Medicare Supplement Insurance€¦ · Senior Health Insurance Program 800-548-9034. [email protected] 10/23/2017 Medicare Supplements 1. 10/23/2017 Medicare Supplements 2 What

Medicare Supplement Insurance

2017 SHIP Fall Conference

Senior Health Insurance Program

800-548-9034 [email protected]/23/2017 Medicare Supplements 1

10/23/2017 Medicare Supplements 2

What is SHIPSenior Health Insurance Program• Established in 1988 • Free Medicare Counseling Program• Sponsored by the State of Illinois

o Illinois Department on Aging• Do not sell or solicit insurance• Dedicated to educating people with Medicare• SHIP trains volunteer counselors throughout Illinois • Provide one-on-one counseling

o With Medicare Beneficiaries, family members and caregivers• Enroll beneficiaries into various Medicare programs

o Medicare Prescription Drug Coverage, SSA “Extra Help”, …etc.• Through community based sites

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Does anyone ever feel like this?

Medicare Supplement Insurance

Medicare Supplement Insurance

Often called Medigap or MedSup• Private health insurance• Supplements the financial gaps in Original Medicare

o Does not work with Medicare Advantage (MA)

Helps pay some health care costs that Original Medicare doesn’t cover (coverage “gaps”)

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Medicare Supplement Insurance

Medicare will pay its share of the Medicare-approved amounts for covered health care costs• Then your Medigap policy pays its share

A Medigap policy covers one person

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About Medigap Policies

You must have both Medicare Part A and Part B to get a Medigap policy

You pay a monthly premium for the Medigap policy

You pay your Medicare Part B premium

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Medigap Plans

Standardized plans identified by a letter• Plans A, B, C, D, F, G, K, L, M, and N are currently sold

• Companies don’t have to sell all plans

• Plans with the same letter must offer the same basic benefits

“An A is an A”, no matter who you buy from and what they charge

• Only the policy cost will vary between companies

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Medicare SELECT Policies

A type of Medigap policy with a network

To get full benefits (except in emergency)

• Must use specific hospitals, and

• May have to see specific doctors

Can be any of the standardized policies

Generally cost less than non-network policies

Not all companies sell

Can switch to plan with equal or lesser value at any time10/23/2017 Medicare Supplements 11

Medigap Costs

Premiums may vary greatly for same Medigap plan

Cost (monthly premium) can depend on • Your age (in some states)• Where you live (e.g., urban, rural, or ZIP Code)• Company selling the policy• Discounts (women, non-smokers, married couples)

Medicare SELECT policies generally have lower premiums

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Medigap Pricing Based on AgeType of Rating Description

No-age-rated(community-rated)

Everyone pays same regardless of age if 65 or older Generally least expensive over lifetime

Issue-age-rated Based on age when purchased Doesn’t go up automatically as you get older

Note: No companies in Illinois currently use the issue age method.

Attained-age-rated Premium based on current age Costs less when you’re 65 Cost goes up each year as you get older

Note: The only company using this rating methodology in Illinois is AARP/United Healthcare (UHC).

Premiums may go up due to inflation and other factors.10/23/2017 Medicare Supplements 13

The Best Time to Buy a Medigap Policy

Medigap Open Enrollment Period (OEP) for beneficiary turning age 65

• A 6 month guaranteed issue period, beginning when you’re first enrolled in Part B

• During that time, an insurance company must sell you a plan

Can’t be changed or repeated If miss Medigap Open Enrollment and are on Medicare due to age 65, you

may be able to buy a Medigap policy any time an insurance company will sell you one subject to underwriting (denial)

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Open Enrollment for the Disabled Under Age 65

In Illinois, those on Medicare due to disability and are under age 65 have the same rights as those 65 and older.

• 6 month guaranty to get any policy, from any company

• Will pay that company’s highest rate

• At age 65, you will get an additional 6 month OEP without underwriting

Note: Some States do not have guaranteed issue for disability eligible Medicareenrollees10/23/2017 Medicare Supplements 15

Two Guaranteed Issue Companies

In Illinois, only two companies offer guaranteed issue Medigap plans for those on Medicare due to disability and not in the OEP or guaranteed issue period Blue Cross Blue Shield Health Alliance

IMPORTANT: This is only offered during the Annual Open Enrollment period from October 15 – December 710/23/2017 Medicare Supplements 16

Delayed Medigap Open Enrollment Period (OEP)

If you defer enrolling in Medicare Part B• Because you or your spouse is still working, and• You have group health coverage

Medigap OEP is delayed• Until you’re 65 or older and enroll in Part B• No late enrollment penalty

Notify Social Security to delay Part B10/23/2017 Medicare Supplements 17

Pre-existing Conditions and Medigap

Health problem(s) you had before the new insurance policy starts • Treated or diagnosed 6 months before coverage start date

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Pre-existing Conditions and Medigap

Pre-existing Condition Waiting Period• Insurance companies can refuse to cover costs for excluded

conditions for up to 6 months from policy start date (“look-back period”)

• Occurs when no prior creditable coverage and no break in coverage more than 63 days, for the six months prior to application

Note: Some plans have no pre-existing condition waiting period (0, 3 or 6 month)

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Medicare and the Marketplace

The Affordable Care Act does not

impact the pre-existing condition waiting period for

Medigap coverage.

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Can I Switch Medigap Policies?

You might switch policies if you

• Are paying for benefits you don’t need• Need more benefits now• Want to change your insurance company• Find a cheaper policy

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Switching Medigap Policies?

If not in your Medigap Open Enrollment Period• You may pay more for the new policy

• There might be medical underwriting (Can be denied)

• Could have a delay in coverage for pre-existing condition

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When Can You Switch Medigap Policies?

A guaranteed right under federal law allows you to switch only: • During your Medigap Open Enrollment Period or• If you have a guaranteed issue right

You can buy anytime insurance company will sell to you

When you buy a new Medigap policy• You’ll have a 30-day “free-look period”

Don’t cancel policy until new one is fully in effect May need to pay premiums on both policies while in

transition.10/23/2017 Medicare Supplements 23

Guaranteed Issue Rights

Federal protections in certain situations• Companies must sell you a Medigap policy• All pre-existing conditions must be covered• Can’t be charged more• Must apply within 63 days of date other coverage ends

See the next two slides for all situations

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Guaranteed Issue RightsThis chart describes the situations, under federal law, that give you a right to buya policy, the kind of policy you can buy, and when you can or must apply for it. All situations have no pre-existing wait periods.

Chart is on Page 11-12 of the SHIP Medicare Supplement Guide

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Guaranteed Issue RightsThis chart describes the situations, under federal law, that give you a right to buya policy, the kind of policy you can buy, and when you can or must apply for it. All situations have no pre-existing wait periods.

Chart is on Page 11-12 of the SHIP Medicare Supplement Guide

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Guaranteed Renewable

Medigap policies purchased after 1992 are guaranteed renewable

Your insurance company can’t drop you unless one of the following happens:• You stop paying your premium • You weren’t truthful on the Medigap application• The insurance company becomes bankrupt or insolvent

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Right to Suspend Medigap for People With Medicaid

If you have both Medicare and Medicaid• You generally can’t buy a Medigap policy (duplication of

coverage per insurance law)

You can suspend your Medigap policy • Within 90 days of getting Medicaid

For up to 2 years

You can start it up again• No new medical underwriting or waiting periods10/23/2017 Medicare Supplements 28

Right to Suspend Medigap

If you suspend your Medigap policy• You don't pay Medigap premiums• The Medigap policy won’t pay benefits

You may not want to suspend your policy if you see doctors who don’t accept Medicaid

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New Information on Plans C and F

Plans C and F will no longer be available as of 2020

This applies only to newly eligible beneficiaries• Defined as those individuals who: (a) have attained age 65 on or after

January 1, 2020; or (b) first become eligible for Medicare due to age, disability or end-stage renal disease, on or after January 1, 2020.

If you were “eligible” for Medicare prior to 2020, you can still buy either plan after 2020, or switch your current Med Supp for a Plan C or F

If you already have a Plan C or F, you can keep it!10/23/2017 Medicare Supplements 30

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For plans sold to “newly eligible”, on or after January 1, 2020:

Plan G will be offered as the high deductible option

2020 High Deductible Option

FYI: New Innovative Benefits

Medicare Supplemental insurers can now add innovative benefits to a standardized supplemental policy Innovative benefits may include vision and dental benefits,

comparable to many managed care plans

Currently, Humana is the only company in Illinois offering these benefits, calling these plans “Healthy Living” plans

Contact Humana for more details (listed in SHIP MedSup Guide)

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How can I find out more about Medigap plans?

Illinois Department Aging, SHIP800-252-8966www.illinois.gov/aging/SHIPOr email SHIP at [email protected]

MedicareMedicare & You 2017 handbook800-633-4227 (24 hours a day, 7 days a week)www.medicare.govwww.mymedicare.govTTY 1-877-486-2048

SHIP Medicare Supplement Comparison GuideWeb site: http://www.illinois.gov/aging/ship/Download the Medicare Supplement Comparison Guide

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Are There Any Questions?

Thank you

Senior Health Insurance Program

800-548-9034 [email protected]

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