a Medigappolicy, such as exclusions or pre-existing conditions, and can’tcharge you more or a Medigap policy because o a past or presenthealth problem.

Where words in BLUE are defined


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50 Section 9: Definitions

Guaranteed renewable policy —An insurancepolicy that can’t be terminated by the insurancecompany unless you make untrue statements tothe insurance company, commit raud, or don’t pay

your premiums. All Medigap policies issued since1992 are guaranteed renewable.

Medicaid—A joint ederal and state program thathelps with medical costs or some people withlimited income and resources. Medicaid programs

vary rom state to state, but most health care costsare covered i you qualiy or both Medicare andMedicaid.

Medical underwriting—Te process that aninsurance company uses to decide, based onyour medical history, whether or not to takeyour application or insurance, whether or not toadd a waiting period or pre-existing conditions(i your state law allows it), and how much tocharge you or that insurance.

Medicare Advantage Plan (Part C)—A typeo Medicare health plan offered by a privatecompany that contracts with Medicare to provide

you with all your Medicare Part A and Part Bbenefits. Medicare Advantage Plans includeHealth Maintenance Organizations, PreerredProvider Organizations, Private Fee-or-ServicePlans, Special Needs Plans, and Medicare MedicalSavings Account Plans. I you’re enrolled in aMedicare Advantage Plan, Medicare servicesare covered through the plan and aren’t paidor under Original Medicare. Most MedicareAdvantage Plans offer prescription drug coverage.

Medicare-approved amount—In OriginalMedicare, this is the amount a doctor or supplierthat accepts assignment can be paid. It may beless than the actual amount a doctor or suppliercharges. Medicare pays part o this amount andyou're responsible or the difference.

Medicare prescription drug plan (Part D)—Part D adds prescription drug coverage toOriginal Medicare, some Medicare Cost Plans,some Medicare Private-Fee-or-Service Plans, and

Medicare Medical Savings Account Plans. heseplans are oered by insurance companies andother private companies approved by Medicare.Medicare Advantage Plans may also oerprescriptio

Documents

02110_Choosing Medigap Policy