great southern life medicare supplement...you have the right to buy medicare supplement plan a, b,...
TRANSCRIPT
For Use in Maryland18-247-17-MD
Home Office: Dallas, Texas • Medicare Supplement Administrative Office: PO BOX 10812, Clearwater, FL 33757-8812 • https://service.iasadmin.com/ac
Thank you for your interest in purchasing a Medicare Supplement insurance policy underwritten by Great Southern Life Insurance Company. Below are the forms your agent discussed with you during your application process. These forms are provided for your review. If you have questions, please contact your agent.
All Medicare Supplement standardized plans are offered to qualified individuals under the age of 65due to disability.
Included in this disclosure packet: î Important Consumer Notices î Guaranteed Issue Eligibility Disclosure î Outline of Coverage î Rate Guide î Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare
MedicareDisclosure Packet
Great Southern Life
Supplement
Home Office: Dallas, Texas • Medicare Supplement Administrative Office: PO Box 10812, Clearwater, FL 33757-8812 GAA8394-MS (01/17) Leave with Applicant
INFORMATION PRACTICES NOTICE THIS NOTIFICATION MUST BE DELIVERED TO THE PROPOSED INSURED WHEN THE APPLICATION IS COMPLETED.
Thank you for your application. This notice is given to you at the time you apply for insurance to tell you about the kinds of information we may obtain in connection with your application. We rely primarily on information provided by you. We may also collect information from others, such as medical professionals who have treated you, hospitals, other insurance companies, and consumer reporting agencies. In certain limited situations, we are allowed by law to disclose necessary items of personal information to third parties without your specific authorization. You have a right of access and correction with respect to this information. You have the right to receive, in writing, the specific reason for an adverse underwriting decision. If you wish a more detailed explanation of our information practices, please write us at: Great Southern Life Insurance Company, PO BOX 410288, Kansas City, MO 64141-0288, Attention: Underwriting/New Business Department. Any requests to correct, amend or alter will be responded to within 30 days. Within a seven year timeframe, information that is corrected will be provided to any person who is designated by the requesting party and who may have received the information in the prior two years. Any statement of disagreement made by a requesting party will be filed and made available to those reviewing it in the future.
MIB, INC. PRE-NOTICE Information regarding your insurability will be treated as confidential. However, Great Southern Life Insurance Company or its reinsurers may make a brief report to the MIB, Inc. formerly known as Medical Information Bureau, a nonprofit membership organization of life insurance companies operating as an information exchange for its members. If you apply to another MIB member company for life or health insurance or a claim is submitted to such a company, upon request the MIB will supply the company with the information it has in its file. Upon receipt of a request from you, the MIB, Inc., will arrange disclosure of any information it has in your file. Please contact MIB at 866.692.6901 (TTY 866.346.3642). If you question the accuracy of information in the file, you may contact the MIB and seek a correction in accordance with the procedures in the Fair Credit Reporting Act. The MIB’s information office address is 50 Braintree Hill Park, Suite 400, Braintree, MA 02184-8734. The Company or its reinsurers may release information in its file to its reinsurers and to other life and health insurance companies to whom you apply for insurance or to whom a claim is submitted. Information for consumers about MIB may be obtained on its website at www.mib.com.
Important Consumer Notices GAA8394-MS (01/17)
Home Office: Dallas, Texas • Medicare Supplement Administrative Office: PO Box 10812, Clearwater, FL 33757-8812 GMD8564 Leave with Applicant For Use in Maryland
Eligibility for Open Enrollment: You are eligible for open enrollment if any of the following situations are applicable:
1. You are applying during the six month period beginning with the first month in which You are at least 65 years old and You first enroll for benefits under Medicare Part B; or
2. You are covered under Medicare Part B prior to age 65 (eligible for a six-month open enrollment period upon reaching age 65);
3. You are under the age of 65, but are eligible for Medicare due to a disability, and an application for a Medicare supplement policy or certificate plans A or C is submitted during the 6-month period following Your enrollment in Part B of Medicare.
Eligibility for Guaranteed Issue: You are eligible for guaranteed issue if any of the following situations are applicable: 1. You are enrolled under an employee welfare benefit plan that provides health benefits that supplement the benefits under Medicare,
and the plan terminates or the plan ceases to provide all supplemental health benefits to You;
2. You are enrolled with a Medicare Advantage (MA) organization under a MA plan under Part C of Medicare, and any of the following circumstances apply: a) The Certification of the organization or plan under the federal Social Security Act has been terminated; b) The organization has terminated or otherwise discontinued providing the plan in the area in which You reside; c) You are no longer eligible to elect the plan because:
i. Of a change in Your place of residence; ii. Of another change in circumstances specified by the Secretary, but not including termination of Your enrollment on the
basis described in the federal Social Security Act (when You have not paid premiums on a timely basis or has engaged in disruptive behavior as specified in standards under the federal Social Security Act); or
iii. The plan is terminated for all individuals in Your residence area; d) You demonstrate, in accordance with guidelines established by the Secretary, that:
i. The Organization offering the plan substantially violated a material provision of the organization’s contract under Part C of Medicare in relation to You, including the failure to provide an enrollee on a timely basis medically necessary care for which benefits are available under the plan or the failure to provide medically necessary covered care in accordance with applicable quality standards; or
ii. The organization, or agent or other entity acting on the organization’s behalf, materially misrepresented the plan’s provisions in marketing the plan to the individual; or
e) You meet any other exceptional condition as the Secretary may provide; or
3. You are 65 years old or older and are enrolled with a Program of All-Inclusive Care for Elderly (PACE) provider under the federal Social Security Act, and there are circumstances similar to those described in (2) that would permit discontinuance of You were enrolled in a MA plan;
4. You: a) Are enrolled with:
i. An eligible organization under a contract under the federal Social Security Act (Medicare cost); or ii. A similar organization to the organization described in (4)(a)(i) operating under demonstration project authority,
effective for periods before April 1, 1999; or
iii. An organization under an agreement under the federal Social Security Act (health care prepayment plan); or iv. An organization under a Medicare Select Policy; and
b) Cease to be enrolled under the same circumstances that would permit discontinuance of Your election of coverage under (2).
Disclosure Open Enrollment and Guaranteed Issue Eligibility GMD8564
Home Office: Dallas, Texas • Medicare Supplement Administrative Office: PO Box 10812, Clearwater, FL 33757-8812 GMD8564 Leave with Applicant For Use in Maryland
5. You are enrolled under a Medicare Supplement Policy and the enrollment ceases because of: a) The insolvency of the issuer or bankruptcy of the non-issuer organization or other involuntary termination of coverage or
enrollment under the Policy; b) The Company who issued the Policy substantially violated a material provision of the Policy; or c) The Company, or an agent or other entity acting on the Company’s behalf, materially misrepresented the Policy’s provisions in
marketing the Policy to You.
6. You: a) Were enrolled under a Medicare Supplement Policy, and You terminate enrollment and subsequently enroll, for the first time
with: i. Any Medicare Advantage organization under a Medicare Advantage (MA) plan under Part C of Medicare; ii. Any eligible organization under a contract under the federal Social Security Act (Medicare cost), iii. Any similar organization operating under demonstration project authority; iv. A Medicare Select Policy; or v. Any Program of All-Inclusive Car for the Elderly (PACE) provider under the federal Social Security Act; and
b) Terminate the subsequent enrollment under (6)(a) during any period within the first 12 months of the subsequent enrollment (during which the enrollee is permitted to terminate the subsequent enrollment under the federal Social Security Act);
7. You, upon first becoming enrolled in Part B of Medicare at 65 years old or older, enrolled in a MA plan under Part C of Medicare, or with a PACE provider under the federal Social Security Act, and dis-enrolled from the plan or program by not later than 12 months after the effective date of enrollment; or
8. You: a) Enroll in a Medicare Part D plan during the initial enrollment period; b) At the time of enrollment in Part D:
i. Were enrolled under a Medicare Supplement Policy that covers outpatient prescription drugs; and ii. Terminate enrollment in the Medicare Supplement Policy described in (8)(b)(i); and
c) Submit evidence of enrollment in Medicare Part D with the application for a policy. You have the right to buy Medicare Supplement Plan A, B, C, F, high deductible F, K or L that is sold in Your state by any insurance Company if eligible under any of items 1 through 5 above. If you qualify under number 6 above, You have the right to the same Medicare Supplement Policy in which You were previously enrolled, if available from the same Company, or if not available from the same Company, You may purchase any Medicare Supplement Plan A, B, C, F, high deductible F, K or L that is sold in Your state by any insurance Company. You have the right to buy any Medicare Supplement Plan that is sold in Your state by any insurance Company if eligible under number 7 above. You have the right to buy any Medicare Supplement Plan A, B, C, F, high deductible F, K or L that is offered and is available for issuance to new enrollees by the same Company that issued Your Medicare Supplement Policy with outpatient prescription drug coverage if eligible under number 8 above.
GREA
T SO
UTHE
RN L
IFE
INSU
RANC
E CO
MPAN
Y Ou
tline
of C
over
age
Medi
care
Sup
plem
ent B
enef
it Pl
ans A
, F, H
igh
Dedu
ctib
le F,
G, a
nd N
.
GM
D50
0-O
C
Effe
ctiv
e: 0
3/01
/201
9
Bene
fit Ch
art o
f Med
icare
Sup
pleme
nt Pl
ans S
old fo
r Effe
ctive
Date
s on o
r Afte
r Jun
e 1, 2
010.
Ever
y ins
urer
mus
t mak
e ava
ilable
Plan
“A.”
Some
plan
s may
not b
e av
ailab
le in
your
state
. See
Outl
ine of
Cov
erag
e sec
tions
for d
etails
abou
t ALL
plan
s. “B
asic
Bene
fits”
are:
•Ho
spita
lizat
ion
– Par
t A co
insur
ance
plus
cove
rage
for 3
65 ad
dition
al da
ys af
ter M
edica
re B
enefi
ts en
d.•
Medi
cal E
xpen
ses –
Par
t B co
insur
ance
(gen
erall
y 20%
of M
edica
re ap
prov
ed am
ounts
) or c
opay
ments
for h
ospit
al ou
tpatie
nt se
rvice
s. Pl
ans K
, L, a
nd N
requ
ireins
ured
’s to
pay a
portio
n of P
art B
coins
uran
ce or
copa
ymen
ts.•
Bloo
d – F
irst th
ree p
ints o
f bloo
d eac
h yea
r.•
Hosp
ice –
Part
A co
insur
ance
•On
ly Me
dica
re S
uppl
emen
t Ben
efit
Plan
s A, F
, Hig
h De
duct
ible
F, G
, and
N ar
e offe
red
by G
reat
Sou
ther
n Li
fe In
sura
nce C
ompa
ny.
A B
C D
F / F
* G
K L
M N
Basic
inc
luding
10
0% P
art B
Co
insur
ance
Basic
inclu
ding
100%
Par
t B
Coins
uran
ce
Basic
inclu
ding
100%
Par
t B
Coins
uran
ce
Basic
inclu
ding
100%
Par
t B
Coins
uran
ce
Basic
inclu
ding
100%
Par
t B
Coins
uran
ce
Basic
inclu
ding
100%
Par
t B
Coins
uran
ce
Hosp
italiz
ation
an
d pre
venta
tive
care
paid
at 10
0%; o
ther
Basic
Ben
efits
pa
id at
50%
Hosp
italiz
ation
an
d pre
venta
tive
care
paid
at 10
0%; o
ther
Basic
Ben
efits
pa
id at
75%
Basic
inclu
ding
100%
Par
t B
Coins
uran
ce
Basic
inclu
ding 1
00%
Pa
rt B
Coins
uran
ce,
exce
pt up
to $2
0 co
paym
ent fo
r offic
e vis
it, an
d up t
o $50
co
paym
ent fo
r Em
erge
ncy R
oom
that d
on’t r
esult
in
inpati
ent a
dmiss
ion.
Skille
d Nu
rsing
Fa
cility
Co
insur
ance
Skille
d Nu
rsing
Fa
cility
Co
insur
ance
Skille
d Nu
rsing
Fa
cility
Co
insur
ance
Skille
d Nu
rsing
Fa
cility
Co
insur
ance
50%
Skil
led
Nursi
ng F
acilit
y Co
insur
ance
75%
Skil
led
Nursi
ng F
acilit
y Co
insur
ance
Skille
d Nu
rsing
Fa
cility
Co
insur
ance
Skille
d Nu
rsing
Fa
cility
Coin
sura
nce
Part
A De
ducti
ble
Part
A De
ducti
ble
Part
A De
ducti
ble
Part
A De
ducti
ble
Part
A De
ducti
ble
50%
Par
t A
Dedu
ctible
75
% P
art A
De
ducti
ble
50%
Par
t A
Dedu
ctible
Pa
rt A
Dedu
ctible
Part
B De
ducti
ble
Part
B De
ducti
ble
Part
B Ex
cess
10
0%
Part
B Ex
cess
10
0%
Fore
ign T
rave
l Em
erge
ncy
Fore
ign T
rave
l Em
erge
ncy
Fore
ign T
rave
l Em
erge
ncy
Fore
ign T
rave
l Em
erge
ncy
Fore
ign T
rave
l Em
erge
ncy
Fore
ign T
rave
l Em
erge
ncy
Out-o
f-Poc
ket
limit $
5,560
; paid
at
100%
after
limit
reac
hed.
Out–o
f-Poc
ket
limit $
2,780
; pa
id at
100%
aft
er lim
it re
ache
d. *P
lan F
also
has a
n opti
on ca
lled a
High
Ded
uctib
le Pl
an F
. This
high
dedu
ctible
plan
pays
the s
ame b
enefi
ts as
Plan
F af
ter on
e has
paid
a cale
ndar
year
’s $2
,300
dedu
ctible
. Ben
efits
from
High
Ded
uctib
le Pl
an F
will
not b
egin
until
out-o
f-poc
ket e
xpen
ses e
xcee
d $2,3
00. O
ut-of-
pock
et ex
pens
es fo
r this
dedu
ctible
are e
xpen
ses t
hat
would
have
ordin
arily
been
paid
by th
e Poli
cy. T
hese
expe
nses
inclu
de th
e Med
icare
dedu
ctible
s for
Par
t A an
d Par
t B, b
ut do
not in
clude
the p
lan’s
sepa
rate
Fore
ignTr
avel
Emer
genc
y ded
uctib
le.
1 of 1
6
For A
nnua
l Pre
mium
mod
e, mu
ltiply
month
ly ra
tes by
12. F
or C
lass 1
rates
mult
iply b
y 1.15
. GM
D500
-OC
RATE
S Ho
useh
old P
remi
um D
iscou
nt of
10%
may
apply
. See
Hou
seho
ld Pr
emium
Disc
ount
desc
riptio
n. Ef
fectiv
e: 03
/01/20
19
RA
TES
Mont
hly R
ates
by P
lan –
Mary
land
Zip
Code
s: A
ll Zip
Cod
es
Non-
Toba
cco
Rate
s At
tain
ed
Age
Plan
AHD
Plan
FPl
an F
Plan
GPl
an N
Fem
aleMa
leFe
male
Male
Fem
aleMa
leFe
male
Male
Fem
aleMa
le0-
6435
6.86
410.3
9NA
NANA
NANA
NANA
NA65
233.8
626
8.94
48.08
55.30
166.9
219
1.96
135.7
515
6.11
115.5
113
2.84
6623
3.86
268.9
448
.0855
.3016
6.92
191.9
613
5.75
156.1
111
5.51
132.8
467
233.8
626
8.94
48.08
55.30
166.9
219
1.96
135.7
515
6.11
115.5
113
2.84
6823
3.86
268.9
448
.0855
.3016
6.92
191.9
613
5.75
156.1
111
5.51
132.8
469
238.3
827
4.14
49.63
57.08
169.9
119
5.40
138.8
215
9.64
117.9
513
5.64
7024
7.28
284.3
752
.0759
.8817
5.81
202.1
814
4.22
165.8
512
2.43
140.8
071
254.6
829
2.88
53.92
62.00
181.4
920
8.71
149.4
117
1.82
126.9
014
5.93
7226
2.08
301.3
955
.7664
.1318
7.17
215.2
415
4.61
177.8
013
1.36
151.0
773
270.2
831
0.83
57.79
66.45
193.4
322
2.44
160.2
818
4.33
136.2
415
6.67
7427
8.54
320.3
259
.8268
.7919
9.72
229.6
816
5.99
190.8
914
1.14
162.3
175
289.1
233
2.49
62.17
71.50
207.6
923
8.85
173.1
019
9.07
147.2
316
9.32
7629
6.74
341.2
664
.0973
.7021
4.54
246.7
217
9.15
206.0
215
2.60
175.4
977
304.5
135
0.19
66.03
75.94
221.5
325
4.76
185.3
221
3.12
158.0
918
1.80
7831
2.74
359.6
668
.0178
.2122
8.89
263.2
219
1.81
220.5
816
3.85
188.4
379
321.4
636
9.68
70.01
80.51
236.6
527
2.14
198.6
422
8.44
169.9
119
5.40
8033
0.37
379.9
272
.0382
.8424
4.58
281.2
720
5.63
236.4
817
6.12
202.5
381
340.5
439
1.62
74.11
85.22
254.3
929
2.54
214.2
124
6.34
183.9
021
1.48
8235
0.99
403.6
476
.2187
.6426
4.50
304.1
822
3.05
256.5
119
1.94
220.7
383
361.3
941
5.60
78.33
90.08
274.6
731
5.87
231.9
626
6.75
200.0
523
0.06
8437
2.07
427.8
880
.4992
.5728
5.15
327.9
224
1.14
277.3
120
8.41
239.6
785
383.0
344
0.49
82.60
94.99
295.9
534
0.34
250.6
028
8.19
217.0
424
9.60
8639
2.71
451.6
184
.3997
.0530
5.72
351.5
825
9.12
297.9
922
4.82
258.5
487
402.6
246
3.01
86.20
99.13
315.7
836
3.14
267.8
930
8.07
232.8
326
7.75
8841
2.78
474.6
988
.0310
1.23
326.1
237
5.03
276.9
131
8.44
241.0
727
7.24
8942
3.18
486.6
689
.8810
3.37
336.7
538
7.26
286.1
932
9.11
249.5
628
7.00
9043
3.84
498.9
291
.7610
5.52
347.6
939
9.84
295.7
334
0.09
258.3
129
7.05
9144
3.39
509.9
093
.4710
7.49
358.1
341
1.84
304.8
135
0.53
266.6
930
6.70
9245
1.37
519.0
895
.1910
9.47
367.4
042
2.51
312.9
135
9.84
274.2
431
5.38
9345
9.49
528.4
296
.9411
1.48
376.8
943
3.42
321.1
936
9.37
281.9
732
4.26
9446
7.76
537.9
398
.7111
3.52
386.5
944
4.58
329.6
737
9.12
289.8
833
3.36
9547
6.18
547.6
110
0.50
115.5
739
6.51
455.9
933
8.34
389.0
929
7.98
342.6
796
483.3
355
5.83
101.2
011
6.38
402.4
646
2.83
343.4
139
4.92
302.4
434
7.81
9749
0.58
564.1
610
1.91
117.1
940
8.50
469.7
734
8.56
400.8
530
6.98
353.0
398
497.9
457
2.62
102.6
211
8.01
414.6
347
6.82
353.7
940
6.86
311.5
935
8.32
9950
5.40
581.2
110
3.34
118.8
442
0.84
483.9
735
9.10
412.9
631
6.26
363.7
0
2 of 1
6
For A
nnua
l Pre
mium
mod
e, mu
ltiply
month
ly ra
tes by
12. F
or C
lass 1
rates
mult
iply b
y 1.15
. GM
D500
-OC
RATE
S Ho
useh
old P
remi
um D
iscou
nt of
10%
may
apply
. See
Hou
seho
ld Pr
emium
Disc
ount
desc
riptio
n. Ef
fectiv
e: 03
/01/20
19
RA
TES
Mont
hly R
ates
by P
lan –
Mary
land
Zip
Code
s: A
ll Zip
Cod
es
Toba
cco
Rate
s At
tain
ed
Age
Plan
AHD
Plan
FPl
an F
Plan
GPl
an N
Fem
aleMa
leFe
male
Male
Fem
aleMa
leFe
male
Male
Fem
aleMa
le0-
6441
0.39
471.9
5NA
NANA
NANA
NANA
NA65
268.9
430
9.29
55.30
63.59
191.9
622
0.76
156.1
117
9.53
132.8
415
2.76
6626
8.94
309.2
955
.3063
.5919
1.96
220.7
615
6.11
179.5
313
2.84
152.7
667
268.9
430
9.29
55.30
63.59
191.9
622
0.76
156.1
117
9.53
132.8
415
2.76
6826
8.94
309.2
955
.3063
.5919
1.96
220.7
615
6.11
179.5
313
2.84
152.7
669
274.1
431
5.26
57.08
65.64
195.4
022
4.71
159.6
418
3.59
135.6
415
5.99
7028
4.37
327.0
359
.8868
.8620
2.18
232.5
016
5.85
190.7
314
0.80
161.9
271
292.8
833
6.81
62.00
71.31
208.7
124
0.02
171.8
219
7.60
145.9
316
7.82
7230
1.39
346.6
064
.1373
.7521
5.24
247.5
317
7.80
204.4
715
1.07
173.7
373
310.8
335
7.45
66.45
76.42
222.4
425
5.81
184.3
321
1.98
156.6
718
0.17
7432
0.32
368.3
668
.7979
.1122
9.68
264.1
319
0.89
219.5
316
2.31
186.6
675
332.4
938
2.37
71.50
82.22
238.8
527
4.68
199.0
722
8.93
169.3
219
4.72
7634
1.26
392.4
473
.7084
.7624
6.72
283.7
320
6.02
236.9
217
5.49
201.8
277
350.1
940
2.72
75.94
87.33
254.7
629
2.97
213.1
224
5.08
181.8
020
9.07
7835
9.66
413.6
078
.2189
.9426
3.22
302.7
122
0.58
253.6
718
8.43
216.6
979
369.6
842
5.13
80.51
92.58
272.1
431
2.96
228.4
426
2.70
195.4
022
4.71
8037
9.92
436.9
182
.8495
.2628
1.27
323.4
623
6.48
271.9
520
2.53
232.9
181
391.6
245
0.36
85.22
98.00
292.5
433
6.43
246.3
428
3.29
211.4
824
3.21
8240
3.64
464.1
987
.6410
0.78
304.1
834
9.80
256.5
129
4.99
220.7
325
3.84
8341
5.60
477.9
390
.0810
3.60
315.8
736
3.25
266.7
530
6.76
230.0
626
4.56
8442
7.88
492.0
692
.5710
6.45
327.9
237
7.11
277.3
131
8.91
239.6
727
5.63
8544
0.49
506.5
694
.9910
9.24
340.3
439
1.39
288.1
933
1.42
249.6
028
7.04
8645
1.61
519.3
697
.0511
1.60
351.5
840
4.32
297.9
934
2.69
258.5
429
7.32
8746
3.01
532.4
799
.1311
4.00
363.1
441
7.61
308.0
735
4.28
267.7
530
7.92
8847
4.69
545.9
010
1.23
116.4
237
5.03
431.2
931
8.44
366.2
127
7.24
318.8
289
486.6
655
9.66
103.3
711
8.87
387.2
644
5.36
329.1
137
8.48
287.0
033
0.05
9049
8.92
573.7
610
5.52
121.3
539
9.84
459.8
234
0.09
391.1
129
7.05
341.6
191
509.9
058
6.38
107.4
912
3.61
411.8
447
3.62
350.5
340
3.11
306.7
035
2.70
9251
9.08
596.9
410
9.47
125.8
942
2.51
485.8
935
9.84
413.8
231
5.38
362.6
893
528.4
260
7.68
111.4
812
8.20
433.4
249
8.43
369.3
742
4.77
324.2
637
2.90
9453
7.93
618.6
211
3.52
130.5
444
4.58
511.2
637
9.12
435.9
833
3.36
383.3
695
547.6
162
9.75
115.5
713
2.90
455.9
952
4.39
389.0
944
7.45
342.6
739
4.07
9655
5.83
639.2
011
6.38
133.8
446
2.83
532.2
539
4.92
454.1
634
7.81
399.9
897
564.1
664
8.79
117.1
913
4.77
469.7
754
0.24
400.8
546
0.98
353.0
340
5.98
9857
2.62
658.5
211
8.01
135.7
247
6.82
548.3
440
6.86
467.8
935
8.32
412.0
799
581.2
166
8.40
118.8
413
6.67
483.9
755
6.57
412.9
647
4.91
363.7
041
8.25
3 of 1
6
GREA
T SO
UTHE
RN L
IFE
INSU
RANC
E CO
MPAN
Y Ou
tline
of C
over
age
Medi
care
Sup
plem
ent B
enef
it Pl
ans A
, F, H
igh
Dedu
ctib
le F,
G, a
nd N
.
GM
D50
0-O
C
Effe
ctiv
e: 0
3/01
/201
9
Prem
ium
Info
rmat
ion.
Gre
at So
uther
n Life
Insu
ranc
e Com
pany
can o
nly ra
ise yo
ur pr
emium
if we
raise
the p
remi
um fo
r all p
olicie
s like
your
s in t
his st
ate. U
ntil y
ou
are a
ge 99
, you
r pre
mium
may
chan
ge ea
ch ye
ar, s
ubjec
t to ap
prov
al by
the M
aryla
nd In
sura
nce A
dmini
strati
on. T
his ch
ange
will
only
be m
ade o
n the
first
rene
wal d
ate
that c
oincid
es w
ith or
follo
ws ea
ch an
niver
sary
of the
effec
tive d
ate. S
ched
ules o
f rate
s may
vary
depe
nding
upon
your
effec
tive d
ate.
One t
ime P
olicy
Fee
: $25
.00
Disc
losu
res.
Use
this
outlin
e to c
ompa
re be
nefits
and p
remi
ums a
mong
polic
ies.
Hous
ehol
d Pr
emiu
m D
iscou
nt. I
f you
resid
ed w
ith at
leas
t one
, but
no m
ore t
han t
hree
, othe
r adu
lts w
ho ar
e age
60 or
olde
r for
the p
ast y
ear,
you w
ill be
eligi
ble fo
r a
hous
ehold
prem
ium di
scou
nt. T
he di
scou
nted p
remi
um w
ill be
price
d 10%
lowe
r tha
n the
rates
illus
trated
. You
r poli
cy's
hous
ehold
prem
ium di
scou
nt wi
ll be r
emov
ed if
the ot
her a
dult n
o lon
ger r
eside
s with
you (
other
than
in th
e cas
e of h
is or
her d
eath)
.
Read
You
r Pol
icy V
ery C
aref
ully.
Thi
s is o
nly a
n ou
tline
des
crib
ing
your
pol
icy’s
mos
t im
porta
nt fe
atur
es. T
he p
olicy
is yo
ur in
sura
nce c
ontra
ct. Y
ou m
ust
read
the p
olicy
itse
lf to
und
erst
and
all o
f the
righ
ts an
d du
ties o
f bot
h yo
u an
d us
.
Righ
t to
Retu
rn P
olicy
. If y
ou fin
d tha
t you
are n
ot sa
tisfie
d with
your
polic
y, yo
u may
retur
n it to
us at
our M
edica
re S
upple
ment
Admi
nistra
tive O
ffices
: PO
Box 1
0812
, Cl
earw
ater,
FL 33
757-
8812
. If yo
u sen
d the
polic
y bac
k to u
s with
in 30
days
after
you r
eceiv
e it, w
e will
treat
the po
licy a
s if it
had n
ever
been
issu
ed an
d retu
rn al
l of
your
paym
ents.
Polic
y Rep
lacem
ent.
If you
are r
eplac
ing an
other
healt
h ins
uran
ce po
licy,
do N
OT ca
ncel
it unti
l you
have
actua
lly re
ceive
d you
r new
polic
y and
are s
ure y
ou w
ant to
ke
ep it.
Notic
e. T
he po
licy m
ay no
t fully
cove
r all o
f you
r med
ical c
osts.
Neit
her w
e nor
our a
gents
are c
onne
cted w
ith M
edica
re. T
his ou
tline d
oes n
ot giv
e all t
he de
tails
of Me
dicar
e cov
erag
e. Co
ntact
your
loca
l Soc
ial S
ecur
ity of
fice o
r con
sult “
Medic
are &
You
” for
mor
e deta
ils.
Refu
nd o
f Pre
miu
m. In
the e
vent
of ca
ncell
ation
or de
ath, W
e will
prom
ptly r
eturn
the u
near
ned p
ortio
n of a
ny pr
emium
paid.
Com
plet
e Ans
wers
Are
Ver
y Im
porta
nt. W
hen y
ou fil
l out
the ap
plica
tion f
or th
e new
polic
y, be
sure
to an
swer
truth
fully
and c
omple
tely a
ll que
stion
s abo
ut yo
ur
medic
al an
d hea
lth hi
story.
We m
ay ca
ncel
your
polic
y and
refus
e to p
ay an
y clai
ms if
you l
eave
out o
r fals
ify im
porta
nt me
dical
infor
matio
n. Re
view
the a
pplic
atio
n ca
refu
lly b
efor
e you
sign
it. B
e cer
tain
that
all in
form
atio
n ha
s bee
n pr
oper
ly re
cord
ed.
No H
ealth
Rev
iew. N
o hea
lth re
view
is re
quire
d if y
ou en
roll w
ithin
the fir
st six
mon
ths af
ter yo
u rea
ch ag
e 65 a
nd en
roll i
n Med
icare
Par
t B, o
r in ot
her s
ituati
ons a
s re
quire
d by l
aw.
PLEA
SE R
EFER
TO
YOUR
POL
ICY
FOR
DETA
ILS.
4 of 1
6
GREA
T SO
UTHE
RN L
IFE
INSU
RANC
E CO
MPAN
Y Ou
tline
of C
over
age
Medi
care
Sup
plem
ent B
enef
it Pl
ans A
, F, H
igh
Dedu
ctib
le F,
G, a
nd N
.
GM
D50
0-O
C
E
ffect
ive:
03/
01/2
019
Plan
A
Plan
A
Medi
care
Par
t A –
Hosp
ital S
ervic
es P
er B
enef
it Pe
riod
*A be
nefit
perio
d beg
ins on
the f
irst d
ay yo
u rec
eive s
ervic
e as a
n inp
atien
t in a
hosp
ital a
nd en
ds af
ter yo
u hav
e bee
n out
of the
hosp
ital a
nd ha
ve no
t rec
eived
skille
dca
re in
any o
ther f
acilit
y for
60 da
ys in
a ro
w.Se
rvice
s Me
dica
re P
ays
Plan
A P
ays
You
Pay
Hosp
italiz
atio
n*
Semi
priva
te ro
om an
d boa
rd, g
ener
al nu
rsing
and m
iscell
aneo
us
servi
ces a
nd su
pplie
s. Fir
st 60
days
Al
l but
$1,36
4 $0
$1
,364 P
art A
Ded
uctib
le 61
st thr
u 90th d
ay
All b
ut $3
41 a
day
$341
a da
y $0
91
st day
and a
fter
-W
hile u
sing 6
0 life
time r
eser
ve da
ys-
Once
lifeti
me re
serve
days
are u
sed
Ad
dition
al 36
5 day
s
Beyo
nd th
e add
itiona
l 365
days
All b
ut $6
82 a
day
$0
$0
$682
a da
y
100%
of M
edica
re E
ligibl
e Exp
ense
s $0
$0
$0**
All C
osts
Skille
d Nu
rsin
g Fa
cility
Car
e*
You m
ust m
eet M
edica
re’s
requ
ireme
nts, in
cludin
g hav
ing be
en in
a ho
spita
l for a
t leas
t 3 da
ys an
d ente
red a
Med
icare
appr
oved
facil
ity
withi
n 30 d
ays a
fter le
aving
the h
ospit
al.
First
20 da
ys
21st t
hru 1
00th d
ays
101st d
ay an
d afte
r
All a
ppro
ved a
moun
ts Al
l but
$170
.50 a
day
$0
$0
$0
$0
$0
Up to
$170
.50 a
day
All C
osts
Bloo
d Fir
st 3 p
ints
Addit
ional
amou
nts
$0
100%
3 p
ints
$0
$0
$0
Hosp
ice C
are
You m
ust m
eet M
edica
re’s
requ
ireme
nts, in
cludin
g a do
ctor’s
ce
rtifica
tion o
f term
inal il
lness
. Al
l but
very
limite
d co
paym
ent/c
oinsu
ranc
e for
outpa
tient
drug
s and
inp
atien
t res
pite c
are.
Medic
are c
opay
ment/
coins
uran
ce
$0
** W
hen y
our M
edica
re P
art A
hosp
ital b
enefi
ts ar
e exh
auste
d, the
insu
rer s
tands
in th
e plac
e of M
edica
re an
d will
pay w
hatev
er am
ount
Medic
are w
ould
have
paid
for up
to
an ad
dition
al 36
5 day
s as p
rovid
ed in
the p
olicy
’s “C
ore B
enefi
ts.” D
uring
this
time,
the ho
spita
l is pr
ohibi
ted fr
om bi
lling y
ou fo
r the
balan
ce ba
sed o
n any
diffe
renc
e be
twee
n its
billed
char
ges a
nd th
e amo
unt M
edica
re w
ould
have
paid.
5 of 1
6
GREA
T SO
UTHE
RN L
IFE
INSU
RANC
E CO
MPAN
Y Ou
tline
of C
over
age
Medi
care
Sup
plem
ent B
enef
it Pl
ans A
, F, H
igh
Dedu
ctib
le F,
G, a
nd N
.
GM
D50
0-O
C
E
ffect
ive:
03/
01/2
019
Plan
A
Plan
A
Medi
care
Par
t B –
Medi
cal S
ervic
es p
er C
alend
ar Y
ear
*Onc
e you
have
been
bille
d $18
5 of M
edica
re E
ligibl
e Exp
ense
s for
cove
red s
ervic
es, y
our M
edica
re P
art B
Ded
uctib
le wi
ll hav
e bee
n met
for th
e cale
ndar
year
.Se
rvice
s Me
dica
re P
ays
Plan
A P
ays
You
Pay
Medi
cal E
xpen
ses
In or
out o
f the h
ospit
al an
d outp
atien
t hos
pital
treatm
ent, s
uch a
s Phy
sician
’s se
rvice
s, inp
atien
t and
outpa
tient
medic
al an
d sur
gical
servi
ces a
nd su
pplie
s, ph
ysica
l and
spee
ch th
erap
y, dia
gnos
tic te
sts, d
urab
le me
dical
equip
ment
First
$185
of M
edica
re ap
prov
ed am
ounts
* Re
maind
er of
Med
icare
appr
oved
amou
nts
$0
Gene
rally
80%
$0
Ge
nera
lly 20
%
$185
Par
t B D
educ
tible
$0
Part
B Ex
cess
Cha
rges
(abo
ve M
edica
re ap
prov
ed am
ounts
) $0
$0
Al
l cos
ts Bl
ood
First
3 pint
s Ne
xt $1
85 of
Med
icare
appr
oved
amou
nts*
Rema
inder
of M
edica
re ap
prov
ed am
ounts
$0
$0
80%
All c
osts
$0
20%
$0
$185
Par
t B D
educ
tible
$0
Clin
ical L
abor
ator
y Ser
vices
– Te
sts fo
r diag
nosti
c ser
vices
10
0%
$0
$0
Parts
A &
B
Serv
ices
Medi
care
Pay
s Pl
an A
Pay
s Yo
u Pa
y Ho
me H
ealth
Car
e Me
dicar
e Elig
ible S
ervic
es
-Med
ically
nece
ssar
y skil
led ca
re se
rvice
s and
med
ical s
uppli
es-D
urab
le me
dical
equip
ment.
Firs
t $18
5 of M
edica
re ap
prov
ed am
ounts
*-R
emain
der o
f Med
icare
appr
oved
amou
nts
100%
$0
80
%
$0
$0
20%
$0
$185
Par
t B D
educ
tible
$0
6 of 1
6
GREA
T SO
UTHE
RN L
IFE
INSU
RANC
E CO
MPAN
Y Ou
tline
of C
over
age
Medi
care
Sup
plem
ent B
enef
it Pl
ans A
, F, H
igh
Dedu
ctib
le F,
G, a
nd N
.
GM
D50
0-O
C
E
ffect
ive:
03/
01/2
019
Plan
F a
nd H
igh
Ded
uctib
le P
lan
F
Plan
F an
d Hi
gh D
educ
tible
Plan
F
Medi
care
Par
t A –
Hosp
ital S
ervic
es P
er B
enef
it Pe
riod
*A be
nefit
perio
d beg
ins on
the f
irst d
ay yo
u rec
eive s
ervic
e as a
n inp
atien
t in a
hosp
ital a
nd en
ds af
ter yo
u hav
e bee
n out
of the
hosp
ital a
nd ha
ve no
t rec
eived
skille
dca
re in
any o
ther f
acilit
y for
60 da
ys in
a ro
w.
Serv
ices
Medi
care
Pay
s Pl
an F
Pay
s Yo
u Pa
y
High
Ded
uctib
le Pl
an F
Pa
ys (a
fter y
ou p
ay $2
,300
Dedu
ctib
le***
You
Pay
(In ad
ditio
n to
$2
,300
Dedu
ctib
le***)
Ho
spita
lizat
ion*
Se
mipr
ivate
room
and b
oard
, gen
eral
nursi
ng
and m
iscell
aneo
us se
rvice
s and
supp
lies.
First
60 da
ys
All b
ut $1
,364
$1,36
4 Par
t A
Dedu
ctible
$0
$1
,364 P
art A
Ded
uctib
le $0
61st t
hru 9
0th day
Al
l but
$341
a da
y $3
41 a
day
$0
$341
a da
y $0
91
st day
and a
fter
-W
hile u
sing 6
0 life
time r
eser
ve da
ys-
Once
lifeti
me re
serve
days
are u
sed
Ad
dition
al 36
5 day
s
Be
yond
the a
dditio
nal 3
65 da
ys
All b
ut $6
82 a
day
$0
$0
$682
a da
y
100%
of M
edica
re
Eligi
ble E
xpen
ses
$0
$0
$0**
All C
osts
$682
a da
y
100%
of M
edica
re E
ligibl
e Ex
pens
es
$0
$0
$0**
All C
osts
Skille
d Nu
rsin
g Fa
cility
Car
e*
You m
ust m
eet M
edica
re’s
requ
ireme
nts,
includ
ing ha
ving b
een i
n a ho
spita
l for a
t leas
t 3
days
and e
ntere
d a M
edica
re ap
prov
ed fa
cility
wi
thin 3
0 day
s afte
r leav
ing th
e hos
pital.
Fir
st 20
days
21st t
hru 1
00th d
ays
101st d
ay an
d afte
r
All a
ppro
ved
amou
nts
All b
ut $1
70.50
a da
y $0
$0
Up to
$170
.50 a
day
$0
$0
$0
All C
osts
$0
Up to
$170
.50 a
day
$0
$0
$0
All C
osts
7 of 1
6
GREA
T SO
UTHE
RN L
IFE
INSU
RANC
E CO
MPAN
Y Ou
tline
of C
over
age
Medi
care
Sup
plem
ent B
enef
it Pl
ans A
, F, H
igh
Dedu
ctib
le F,
G, a
nd N
.
GM
D50
0-O
C
E
ffect
ive:
03/
01/2
019
Plan
F a
nd H
igh
Ded
uctib
le P
lan
F
Plan
F an
d Hi
gh D
educ
tible
Plan
F
Medi
care
Par
t A –
Hosp
ital S
ervic
es P
er B
enef
it Pe
riod
(Con
tinue
d)
Serv
ices
Medi
care
Pay
s Pl
an F
Pay
s Yo
u Pa
y
High
Ded
uctib
le Pl
an F
Pa
ys (a
fter y
ou p
ay $2
,300
Dedu
ctib
le***
You
Pay
(In ad
ditio
n to
$2
,300
Dedu
ctib
le***)
Bl
ood
First
3 pint
s Ad
dition
al am
ounts
$0
10
0%
3 pint
s $0
$0
$0
3 p
ints
$0
$0
$0
Hosp
ice C
are
You m
ust m
eet M
edica
re’s
requ
ireme
nts,
includ
ing a
docto
r’s ce
rtifica
tion o
f term
inal
illnes
s.
All b
ut ve
ry lim
ited
copa
ymen
t/ co
insur
ance
for
outpa
tient
drug
s an
d inp
atien
t re
spite
care
.
Medic
are
copa
ymen
t/ co
insur
ance
$0
Medic
are
copa
ymen
t/coin
sura
nce
$0
**Whe
n you
r Med
icare
Par
t A ho
spita
l ben
efits
are e
xhau
sted,
the in
sure
r stan
ds in
the p
lace o
f Med
icare
and w
ill pa
y wha
tever
amou
nt Me
dicar
e wou
ld ha
ve pa
id for
up
to an
addit
ional
365 d
ays a
s pro
vided
in th
e poli
cy’s
“Cor
e Ben
efits.
” Dur
ing th
is tim
e, the
hosp
ital is
proh
ibited
from
billin
g you
for t
he ba
lance
base
d on a
ny di
ffere
nce
betw
een i
ts bil
led ch
arge
s and
the a
moun
t Med
icare
wou
ld ha
ve pa
id. **
*High
Ded
uctib
le Pl
an F
pays
the s
ame b
enefi
ts as
Plan
F af
ter on
e has
paid
a cale
ndar
year
$2
,300 d
educ
tible.
Ben
efits
from
High
Ded
uctib
le Pl
an F
will
not b
egin
until
out-o
f-poc
ket e
xpen
ses e
xcee
d $2,3
00. O
ut-of-
pock
et ex
pens
es fo
r this
dedu
ctible
are
expe
nses
that
would
ordin
arily
be pa
id by
the p
olicy
/certif
icate.
The
se ex
pens
es in
clude
the M
edica
re de
ducti
bles f
or P
ay A
and P
art B
, but
do no
t inclu
de th
e plan
’s se
para
te Fo
reign
Tra
vel E
merg
ency
dedu
ctible
.
8 of 1
6
GREA
T SO
UTHE
RN L
IFE
INSU
RANC
E CO
MPAN
Y Ou
tline
of C
over
age
Medi
care
Sup
plem
ent B
enef
it Pl
ans A
, F, H
igh
Dedu
ctib
le F,
G, a
nd N
.
GM
D50
0-O
C
E
ffect
ive:
03/
01/2
019
Plan
F a
nd H
igh
Ded
uctib
le P
lan
F
Plan
F an
d Hi
gh D
educ
tible
Plan
F
Medi
care
Par
t B –
Medi
cal S
ervic
es p
er C
alend
ar Y
ear
*Onc
e you
have
been
bille
d $18
5 of M
edica
re A
ppro
ved a
moun
ts for
cove
red s
ervic
es, y
our M
edica
re P
art B
Ded
uctib
le wi
ll hav
e bee
n met
for th
e cale
ndar
year
.
Serv
ices
Medi
care
Pay
s Pl
an F
Pay
s Yo
u Pa
y
High
Ded
uctib
le Pl
an F
Pay
s (af
ter
you
pay $
2,300
De
duct
ible*
**
You
Pay
(In ad
ditio
n to
$2
,300
Dedu
ctib
le***)
Me
dica
l Exp
ense
s In
or ou
t of th
e hos
pital
and o
utpati
ent h
ospit
al tre
atmen
t, suc
h as P
hysic
ian’s
servi
ces,
inpati
ent a
nd
outpa
tient
medic
al an
d sur
gical
servi
ces a
nd su
pplie
s, ph
ysica
l and
spee
ch th
erap
y, dia
gnos
tic te
sts, d
urab
le me
dical
equip
ment
First
$185
of M
edica
re ap
prov
ed am
ounts
*
Rema
inder
of M
edica
re ap
prov
ed am
ounts
$0
Gene
rally
80%
$185
Par
t B
Dedu
ctible
Ge
nera
lly 20
%
$0
$0
$185
Par
t B
Dedu
ctible
Ge
nera
lly 20
%
$0
$0
Part
B Ex
cess
Cha
rges
(abo
ve M
edica
re ap
prov
ed
amou
nts)
$0
100%
$0
10
0%
$0
Bloo
d Fir
st 3 p
ints
Next
$185
of M
edica
re ap
prov
ed am
ounts
*
Rema
inder
of M
edica
re ap
prov
ed am
ounts
$0
$0
80%
All c
osts
$185
Par
t B
Dedu
ctible
20
%
$0
$0
$0
All c
osts
$185
Par
t B
Dedu
ctible
20
%
$0
$0
$0
Clin
ical L
abor
ator
y Ser
vices
– Te
sts fo
r Diag
nosti
c se
rvice
s 10
0%
$0
$0
$0
$0
***Hi
gh D
educ
tible
Plan
F pa
ys th
e sam
e ben
efits
as P
lan F
after
one h
as pa
id a c
alend
ar ye
ar $2
,300 d
educ
tible.
Ben
efits
from
High
Ded
uctib
le Pl
an F
will
not b
egin
until
out-o
f-poc
ket e
xpen
ses e
xcee
d $2,3
00. O
ut-of-
pock
et ex
pens
es fo
r this
dedu
ctible
are e
xpen
ses t
hat w
ould
ordin
arily
be pa
id by
the p
olicy
/certif
icate.
The
se
expe
nses
inclu
de th
e Med
icare
dedu
ctible
s for
Pay
A an
d Par
t B, b
ut do
not in
clude
the p
lan’s
sepa
rate
Fore
ign T
rave
l Eme
rgen
cy de
ducti
ble.
9 of 1
6
GREA
T SO
UTHE
RN L
IFE
INSU
RANC
E CO
MPAN
Y Ou
tline
of C
over
age
Medi
care
Sup
plem
ent B
enef
it Pl
ans A
, F, H
igh
Dedu
ctib
le F,
G, a
nd N
.
GM
D50
0-O
C
E
ffect
ive:
03/
01/2
019
Plan
F a
nd H
igh
Ded
uctib
le P
lan
F
Plan
F an
d Hi
gh D
educ
tible
Plan
F
Parts
A &
B
Serv
ices
Medi
care
Pa
ys
Plan
F P
ays
You
Pay
High
Ded
uctib
le
Plan
F P
ays (
afte
r yo
u pa
y $2,3
00
Dedu
ctib
le***
You
Pay
(In ad
ditio
n to
$2,30
0 De
duct
ible*
**)
Hom
e Hea
lth C
are
Medic
are E
ligibl
e Ser
vices
-M
edica
lly ne
cess
ary s
killed
care
servi
ces a
ndme
dical
supp
lies
-Dur
able
medic
al eq
uipme
nt. F
irst $
185 o
fMe
dicar
e app
rove
d amo
unts*
-Rem
ainde
r of M
edica
re ap
prov
ed am
ounts
100%
$0
80%
$0
$185
Par
t B
Dedu
ctible
20
%
$0
$0
$0
$0
$185
Par
t B
Dedu
ctible
20
%
$0
$0
$0
Othe
r Ben
efits
Not
Cov
ered
by M
edica
re
Serv
ices
Medi
care
Pa
ys
Plan
F P
ays
You
Pay
High
Ded
uctib
le
Plan
F P
ays (
afte
r yo
u pa
y $2,3
00
Dedu
ctib
le***
You
Pay
(In ad
ditio
n to
$2,30
0 De
duct
ible*
**)
Fore
ign
Trav
el
Medic
ally n
eces
sary
emer
genc
y car
e ser
vices
be
ginnin
g dur
ing th
e firs
t 60 d
ays o
f eac
h trip
ou
tside
the U
SA.
First
$250
each
calen
dar y
ear
Rema
inder
of ch
arge
s
$0
$0
$0
80%
to a
lifetim
e ma
ximum
bene
fit of
$50,0
00.
$250
20
% an
d amo
unts
over
the $
50,00
0 life
time m
axim
um.
$0
80%
to a
lifetim
e ma
ximum
bene
fit of
$50,0
00.
$250
20
% an
d amo
unts
over
the $
50,00
0 life
time m
axim
um.
**High
Ded
uctib
le Pl
an F
pays
the s
ame b
enefi
ts as
Plan
F af
ter on
e has
paid
a cale
ndar
year
$2,30
0 ded
uctib
le. B
enefi
ts fro
m Hi
gh D
educ
tible
Plan
F w
ill no
t beg
in un
til ou
t-of-p
ocke
t exp
ense
s exc
eed $
2,300
. Out-
of-po
cket
expe
nses
for t
his de
ducti
ble ar
e exp
ense
s tha
t wou
ld or
dinar
ily be
paid
by th
e poli
cy/ce
rtifica
te. T
hese
ex
pens
es in
clude
the M
edica
re de
ducti
bles f
or P
ay A
and P
art B
, but
do no
t inclu
de th
e plan
’s se
para
te for
eign t
rave
l eme
rgen
cy de
ducti
ble.
10 of
16
GREA
T SO
UTHE
RN L
IFE
INSU
RANC
E CO
MPAN
Y Ou
tline
of C
over
age
Medi
care
Sup
plem
ent B
enef
it Pl
ans A
, F, H
igh
Dedu
ctib
le F,
G, a
nd N
.
GM
D50
0-O
C
Effe
ctiv
e: 0
3/01
/201
9 Pl
an G
Plan
G
Medi
care
Par
t A –
Hosp
ital S
ervic
es P
er B
enef
it Pe
riod
*A be
nefit
perio
d beg
ins on
the f
irst d
ay yo
u rec
eive s
ervic
e as a
n inp
atien
t in a
hosp
ital a
nd en
ds af
ter yo
u hav
e bee
n out
of the
hosp
ital a
nd ha
ve no
t rec
eived
skille
dca
re in
any o
ther f
acilit
y for
60 da
ys in
a ro
w.Se
rvice
s Me
dica
re P
ays
Plan
G P
ays
You
Pay
*Hos
pita
lizat
ion
Semi
priva
te ro
om an
d boa
rd, g
ener
al nu
rsing
and m
iscell
aneo
usse
rvice
s and
supp
lies.
First
60 da
ysAl
l but
$1,36
4 $1
,364 P
art A
Ded
uctib
le $0
61
st thr
u 90th d
ayAl
l but
$341
a da
y $3
41 a
day
$0
91st d
ay an
d afte
r-
Whil
e usin
g 60 l
ifetim
e res
erve
days
-On
ce lif
etime
rese
rve da
ys ar
e use
d
Addit
ional
365 d
ays
Be
yond
the a
dditio
nal 3
65 da
ys
All b
ut $6
82 a
day
$0
$0
$682
a da
y
100%
of M
edica
re E
ligibl
e Exp
ense
s $0
$0
$0**
All C
osts
*Skil
led N
ursin
g Fa
cility
Car
eYo
u mus
t mee
t Med
icare
’s re
quire
ments
, inclu
ding h
aving
been
in a
hosp
ital fo
r at le
ast 3
days
and e
ntere
d a M
edica
re ap
prov
ed fa
cility
withi
n 30 d
ays a
fter le
aving
the h
ospit
al.Fir
st 20
days
21st t
hru 1
00 da
ys10
1st day
and a
fter
All a
ppro
ved a
moun
ts Al
l but
$170
.50 a
day
$0
$0
Up to
$170
.50 a
day
$0
$0
$0
All C
osts
Bloo
d Fir
st 3 p
ints
Addit
ional
amou
nts
$0
100%
3 p
ints
$0
$0
$0
Hosp
ice C
are
You m
ust m
eet M
edica
re’s
requ
ireme
nts, in
cludin
g a do
ctor’s
ce
rtifica
tion o
f term
inal il
lness
. Al
l but
very
limite
d co
paym
ent/c
oinsu
ranc
e for
outpa
tient
drug
s and
inp
atien
t res
pite c
are.
Medic
are c
opay
ment/
coins
uran
ce
$0
** W
hen y
our M
edica
re P
art A
hosp
ital b
enefi
ts ar
e exh
auste
d, the
insu
rer s
tands
in th
e plac
e of M
edica
re an
d will
pay w
hatev
er am
ount
Medic
are w
ould
have
paid
for
up to
an ad
dition
al 36
5 day
s as p
rovid
ed in
the p
olicy
’s “C
ore B
enefi
ts.” D
uring
this
time,
the ho
spita
l is pr
ohibi
ted fr
om bi
lling y
ou fo
r the
balan
ce ba
sed o
n any
dif
feren
ce be
twee
n its
billed
char
ges a
nd th
e amo
unt M
edica
re w
ould
have
paid.
11 of
16
GREA
T SO
UTHE
RN L
IFE
INSU
RANC
E CO
MPAN
Y Ou
tline
of C
over
age
Medi
care
Sup
plem
ent B
enef
it Pl
ans A
, F, H
igh
Dedu
ctib
le F,
G, a
nd N
.
GM
D50
0-O
C
Effe
ctiv
e: 0
3/01
/201
9 Pl
an G
Plan
G
Medi
care
Par
t B –
Medi
cal S
ervic
es p
er C
alend
ar Y
ear
*Onc
e you
have
been
bille
d $18
5 of M
edica
re ap
prov
ed am
ounts
for c
over
ed se
rvice
s, yo
ur M
edica
re P
art B
Ded
uctib
le wi
ll hav
e bee
n met
for th
e cale
ndar
year
.Se
rvice
s Me
dica
re P
ays
Plan
G P
ays
You
Pay
*Med
ical E
xpen
ses
In or
out o
f the h
ospit
al an
d outp
atien
t hos
pital
treatm
ent, s
uch a
s Ph
ysici
an’s
servi
ces,
inpati
ent a
nd ou
tpatie
nt me
dical
and s
urgic
al se
rvice
s an
d sup
plies
, phy
sical
and s
peec
h the
rapy
, diag
nosti
c tes
ts, du
rable
me
dical
equip
ment
First
$185
of M
edica
re ap
prov
ed am
ounts
* Re
maind
er of
Med
icare
appr
oved
amou
nts
$0
Gene
rally
80%
$0
Ge
nera
lly 20
%
$185
Par
t B D
educ
tible
$0
Part
B Ex
cess
Cha
rges
(abo
ve M
edica
re ap
prov
ed am
ounts
) $0
10
0%
$0
Bloo
d Fir
st 3 p
ints
Next
$185
of M
edica
re ap
prov
ed am
ounts
* Re
maind
er of
Med
icare
appr
oved
amou
nts
$0
$0
80%
All c
osts
$0
20%
$0
$185
Par
t B D
educ
tible
$0
Clin
ical L
abor
ator
y Ser
vices
– Te
sts fo
r Diag
nosti
c ser
vices
10
0%
$0
$0
Parts
A &
B
Serv
ices
Medi
care
Pay
s Pl
an G
Pay
s Yo
u Pa
y Ho
me H
ealth
Car
e Me
dicar
e Elig
ible S
ervic
es
-Med
ically
nece
ssar
y skil
led ca
re se
rvice
s and
med
ical s
uppli
es-D
urab
le me
dical
equip
ment.
Firs
t $18
5 of M
edica
re ap
prov
ed am
ounts
*-R
emain
der o
f Med
icare
appr
oved
amou
nts
100%
$0
80
%
$0
$0
20%
$0
$185
Par
t B D
educ
tible
$0
12 of
16
GREA
T SO
UTHE
RN L
IFE
INSU
RANC
E CO
MPAN
Y Ou
tline
of C
over
age
Medi
care
Sup
plem
ent B
enef
it Pl
ans A
, F, H
igh
Dedu
ctib
le F,
G, a
nd N
.
GM
D50
0-O
C
Effe
ctiv
e: 0
3/01
/201
9 Pl
an G
Plan
G
Othe
r Ben
efits
Not
Cov
ered
by M
edica
re
Serv
ices
Medi
care
Pay
s Pl
an G
Pay
s Yo
u Pa
y Fo
reig
n Tr
avel
Me
dicall
y nec
essa
ry em
erge
ncy c
are s
ervic
es be
ginnin
g dur
ing th
e firs
t 60
days
of ea
ch tr
ip ou
tside
the U
SA.
First
$250
each
calen
dar y
ear
Rema
inder
of C
harg
es
$0
$0
$0
80%
to a
lifetim
e max
imum
be
nefit
of $5
0,000
.
$250
20
% an
d amo
unts
over
the
$50,0
00 lif
etime
max
imum
.
13 of
16
GREA
T SO
UTHE
RN L
IFE
INSU
RANC
E CO
MPAN
Y Ou
tline
of C
over
age
Medi
care
Sup
plem
ent B
enef
it Pl
ans A
, F, H
igh
Dedu
ctib
le F,
G, a
nd N
.
GM
D50
0-O
C
Effe
ctiv
e: 0
3/01
/201
9Pl
an N
Plan
N
Medi
care
Par
t A –
Hosp
ital S
ervic
es P
er B
enef
it Pe
riod
*A be
nefit
perio
d beg
ins on
the f
irst d
ay yo
u rec
eive s
ervic
e as a
n inp
atien
t in a
hosp
ital a
nd en
ds af
ter yo
u hav
e bee
n out
of the
hosp
ital a
nd ha
ve no
t rec
eived
skille
dca
re in
any o
ther f
acilit
y for
60 da
ys in
a ro
w.Se
rvice
s Me
dica
re P
ays
Plan
N P
ays
You
Pay
Hosp
italiz
atio
n*
Semi
priva
te ro
om an
d boa
rd, g
ener
al nu
rsing
and m
iscell
aneo
us
servi
ces a
nd su
pplie
s. Fir
st 60
days
Al
l but
$1,36
4 $1
,364 P
art A
Ded
uctib
le $0
61
st thr
u 90th d
ay
All b
ut $3
41 a
day
$341
a da
y $0
91
st day
and a
fter
-W
hile u
sing 6
0 life
time r
eser
ve da
ys-
Once
lifeti
me re
serve
days
are u
sed
Ad
dition
al 36
5 day
s
Beyo
nd th
e add
itiona
l 365
days
All b
ut $6
82 a
day
$0
$0
$682
a da
y
100%
of M
edica
re E
ligibl
e Exp
ense
s $0
$0
$0**
All C
osts
Skille
d Nu
rsin
g Fa
cility
Car
e*
You m
ust m
eet M
edica
re’s
requ
ireme
nts, in
cludin
g hav
ing be
en in
a h
ospit
al for
at le
ast 3
days
and e
ntere
d a M
edica
re ap
prov
ed
facilit
y with
in 30
days
after
leav
ing th
e hos
pital.
Fir
st 20
days
21
st thr
u 100
days
10
1st day
and a
fter
All a
ppro
ved a
moun
ts Al
l but
$170
.50 a
day
$0
$0
$Up t
o $17
0.50 a
day
$0
$0
$0
All C
osts
Bloo
d Fir
st 3 p
ints
Addit
ional
amou
nts
$0
100%
3 p
ints
$0
$0
$0
Hosp
ice C
are
You m
ust m
eet M
edica
re’s
requ
ireme
nts, in
cludin
g a do
ctor’s
ce
rtifica
tion o
f term
inal il
lness
. Al
l but
very
limite
d co
paym
ent/c
oinsu
ranc
e for
outpa
tient
drug
s and
inp
atien
t res
pite c
are.
Medic
are c
opay
ment/
coins
uran
ce
$0
** W
hen y
our M
edica
re P
art A
hosp
ital b
enefi
ts ar
e exh
auste
d, the
insu
rer s
tands
in th
e plac
e of M
edica
re an
d will
pay w
hatev
er am
ount
Medic
are w
ould
have
paid
for
up to
an ad
dition
al 36
5 day
s as p
rovid
ed in
the p
olicy
’s “C
ore B
enefi
ts.” D
uring
this
time,
the ho
spita
l is pr
ohibi
ted fr
om bi
lling y
ou fo
r the
balan
ce ba
sed o
n any
dif
feren
ce be
twee
n its
billed
char
ges a
nd th
e amo
unt M
edica
re w
ould
have
paid.
14 of
16
GREA
T SO
UTHE
RN L
IFE
INSU
RANC
E CO
MPAN
Y Ou
tline
of C
over
age
Medi
care
Sup
plem
ent B
enef
it Pl
ans A
, F, H
igh
Dedu
ctib
le F,
G, a
nd N
.
GM
D50
0-O
C
Effe
ctiv
e: 0
3/01
/201
9Pl
an N
Plan
N
Medi
care
Par
t B –
Medi
cal S
ervic
es p
er C
alend
ar Y
ear
*Onc
e you
have
been
bille
d $18
5 of M
edica
re A
ppro
ved a
moun
ts for
cove
red s
ervic
es, y
our M
edica
re P
art B
Ded
uctib
le wi
ll hav
e bee
n met
for th
e cale
ndar
year
.Se
rvice
s Me
dica
re P
ays
Plan
N P
ays
You
Pay
*Med
ical E
xpen
ses
In or
out o
f the h
ospit
al an
d outp
atien
t hos
pital
treatm
ent, s
uch a
s Phy
sician
’sse
rvice
s, inp
atien
t and
outpa
tient
medic
al an
d sur
gical
servi
ces a
nd su
pplie
s,ph
ysica
l and
spee
ch th
erap
y, dia
gnos
tic te
sts, d
urab
le me
dical
equip
ment
First
$185
of M
edica
re ap
prov
ed am
ounts
*Re
maind
er of
Med
icare
appr
oved
amou
nts
$0
Gene
rally
80%
$0
Ba
lance
, othe
r tha
n up t
o $2
0 per
offic
e visi
t and
up
to $5
0 per
emer
genc
y ro
om vi
sit. T
he
copa
ymen
t of u
p to $
50
is wa
ived i
f the i
nsur
ed is
ad
mitte
d to a
ny ho
spita
l an
d the
emer
genc
y visi
t is
cove
red a
s a M
edica
re
Part
A ex
pens
e.
$185
Par
t B D
educ
tible
Up to
$20 p
er of
fice v
isit
and u
p to $
50 pe
r em
erge
ncy r
oom
visit.
The c
opay
ment
of up
to
$50 i
s waiv
ed if
the
insur
ed is
admi
tted t
o an
y hos
pital
and t
he
emer
genc
y visi
t is
cove
red a
s a M
edica
re
Part
A ex
pens
e. Pa
rt B
Exce
ss C
harg
es (a
bove
Med
icare
appr
oved
amou
nts)
$0
$0
All c
osts
Bloo
d Fir
st 3 p
ints
Next
$185
of M
edica
re ap
prov
ed am
ounts
* Re
maind
er of
Med
icare
appr
oved
amou
nts
$0
$0
80%
All c
osts
$0
20%
$0
$185
Par
t B D
educ
tible
$0
Clin
ical L
abor
ator
y Ser
vices
– Te
sts fo
r diag
nosti
c ser
vices
10
0%
$0
$0
Parts
A &
B
Serv
ices
Medi
care
Pay
s Pl
an N
Pay
s Yo
u Pa
y Ho
me H
ealth
Car
e Me
dicar
e Elig
ible S
ervic
es
-Med
ically
nece
ssar
y skil
led ca
re se
rvice
s and
med
ical s
uppli
es-D
urab
le me
dical
equip
ment.
Firs
t $18
5 of M
edica
re ap
prov
ed am
ounts
-Rem
ainde
r of M
edica
re ap
prov
ed am
ounts
100%
$0
80
%
$0
$0
20%
$0
$185
Par
t B D
educ
tible
$0
15 of
16
GREA
T SO
UTHE
RN L
IFE
INSU
RANC
E CO
MPAN
Y Ou
tline
of C
over
age
Medi
care
Sup
plem
ent B
enef
it Pl
ans A
, F, H
igh
Dedu
ctib
le F,
G, a
nd N
.
GM
D50
0-O
C
Effe
ctiv
e: 0
3/01
/201
9
Plan
N
Plan
N
Othe
r Ben
efits
Not
Cov
ered
by M
edica
re
Serv
ices
Medi
care
Pay
s Pl
an N
Pay
s Yo
u Pa
y Fo
reig
n Tr
avel
Medic
ally n
eces
sary
emer
genc
y car
e ser
vices
begin
ning d
uring
the f
irst 6
0 day
s of
each
trip
outsi
de th
e USA
. Fir
st $2
50 ea
ch ca
lenda
r yea
r Re
maind
er of
char
ges
$0
$0
$0
80%
to a
lifetim
e ma
ximum
bene
fit of
$50,0
00.
$250
20
% an
d amo
unts
over
the
$50,0
00 lif
etime
ma
ximum
.
16 of
16
2019Choosing 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
Developed jointly by the Centers for Medicare & Medicaid Services (CMS) and the National Association of Insurance Commissioners (NAIC)
Who should read this guide? This guide can help if you’re thinking about buying a Medigap policy or already have one. It'll help you understand Medicare Supplement Insurance policies (also called Medigap policies). A Medigap policy is a type of private insurance that helps you pay for some of the costs that Original Medicare doesn’t cover.
Important information about this guideThe information in this booklet describes the Medicare Program at the time this booklet was printed. Changes may occur after printing. Visit Medicare.gov, or call 1‑800‑MEDICARE (1‑800‑633‑4227) to get the most current information. TTY users can call 1‑877‑486‑2048.The “2019 Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare” isn’t a legal document. Official Medicare Program legal guidance is contained in the relevant statutes, regulations, and rulings.
Paid for by the Department of Health & Human Services.
3Table of Contents
Medicare Basics 5A brief look at Medicare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5What’s Medicare? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6The different parts of Medicare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Your Medicare coverage choices at a glance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Medicare and the Health Insurance Marketplace . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Medigap Basics 9
What’s a Medigap policy?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9What Medigap policies cover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10What Medigap policies don’t cover. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Types of coverage that are NOT Medigap policies . . . . . . . . . . . . . . . . . . . . . . . . . 12What types of Medigap policies can insurance companies sell? . . . . . . . . . . . . . . 12What do I need to know if I want to buy a Medigap policy?. . . . . . . . . . . . . . . . . 13When’s the best time to buy a Medigap policy? . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Why is it important to buy a Medigap policy when I’m first eligible? . . . . . . . . . 16How do insurance companies set prices for Medigap policies? . . . . . . . . . . . . . . 17What this pricing may mean for you . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Comparing Medigap costs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19What's Medicare SELECT? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20How does Medigap help pay my Medicare Part B bills? . . . . . . . . . . . . . . . . . . . . 20
Your Right to Buy a Medigap Policy 21
What are guaranteed issue rights? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21When do I have guaranteed issue rights?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Can I buy a Medigap policy if 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32Losing Medigap coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36Medigap policies and Medicare prescription drug coverage . . . . . . . . . . . . . . . . 36
Section 1:
Section 2:
Section 3:
Section 4:
Section 5:
4 Table of Contents
Medigap Policies for People with a Disability or ESRD 39
Information for people under 65 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Medigap Coverage in Massachusetts, Minnesota, and Wisconsin 41
Massachusetts benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42Minnesota benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Wisconsin benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
For More Information 45
Where to get more information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45How to get help with Medicare and Medigap questions . . . . . . . . . . . . . . . . . . . . 46State Health Insurance Assistance Program and State Insurance Department. . 47
Definitions 49
Where words in BLUE are defined . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Section 6:
Section 7:
Section 8:
Section 9:
5
SECTION
Medicare Basics
A brief look at MedicareA Medicare Supplement Insurance (Medigap) policy is health insurance that can help pay some of the health care costs that Original Medicare doesn’t cover, like coinsurance, copayments, or deductibles. Private insurance companies sell Medigap policies. Some Medigap policies also cover certain benefits Original Medicare doesn’t cover, like emergency foreign travel expenses. Medigap policies don’t cover your share of the costs under other types of health coverage, including Medicare Advantage Plans (like HMOs or PPOs), stand‑alone Medicare Prescription Drug Plans, employer/union group health coverage, Medicaid, or TRICARE. Insurance companies generally can’t sell you a Medigap policy if you have coverage through Medicaid or a Medicare Advantage Plan.
The next few pages provide a brief look at Medicare. If you already know the basics about Medicare and only want to learn about Medigap, skip to page 9.
Words in blue are defined on pages 49–50.
1
6 Section 1: Medicare Basics
What's Medicare? Medicare is health insurance for:
• People 65 or older• People under 65 with certain disabilities • People of any age with End‑Stage Renal Disease (ESRD) (permanent kidney failure
requiring dialysis or a kidney transplant)
The different parts of Medicare The different parts of Medicare help cover specific services.
Part A (Hospital Insurance)Helps cover:• Inpatient care in hospitals• Skilled nursing facility care• Hospice care• Home health care
Part B (Medical Insurance)Helps cover:• Services from doctors and other health care providers• Outpatient care• Home health care• Durable medical equipment (like wheelchairs, walkers,
hospital beds, and other equipment and supplies)• Many preventive services (like screenings, shots, and yearly
“Wellness” visits)
Part D (Prescription drug coverage)Helps cover:• Cost of prescription drugsPart D plans are run by private insurance companies that follow rules set by Medicare.
7Section 1: Medicare Basics
Your Medicare options When you first enroll in Medicare and during certain times of the year, you can choose how you get your Medicare coverage. There are 2 main ways to get Medicare.
Original Medicare• Original Medicare includes Medicare
Part A (Hospital Insurance) and Part B (Medical Insurance).
• If you want drug coverage, you can join a separate Part D plan.
• To help pay your out-of-pocket costs in Original Medicare (like your deductible and 20% coinsurance), you can also shop for and buy supplemental coverage.
Part A
Part B
You can add:
Part D
You can also add:
Supplemental coverage
(Some examples include coverage from a Medicare Supplement Insurance (Medigap) policy, or coverage from a former employer or union.)
Medicare Advantage(also known as Part C)
• Medicare Advantage is an “all in one” alternative to Original Medicare. These “bundled” plans include Part A, Part B, and usually Part D.
• Some plans may have lower out-of-pocket costs than Original Medicare.
• Some plans offer extra benefits that Original Medicare doesn’t cover — like vision, hearing, or dental.
Part A
Part B
Most plans include:
Part D
Some plans also include:
Lower out-of-pocket-costs
Extra benefits
8 Section 1: Medicare Basics
Medicare and the Health Insurance MarketplaceIf you have coverage through an individual Marketplace plan (not through an employer), you may want to end your Marketplace coverage and enroll in Medicare during your Initial Enrollment Period to avoid the risk of a delay in future Medicare coverage and the possibility of a Medicare late enrollment penalty. It’s important to terminate your Marketplace coverage in a timely manner to avoid an overlap in coverage. Once you’re considered eligible for premium free Part A, you won’t qualify for help paying your Marketplace plan premiums or other medical costs. If you continue to get help paying your Marketplace plan premium after you have Medicare, you may have to pay back some or all of the help you got when you file your taxes. Visit HealthCare.gov to connect to the Marketplace in your state and learn more. You can also find out how to terminate your Marketplace plan or Marketplace financial help when your Medicare enrollment begins to avoid a gap in coverage. You can also call the Marketplace Call Center at 1‑800‑318‑2596. TTY users can call 1‑855‑889‑4325. Note: Medicare isn’t part of the Marketplace. The Marketplace doesn’t offer Medicare Supplement Insurance (Medigap) policies, Medicare Advantage Plans, or Medicare drug plans (Part D).
For more information Remember, this guide is about Medigap policies. To learn more about Medicare, visit Medicare.gov, look at your “Medicare & You” handbook, or call 1‑800‑MEDICARE (1‑800‑633‑4227). TTY users can call 1‑877‑486‑2048.
9
SECTION
Medigap Basics2 What's a Medigap policy? A Medigap policy is private health insurance that helps supplement Original Medicare. This means it helps pay some of the health care costs that Original Medicare doesn’t cover (like copayments, coinsurance, and deductibles). These are “gaps” in Medicare coverage. If you have Original Medicare and a Medigap policy, Medicare will pay its share of the Medicare‑approved amounts for covered health care costs. Then your Medigap policy pays its share. A Medigap policy is different from a Medicare Advantage Plan (like an HMO or PPO) because those plans are ways to get Medicare benefits, while a Medigap policy only supplements the costs of your Original Medicare benefits. Note: Medicare doesn’t pay any of your costs for a Medigap policy.All Medigap policies must follow federal and state laws designed to protect you, and policies must be clearly identified as “Medicare Supplement Insurance.” Medigap insurance companies in most states can only sell you a “standardized” Medigap policy identified by letters A through N. Each standardized Medigap policy must offer the same basic benefits, no matter which insurance company sells it.
Cost is usually the only difference between Medigap policies with the same letter sold by different insurance companies.
10 Section 2: Medigap Basics
What Medigap policies cover
The chart on page 11 gives you a quick look at the standardized Medigap Plans available. You’ll need more details than this chart provides to compare and choose a policy. Call your State Health Insurance Assistance Program (SHIP) for help. See pages 47–48 for your state’s phone number.
• Insurance companies selling Medigap policies are required to make Plan A available. If they offer any other Medigap policy, they must also offer either Plan C or Plan F to individuals who are not new to Medicare and either Plan D or Plan G to individuals who are new to Medicare. Not all types of Medigap policies may be available in your state.
• Plans D and G effective on or after June 1, 2010, have different benefits than Plans D or G bought before June 1, 2010.
• Plans E, H, I, and J are no longer sold, but, if you already have one, you can generally keep it.
• Starting January 1, 2020, Medigap plans sold to people new to Medicare won’t be allowed to cover the Part B deductible. Because of this, Plans C and F will no longer be available to people who are new to Medicare on or after January 1, 2020.
– If you already have either of these two plans (or the high deductible version of Plan F) or are covered by one of these plans prior to January 1, 2020, you will be able to keep your plan. If you were eligible for Medicare before January 1, 2020 but not yet enrolled, you may be able to buy one of these plans.
– People new to Medicare are those who turn 65 on or after January 1, 2020, and those who first become eligible for Medicare benefits due to age, disability or ESRD on or after January 1, 2020.
In Massachusetts, Minnesota, and Wisconsin, Medigap policies are standardized in a different way. See pages 42–44. In some states, you may be able to buy another type of Medigap policy called Medicare SELECT. Medicare SELECT plans are standardized plans that may require you to see certain providers and may cost less than other plans. See page 20.
11Section 2: Medigap Basics
Medicare Supplement Insurance (Medigap) Plans
Benefits A B C D F* G K L M NMedicare Part A coinsurance and hospital costs (up to an additional 365 days after Medicare benefits are used)
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 care coinsurance or copayment
100% 100% 100% 100% 100% 100% 50% 75% 100% 100%
Skilled nursing facility care coinsurance
100% 100% 100% 100% 50% 75% 100% 100%
Part A deductible 100% 100% 100% 100% 100% 50% 75% 50% 100%Part B deductible 100% 100%Part B excess charges 100% 100%Foreign travel emergency (up to plan limits)
80% 80% 80% 80% 80% 80%
Out‑of‑pocket limit
in 2019**$5,560 $2,780
* Plan F is also offered as a high‑deductible plan by some insurance companies in some states. If you choose this option, this means you must pay for Medicare‑covered costs (coinsurance, copayments, deductibles) up to the deductible amount of $2,300 in 2019 before your policy pays anything. **For Plans K and L, after you meet your out‑of‑pocket yearly limit and your yearly Part B deductible ($185 in 2019), the Medigap plan pays 100% of covered services for the rest of the calendar year.*** Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don’t result in an inpatient admission.
This chart shows basic information about the different benefits that Medigap policies cover. If a percentage appears, the Medigap plan covers that percentage of the benefit, and you must pay the rest.
12 Section 2: Medigap Basics
What Medigap policies don’t coverGenerally, Medigap policies don’t cover long‑term care (like care in a nursing home), vision or dental care, hearing aids, eyeglasses, or private‑duty nursing.
Types of coverage that are NOT Medigap policies• Medicare Advantage Plans (Part C), like an HMO or PPO• Medicare Prescription Drug Plans (Part D)• Medicaid• Employer or union plans, including the Federal Employees Health
Benefits Program (FEHBP)• TRICARE • Veterans’ benefits • Long‑term care insurance policies • Indian Health Service, Tribal, and Urban Indian Health plans• Qualified Health Plans sold in the Health Insurance Marketplace
What types of Medigap policies can insurance companies sell?In most cases, Medigap insurance companies can sell you only a “standardized” Medigap policy. All Medigap policies must have specific benefits, so you can compare them easily. If you live in Massachusetts, Minnesota, or Wisconsin, see pages 42– 44.Insurance companies that sell Medigap policies don’t have to offer every Medigap plan. However, they must offer Plan A if they offer any Medigap policy. If they offer any plan in addition to Plan A, they must also offer Plan C or Plan F. Each insurance company decides which Medigap plan it wants to sell, although state laws might affect which ones they offer.In some cases, an insurance company must sell you a Medigap policy if you want one, even if you have health problems. Here are certain times that you’re guaranteed the right to buy a Medigap policy: • When you’re in your Medigap Open Enrollment Period. See pages 14 –15.• If you have a guaranteed issue right. See pages 21–23.
You may be able to buy a Medigap policy at other times, but the insurance company can deny you a Medigap policy based on your health. Also, in some cases it may be illegal for the insurance company to sell you a Medigap policy (like if you already have Medicaid or a Medicare Advantage Plan).
Words in blue are defined on pages 49–50.
13Section 2: Medigap Basics
What do I need to know if I want to buy a Medigap policy?• You must have Medicare Part A (Hospital Insurance) and Medicare Part B
(Medical Insurance) to buy a Medigap policy.
• If you have a Medicare Advantage Plan (like an HMO or PPO) but are planning to return to Original Medicare, you can apply for a Medigap policy before your coverage ends. The Medigap insurer can sell it to you as long as you’re leaving the Plan. Ask that the new Medigap policy start when your Medicare Advantage Plan enrollment ends, so you'll have continuous coverage.
• You pay the private insurance company a premium for your Medigap policy in addition to the monthly Part B premium you pay to Medicare.
• A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you each will have to buy separate Medigap policies.
• When you have your Medigap Open Enrollment Period, you can buy a Medigap policy from any insurance company that’s licensed in your state.
• If you want to buy a Medigap policy, see page 11 for an overview of the basic benefits covered by different Medigap policies. Then, follow the “Steps to Buying a Medigap Policy” on pages 25 –30.
• If you want to drop your Medigap policy, write your insurance company to cancel the policy and confirm it’s cancelled. Your agent can’t cancel the policy for you.
• Any standardized Medigap policy is guaranteed renewable even if you have health problems. This means the insurance company can’t cancel your Medigap policy as long as you stay enrolled and pay the premium.
• Different insurance companies may charge different premiums for the same exact policy. As you shop for a policy, be sure you’re comparing the same policy (for example, compare Plan A from one company with Plan A from another company).
• Some states may have laws that may give you additional protections.
• Although some Medigap policies sold in the past covered prescription drugs, Medigap policies sold after January 1, 2006, aren’t allowed to include prescription drug coverage. If you want prescription drug coverage, you can join a Medicare Prescription Drug Plan (Part D) offered by private companies approved by Medicare. See pages 6–7.
To learn about Medicare prescription drug coverage, visit Medicare.gov, or call 1‑800‑MEDICARE (1‑800‑633‑4227). TTY users can call 1‑877‑486‑2048.
14 Section 2: Medigap Basics
When's the best time to buy a Medigap policy? The best time to buy a Medigap policy is during your Medigap Open Enrollment Period. This period lasts for 6 months and begins on the first day of the month in which you’re both 65 or older and enrolled in Medicare Part B. Some states have additional Open Enrollment Periods including those for people under 65. During this period, an insurance company can’t use medical underwriting. This means the insurance company can’t do any of these because of your health problems:• Refuse to sell you any Medigap policy it offers • Charge you more for a Medigap policy than they charge someone with no
health problems• Make you wait for coverage to start (except as explained below) While the insurance company can’t make you wait for your coverage to start, it may be able to make you wait for coverage related to a pre‑existing condition. A pre‑existing condition is a health problem you have before the date a new insurance policy starts. In some cases, the Medigap insurance company can refuse to cover your out‑of‑pocket costs for these pre‑existing health problems for up to 6 months. This is called a “pre‑existing condition waiting period.” After 6 months, the Medigap policy will cover the pre‑existing condition. Coverage for a pre‑existing condition can only be excluded if the condition was treated or diagnosed within 6 months before the coverage starts under the Medigap policy. This is called the “look‑back period.” Remember, for Medicare‑covered services, Original Medicare will still cover the condition, even if the Medigap policy won’t, but you’re responsible for the Medicare coinsurance or copayment.
Words in blue are defined on pages 49–50.
15Section 2: Medigap Basics
When's the best time to buy a Medigap policy? (continued) Creditable coverageIt’s possible to avoid or shorten waiting periods for pre‑existing conditions, if you have a pre‑existing condition, you buy a Medigap policy during your Medigap Open Enrollment Period, and you’re replacing certain kinds of health coverage that count as “creditable coverage.” Prior creditable coverage is generally any other health coverage you recently had before applying for a Medigap policy. If you’ve had at least 6 months of continuous prior creditable coverage, the Medigap insurance company can’t make you wait before it covers your pre‑existing conditions.There are many types of health care coverage that may count as creditable coverage for Medigap policies, but they’ll only count if you didn’t have a break in coverage for more than 63 days.Your Medigap insurance company can tell you if your previous coverage will count as creditable coverage for this purpose. You can also call your State Health Insurance Assistance Program. See pages 47– 48.If you buy a Medigap policy when you have a guaranteed issue right (also called “Medigap protection”), the insurance company can’t use a pre‑existing condition waiting period. See pages 21–23 for more information about guaranteed issue rights.Note: If you’re under 65 and have Medicare because of a disability or End‑Stage Renal Disease (ESRD), you might not be able to buy the Medigap policy you want, or any Medigap policy, until you turn 65. Federal law generally doesn’t require insurance companies to sell Medigap policies to people under 65. However, some states require Medigap insurance companies to sell you a Medigap policy, even if you’re under 65. See page 39 for more information.
16 Section 2: Medigap Basics
Why is it important to buy a Medigap policy when I'm first eligible? When you’re first eligible, you have the right to buy any Medigap policy offered in your state. In addition, you generally will get better prices and more choices among policies. It’s very important to understand your Medigap Open Enrollment Period. Medigap insurance companies are generally allowed to use medical underwriting to decide whether to accept your application and how much to charge you for the Medigap policy. However, if you apply during your Medigap Open Enrollment Period, you can buy any Medigap policy the company sells, even if you have health problems, for the same price as people with good health. If you apply for Medigap coverage after your Open Enrollment Period, there’s no guarantee that an insurance company will sell you a Medigap policy if you don’t meet the medical underwriting requirements, unless you’re eligible for guaranteed issue rights (Medigap protections) because of one of the limited situations listed on pages 22–23.It’s also important to understand that your Medigap rights may depend on when you choose to enroll in Medicare Part B. If you’re 65 or older, your Medigap Open Enrollment Period begins when you enroll in Part B and can’t be changed or repeated. In most cases, it makes sense to enroll in Part B and purchase a Medigap policy when you’re first eligible for Medicare, because you might otherwise have to pay a Part B late enrollment penalty and might miss your Medigap Open Enrollment Period. However, there are exceptions if you have employer coverage.
Employer coverageIf you have group health coverage through an employer or union, because either you or your spouse is currently working, you may want to wait to enroll in Part B. Benefits based on current employment often provide coverage similar to Part B, so you wouldn't want to pay for Part B before you need it, and your Medigap Open Enrollment Period might expire before a Medigap policy would be useful. When the employer coverage ends, you’ll get a chance to enroll in Part B without a late enrollment penalty which means your Medigap Open Enrollment Period will start when you’re ready to take advantage of it. If you or your spouse is still working and you have coverage through an employer, contact your employer or union benefits administrator to find out how your insurance works with Medicare. See page 24 for more information.
Words in blue are defined on pages 49–50.
17Section 2: Medigap Basics
How do insurance companies set prices for Medigap policies? Each insurance company decides how it’ll set the price, or premium, for its Medigap policies. The way they set the price affects how much you pay now and in the future. Medigap policies can be priced or “rated” in 3 ways: 1. Community‑rated (also called “no‑age‑rated”)
2. Issue‑age‑rated (also called “entry‑age‑rated”)
3. Attained‑age‑rated
Each of these ways of pricing Medigap policies is described in the chart on the next page. The examples show how your age affects your premiums, and why it’s important to look at how much the Medigap policy will cost you now and in the future. The amounts in the examples aren’t actual costs. Other factors like where you live, medical underwriting, and discounts can also affect the amount of your premium.
18 Section 2: Medigap Basics
How do insurance companies set prices for Medigap policies? (continued)
Type of pricing
Community-rated (also called “no-age-rated”)
How it’s priced
What this pricing may mean for you
Examples
Generally the same premium is charged to everyone who has the Medigap policy, regardless of age or gender.
The premium is based on the age you are when you buy (are “issued”) the Medigap policy.
The premium is based on your current age (the age you've “attained”), so your premium goes up as you get older.
Your premium isn’t based on your age. Premiums may go up because of inflation and other factors but not because of your age.
Premiums are lower for people who buy at a younger age and won’t change as you get older. Premiums may go up because of inflation and other factors but not because of your age.
Premiums are low for younger buyers but go up as you get older. They may be the least expensive at first, but they can eventually become the most expensive. Premiums may also go up because of inflation and other factors.
Mr. Smith is 65. He buys a Medigap policy and pays a $165 monthly premium.
Mrs. Perez is 72. She buys the same Medigap policy as Mr. Smith. She also pays a $165 monthly premium.
Mr. Han is 65. He buys a Medigap policy and pays a $145 monthly premium.
Mrs. Wright is 72. She buys the same Medigap policy as Mr. Han. Since she is older when she buys it, her monthly premium is $175.
Mrs. Anderson is 65. She buys a Medigap policy and pays a $120 monthly premium. Her premium will go up each year: • At 66, her premium goes up to $126. • At 67, her premium goes up to $132.
Mr. Dodd is 72. He buys the same Medigap policy as Mrs. Anderson. He pays a $165 monthly premium. His premium is higher than Mrs. Anderson’s because it’s based on his current age. Mr. Dodd’s premium will go up each year:• At 73, his premium goes up to $171. • At 74, his premium goes up to $177.
Issue-age-rated (also called “entry age-rated”)
Attained-age-rated
19Section 2: Medigap Basics
Comparing Medigap costs As discussed on the previous pages, the cost of Medigap policies can vary widely. There can be big differences in the premiums that different insurance companies charge for exactly the same coverage. As you shop for a Medigap policy, be sure to compare the same type of Medigap policy, and consider the type of pricing used. See pages 17–18. For example, compare a Plan C from one insurance company with a Plan C from another insurance company. Although this guide can’t give actual costs of Medigap policies, you can get this information by calling insurance companies or your State Health Insurance Assistance Program. See pages 47– 48.You can also find out which insurance companies sell Medigap policies in your area by visiting Medicare.gov.The cost of your Medigap policy may also depend on whether the insurance company:
• Offers discounts (like discounts for women, non‑smokers, or people who are married; discounts for paying yearly; discounts for paying your premiums using electronic funds transfer; or discounts for multiple policies).
• Uses medical underwriting, or applies a different premium when you don’t have a guaranteed issue right or aren’t in a Medigap Open Enrollment Period.
• Sells Medicare SELECT policies that may require you to use certain providers. If you buy this type of Medigap policy, your premium may be less. See page 20.
• Offers a “high‑deductible option” for Plan F. If you buy Plan F with a high‑deductible option, you must pay the first $2,300 of deductibles, copayments, and coinsurance (in 2019) for covered services not paid by Medicare before the Medigap policy pays anything. You must also pay a separate deductible ($250 per year) for foreign travel emergency services.
If you bought Medigap Plan J before January 1, 2006, and it still covers prescription drugs, you would also pay a separate deductible ($250 per year) for prescription drugs covered by the Medigap policy. And, if you have a Plan J with a high deductible option, you must also pay a $2,300 deductible (in 2019) before the policy pays anything for medical benefits.
20 Section 2: Medigap Basics
What's Medicare SELECT? Medicare SELECT is a type of Medigap policy sold in some states that requires you to use hospitals and, in some cases, doctors within its network to be eligible for full insurance benefits (except in an emergency). Medicare SELECT can be any of the standardized Medigap plans (see page 11). These policies generally cost less than other Medigap policies. However, if you don’t use a Medicare SELECT hospital or doctor for non‑emergency services, you’ll have to pay some or all of what Medicare doesn’t pay. Medicare will pay its share of approved charges no matter which hospital or doctor you choose.
How does Medigap help pay my Medicare Part B bills? In most Medigap policies, when you sign the Medigap insurance contract you agree to have the Medigap insurance company get your Medicare Part B claim information directly from Medicare, and then they pay the doctor directly whatever amount is owed under your policy. Some Medigap insurance companies also provide this service for Medicare Part A claims.If your Medigap insurance company doesn’t provide this service, ask your doctors if they participate in Medicare. Participating providers have signed an arrangement to accept assignment for all Medicare‑covered services. If your doctor participates, the Medigap insurance company is required to pay the doctor directly if you request. If your doctor doesn't participate but still accepts Medicare, you may be asked to pay the coinsurance amount at the time of service. In these cases, your Medigap insurance company will pay you directly according to policy limits.If you have any questions about Medigap claim filing, call 1‑800‑MEDICARE (1‑800‑633‑4227). TTY users can call 1‑877‑486‑2048.
21
SECTION
Your Right to Buy a Medigap Policy3 What are guaranteed issue rights?
Guaranteed issue rights are rights you have in certain situations when insurance companies must offer you certain Medigap policies when you aren’t in your Medigap Open Enrollment Period. In these situations, an insurance company must: • Sell you a Medigap policy • Cover all your pre‑existing health conditions • Can’t charge you more for a Medigap policy regardless of past or present
health problems If you live in Massachusetts, Minnesota, or Wisconsin, you have guaranteed issue rights to buy a Medigap policy, but the Medigap policies are different. See pages 42– 44 for your Medigap policy choices.
When do I have guaranteed issue rights? In most cases, you have a guaranteed issue right when you have certain types of other health care coverage that changes in some way, like when you lose the other health care coverage. In other cases, you have a “trial right” to try a Medicare Advantage Plan and still buy a Medigap policy if you change your mind. For information on trial rights, see page 23.
22 Section 3: Your Right to Buy a Medigap Policy
This chart describes the most common situations, under federal law, that give you a right to buy a policy, the kind of policy you can buy, and when you can or must apply for it. States may provide additional Medigap guaranteed issue rights.
You have a guaranteed issue right if...
You’re in a Medicare Advantage Plan (like an HMO or PPO), and your plan is leaving Medicare or stops giving care in your area, or you move out of the plan’s service area.
You have Original Medicare and an employer group health plan (including retiree or COBRA coverage) or union coverage that pays after Medicare pays and that plan is ending.
Note: In this situation, you may have additional rights under state law.
You have Original Medicare and a Medicare SELECT policy. You move out of the Medicare SELECT policy’s service area.
Call the Medicare SELECT insurer for more information about your options.
You have the right to buy...
Medigap Plan A, B, C, F, K, or L that’s sold in your state by any insurance company.
You only have this right if you switch to Original Medicare rather than join another Medicare Advantage Plan.
Medigap Plan A, B, C, F, K, or L that’s sold in your state by any insurance company.
If you have COBRA coverage, you can either buy a Medigap policy right away or wait until the COBRA coverage ends.
Medigap Plan A, B, C, F, K, or L that’s sold by any insurance company in your state or the state you’re moving to.
You can/must apply for a Medigap policy...
As early as 60 calendar days before the date your health care coverage will end, but no later than 63 calendar days after your health care coverage ends. Medigap coverage can’t start until your Medicare Advantage Plan coverage ends.
No later than 63 calendar days after the latest of these 3 dates:
1. Date the coverage ends.
2. Date on the notice you get telling you that coverage is ending (if you get one).
3. Date on a claim denial, if this is the only way you know that your coverage ended.
As early as 60 calendar days before the date your Medicare SELECT coverage will end, but no later than 63 calendar days after your Medicare SELECT coverage ends.
23Section 3: Your Right to Buy a Medigap Policy
You have a guaranteed issue right if...
(Trial right) You joined a Medicare Advantage Plan (like an HMO or PPO) or Programs of All‑inclusive Care for the Elderly (PACE) when you were first eligible for Medicare Part A at 65, and within the first year of joining, you decide you want to switch to Original Medicare.
(Trial right) You dropped a Medigap policy to join a Medicare Advantage Plan (or to switch to a Medicare SELECT policy) for the first time, you’ve been in the plan less than a year, and you want to switch back.
Your Medigap insurance company goes bankrupt and you lose your coverage, or your Medigap policy coverage otherwise ends through no fault of your own.
You leave a Medicare Advantage Plan or drop a Medigap policy because the company hasn’t followed the rules, or it misled you.
You have the right to buy...
Any Medigap policy that’s sold in your state by any insurance company.
The Medigap policy you had before you joined the Medicare Advantage Plan or Medicare SELECT policy, if the same insurance company you had before still sells it. If your former Medigap policy isn’t available, you can buy Medigap Plan A, B, C, F, K, or L that’s sold in your state by any insurance company.
Medigap Plan A, B, C, F, K, or L that’s sold in your state by any insurance company.
Medigap Plan A, B, C, F, K, or L that’s sold in your state by any insurance company.
You can/must apply for a Medigap policy...
As early as 60 calendar days before the date your coverage will end, but no later than 63 calendar days after your coverage ends.
Note: Your rights may last for an extra 12 months under certain circumstances.
As early as 60 calendar days before the date your coverage will end, but no later than 63 calendar days after your coverage ends. Note: Your rights may last for an extra 12 months under certain circumstances.
No later than 63 calendar days from the date your coverage ends.
No later than 63 calendar days from the date your coverage ends.
This chart describes the most common situations, under federal law, that give you a right to buy a policy, the kind of policy you can buy, and when you can or must apply for it. States may provide additional Medigap guaranteed issue rights. (continued)
24
Can I buy a Medigap policy if I lose my health care coverage? Yes, you may be able to buy a Medigap policy. Because you may have a guaranteed issue right to buy a Medigap policy, make sure you keep these: • A copy of any letters, notices, emails, and/or claim denials that have your name on
them as proof of your coverage being terminated.
• The postmarked envelope these papers come in as proof of when it was mailed. You may need to send a copy of some or all of these papers with your Medigap application to prove you have a guaranteed issue right. If you have a Medicare Advantage Plan (like an HMO or PPO) but you’re planning to return to Original Medicare, you can apply for a Medigap policy before your plan coverage ends. The Medigap insurer can sell it to you as long as you’re leaving the Medicare Advantage Plan. Ask that the new policy take effect when your Medicare Advantage enrollment ends, so you’ll have continuous health coverage.
For more information about Medigap rights If you have any questions or want to learn about any additional Medigap rights in your state, you can: • Call your State Health Insurance Assistance Program to make sure that you qualify
for these guaranteed issue rights. See pages 47– 48. • Call your State Insurance Department if you’re denied Medigap coverage in any of
these situations. See pages 47– 48.
Important: The guaranteed issue rights in this section are from federal law. These rights are for both Medigap and Medicare SELECT policies. Many states provide additional Medigap rights.
There may be times when more than one of the situations in the chart on pages 22–23 applies to you. When this happens, you can choose the guaranteed issue right that gives you the best choice. Some of the situations listed include loss of coverage under Programs of All‑inclusive Care for the Elderly (PACE). PACE combines medical, social, and long‑term care services, and prescription drug coverage for frail people. To be eligible for PACE, you must meet certain conditions. PACE may be available in states that have chosen it as an optional Medicaid benefit. If you have Medicaid, an insurance company can sell you a Medigap policy only in certain situations. For more information about PACE, visit Medicare.gov, or call 1‑800‑MEDICARE (1‑800‑633‑4227). TTY users can call 1‑877‑486‑2048.
Section 3: Your Right to Buy a Medigap Policy
25
SECTION
Steps to Buying a Medigap Policy4 Step-by-step guide to buying a Medigap policy
Buying a Medigap policy is an important decision. Only you can decide if a Medigap policy is the way for you to supplement Original Medicare coverage and which Medigap policy to choose. Shop carefully. Compare available Medigap policies to see which one meets your needs. As you shop for a Medigap policy, keep in mind that different insurance companies may charge different amounts for exactly the same Medigap policy, and not all insurance companies offer all of the Medigap policies. Below is a step‑by‑step guide to help you buy a Medigap policy. If you live in Massachusetts, Minnesota, or Wisconsin, see pages 42– 44.
STEP 1: Decide which benefits you want, then decide which of the standardized Medigap policies meet your needs.
STEP 2: Find out which insurance companies sell Medigap policies in your state.
STEP 3: Call the insurance companies that sell the Medigap policies you’re interested in and compare costs.
STEP 4: Buy the Medigap policy.
26
STEP 1: Decide which benefits you want, then decide which Medigap policy meets your needs. Think about your current and future health care needs when deciding which benefits you want because you might not be able to switch Medigap policies later. Decide which benefits you need, and select the Medigap policy that will work best for you. The chart on page 11 provides an overview of Medigap benefits.
STEP 2: Find out which insurance companies sell Medigap policies in your state.
To find out which insurance companies sell Medigap policies in your state: • Call your State Health Insurance Assistance Program. See pages 47– 48.
Ask if they have a “Medigap rate comparison shopping guide” for your state. This guide usually lists companies that sell Medigap policies in your state and their costs.
• Call your State Insurance Department. See pages 47– 48. • Visit Medicare.gov/find‑a‑plan:
This website will help you find information on your health plan options, including the Medigap policies in your area. You can also get information on: 4 How to contact the insurance companies that sell Medigap policies in your state.4 What each Medigap policy covers.4 How insurance companies decide what to charge you for a Medigap policy premium.
If you don’t have a computer, your local library or senior center may be able to help you look at this information. You can also call 1‑800‑MEDICARE (1‑800‑633‑4227). A customer service representative will help you get information on all your health plan options including the Medigap policies in your area. TTY users can call 1‑877‑486‑2048.
Section 4: Steps to Buying a Medigap Policy
Words in blue are defined on pages 49–50.
27Section 4: Steps to Buying a Medigap Policy
STEP 2: (continued)
Since costs can vary between companies, plan to call more than one insurance company that sells Medigap policies in your state. Before you call, check the companies to be sure they’re honest and reliable by: • Calling your State Insurance Department. Ask if they keep a record of
complaints against insurance companies that can be shared with you. When deciding which Medigap policy is right for you, consider these complaints, if any.
• Calling your State Health Insurance Assistance Program. These programs can give you help at no cost to you with choosing a Medigap policy.
• Going to your local public library for help with: – Getting information on an insurance company’s financial strength
from independent rating services like weissratings.com, A.M. Best, and Standard & Poor’s.
– Looking at information about the insurance company online. • Talking to someone you trust, like a family member, your insurance
agent, or a friend who has a Medigap policy from the same Medigap insurance company.
28 Section 4: Steps to Buying a Medigap Policy
Before you call any insurance companies, figure out if you’re in your Medigap Open Enrollment Period or if you have a guaranteed issue right. Read pages 14 –15 and 22–23 carefully. If you have questions, call your State Health Insurance Assistance Program. See pages 47– 48. This chart can help you keep track of the information you get.
STEP 3: Call the insurance companies that sell the Medigap policies you’re interested in and compare costs.
Community Issue‑age Attained‑age
Community Issue‑age Attained‑age
Ask each insurance company…
“Are you licensed in ___?” (Say the name of your state.) Note: If the answer is NO, STOP here, and try another company. “Do you sell Medigap Plan ___?” (Say the letter of the Medigap Plan you’re interested in.) Note: Insurance companies usually offer some, but not all, Medigap policies. Make sure the company sells the plan you want. Also, if you’re interested in a Medicare SELECT or high‑deductible Medigap policy, tell them.
“Do you use medical underwriting for this Medigap policy?” Note: If the answer is NO, go to step 4 on page 30. If the answer is YES, but you know you’re in your Medigap Open Enrollment Period or have a guaranteed issue right to buy that Medigap policy, go to step 4. Otherwise, you can ask, “Can you tell me if I'm likely to qualify for the Medigap policy?”
“Do you have a waiting period for pre‑existing conditions?” Note: If the answer is YES, ask how long the waiting period is and write it in the box.
“Do you price this Medigap policy by using community‑rating, issue‑age‑rating, or attained‑age‑rating?” See page 18. Note: Circle the one that applies for that insurance company.
“I’m ___ years old. What would my premium be under this Medigap policy?” Note: If it’s attained‑age, ask, “How frequently does the premium increase due to my age?”
“Has the premium for this Medigap policy increased in the last 3 years due to inflation or other reasons?” Note: If the answer is YES, ask how much it has increased, and write it in the box.
“Do you offer any discounts or additional benefits?” See page 19.
Company 2 Company 1
29Section 4: Steps to Buying a Medigap Policy
STEP 3: (continued)
Watch out for illegal practices. It’s illegal for anyone to:
• Pressure you into buying a Medigap policy, or lie to or mislead you to switch from one company or policy to another.
• Sell you a second Medigap policy when they know that you already have one, unless you tell the insurance company in writing that you plan to cancel your existing Medigap policy.
• Sell you a Medigap policy if they know you have Medicaid, except in certain situations.
• Sell you a Medigap policy if they know you’re in a Medicare Advantage Plan (like an HMO or PPO) unless your coverage under the Medicare Advantage Plan will end before the effective date of the Medigap policy.
• Claim that a Medigap policy is a part of Medicare or any other federal program. Medigap is private health insurance.
• Claim that a Medicare Advantage Plan is a Medigap policy. • Sell you a Medigap policy that can’t legally be sold in your state. Check with
your State Insurance Department (see pages 47– 48) to make sure that the Medigap policy you’re interested in can be sold in your state.
• Misuse the names, letters, or symbols of the U.S. Department of Health & Human Services (HHS), Social Security Administration (SSA), Centers for Medicare & Medicaid Services (CMS), or any of their various programs like Medicare. (For example, they can’t suggest the Medigap policy has been approved or recommended by the federal government.)
• Claim to be a Medicare representative if they work for a Medigap insurance company.
• Sell you a Medicare Advantage Plan when you say you want to stay in Original Medicare and buy a Medigap policy. A Medicare Advantage Plan isn’t the same as Original Medicare. See page 5. If you enroll in a Medicare Advantage Plan, you can’t use a Medigap policy.
If you believe that a federal law has been broken, call the Inspector General’s hotline at 1‑800‑HHS‑TIPS (1‑800‑447‑8477). TTY users can call 1‑800‑377‑4950. Your State Insurance Department can help you with other insurance‑related problems.
30
STEP 4: Buy the Medigap policy. Once you decide on the insurance company and the Medigap policy you want, apply. The insurance company must give you a clearly worded summary of your Medigap policy. Read it carefully. If you don’t understand it, ask questions. Remember these when you buy your Medigap policy: • Filling out your application. Fill out the application carefully and completely,
including medical questions. The answers you give will determine your eligibility for an Open Enrollment Period or guaranteed issue rights. If the insurance agent fills out the application, make sure it’s correct. If you buy a Medigap policy during your Medigap Open Enrollment Period or provide evidence that you’re entitled to a guaranteed issue right, the insurance company can’t use any medical answers you give to deny you a Medigap policy or change the price. The insurance company can’t ask you any questions about your family history or require you to take a genetic test.
• Paying for your Medigap policy. You can pay for your Medigap policy by check, money order, or bank draft. Make it payable to the insurance company, not the agent. If buying from an agent, get a receipt with the insurance company’s name, address, and phone number for your records. Some companies may offer electronic funds transfer.
• Starting your Medigap policy. Ask for your Medigap policy to become effective when you want coverage to start. Generally, Medigap policies begin the first of the month after you apply. If, for any reason, the insurance company won’t give you the effective date for the month you want, call your State Insurance Department. See pages 47– 48. Note: If you already have a Medigap policy, ask for your new Medigap policy to become effective when your old Medigap policy coverage ends.
• Getting your Medigap policy. If you don’t get your Medigap policy in 30 days, call your insurance company. If you don’t get your Medigap policy in 60 days, call your State Insurance Department.
Section 4: Steps to Buying a Medigap Policy
31
SECTION
If You Already Have a Medigap Policy5 Read this section if any of these situations apply to you:
• You’re thinking about switching to a different Medigap policy. See pages 32–35.
• You’re losing your Medigap coverage. See page 36.
• You have a Medigap policy with Medicare prescription drug coverage. See pages 36–38.
If you just want a refresher about Medigap insurance, turn to page 11.
32
Switching Medigap policies If you’re thinking about switching to a new Medigap policy, see below and pages 33–35 to answer some common questions.
Can I switch to a different Medigap policy?
In most cases, you won’t have a right under federal law to switch Medigap policies, unless you’re within your 6‑month Medigap Open Enrollment Period or are eligible under a specific circumstance for guaranteed issue rights. But, if your state has more generous requirements, or the insurance company is willing to sell you a Medigap policy, make sure you compare benefits and premiums before switching. If you bought your Medigap policy before 2010, it may offer coverage that isn’t available in a newer Medigap policy. On the other hand, Medigap policies bought before 1992 might not be guaranteed renewable and might have bigger premium increases than newer, standardized Medigap policies currently being sold.If you decide to switch, don’t cancel your first Medigap policy until you’ve decided to keep the second Medigap policy. On the application for the new Medigap policy, you’ll have to promise that you’ll cancel your first Medigap policy. You have 30 days to decide if you want to keep the new Medigap policy. This is called your “free look period.” The 30‑day free look period starts when you get your new Medigap policy. You’ll need to pay both premiums for one month.
Section 5: If You Already Have a Medigap Policy
Words in blue are defined on pages 49–50.
33Section 5: If You Already Have a Medigap Policy
Switching Medigap policies (continued)
Do I have to switch Medigap policies if I have a Medigap policy that's no longer sold?
No. But you can’t have more than one Medigap policy, so if you buy a new Medigap policy, you have to give up your old policy (except for your 30‑day “free look period,” described on page 32). Once you cancel the old policy, you can’t get it back.
Do I have to wait a certain length of time after I buy my first Medigap policy before I can switch to a different Medigap policy?
No. If you’ve had your old Medigap policy for less than 6 months, the Medigap insurance company may be able to make you wait up to 6 months for coverage of a pre‑existing condition. However, if your old Medigap policy had the same benefits, and you had it for 6 months or more, the new insurance company can’t exclude your pre‑existing condition. If you’ve had your Medigap policy less than 6 months, the number of months you’ve had your current Medigap policy must be subtracted from the time you must wait before your new Medigap policy covers your pre‑existing condition.If the new Medigap policy has a benefit that isn’t in your current Medigap policy, you may still have to wait up to 6 months before that benefit will be covered, regardless of how long you’ve had your current Medigap policy.If you’ve had your current Medigap policy longer than 6 months and want to replace it with a new one with the same benefits and the insurance company agrees to issue the new policy, they can’t write pre‑existing conditions, waiting periods, elimination periods, or probationary periods into the replacement policy.
34
Switching Medigap policies (continued)Why would I want to switch to a different Medigap policy?
Some reasons for switching may include: • You’re paying for benefits you don’t need. • You need more benefits than you needed before. • Your current Medigap policy has the right benefits, but you want to
change your insurance company. • Your current Medigap policy has the right benefits, but you want to find a
policy that’s less expensive.
It’s important to compare the benefits in your current Medigap policy to the benefits listed on page 11. If you live in Massachusetts, Minnesota, or Wisconsin, see pages 42– 44. To help you compare benefits and decide which Medigap policy you want, follow the “Steps to Buying a Medigap Policy” in Section 4. If you decide to change insurance companies, you can call the new insurance company and apply for your new Medigap policy. If your application is accepted, call your current insurance company, and ask to have your coverage end. The insurance company can tell you how to submit a request to end your coverage.As explained on page 32, make sure your old Medigap policy coverage ends after you have the new Medigap policy for 30 days. Remember, this is your 30‑day free look period. You’ll need to pay both premiums for one month.
Section 5: If You Already Have a Medigap Policy
35Section 5: If You Already Have a Medigap Policy
Switching Medigap policies (continued)
Can I keep my current Medigap policy (or Medicare SELECT policy) or switch to a different Medigap policy if I move out-of-state?
In general, you can keep your current Medigap policy regardless of where you live as long as you still have Original Medicare. If you want to switch to a different Medigap policy, you’ll have to check with your current or the new insurance company to see if they’ll offer you a different Medigap policy.You may have to pay more for your new Medigap policy and answer some medical questions if you’re buying a Medigap policy outside of your Medigap Open Enrollment Period. See pages 14–16.If you have a Medicare SELECT policy and you move out of the policy’s area, you can:• Buy a standardized Medigap policy from your current Medigap policy
insurance company that offers the same or fewer benefits than your current Medicare SELECT policy. If you’ve had your Medicare SELECT policy for more than 6 months, you won’t have to answer any medical questions.
• Use your guaranteed issue right to buy any Plan A, B, C, F, K, or L that’s sold in most states by any insurance company.
Your state may provide additional Medigap rights. Call your State Health Insurance Assistance Program or State Department of Insurance for more information. See pages 47–78 for their phone numbers.
What happens to my Medigap policy if I join a Medicare Advantage Plan?
Medigap policies can’t work with Medicare Advantage Plans. If you decide to keep your Medigap policy, you’ll have to pay your Medigap policy premium, but the Medigap policy can’t pay any deductibles, copayments, coinsurance, or premiums under a Medicare Advantage Plan. So, if you join a Medicare Advantage Plan, you may want to drop your Medigap policy. Contact your Medigap insurance company to find out how to disenroll. However, if you leave the Medicare Advantage Plan you might not be able to get the same Medigap policy back, or in some cases, any Medigap policy unless you have a “trial right.” See page 23. Your rights to buy a Medigap policy may vary by state. You always have a legal right to keep the Medigap policy after you join a Medicare Advantage Plan. However, because you have a Medicare Advantage Plan, the Medigap policy would no longer provide benefits that supplement Medicare.
Words in blue are defined on pages 49–50.
36
Losing Medigap coverage Can my Medigap insurance company drop me?
If you bought your Medigap policy after 1992, in most cases the Medigap insurance company can’t drop you because the Medigap policy is guaranteed renewable. This means your insurance company can’t drop you unless one of these happens: • You stop paying your premium. • You weren’t truthful on the Medigap policy application. • The insurance company becomes bankrupt or insolvent.
If you bought your Medigap policy before 1992, it might not be guaranteed renewable. This means the Medigap insurance company can refuse to renew the Medigap policy, as long as it gets the state’s approval to cancel your Medigap policy. However, if this does happen, you have the right to buy another Medigap policy. See the guaranteed issue right on page 23.
Medigap policies and Medicare prescription drug coverage If you bought a Medigap policy before January 1, 2006, and it has coverage for prescription drugs, see below and page 37.
Medicare offers prescription drug coverage (Part D) for everyone with Medicare. If you have a Medigap policy with prescription drug coverage, that means you chose not to join a Medicare Prescription Drug Plan when you were first eligible. However, you can still join a Medicare drug plan. Your situation may have changed in ways that make a Medicare Prescription Drug Plan fit your needs better than the prescription drug coverage in your Medigap policy. It’s a good idea to review your coverage each fall, because you can join a Medicare Prescription Drug Plan between October 15–December 7. Your new coverage will begin on January 1.
Section 5: If You Already Have a Medigap Policy
37Section 5: If You Already Have a Medigap Policy
Medigap policies and Medicare prescription drug coverage (continued)
What if I change my mind and join a Medicare Prescription Drug Plan?
If your Medigap premium or your prescription drug needs were very low when you had your first chance to join a Medicare Prescription Drug Plan, your Medigap prescription drug coverage may have met your needs. However, if your Medigap premium or the amount of prescription drugs you use has increased recently, a Medicare Prescription Drug Plan might now be a better choice for you.In a Medicare Prescription Drug Plan, you may have to pay a monthly premium, but Medicare pays a large part of the cost. There’s no yearly maximum coverage amounts as with Medigap prescription drug benefits in old Plans H, I, and J (these plans are no longer sold). However, a Medicare Prescription Drug Plan might only cover certain prescription drugs (on its “formulary” or “drug list”). It’s important that you check whether your current prescription drugs are on the Medicare Prescription Drug Plan's list of covered prescription drugs before you join.
Will I have to pay a late enrollment penalty if I join a Medicare Prescription Drug Plan now?
If you qualify for Extra Help, you won’t pay a late enrollment penalty. If you don’t qualify for Extra Help, it will depend on whether your Medigap policy includes “creditable prescription drug coverage.” This means that the Medigap policy’s drug coverage pays, on average, at least as much as Medicare’s standard prescription drug coverage. If your Medigap policy's drug coverage isn’t creditable coverage, and you join a Medicare Prescription Drug Plan now, you’ll probably pay a higher premium (a penalty added to your monthly premium) than if you had joined when you were first eligible. Each month that you wait to join a Medicare Prescription Drug Plan will make your late enrollment penalty higher. Your Medigap carrier must send you a notice each year telling you if the prescription drug coverage in your Medigap policy is creditable. Keep these notices in case you decide later to join a Medicare Prescription Drug Plan. Also consider that your prescription drug needs could increase as you get older.
38
Will I have to pay a late enrollment penalty if I join a Medicare Prescription Drug Plan now? (continued)
If your Medigap policy includes creditable prescription drug coverage and you decide to join a Medicare Prescription Drug Plan, you won’t have to pay a late enrollment penalty as long as you don’t go 63 or more days in a row without creditable prescription drug coverage. So, don’t drop your Medigap policy before you join the Medicare Prescription Drug Plan and the coverage starts. In general, you can only join a Medicare drug plan between October 15 –December 7. However, if you lose your Medigap policy (for example, if it isn’t guaranteed renewable, and your company cancels it), you may be able to join a Medicare drug plan at the time you lose your Medigap policy.
Can I join a Medicare Prescription Drug Plan and have a Medigap policy with prescription drug coverage?
No. If your Medigap policy covers prescription drugs, you must tell your Medigap insurance company if you join a Medicare Prescription Drug Plan so it can remove the prescription drug coverage from your Medigap policy and adjust your premium. Once the drug coverage is removed, you can’t get that coverage back even though you didn’t change Medigap policies.
What if I decide to drop my entire Medigap policy (not just the Medigap prescription drug coverage) and join a Medicare Advantage Plan that offers prescription drug coverage?
In general, you can only join a Medicare Prescription Drug Plan or Medicare Advantage Plan (like an HMO or PPO) during the Medicare Open Enrollment Period between October 15 –December 7. If you join during Medicare Open Enrollment Period, your coverage will begin on January 1. In most cases, if you drop your Medigap policy to join a Medicare Advantage Plan, you won’t be able to get it back so pay careful attention to the timing.
Section 5: If You Already Have a Medigap Policy
39
SECTION
Medigap Policies for People with a Disability or ESRD6 Information for people under 65Medigap policies for people under 65 and eligible for Medicare because of a disability or End-Stage Renal Disease (ESRD) You may have Medicare before turning 65 due to a disability or ESRD (permanent kidney failure requiring dialysis or a kidney transplant).If you're under 65 and have Medicare because of a disability or ESRD, you might not be able to buy the Medigap policy you want, or any Medigap policy, until you turn 65. Federal law generally doesn’t require insurance companies to sell Medigap policies to people under 65. However, some states require Medigap insurance companies to sell you a Medigap policy, even if you’re under 65. These states are listed on the next page.
Important: This section provides information on the minimum federal standards. For your state requirements, call your State Health Insurance Assistance Program. See pages 47– 48.
40
Medigap policies for people under 65 and eligible for Medicare because of a disability or End-Stage Renal Disease (ESRD) (continued)At the time of printing this guide, these states required insurance companies to offer at least one kind of Medigap policy to people with Medicare under 65:
Section 6: Medigap Policies for People with a Disability or ESRD
• Arkansas• California • Colorado • Connecticut • Delaware• Florida• Georgia• Hawaii • Illinois• Idaho • Kansas
• Kentucky• Louisiana • Maine • Maryland • Massachusetts • Michigan • Minnesota • Mississippi • Missouri• Montana• New Hampshire
• New Jersey • New York • North Carolina • Oklahoma • Oregon • Pennsylvania • South Dakota• Tennessee • Texas • Vermont • Wisconsin
Note: Some states provide these rights to all people with Medicare under 65, while others only extend them to people eligible for Medicare because of disability or only to people with ESRD. Check with your State Insurance Department about what rights you might have under state law.
Even if your state isn’t on the list above, some insurance companies may voluntarily sell Medigap policies to people under 65, although they’ll probably cost you more than Medigap policies sold to people over 65, and they can probably use medical underwriting. Also, some of the federal guaranteed rights are available to people with Medicare under 65, see pages 21–24. Check with your State Insurance Department about what additional rights you might have under state law.Remember, if you’re already enrolled in Medicare Part B, you’ll get a Medigap Open Enrollment Period when you turn 65. You'll probably have a wider choice of Medigap policies and be able to get a lower premium at that time. During the Medigap Open Enrollment Period, insurance companies can’t refuse to sell you any Medigap policy due to a disability or other health problem, or charge you a higher premium (based on health status) than they charge other people who are 65.Because Medicare (Part A and/or Part B) is creditable coverage, if you had Medicare for more than 6 months before you turned 65, you may not have a pre‑existing condition waiting period imposed for coverage bought during the Medigap Open Enrollment Period. For more information about the Medigap Open Enrollment Period and pre‑existing conditions, see pages 16 –17. If you have questions, call your State Health Insurance Assistance Program. See pages 47–48.
Words in blue are defined on pages 49–50.
41
SECTION
Medigap Coverage in Massachusetts, Minnesota,
and Wisconsin7Massachusetts benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Minnesota benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Wisconsin benefits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
42 Section 7: Medigap Coverage Charts
Massachusetts benefits • Inpatient hospital care: covers the Medicare Part A coinsurance plus coverage for 365
additional days after Medicare coverage ends • Medical costs: covers the Medicare Part B coinsurance (generally 20% of the
Medicare‑approved amount) • Blood: covers the first 3 pints of blood each year• Part A hospice coinsurance or copaymentThe check marks in this chart mean the benefit is covered.
Massachusetts—Chart of standardized Medigap policies
Basic benefits
Part A inpatient hospital deductible
Part A skilled nursing facility (SNF) coinsurance
Part B deductible
Foreign travel emergency
Inpatient days in mental health hospitals
State‑mandated benefits (annual Pap tests and mammograms—check your plan for other state‑mandated benefits)
60 days per calendar year
120 days per benefit year
3 3
3 3
3
3
3
3
Medigap benefits
Supplement 1 Plan Core plan
For more information on these Medigap policies, visit Medicare.gov/find‑a‑plan, or call your State Insurance Department. See pages 47– 48.
43Section 7: Medigap Coverage Charts
Minnesota benefits • Inpatient hospital care: covers the Part A coinsurance • Medical costs: covers the Part B coinsurance (generally 20% of the Medicare‑approved amount)• Blood: covers the first 3 pints of blood each year• Part A hospice and respite cost sharing• Parts A and B home health services and supplies cost sharingThe check marks in this chart mean the benefit is covered.
Minnesota—Chart of standardized Medigap policies
Basic benefits
Part A inpatient hospital deductible
Part A skilled nursing facility (SNF) coinsurance
Part B deductible
Foreign travel emergency
Outpatient mental health
Usual and customary fees
Medicare‑covered preventive care
Physical therapy
Coverage while in a foreign country
State‑mandated benefits (diabetic equipment and supplies, routine cancer screening, reconstructive surgery, and immunizations)
Medigap benefits Basic plan Extended
20% 20%
3 3
3 3
80%*
3
3(Provides 120 days of
SNF care)
3
3(Provides 100 days of
SNF care)
80%
80%*
20% 20%
80%*
basic plan
3 3
Mandatory riders
Insurance companies can offer 4 additional riders that can be added to a basic plan. You may choose any one or all of these riders to design a Medigap policy that meets your needs:
1. Part A inpatient hospital deductible
2. Part B deductible 3. Usual and
customary fees 4. Non‑Medicare
preventive care
* Pays 100% after you spend $1,000 in out-of-pocket costs for a calendar year. Minnesota versions of Medigap Plans K, L, M, N, and high-deductible F are available.
Important: The basic and extended basic benefits are available when you enroll in Part B, regardless of age or health problems. If you are under 65, return to work and drop Part B to elect your employer’s health plan, you’ll get a 6‑month Medigap Open Enrollment Period after you turn 65 and retire from that employer when you can join Part B again.
44 Section 7: Medigap Coverage Charts
Basic benefits
Part A skilled nursing facility (SNF) coinsurance
Inpatient mental health coverage
Home health care
State‑mandated benefits
Wisconsin benefits • Inpatient hospital care: covers the Part A coinsurance • Medical costs: covers the Part B coinsurance (generally 20% of the
Medicare‑approved amount) • Blood: covers the first 3 pints of blood each year• Part A hospice coinsurance or copayment
The check marks in this chart mean the benefit is covered.
For more information on these Medigap policies, visit Medicare.gov/find‑a‑plan or call your State Insurance Department. See pages 47– 48.
Plans known as “50% and 25% cost‑sharing plans” are available. These plans are similar to standardized Plans K (50%) and L (25%). A high‑deductible plan ($2,300 deductible for 2019) is also available.
175 days per lifetime in addition to Medicare’s benefit
3
3
3
40 visits per year in addition to those paid by Medicare
Wisconsin — Chart of standardized Medigap policies
Medigap benefits Basic plan Optional riders
Insurance companies are allowed to offer these 7 additional riders to a Medigap policy:1. Part A deductible 2. Additional home health
care (365 visits including those paid by Medicare)
3. Part B deductible 4. Part B excess charges5. Foreign travel emergency6. 50% Part A deductible7. Part B copayment or coinsurance
45
SECTION
For More Information8 Where to get more information On pages 47– 48, you’ll find phone numbers for your State Health Insurance Assistance Program (SHIP) and State Insurance Department.
• Call your SHIP for help with:
– Buying a Medigap policy or long‑term care insurance.
– Dealing with payment denials or appeals.
– Medicare rights and protections.
– Choosing a Medicare plan.
– Deciding whether to suspend your Medigap policy.
– Questions about Medicare bills.
• Call your State Insurance Department if you have questions about the Medigap policies sold in your area or any insurance‑related problems.
46
How to get help with Medicare and Medigap questions If you have questions about Medicare, Medigap, or need updated phone numbers for the contacts listed on pages 47– 48:
Visit Medicare.gov: • For Medigap policies in your area, visit Medicare.gov/find‑a‑plan.• For updated phone numbers, visit Medicare.gov/contacts.
Call 1-800-MEDICARE (1-800-633-4227): Customer service representatives are available 24 hours a day, 7 days a week. TTY users can call 1‑877‑486‑2048. If you need help in a language other than English or Spanish, let the customer service representative know the language.
Section 8: For More Information
47Section 8: For More Information
State Insurance Department
State State Health Insurance Assistance Program
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 California 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 1‑671‑735‑7415 1‑671‑635‑1835 Hawaii 1‑888‑875‑9229 1‑808‑586‑2790 Idaho 1‑800‑247‑4422 1‑800‑721‑3272 Illinois 1‑800‑252‑8966 1‑888‑473‑4858 Indiana 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 1‑800‑262‑2232 1‑800‑300‑5000 Maryland 1‑800‑243‑3425 1‑800‑735‑2258 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 1‑601‑359‑4577 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
State Health Insurance Assistance Program and State Insurance Department
48 Section 8: For More Information
Nevada 1‑800‑307‑4444 1‑800‑992‑0900 New Hampshire 1‑866‑634‑9412 1‑800‑852‑3416 New Jersey 1‑800‑792‑8820 1‑800‑446‑7467 New Mexico 1‑800‑432‑2080 1‑888‑727‑5772 New York 1‑800‑701‑0501 1‑800‑342‑3736 North Carolina 1‑855‑408‑1212 1‑800‑546‑5664 North Dakota 1‑888‑575‑6611 1‑800‑247‑0560 Northern Mariana Not available 1‑670‑664‑3064 Islands Ohio 1‑800‑686‑1578 1‑800‑686‑1526 Oklahoma 1‑800‑763‑2828 1‑800‑522‑0071 Oregon 1‑800‑722‑4134 1‑888‑877‑4894 Pennsylvania 1‑800‑783‑7067 1‑877‑881‑6388 Puerto Rico 1‑877‑725‑4300 1‑888‑722‑8686 Rhode Island 1‑888‑884‑8721 1‑401‑462‑9500 South Carolina 1‑800‑868‑9095 1‑803‑737‑6160 South Dakota 1‑800‑536‑8197 1‑605‑773‑3563 Tennessee 1‑877‑801‑0044 1‑800‑342‑4029 Texas 1‑800‑252‑9240 1‑800‑252‑3439 Utah 1‑800‑541‑7735 1‑800‑439‑3805 Vermont 1‑800‑642‑5119 1‑800‑964‑1784 Virgin Islands 1‑340‑772‑7368 1‑340‑774‑7166 1‑340‑714‑4354 (St. Thomas) Virginia 1‑800‑552‑3402 1‑877‑310‑6560 Washington 1‑800‑562‑6900 1‑800‑562‑6900 Washington D.C. 1‑202‑994‑6272 1‑202‑727‑8000 West Virginia 1‑877‑987‑4463 1‑888‑879‑9842 Wisconsin 1‑800‑242‑1060 1‑800‑236‑8517 Wyoming 1‑800‑856‑4398 1‑800‑438‑5768
State Insurance Department
State State Health Insurance Assistance Program
49
SECTION
Definitions9 Assignment—An agreement by your doctor, provider, or supplier to be paid directly by Medicare, to accept the payment amount Medicare approves for the service, and not to bill you for any more than the Medicare deductible and coinsurance.
Coinsurance—An amount you may be required to pay as your share of the costs for services after you pay any deductibles. Coinsurance is usually a percentage (for example, 20%).
Copayment—An amount you may be required to pay as your share of the cost for a medical service or supply, like a doctor’s visit, hospital outpatient visit, or a prescription drug. A copayment is usually a set amount, rather than a percentage. For example, you might pay $10 or $20 for a doctor’s visit or prescription drug.
Deductible—The amount you must pay for health care or prescriptions before Original Medicare, your prescription drug plan, or your other insurance begins to pay.
Excess charge—If you have Original Medicare, and the amount a doctor or other health care provider is legally permitted to charge is higher than the Medicare‑approved amount, the difference is called the excess charge.
Guaranteed issue rights —Rights you have in certain situations when insurance companies are required by law to sell or offer you a Medigap policy. In these situations, an insurance company can’t deny you a Medigap policy, or place conditions on a Medigap policy, such as exclusions for pre‑existing conditions, and can’t charge you more for a Medigap policy because of a past or present health problem.
Where words in BLUE are defined
50 Section 9: Definitions
Guaranteed renewable policy—An insurance policy that can’t be terminated by the insurance company unless you make untrue statements to the insurance company, commit fraud, or don’t pay your premiums. All Medigap policies issued since 1992 are guaranteed renewable.
Medicaid—A joint federal and state program that helps with medical costs for some people with limited income and resources. Medicaid programs vary from state to state, but most health care costs are covered if you qualify for both Medicare and Medicaid.
Medical underwriting—The process that an insurance company uses to decide, based on your medical history, whether or not to take your application for insurance, whether or not to add a waiting period for pre‑existing conditions (if your state law allows it), and how much to charge you for that insurance.
Medicare Advantage Plan (Part C)—A type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Medicare Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee‑for‑Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you’re enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan and aren’t paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage.
Medicare-approved amount—In Original Medicare, this is the amount a doctor or supplier that accepts assignment can be paid. It may be less than the actual amount a doctor or supplier charges. Medicare pays part of this amount and you're responsible for the difference.
Medicare prescription drug plan (Part D)— Part D adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private‑Fee‑for‑Service Plans, and Medicare Medical Savings Account Plans. These plans are offered by insurance companies and other private companies approved by Medicare. Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans.
Medicare SELECT—A type of Medigap policy that may require you to use hospitals and, in some cases, doctors within its network to be eligible for full benefits.
Medigap Open Enrollment Period—A one‑time‑only, 6‑month period when federal law allows you to buy any Medigap policy you want that’s sold in your state. It starts in the first month that you’re covered under Medicare Part B, and you’re 65 or older. During this period, you can’t be denied a Medigap policy or charged more due to past or present health problems. Some states may have additional Open Enrollment rights under state law.
Premium—The periodic payment to Medicare, an insurance company, or a health care plan for health care or prescription drug coverage.
State Health Insurance Assistance Program (SHIP)—A state program that gets money from the federal government to give free local health insurance counseling to people with Medicare.
State Insurance Department—A state agency that regulates insurance and can provide information about Medigap policies and other private health insurance.
Notice of Accessible CommunicationsTo help ensure people with disabilities have an equal opportunity to participate in our services, activities, programs, and other benefits, we provide communications in accessible formats. The Centers for Medicare & Medicaid Services (CMS) provides auxiliary aids and services, like publications, documents and communications, in Braille, large print, data/audio CD, relay services and TTY communications.CMS provides free auxiliary aids and services to help us better communicate with people with disabilities. Auxiliary aids include materials in Braille, audio/data CD or other accessible formats.Note: You can get the Choosing a Medigap Policy electronically in standard print, large print, or as an eBook.For Medicare publications, call us at 1‑800‑MEDICARE (1‑800‑633‑4227). TTY: 1‑877‑486‑2048.For all other CMS publications and documents, you can contact our Customer Accessibility Resource Staff:Call 1‑844‑ALT‑FORM (1‑844‑258‑3676). TTY: 1‑844‑716‑3676.Send a fax to 1‑844‑530‑3676.Send an email to [email protected] a letter to: Centers for Medicare & Medicaid Services Offices of Hearings and Inquiries (OHI) 7500 Security Boulevard, Mail Stop S1‑13‑25 Baltimore, MD 21244‑1850 Attn: Customer Accessibility Resource Staff
You can also contact the Customer Accessibility Resource staff:• To follow up on a previous accessibility request• If you have questions about the quality or timeliness of your previous requestNote: Your request for a CMS publication or document should include:• Your name, phone number, and the mailing address where we should send the publications or documents.• The publication title and CMS Product No., if known.• The format you need, like Braille, large print, or data/audio CD.Note: If you’re enrolled in a Medicare Advantage or Prescription Drug Plan, you can contact your plan to request their documents in an accessible format.
Nondiscrimination NoticeCMS doesn’t exclude, deny benefits to, or otherwise discriminate against any person on the basis of race, color, national origin, disability, sex, or age in admission to, participation in, or receipt of the services and benefits under any of its programs and activities, whether carried out by CMS directly or through a contractor or any other entity with which CMS arranges to carry out its programs and activities.
How to file a complaintIf you believe you’ve been subjected to discrimination in a CMS program or activity, there are 3 ways to file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights:1. Online at hhs.gov/civil‑rights/filing‑a‑complaint/complaint‑process/index.html.2. By phone: Call 1‑800‑368‑1019. TDD user can call 1‑800‑537‑7697.3. In writing: Send information about your complaint to:
Office for Civil Rights U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services 7500 Security Boulevard Baltimore, Maryland 21244‑1850
Official Business Penalty for Private Use, $300
CMS Product No. 02110 Revised January 2019
To get this publication in Braille, Spanish, or large print (English), visit Medicare.gov, or call 1‑800‑MEDICARE (1‑800‑633‑4227). TTY users can call 1‑877‑486‑2048.
¿Necesita una copia en español? Visite Medicare.gov en el sitio Web. Para saber si esta publicación esta impresa y disponible (en español), llame GRATIS al 1‑800‑MEDICARE (1‑800‑633‑4227). Los usuarios de TTY deben llamar al 1‑877‑486‑2048.