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2013Choosing a Medigap Policy:A Guide to Health Insurance for People with Medic

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 RV I C E S

This official government guide hasimportant information about:

What is a Medicare SupplementInsurance (Medigap) policy

What Medigap policies cover

Your rights to buy a Medigap policy

How to buy a Medigap policy

This guide can help if youre thinking about buying

a Medigap policy or already have one.

Developed jointly by the Centers or Medicare & Medicaid Services (CMS)and the National Association o Insurance Commissioners (NAIC)


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3Table of Contents

Section 1: Medicare Basics 5

A brie look at Medicare. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5What is Medicare? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Te different parts o Medicare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Your Medicare coverage choices at a glance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Medigap Basics 9What is a Medigap policy? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9What Medigap policies cover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10What Medigap policies dont cover. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12ypes o coverage that are NO Medigap policies . . . . . . . . . . . . . . . . . . . . . . . . . 12What types o Medigap policies can insurance companies sell? . . . . . . . . . . . . . . 12What do I need to know i I want to buy a Medigap policy?. . . . . . . . . . . . . . . . . 13When is the best time to buy a Medigap policy? . . . . . . . . . . . . . . . . . . . . . . . . . . 14Why is it important to buy a Medigap policy when I'm rst eligible? . . . . . . . . 16How do insurance companies set prices or Medigap policies? . . . . . . . . . . . . . . 17What this pricing may mean or you . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Comparing Medigap costs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19What is Medicare SELEC ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20How does Medigap help pay your 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 i I lose my health care coverage? . . . . . . . . . . . . . . 24

Steps to Buying a Medigap Policy 25

Step-by-Step Guide to Buying a Medigap Policy . . . . . . . . . . . . . . . . . . . . . . . . . . 25

For People Who Already Have a Medigap Policy 31Switching Medigap policies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32Losing Medigap coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36Medigap policies and Medicare prescription drug coverage . . . . . . . . . . . . . . . . 36

Section 2:

Section 3:

Section 4:

Section 5:


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4 Table of Contents

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

In ormation or people under 65 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39Medigap Coverage in Massachusetts, Minnesota, and Wisconsin 41

Massachusetts benets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42Minnesota benets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

Wisconsin benets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

For More Information 45

Where to get more in ormation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

How to get help with Medicare and Medigap questions . . . . . . . . . . . . . . . . . . . . 46State Health Insurance Assistance Program and State Insurance Department. . 47

Denitions 49

Where words in Blue are dened . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

List of Topics 53

An alphabetical list o whats in this guide. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

Section 7:

Section 8:

Section 9:

Section 10:


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5

SECTION

1Medicare Basics

A brief look at MedicareTis guide helps people with Medicare understand Medigap (alsocalled Medicare Supplement Insurance) policies.

A Medigap policy is health insurance sold by private insurancecompanies to ll gaps in Original Medicare coverage. Medigap policiescan help pay your share ( coinsurance , copayments , or deductibles)o the costs o Medicare-covered services. Some Medigap policiesalso cover certain benets Original Medicare doesnt cover. Medigap

policies dont cover your share o the costs under other types o healthcoverage, including Medicare Advantage Plans , stand-alone MedicarePrescription Drug Plans , employer/union group health coverage,Medicaid, Department o Veterans Affairs (VA) benets, or RICARE.Insurance companies generally cant sell you a Medigap policy i youhave coverage through Medicaid or a Medicare Advantage Plan.

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

Words in blue are dened on pages 4952.


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7Section 1: Medicare Basics

Your Medicare coverage choices at a glanceTere are two main ways to get your Medicare coverage: Original Medicare or aMedicare Advantage Plan. Use these steps to help you decide which way to get yourcoverage. See page 35 or in ormation about Medicare Advantage Plans and Medigappolicies.

Part AHospitalInsurance

Part BMedicalInsurance

Medigap (MedicareSupplementInsurance)policy

Part DPrescriptionDrug Coverage

Part CCombines Part A, Part B, andusually Part D

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

Part D PrescriptionDrug Coverage(i not alreadyincluded)

Start

or

ORIGINAL MEDICARE MEDICARE ADVANTAGE PLAN(like an HMO or PPO)

Step 2: Decide i you need to add drug coverage.

Step 3: Decide i you need to addsupplemental coverage.

I you join a Medicare AdvantagePlan, you dont need and cant besold a Medigap policy.

End

End


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8 Section 1: Medicare Basics

For more information

Remember, this guide is about Medigap policies. o learn more about Medicare, visit www.medicare.gov/publications to view the Medicare & You handbook.You can also call 1-800-MEDICARE (1-800-633-4227). Y users should call1-877-486-2048.
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9

SECTION

Medigap Basics

2 What is a Medigap policy?A Medicare Supplement Insurance policy (also called Medigap)is private health insurance thats designed to supplement OriginalMedicare. Tis means it helps pay some o the health care costs thatOriginal Medicare doesnt cover (like copayments , coinsurance , anddeductibles). Tese are "gaps" in Medicare coverage. I you haveOriginal Medicare and a Medigap policy, Medicare will pay its shareo the Medicare-approved amounts or covered health care costs. Tenyour Medigap policy pays its share. A Medigap policy is different roma Medicare Advantage Plan (like an HMO or PPO) because thoseplans are ways to get Medicare benets, while a Medigap policy only

supplements your Original Medicare benets. Note: Medicare doesntpay any o the costs or you to get a Medigap policy.

Every Medigap policy must ollow Federal and state laws designedto protect you, and the policy must be clearly identied as MedicareSupplement Insurance. Medigap insurance companies in moststates can only sell you a standardized Medigap policy identied byletters A through N. Each standardized Medigap policy must offerthe same basic benets, no matter which insurance company sells it.Cost is usually the only difference between Medigap policies withthe same letter sold by different insurance companies.

In Massachusetts, Minnesota, and Wisconsin, Medigap policies arestandardized in a different way. See pages 4244. In some states, youmay be able to buy another type o Medigap policy called MedicareSELEC . Medicare SELEC plans are standardized plans that mayrequire you to see certain providers and may cost less than other plans.See page 20.


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10 Section 2: Medigap Basics

What Medigap policies cover

In ormation about the chart on page 11Te chart on the next page gives you a quick look at the standardized MedigapPlans available.Notes:

Insurance companies selling Medigap policies are required to make Plan Aavailable. I they offer any other Medigap plan, they must also offer either MedigapPlan C or Plan F. Not all types o Medigap policies may be available in your state.See pages 4244 i you live in Massachusetts , Minnesota , or Wisconsin . I youneed more in ormation, call your State Insurance Department or State Health

Insurance Assistance Program . See pages 4748 or your states phone number. Plans D and G Plans D and G effective on or afer June 1, 2010, have different

benets than D or G Plans bought be ore June 1, 2010.

Plans No Longer or Sale Plans E, H, I, and J are no longer sold, but , i youalready have one, you can keep it.
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11

M e

d i g a p

P l a n s

H o w t o r e a d t h e c h a r t :

T e c h a r t b e l o w s h o w s b a s i c i n o r m a t i o n a b o u t t h e d i ff e r e n t b e n e t s t h a t M e d i g a p p o l i c i e s c o v e r . I

a p e r c e n t a g e a p p e a r s ,

t h e M e d i g a p p l a n c o v e r s t h a t p e r c e n t a g e o t h e b e n e t

. I a r o w i s b l a n k , t h e p o l i c y d o e s n t c o v e r t h a t b e n e t . N o t e : T e

M e d i g a p p o l i c y c o v e r s c o i n s u r a n c e o n l y a f e r y o u h a v e p a i d t h e d e d u c t i b l e ( u n l e s s t h e M e d i g a p p o l i c y a

l s o c o v e r s t h e

d e d u c t i b l e ) .

M e

d i g a p

P l a n s

M e

d i g a p

B e n e

t s

A

B

C

D

F *

G

K

L

M

N

M e d i c a r e P a r t A C o i n s u r a n c e a n d h o s p i t a l c o s t s u p t o a n

a d d i t i o n a l 3 6 5 d a y s a f e r M e d i c a r e b e n e t s a r e u s e d u p

1 0 0 %

1 0 0 %

1 0 0 %

1 0 0 %

1 0 0 %

1 0 0 %

1 0 0 %

1 0 0 %

1 0 0 %

1 0 0 %

M e d i c a r e P a r t B C o i n s u r a n c e o r C o p a y m e n t

1 0 0 %

1 0 0 %

1 0 0 %

1 0 0 %

1 0 0 %

1 0 0 %

5 0 %

7 5 %

1 0 0 %

1 0 0 % * * *

B l o o d ( F i r s t 3 P i n t s )

1 0 0 %

1 0 0 %

1 0 0 %

1 0 0 %

1 0 0 %

1 0 0 %

5 0 %

7 5 %

1 0 0 %

1 0 0 %

P a r t A H o s p i c e C a r e C o i n s u r a n c e o r C o p a y m e n t

1 0 0 %

1 0 0 %

1 0 0 %

1 0 0 %

1 0 0 %

1 0 0 %

5 0 %

7 5 %

1 0 0 %

1 0 0 %

S k i l l e d N u r s i n g F a c i l i t y C a r e C o i n s u r a n c e

1 0 0 %

1 0 0 %

1 0 0 %

1 0 0 %

5 0 %

7 5 %

1 0 0 %

1 0 0 %

M e d i c a r e P a r t A D e d u c t i b l e

1 0 0 %

1 0 0 %

1 0 0 %

1 0 0 %

1 0 0 %

5 0 %

7 5 %

5 0 %

1 0 0 %

M e d i c a r e P a r t B D e d u c t i b l e

1 0 0 %

1 0 0 %

M e d i c a r e P a r t B E x c e s s C h a r g e s

1 0 0 %

1 0 0 %

F o r e i g n r a v e l E m e r g e n c y ( U p t o P l a n L i m i t s )

1 0 0 %

1 0 0 %

1 0 0 %

1 0 0 %

1 0 0 %

1 0 0 %

Section 2: Medigap Basics

* P l a n F a l s o o ff e r s a h i g h - d e d u c t i b l e p l a n . I

y o u c h o o s e t h i s o p t i o n , t h i s m e a n s y o u

m u s t p a y o r M e d i c a r e - c o v e r e d c o s t s u p t o t h e d e d u c t i b l e a m o u n t o $ 2

, 1 1 0 i n 2 0 1 3

b e o r e y o u r M e d i g a p p l a n p a y s a n y t

h i n g .

* * F o r P l a n s K a n d L , a f e r y o u m e e t y o u r o u t - o

- p o c k e t y e a r l y l i m i t a n d y o u r y e a r l y

P a r t B d e d u c t i b l e ( $ 1 4 7

i n 2 0 1 3 ) , t h e M e d i g a p p l a n p a y s 1 0 0 % o c o v e r e d s e r v i c e s o r

t h e r e s t o t h e c a l e n d a r y e a r .

* * * P l a n N p a y s 1 0 0 % o t h e P a r t B c o i n s u r a n c e , e x c e p t o r a c o p a y m e n t o u p t o $ 2 0 o r

s o m e o ffi c e v i s i t s a n d u p t o a $ 5 0 c o p a y m e n t o r e m e r g e n c y r o o m v i s i t s t h a t d o n t r e s u l t

i n a n i n p a t i e n t a d m i s s i o n .

O u

t - o f - P o c k e t

L i m i t * *

$ 4 , 8

0 0

$ 2 , 4

0 0


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What Medigap policies dont coverGenerally, Medigap policies dont cover long-term care (like care in a nursinghome), vision or dental care, hearing aids, eyeglasses, or private-duty nursing.

Types of coverage that are NOT Medigap policies Medicare Advantage Plans (Part C) , like an HMO, PPO, or

Private Fee- or-Service Plan Medicare Prescription Drug Plans (Part D) Medicaid Employer or union plans, including the Federal Employees Health

Benets Program (FEHBP) RICARE Veterans benets Long-term care insurance policies Indian Health Service, ribal, and Urban Indian Health plans

What types of Medigap policies can insurancecompanies sell?

In most cases, Medigap insurance companies can sell you only a standardizedMedigap policy. All Medigap policies must have specic benets so you cancompare them easily. I you live in Massachusetts, Minnesota, or Wisconsin, seepages 4244.Insurance companies that sell Medigap policies dont have to offer every Medigapplan. However, they must offer Medigap Plan A i they offer any Medigap policy.I they offer any plan in addition to Plan A, they must also offer Plan C or Plan F. Eachinsurance company decides which Medigap policies it wants to sell, although statelaws might affect which ones they offer.In some cases, an insurance company must sell you a Medigap policy, even i youhave health problems. Listed below are certain times that youre guaranteed the rightto buy a Medigap policy: When youre in your Medigap open enrollment period . See pages 1415. I you have a guaranteed issue right . See pages 2123.

You may be able to buy a Medigap policy at other times, but the insurance companycan deny you a Medigap policy based on your health. Also, in some cases it maybe illegal or the insurance company to sell you a Medigap policy (such as i youalready have Medicaid or a Medicare Advantage Plan).

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13Section 2: Medigap Basics

What do I need to know if I want to buy a Medigap policy? You must have Medicare Part A and Part B to buy a Medigap policy.

I you have a Medicare Advantage Plan but are planning to return to OriginalMedicare, you can apply or a Medigap policy be ore your coverage ends. TeMedigap insurer can sell it to you as long as youre leaving the plan. Ask that thenew policy start no later than when your Medicare Advantage Plan enrollmentends, so you will have continuous coverage.

Plans E, H, I, and J are no longer or sale, but you can keep these plans i youalready have one.

You pay the private insurance company a monthly premium or your Medigappolicy in addition to the monthly Part B premium that you pay to Medicare.

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

You can buy a Medigap policy rom any insurance company thats licensed inyour state to sell one.

I you want to buy a Medigap policy, see page 11 to review the benet choices.Ten, ollow the Steps to Buying a Medigap Policy on pages 2530.

I you want to drop your Medigap policy, write your insurance company to cancelthe policy and conrm its cancelled. Your agent cant cancel the policy or you.

Any standardized Medigap policy is guaranteed renewable even i you havehealth problems. Tis means the insurance company cant cancel your Medigappolicy as long as you pay the premium.

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

Any state-specic laws that may give you additional protections.
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What do I need to know if I want to buy a Medigappolicy? (continued) Although some Medigap policies sold in the past covered prescription

drugs, Medigap policies sold afer January 1, 2006, arent allowed to includeprescription drug coverage.

I you want prescription drug coverage, you can join a Medicare PrescriptionDrug Plan (Part D) offered by private companies approved by Medicare.See pages 67.

o learn about Medicare prescription drug coverage, visitwww.medicare.gov/publications to view the booklet Your Guide to Medicare

Prescription Drug Coverage, or call 1-800-MEDICARE (1-800-633-4227).Y users should call 1-877-486-2048.

When is the best time to buy a Medigap policy?Te best time to buy a Medigap policy is during your Medigap open enrollmentperiod . Tis period lasts or 6 months and begins on the rst day o the month inwhich youre both 65 or older and enrolled in Medicare Part B. Some states haveadditional open enrollment periods including those or people under 65. Duringthis period, an insurance company cant use medical underwriting . Tis meansthe insurance company cant do any o the ollowing because o your healthproblems: Re use to sell you any Medigap policy it offers Charge you more or a Medigap policy than they charge someone with no

health problems Make you wait or coverage to start (except as explained below)While the insurance company cant make you wait or your coverage to start, it maybe able to make you wait or coverage related to a pre-existing condition . Apre-existing condition is a health problem you have be ore the date a new insurance

policy starts. In some cases, the Medigap insurance company can re use to coveryour out-o -pocket costs or these pre-existing health problems or up to 6 months.Tis is called a pre-existing condition waiting period. Afer 6 months, theMedigap policy will cover the pre-existing condition.

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When is the best time to buy a Medigap policy? (continued)Coverage or a pre-existing condition can only be excluded in a Medigap policyi the condition was treated or diagnosed within 6 months be ore the date thecoverage starts under the Medigap policy. Tis is called the look-back period.Afer the 6-month pre-existing condition waiting period, the Medigap policywill cover the condition that was excluded. Remember, or Medicare-coveredservices, Original Medicare will still cover the condition, even i the Medigappolicy wont cover your out-o -pocket costs, but youre responsible or theMedicare coinsurance or copayment .

Creditable coverageI you have a pre-existing condition and you buy a Medigap policy duringyour Medigap open enrollment period and youre replacing certain kindso health coverage that count as creditable coverage, its possible to avoidor shorten waiting periods or pre-existing conditions. Prior creditablecoverage is generally any other health coverage you recently had be oreapplying or a Medigap policy. I you have had at least 6 months ocontinuous prior creditable coverage, the Medigap insurance company cantmake you wait be ore it covers your pre-existing conditions.

Tere are many types o health care coverage that may count as creditablecoverage or Medigap policies, but they will only count i you didnt have abreak in coverage or more than 63 days.alk to your Medigap insurance company. It'll be able to tell you i yourprevious coverage will count as creditable coverage or this purpose. You canalso call your State Health Insurance Assistance Program . See pages 4748.

I you buy a Medigap policy when you have a guaranteed issue right (alsocalled Medigap protection), the insurance company cant use a pre-existingcondition waiting period. See pages 2123 or more in ormation aboutguaranteed issue rights.

Note: I youre under 65 and have Medicare, generally because o a disabilityor ESRD, you might not be able to buy the Medigap policy you want, or anyMedigap policy, until you turn 65. Federal law doesnt require insurancecompanies to sell Medigap policies to people under 65. However, somestates require Medigap insurance companies to sell you a Medigap policy,even i youre under 65. See page 39 or more in ormation.
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Why is it important to buy a Medigap policy whenI'm rst eligible?Its very important to understand your Medigap open enrollment period .Medigap insurance companies are generally allowed to use medicalunderwriting to decide whether to accept your application and how muchto charge you or the Medigap policy. However, i you apply during yourMedigap open enrollment period, you can buy any Medigap policy thecompany sells, even i you have health problems, or the same price aspeople with good health. I you apply or Medigap coverage afer youropen enrollment period, theres no guarantee that an insurance companywill sell you a Medigap policy i you dont meet the medical underwriting

requirements, unless youre eligible because o one o the limited situationslisted on pages 2223.

Its also important to understand that your Medigap rights may depend onwhen you choose to enroll in Medicare Part B. I youre 65 or older, yourMedigap open enrollment period begins when you enroll in Part B and cantbe changed or repeated. In most cases, it makes sense to enroll in Part B whenyoure rst eligible, because you might otherwise have to pay a Part B lateenrollment penalty.

Employer coverageHowever, i you have group health coverage through an employer or union,because either you or your spouse is currently working, you may want to waitto enroll in Part B. Tis is because employer plans ofen provide coveragesimilar to Medigap, so you dont need a Medigap policy. When your employercoverage ends, youll get a chance to enroll in Part B without a late enrollmentpenalty which means your Medigap open enrollment period will start whenyoure ready to take advantage o it. I you enrolled in Part B while you stillhad the employer coverage, your Medigap open enrollment period wouldstart, and unless you bought a Medigap policy be ore you needed it, youwould miss your open enrollment period entirely. I you or your spouse is stillworking and you have coverage through an employer, contact your employeror union benets administrator to nd out how your insurance works withMedicare. See page 21 or more in ormation.



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How do insurance companies set prices for Medigappolicies?Each insurance company decides how itll set the price, or premium , or itsMedigap policies. Its important to ask how an insurance company prices itspolicies. Te way they set the price affects how much you pay now and inthe uture. Medigap policies can be priced or rated in 3 ways:

1. Community-rated (also called no-age-rated)

2. Issue-age-rated (also called entry-age-rated)

3. Attained-age-rated

Each o these ways o pricing Medigap policies is described in the chart onthe next page. Te examples show how your age affects your premiums,and why its important to look at how much the Medigap policy will costyou now and in the uture. Te amounts in the examples arent actual costs.Other actors such as geographical rating, medical underwriting , anddiscounts can also affect the amount o your premiums.
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How do insurance companies set prices for Medigap policies? (continued)

Type ofpricing

Community-rated(also calledno-age-rated)

Issue-age-rated (alsocalled entryage-rated)

Attained-age-rated

How itspriced

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

Te premium isbased on the ageyou are whenyou buy (areissued) theMedigap policy.

Te premium isbased on yourcurrent age (theage you haveattained), soyour premiumgoes up as youget older.

What this pricing maymean for you

Your premium isnt based onyour age. Premiums may goup because o ination andother actors but not becauseo your age.

Premiums are lower or peoplewho buy at a younger age andwont change as you get older.Premiums may go up becauseo ination and other actorsbut not because o your age.

Premiums are low oryounger buyers but go upas you get older. Tey maybe the least expensive atrst, but they can eventuallybecome the most expensive.Premiums may also go upbecause o ination andother actors.

Examples

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

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

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

Mrs. Wright is 72. She buys the sameMedigap policy as Mr. Han. Since sheis older when she buys it, her monthlypremium is $175.

Mrs. Anderson is 65. She buys aMedigap policy and pays a $120monthly premium. At 66, her premium goes up to $126. At 67, her premium goes up to $132. At 72, her premium goes up to $165.

Mr. Dodd is 72. He buys the sameMedigap policy as Mrs. Anderson.He pays a $165 monthly premium.His premium is higher than Mrs.Andersons because its based on hiscurrent age. Mr. Dodds premium willgo up each year. At 73, his premium goes up to $171. At 74, his premium goes up to $177.
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Comparing Medigap costsAs discussed on the previous pages, the cost o Medigap policies can varywidely. Tere can be big differences in the premiums that differentinsurance companies charge or exactly the same coverage . As you shopor a Medigap policy, be sure to compare the same type o Medigap policy,and consider the type o pricing used. See pages 1718. For example,compare a Medigap Plan C rom one insurance company with a MedigapPlan C rom another insurance company. Although this guide cant giveactual costs o Medigap policies, you can get this in ormation by callinginsurance companies or your State Health Insurance Assistance Program .See pages 4748.

You can also nd out which insurance companies sell Medigap policies inyour area by visiting www.medicare.gov/medigap.Te cost o your Medigap policy may also depend on whether the insurancecompany does any o the ollowing:

Offers discounts (such as discounts or women, non-smokers, or peoplewho are married; discounts or paying yearly; discounts or paying yourpremiums using electronic unds trans er; or discounts or multiplepolicies).

Uses medical underwriting , or applies a different premium when you donthave a guaranteed issue right , or arent in a Medigap open enrollmentperiod .

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

Offers a high-deductible option or Medigap Plan F. I you buy MedigapPlan F with a high-deductible option, you must pay the rst $2,110 (in 2013)o deductibles, copayments , and coinsurance not paid by Medicare be ore

the Medigap policy pays anything. You must also pay a separate deductible($250 per year) or oreign travel emergency services.

I you bought your Medigap Plan J be ore January 1, 2006, and it still coversprescription drugs, you would also pay a separate deductible ($250 per year)or prescription drugs covered by the Medigap policy. And, i you have aPlan J with a high deductible option, you must pay a $2,110 deductiblebe ore the policy pays anything.
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What is Medicare SELECT?Medicare SELEC is a type o Medigap policy sold in some states thatrequires you to use hospitals and, in some cases, doctors within its networkto be eligible or ull insurance benets (except in an emergency). MedicareSELEC can be any o the standardized Medigap Plans. See page 11. Tesepolicies generally cost less than other Medigap policies. However, i you dontuse a Medicare SELEC hospital or doctor or non-emergency services, youllhave to pay some or all o what Medicare doesnt pay. Medicare will pay itsshare o approved charges no matter which hospital or doctor you choose.

How does Medigap help pay your Medicare Part B bills?

In most Medigap policies, when you sign the Medigap insurance contractyou agree to have the Medigap insurance company get your MedicarePart B claim in ormation directly rom Medicare, and then they pay thedoctor directly. Some Medigap insurance companies also provide thisservice or Medicare Part A claims.

I your Medigap insurance company doesnt provide this service, ask yourdoctors i they participate in Medicare. Tis means that they acceptassignment or all Medicare patients. I your doctor participates, theMedigap insurance company is required to pay the doctor directly i you

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


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SEC ION

Your Right to Buy aMedigap Policy3 What are guaranteed issue rights?As explained on pages 1416, the best time to buy a Medigap policy isduring your Medigap open enrollment period , when you have the right tobuy any Medigap policy offered in your state. However, even i you arent inyour Medigap open enrollment period, there are several situations in which

you may still have a guaranteed right to buy a Medigap policy i youre 65 orolder. See pages 2223 or more in ormation.Guaranteed issue rights (also called Medigap protections) are rights youhave in certain situations when insurance companies must offer you certainMedigap policies. In these situations, an insurance company must: Sell you a Medigap policy Cover all your pre-existing health conditions Cant charge you more or a Medigap policy regardless o past or present

health problemsI you live in Massachusetts, Minnesota, or Wisconsin, you have guaranteedissue rights to buy a Medigap policy, but the Medigap policies are different.See pages 4244 or your Medigap policy choices.

When do I have guaranteed issue rights?In most cases, you have a guaranteed issue right when you have otherhealth care coverage that changes in some way, such as when you lose theother health care coverage. In other cases, you have a trial right to trya Medicare Advantage Plan and still buy a Medigap policy i you changeyour mind. For trial rights, see page 23.
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22 Section 3: Your Right to Buy a Medigap Policy

An insurance company cant refuse to sell you a Medigap policy in thefollowing situations:

You have a guaranteed issueright if...

Youre in a Medicare AdvantagePlan, and your plan is leavingMedicare or stops giving care inyour area, or you move out o theplans service area.

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

Note: In this situation, you may have

additional rights under state law.

You have Original Medicare anda Medicare SELEC policy. Youmove out o the Medicare SELECpolicys service area.

Call the Medicare SELEC insurer

or more in ormation about youroptions.

You have the rightto buy...

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

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


I you have COBRA coverage,you can either buy a Medigappolicy right away or wait untilthe COBRA coverage ends.

Medigap Plan A, B, C, F, K, orL thats sold by any insurancecompany in your state or thestate youre moving to.

You can/must apply for aMedigap policy...

As early as 60 calendar daysbe ore the date your health carecoverage will end, but no laterthan 63 calendar days aferyour health care coverage ends.Medigap coverage cant start untilyour Medicare Advantage Plancoverage ends.

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

1. Date the coverage ends

2. Date on the notice you gettelling you that coverage isending (i you get one)

3. Date on a claim denial, i thisis the only way you know thatyour coverage ended

As early as 60 calendar days be orethe date your Medicare SELECcoverage will end, but no laterthan 63 calendar days afer yourMedicare SELEC coverage ends.


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23Section 3: Your Right to Buy a Medigap Policy

You have a guaranteedissue right if...

( rial Right ) You joined aMedicare Advantage Plan orPrograms o All-inclusive Care orthe Elderly (PACE) when you wererst eligible or Medicare Part Aat 65, and within the rst year o joining, you decide you want toswitch to Original Medicare .

(Trial Right) You dropped aMedigap policy to join a MedicareAdvantage Plan (or to switch to aMedicare SELEC policy) or therst time, you have been in theplan less than a year, and you wantto switch back.

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

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

You have the rightto buy...

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

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

I your ormer Medigap policyisnt available, you can buyMedigap Plan A, B, C, F, K, orL thats sold in your state by anyinsurance company.



You can/must apply for aMedigap policy...

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

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

As early as 60 calendar days be orethe date your coverage will end,but no later than 63 calendar daysafer your coverage ends.Note: Your rights may lastor an extra 12 monthsunder certain circumstances.

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

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

An insurance company cant refuse to sell you a Medigap policy in the followingsituations: (continued)


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Can I buy a Medigap policy if I lose my health care coverage?Because you may have a guaranteed issue right to buy a Medigap policy, make sureyou keep the ollowing:

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

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

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

I you have a Medicare Advantage Plan but youre planning to return to OriginalMedicare, you can apply or a Medigap policy be ore your coverage ends. TeMedigap insurer can sell it to you as long as youre leaving the plan. Ask that the newpolicy take effect no later than when your Medicare Advantage enrollment ends, soyoull have continuous coverage.

For more informationI you have any questions or want to learn about any additional Medigap rights inyour state, you can do the ollowing:

Call your State Health Insurance Assistance Program to make sure that you quali yor these guaranteed issue rights. See pages 4748.

Call your State Insurance Department i youre denied Medigap coverage in any othese situations. See pages 4748.

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

Tere may be times when more than one o the situations in the chart onpages 2223 applies to you. When this happens, you can choose the guaranteedissue right that gives you the best choice.

Some o the situations listed on pages 2223 include loss o coverage underPrograms o All-inclusive Care or the Elderly (PACE). PACE combines medical,social, and long-term care services, and prescription drug coverage or rail people.o be eligible or PACE, you must meet certain conditions. PACE may be available instates that have chosen it as an optional Medicaid benet. I you have Medicaid, aninsurance company can sell you a Medigap policy only in certain situations.For more in ormation about PACE, call 1-800-MEDICARE (1-800-633-4227).Y users should call 1-877-486-2048.

Section 3: Your Right to Buy a Medigap Policy


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SECTION

Steps to Buyinga Medigap Policy

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

Below is a step-by-step guide to help you buy a Medigap policy. I youlive in Massachusetts, Minnesota, or Wisconsin, see pages 4244.

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

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

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

STEP 4: Buy the Medigap policy.


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STEP 1: Decide which benets you want, thendecide which of the Medigap Plans meetsyour needs.

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

STEP 2: Find out which insurance companies sellMedigap policies in your state.

o nd out which insurance companies sell Medigap policies in your state,you can do any o the ollowing: Call your State Health Insurance Assistance Program . See pages 4748.

Ask i they have a Medigap rate comparison shopping guide or yourstate. Tis guide usually lists companies that sell Medigap policies in yourstate and their costs.

Call your State Insurance Department . See pages 4748. Visit www.medicare.gov/medigap.

Tis website will help you nd in ormation on all your health planoptions, including the Medigap policies in your area. You can also getin ormation on the ollowing:4 How to contact the insurance companies that sell Medigap policies in

your state4 What each Medigap policy covers4 How insurance companies decide what to charge you or a Medigap

policy premium

I you dont have a computer, your local library or senior center may be ableto help you look at this in ormation. You can also call 1-800-MEDICARE(1-800-633-4227). A customer service representative will help you getin ormation on all your health plan options including the Medigap policiesin your area. Y users should call 1-877-486-2048.

Section 4: Steps to Buying a Medigap Policy

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27Section 4: Steps to Buying a Medigap Policy

STEP 2: (continued)

Since costs can vary between companies, you should plan to call more thanone insurance company that sells Medigap policies in your state. Be oreyou call, check the companies to be sure theyre honest and reliable byusing one o the resources listed below.

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

Call your State Health Insurance Assistance Program . Tese programscan give you ree help with choosing a Medigap policy.

Go to your local public library or help with:

Getting in ormation on an insurance companys nancial strengthrom independent rating services such as Te Street.com Ratings,A.M. Best, and Standard & Poors.

Looking at in ormation about the insurance company online.

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


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28 Section 4: Steps to Buying a Medigap Policy

STEP 3: Call the insurance companies that sell the Medigappolicies youre interested in and compare costs.

Be ore you call any insurance companies, gure out i youre in your Medigap open enrollment period or i you have a guaranteed issue right . Read pages 1415 and 2223 care ully. I you have questions,call your State Health Insurance Assistance Program . See pages 4748. Te chart below can help youkeep track o the in ormation you get.

Ask each insurance company

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

Do you sell Medigap Plan ___? (Say the letter o the Medigap Planyoure interested in.)Note: Insurance companies usually offer some, but not all, Medigap policies.Make sure the company sells the plan you want. Also, i youre interested in aMedicare SELEC or high- deductible Medigap policy, say so.

Do you use medical underwriting or this Medigap policy?Note: I the answer is NO, go to step 4. I the answer is YES, but you knowyoure in your Medigap open enrollment period or have a guaranteed issueright to buy that Medigap policy, go to step 4. Otherwise, you can ask, Canyou tell me whether I am likely to quali y or the Medigap policy?

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

Note: I the answer is YES, ask how long the waiting period is and write itin the box.

Do you price this Medigap policy by using community-rating,issue-age-rating, or attained-age-rating? See page 18.Note: Circle the one that applies or that insurance company.

I am ___ years old. What would my premium be under this Medigappolicy?Note: I its attained-age, ask, How requently does the premium increasedue to my age?

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

Do you offer any discounts or additional (innovative) benets?See page 19.

Is there any extra charge to process my claims automatically?

Company 1

CommunityIssue-ageAttained-age

Company 2

CommunityIssue-ageAttained-age
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29Section 4: Steps to Buying a Medigap Policy

STEP 3: (continued)

Watch out for illegal insurance practices.Its illegal or anyone to do the ollowing:

Pressure you into buying a Medigap policy, or lie to or mislead you to switchrom one company or policy to another.

Sell you a second Medigap policy when they know that you already have one,unless you tell the insurance company in writing that you plan to cancel yourexisting Medigap policy.

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

Sell you a Medigap policy i they know youre in a Medicare Advantage Plan (like an HMO, PPO, or Private Fee- or-Service Plan) unless your coverageunder the Medicare Advantage Plan will end be ore the effective date o theMedigap policy.

Claim that a Medigap policy is part o the Medicare Program or any otherFederal program. Medigap is private health insurance.

Claim that a Medicare Advantage Plan is a Medigap policy. Sell you a Medigap policy that cant legally be sold in your state. Check with

your State Insurance Department (see pages 4748) to make sure that theMedigap policy youre interested in can be sold in your state. Misuse the names, letters, or symbols o the U.S. Department o Health &

Human Services (HHS), Social Security Administration (SSA), Centers orMedicare & Medicaid Services (CMS), or any o their various programs likeMedicare. (For example, they cant suggest the Medigap policy has beenapproved or recommended by the Federal government.)

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

Sell you a Medicare Advantage Plan when you say you want to stay in OriginalMedicare and buy a Medigap policy. A Medicare Advantage Plan isnt the sameas Original Medicare. See page 5. I you enroll in a Medicare Advantage Plan,you cant use a Medigap policy.

I you believe that a Federal law has been broken, call the Inspector Generalshotline at 1-800-HHS- IPS (1-800-447-8477). Y users should call1-800-377-4950. Your State Insurance Department can help you with otherinsurance-related problems.
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STEP 4: Buy the Medigap policy.

Once you decide on the insurance company and the Medigap policy you want,you should apply. Te insurance company must give you a clearly wordedsummary o your Medigap policy. Read it care ully. I you dont understand it,ask questions. Remember the ollowing when you buy your Medigap policy: Filling out your application. Fill out the application care ully and completely,

including medical questions. Te answers you give will determine youreligibility or open enrollment or guaranteed issue rights . I the insuranceagent lls out the application, make sure its correct. I you buy a Medigappolicy during your Medigap open enrollment period or provide evidence thatyoure entitled to a guaranteed issue right, the insurance company cant use

any medical answers you give to deny you a Medigap policy or change theprice. Te insurance company cant ask you any questions about your amilyhistory or require you to take a genetic test.

Paying or your Medigap policy. Its best to pay or your Medigap policyby check, money order, or bank draf. Make it payable to the insurancecompany, not the agent. I buying rom an agent, get a receipt with theinsurance companys name, address, and phone number or your records.Some companies may offer electronic unds trans er.

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

effective when you want coverage to start. Generally, Medigap policiesbegin the rst o the month afer you apply. I , or any reason, the insurancecompany wont give you the effective date or the month you want, call yourState Insurance Department . See pages 4748.Note: I you already have a Medigap policy, ask or your new Medigap policyto become effective when your old Medigap policy coverage ends.

Getting your Medigap policy. I you dont get your Medigap policy in 30days, call your insurance company. I you dont get your Medigap policy in60 days, call your State Insurance Department.

I you already have a Medigap policy, its illegal or an insurance company tosell you a second policy unless you tell them in writing that youll cancel therst Medigap policy. However, dont cancel your old Medigap policy untilthe new one is in place, and you decide to keep it. See page 34. Once youget the new Medigap policy, you have 30 days to decide i you want to keepthe new policy. Tis is called your ree look period. Te 30-day ree lookperiod begins on the day you get your Medigap policy. Youll need to pay bothpremiums or one month.

Section 4: Steps to Buying a Medigap Policy


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31

SECTION

For People Who AlreadyHave a Medigap Policy

5 You should read this section i any o these situations apply to you: Youre thinking about switching to a different Medigap policy.See pages 3235. Youre losing your Medigap coverage. See page 36.

You have a Medigap policy with Medicare prescription drugcoverage. See pages 3638.

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


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32

Switching Medigap policiesI youre satised with your current Medigap policys cost, coverage, andcustomer service, you dont need to do anything. I youre thinking aboutswitching to a new Medigap policy, see below and pages 3335 to answersome common questions about switching Medigap policies.

Can I switch to a different Medigap policy?

In most cases, you wont have a right under Federal law to switch Medigappolicies, unless youre within your 6-month Medigap open enrollmentperiod or are eligible under a specic circumstance or guaranteed issuerights. But, i your state has more generous requirements, or the insurance

company is willing to sell you a Medigap policy, make sure you comparebenets and premiums be ore switching. I you bought your Medigap policybe ore 2010, it may offer coverage that isnt available in a newer Medigappolicy. On the other hand, Medigap policies bought be ore 1992 might notbe guaranteed renewable and might have bigger premium increases thannewer, standardized Medigap policies currently being sold.

I you decide to switch, dont cancel your rst Medigap policy until you havedecided to keep the second Medigap policy. On the application or the newMedigap policy, youll have to promise that youll cancel your rst Medigappolicy. You have 30 days to decide i you want to keep the new Medigappolicy. Tis is called your ree look period. Te 30-day ree look periodstarts when you get your new Medigap policy. Youll need to pay bothpremiums or one month.

Section 5: For People Who Already Have a Medigap Policy



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33Section 5: For People Who Already Have a Medigap Policy

Switching Medigap policies (continued)

Do I have to switch Medigap policies i I have an older Medigap policy?

No. But i you buy a new Medigap policy, you have to give up your old policy(except or your 30-day ree look period, described on page 32 ). Once youcancel the policy, you cant get it back, and it can no longer be sold because itisnt a standardized policy.

Do I have to wait a certain length o time afer I buy my rstMedigap policy be ore I can switch to a different Medigap policy?

No. You should be aware that i youve had your old Medigap policy or lessthan 6 months, the Medigap insurance company may be able to make youwait up to 6 months or coverage o a pre-existing condition . However, iyour old Medigap policy had the same benets, and you had it or6 months or more, the new insurance company cant exclude yourpre-existing condition. I youve had your Medigap policy less than6 months, the number o months youve had your current Medigap policymust be subtracted rom the time you must wait be ore your new Medigappolicy covers your pre-existing condition.

I the new Medigap policy has a benet that isnt in your current Medigap

policy, you may still have to wait up to 6 months be ore that benet will becovered, regardless o how long youve had your current Medigap policy.

I youve had your current Medigap policy longer than 6 months and wantto replace it with a new one with the same benets and the insurancecompany agrees to issue the new policy, they cant write pre-existingconditions, waiting periods, elimination periods, or probationary periodsinto the replacement policy.
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34

Switching Medigap policies (continued)Why would I want to switch to a different Medigap policy?

Some reasons or switching may include the ollowing:

Youre paying or benets you dont need.

You need more benets than you needed be ore.

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

Your current Medigap policy has the right benets, but you want to nd apolicy thats less expensive.

Its important to compare the benets in your current Medigap policy tothe benets listed on page 11. I you live in Massachusetts, Minnesota, orWisconsin, see pages 4244. o help you compare benets and decide whichMedigap policy you want, ollow the Steps to Buying a Medigap Policy in Section 4. I you decide to change insurance companies, you can call thenew insurance company and arrange to apply or your new Medigap policy.I your application is accepted, call your current insurance company, andask to have your coverage end. Te insurance company can tell you how tosubmit a request to end your coverage.

As discussed on page 32, you should have your old Medigap policy coverageend afer you have the new Medigap policy or 30 days. Remember, thisis your 30-day ree look period. Youll need to pay both premiums or onemonth.

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Switching Medigap policies (continued)

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

You can keep your current Medigap policy regardless o where you live aslong as you still have Original Medicare . I you want to switch to a differentMedigap policy, youll have to check with your current or the new insurancecompany to see i theyll offer you a different Medigap policy.You may have to pay more or your new Medigap policy and answer somemedical questions i youre buying a Medigap policy outside o your Medigap open enrollment period . See pages 1416.

I you have a Medicare SELEC policy and you move out o the policys area,you have the ollowing choices: Buy a standardized Medigap policy rom your current Medigap policy

insurance company that offers the same or ewer benets than your currentMedicare SELEC policy. I youve had your Medicare SELEC policy ormore than 6 months, you wont have to answer any medical questions.

You have a guaranteed issue right to buy any Medigap Plan A, B, C, F, K, or Lthats available or sale in most states by any insurance company.

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

Medigap policies cant work with Medicare Advantage Plans . I you decide tokeep your Medigap policy, youll have to pay your Medigap policy premium ,but the Medigap policy cant pay any deductibles, copayments , coinsurance ,or premiums under a Medicare Advantage Plan. So, i you want to joina Medicare Advantage Plan, you may want to drop your Medigap policy.Contact your Medigap insurance company to nd out how to disenroll.However, i 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 unlessyou 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 aferyou join a Medicare Advantage Plan. However, because you have a MedicareAdvantage Plan, the Medigap policy would no longer provide benets thatsupplement Medicare.



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36

Losing Medigap coverageCan my Medigap insurance company drop me?

I you bought your Medigap policy afer 1992 , in most cases the Medigapinsurance company cant drop you because the Medigap policy is guaranteed renewable. Tis means your insurance company cant drop you unless one othe ollowing happens:

You stop paying your premium .

You werent truth ul on the Medigap policy application.

Te insurance company becomes bankrupt or insolvent.

However, i you bought your Medigap policy be ore 1992 , it might not beguaranteed renewable. Tis means the Medigap insurance company canre use to renew the Medigap policy, as long as it gets the states approval tocancel your Medigap policy. However, i this does happen, you have the rightto buy another Medigap policy. See the guaranteed issue right on page 23.

Medigap policies and Medicare prescription drugcoverage

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

Medicare offers prescription drug coverage (Part D) or everyone withMedicare. I you have a Medigap policy with prescription drug coverage,that means you chose not to join a Medicare Prescription Drug Plan whenyou were rst eligible. However, you can still join a Medicare PrescriptionDrug Plan. Your situation may have changed in ways that make a MedicarePrescription Drug Plan t your needs better than the prescription drugcoverage in your Medigap policy. Its a good idea to review your coverageeach all, because you can join a Medicare Prescription Drug Plan betweenOctober 15December 7. Your new coverage will begin on January 1.



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Medigap policies and Medicare prescription drug coverage(continued)

Why would I change my mind and join a Medicare Prescription DrugPlan?

In a Medicare Prescription Drug Plan , you may have to pay a monthlypremium , but Medicare pays a large part o the cost. Teres no maximumyearly amount as with Medigap prescription drug benets in old Plans H,I, and J (these plans are no longer sold). However, a Medicare PrescriptionDrug Plan might only cover certain prescription drugs (on its ormulary ordrug list). Its important that you check whether your current prescriptiondrugs are on the Medicare Prescription Drug Plans list o coveredprescription drugs be ore you join.I your Medigap premium or your prescription drug needs were very lowwhen you had your rst chance to join a Medicare Prescription DrugPlan, your Medigap prescription drug coverage may have met your needs.However, i your Medigap premium or the amount o prescription drugs youuse has increased recently, a Medicare Prescription Drug Plan might now bea better choice or you.

Will I have to pay a late enrollment penalty i I join a MedicarePrescription Drug Plan now?

Tis will depend on whether your Medigap policy includes creditableprescription drug coverage. Tis means that the Medigap policysdrug coverage pays, on average, at least as much as Medicares standardprescription drug coverage. I you quali y or Extra Help, you won't pay a lateenrollment penalty.I it isnt creditable coverage, and you join a Medicare Prescription Drug Plannow, youll probably pay a higher premium (a penalty added to your monthlypremium) than i you had joined when you were rst eligible. You shouldalso consider that your prescription drug needs could increase as you getolder. Each month that you wait to join a Medicare Prescription Drug Planwill make your late enrollment penalty higher. Your Medigap carrier mustsend you a notice each year telling you i the prescription drug coverage inyour Medigap policy is creditable. You should keep these notices in case youdecide later to join a Medicare Prescription Drug Plan.
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Will I have to pay a late enrollment penalty i I join a Medicare PrescriptionDrug Plan now? (continued)

I your Medigap policy includes creditable coverage and you decide to join aMedicare Prescription Drug Plan , you wont have to pay a late enrollment penaltyas long as you dont drop your Medigap policy be ore you join the MedicarePrescription Drug Plan. You can only join a Medicare Prescription Drug Planbetween October 15December 7 unless you lose your Medigap policy ( orexample, i it isnt guaranteed renewable , and your company cancels it). In thatcase, you may be able to join a Medicare Prescription Drug Plan at the time youlose your Medigap policy.

Can I join a Medicare Prescription Drug Plan and have a Medigap policywith prescription drug coverage?

No. I your Medigap policy covers prescription drugs, you must tell yourMedigap insurance company i you join a Medicare Prescription Drug Plan soit can remove the prescription drug coverage rom your Medigap policy andadjust your premium . Once the drug coverage is removed, you cant get thatcoverage back even though you didnt change Medigap policies.

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

You need to be care ul about the timing because you can only join a MedicarePrescription Drug Plan or Medicare Advantage Plan during the open enrollmentperiod between October 15December 7. Your coverage will begin on January 1as long as the plan gets your enrollment request by December 7.

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Medigap Policies for Peoplewith a Disability or ESRD

6 Information for people under 65Medigap policies or people under 65 and eligible or Medicarebecause o a disability or End-Stage Renal Disease (ESRD)You may have Medicare be ore 65 due to a disability or ESRD(permanent kidney ailure requiring dialysis or a kidneytransplant).I youre a person with Medicare under 65 and have a disabilityor ESRD, you might not be able to buy the Medigap policy youwant, or any Medigap policy, until you turn 65. Federal lawdoesnt require insurance companies to sell Medigap policies topeople under 65. However, some states require Medigap insurancecompanies to sell you a Medigap policy, even i youre under 65.Tese states are listed on the next page.

Important: Tese are the minimum Federal standards.For your state requirements, call your State Health InsuranceAssistance Program . See pages 4748.


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Medigap policies or people under 65 and eligible or Medicare because o adisability or End-Stage Renal Disease (ESRD) (continued)

At the time o printing this guide, the ollowing states required insurancecompanies to offer at least one kind o Medigap policy to people with Medicareunder 65:

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

California* Colorado Connecticut Delaware** Florida Georgia

Hawaii Illinois Kansas Louisiana

Maine Maryland Massachusetts* Michigan Minnesota Mississippi

Missouri New Hampshire New Jersey New York

North Carolina Oklahoma Oregon Pennsylvania South Dakota Tennessee

Texas Vermont* Wisconsin

* A Medigap policy isnt available to people with ESRD under 65.** A Medigap policy is only available to people with ESRD.

Even i your state isnt on the list above, some insurance companies may voluntarily sell Medigap policies to people under 65, although theyll probably

cost you more than Medigap policies sold to people over 65, and they can usemedical underwriting . Check with your State Insurance Department aboutwhat rights you might have under state law.

Remember, i youre already enrolled in Medicare Part B, youll get a Medigap open enrollment period when you turn 65. You will probably have a widerchoice o Medigap policies and be able to get a lower premium at that time.During the Medigap open enrollment period, insurance companies cant re useto sell you any Medigap policy due to a disability or other health problem, orcharge 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, i you hadMedicare or more than 6 months be ore you turned 65, you may not have apre-existing condition waiting period. For more in ormation about the Medigapopen enrollment period and pre-existing conditions, see pages 1617. I you havequestions, call your State Health Insurance Assistance Program . See pages 4748.



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Medigap Coverage inMassachusetts, Minnesota,and Wisconsin7Massachusetts benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42Minnesota benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

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


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42 Section 7: Medigap Coverage Charts

Massachusetts benets Inpatient Hospital Care: Covers the Medicare Part A coinsurance plus

coverage or 365 additional days afer Medicare coverage ends Medical Costs: Covers the Medicare Part B coinsurance (generally 20% o the

Medicare-approved amount ) Blood: Covers the rst 3 pints o blood each year Part A hospice coinsurance or copaymentTe check marks in this chart mean the benet is covered.

Massachusetts Chart of standardized Medigap policies

Basic Bene its

Medicare Part A: InpatientHospital Deductible

Medicare Part A: Skilled NursingFacility Coinsurance

Medicare Part B: Deductible

Foreign ravel Emergency

Inpatient Days in MentalHealth Hospitals

State-Mandated Bene its(Annual Pap tests andmammograms. Check your plan

or other state-mandated bene its.)

60 days percalendar year

120 days perbene it year

3 3

3 3

3

3

3

3

Medigap Benefits Supplement 1 Plan Core Plan

For more in ormation on these Medigap policies, visit www.medicare.gov/medigap, or call your State Insurance Department . See pages 4748.
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43Section 7: Medigap Coverage Charts

Minnesota benets Inpatient Hospital Care: Covers the Medicare Part A coinsurance Medical Costs: Covers the Medicare Part B coinsurance (generally 20% o the

Medicare-approved amount ) Blood: Covers the rst 3 pints o blood each year Part A hospice and respite cost sharing Parts A and B home health services and supplies cost sharingTe check marks in this chart mean the benet is covered.

Minnesota Chart of standardized Medigap policies

Basic Bene its

Medicare Part A: InpatientHospital Deductible

Medicare Part A: SkilledNursing Facility (SNF) Coinsurance

Medicare Part B: Deductible

Foreign ravel Emergency

Outpatient Mental Health

Usual and Customary Fees

Medicare-covered Preventive Care

Physical herapy

Coverage while in aForeign Country

State-mandated Bene its(Diabetic equipmentand supplies, routine cancer

screening, reconstructive surgery,and immunizations)

Medigap Benefits Basic Plan Extended

50% 50%

3 3

3 3

80%*

3

3(Provides 120 days o

SNF care)

3

3(Provides 100 days o

SNF care)

80%

80%*

20% 20%

80%*

Basic Plan

3 3

Mandatory Riders

Insurance companiescan o er 4 additionalriders that can be addedto a Basic Plan. You maychoose any one or all othe ollowing riders todesign a Medigap policythat meets your needs:

1. Medicare Part A:Inpatient HospitalDeductible

2. Medicare Part B:Deductible

3. Usual andCustomary Fees

4. Non-MedicarePreventive Care

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

Minnesota versions o Medigap Plans K, L, M, N, and high deductible F are available.

Important: Te Basic and Extended Basic benets are available when you enroll in Part B, regardless o age orhealth problems. I you return to work and drop Part B to elect your employers health plan, you ll get another6-month Medigap open enrollment period afer you retire rom that employer when you can elect Part B again.


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44 Section 7: Medigap Coverage Charts

Basic Benets

Medicare Part A:Skilled Nursing FacilityCoinsurance

Inpatient MentalHealth Coverage

Home Health Care

State Mandated Benets

Wisconsin benets Inpatient Hospital Care: Covers the Part A coinsurance Medical Costs: Covers the Part B coinsurance (generally 20% o the

Medicare-approved amount ) Blood: Covers the rst 3 pints o blood each year

Part A Hospice coinsurance or copayment

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

For more in ormation on these Medigap policies, visit www.medicare.gov/medigap, or call yourState Insurance Department . See pages 4748.Plans known as 50% and 25% Cost-sharing Plans are available. Tese plans are similar tostandardized Plans K (50%) and L (25%). A high deductible plan ($2,110 deductible or 2013) isalso available.

175 days per li etime inaddition to Medicaresbene it

3

3

3

40 visits in addition tothose paid by Medicare

Wisconsin Chart of standardized Medigap policies

Medigap Benefits Basic Plan Optional Riders

Insurance companies areallowed to offer the ollowing 7additional riders to a Medigappolicy:1. Part A Deductible 2. Additional Home Health

Care (365 visits includingthose paid by Medicare)

3. Part B Deductible4. Part B Excess Charges5. Foreign ravel Emergency 6. 50% Part A Deductible7. Part B Copayment or Coinsurance
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SECTION

For More Information

8 Where to get more informationOn pages 4748, youll nd phone numbers or your State HealthInsurance Assistance Program and State Insurance Department . Call your State Health Insurance Assistance Program or help with

any o the ollowing:

Buying a Medigap policy or long-term care insurance

Dealing with payment denials or appeals

Medicare rights and protections Choosing a Medicare plan

Deciding whether to suspend your Medigap policy

Questions about Medicare bills

Call your State Insurance Department i you have questions aboutthe Medigap policies sold in your area or any insurance-relatedproblems.


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How to get help with Medicare and Medigap questionsI you have questions about Medicare, Medigap, or need updated phonenumbers or the contacts listed on pages 4748, you can do the ollowing:

Visit www.medicare.gov:

For Medigap policies in your area, visit www.medicare.gov/medigap

For updated phone numbers, visit ww.medicare.gov/contacts.

Call 1-800-MEDICARE (1-800-633-4227):

Customer service representatives are available 24 hours a day,7 days a week. Y users should call 1-877-486-2048. I you needhelp in a language other than English or Spanish, let the customerservice representative know the language.

Section 8: For More Information
http://www.medicare.gov/http://www.medicare.gov/http://www.medicare.gov/medigaphttp://www.medicare.gov/medigaphttp://www.medicare.gov/


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48 Section 8: For More Information

State State Health InsuranceAssistance Program

State InsuranceDepartment

Nevada 1-800-307-4444 1-888-872-3234New Hampshire 1-866-634-9412 1-800-852-3416New Jersey 1-800-792-8820 1-800-446-7467New Mexico 1-800-432-2080 1-800-947-4722New York 1-800-701-0501 1-800-342-3736North Carolina 1-800-443-9354 1-800-546-5664North Dakota 1-800-247-0560 1-800-247-0560Northern Mariana Not Available 1-670-664-3064

IslandsOhio 1-800-686-1578 1-800-686-1526Oklahoma 1-800-763-2828 1-800-522-0071Oregon 1-800-722-4134 1-888-877-4894Pennsylvania 1-800-783-7067 1-877-881-6388Puerto Rico 1-877-725-4300 1-888-722-8686Rhode Island 1-401-462-0530 1-401-462-9520South Carolina 1-800-868-9095 1-803-737-6160South Dakota 1-877-331-4834 1-605-773-3563ennessee 1-877-801-0044 1-800-342-4029exas 1-800-252-9240 1-800-252-3439Utah 1-877-424-4640 1-800-439-3805Vermont 1-800-642-5119 1-800-631-7788Virgin Islands 1-340-772-7368 1-340-774-7166

1-340-714-4354 (St. homas)

Virginia 1-800-552-3402 1-877-310-6560Washington 1-800-562-6900 1-800-562-6900Washington D.C. 1-202-994-6272 1-202-727-8000West Virginia 1-877-987-4463 1-888-879-9842Wisconsin 1-800-242-1060 1-800-236-8517Wyoming 1-800-856-4398 1-800-438-5768
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SECTION

Denitions

9 Assignment An agreement by your doctor or othersupplier to be paid directly by Medicare, to accept thepayment amount Medicare approves or the service, and notto bill you or any more than the Medicare deductible andcoinsurance.

Coinsurance An amount you may be required to payas your share o the costs or services afer you pay anydeductibles. Coinsurance is usually a percentage ( orexample, 20%).

Copayment An amount you may be required to pay asyour share o the cost or a medical service or supply, like adoctors visit, hospital outpatient visit, or a prescription.A copayment is usually a set amount, rather than apercentage. For example, you might pay $10 or $20 or adoctors visit or prescription.

Deductible Te amount you must pay or health care orprescriptions, be ore Original Medicare, your prescriptiondrug plan, or your other insurance begins to pay.

Excess Charge I you have Original Medicare, and theamount a doctor or other health care provider is legallypermitted to charge is higher than the Medicare-approvedamount, the difference is called the excess charge.

Where words in BLUE are dened


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50 Section 9: Denitions

Guaranteed Issue Rights (also called MedigapProtections) Rights you have in certainsituations when insurance companies arerequired by law to sell or offer you a Medigappolicy. In these situations, an insurancecompany cant deny you a Medigap policy, orplace conditions on a Medigap policy, such asexclusions or pre-existing conditions, and cantcharge you more or a Medigap policy because oa past or present health problem.

Guaranteed Renewable Policy An insurancepolicy cant be terminated by the insurancecompany unless you make untrue statements to

the insurance company, commit raud, or dont payyour premiums. All Medigap policies issued since1992 are guaranteed renewable.

Medicaid A joint Federal and state programthat helps with medical costs or some peoplewith limited income and resources. Medicaidprograms vary rom state to state, but most healthcare costs are covered i you quali y or bothMedicare and Medicaid.

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

Medicare Advantage Plan (Part C) A typeo Medicare health plan offered by a privatecompany that contracts with Medicare to provideyou with all your Medicare Part A and Part Bbenets. Medicare Advantage Plans includeHealth Maintenance Organizations, Pre erredProvider Organizations, Private Fee- or-ServicePlans, Special Needs Plans, and Medicare MedicalSavings Account Plans. I youre enrolled in aMedicare Advantage Plan, Medicare servicesare covered through the plan and arent paidor under Original Medicare. Most MedicareAdvantage Plans offer prescription drug coverage.

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

Medicare Prescription Drug Plan (Part D) A stand-alone drug plan that adds prescriptiondrug coverage to Original Medicare, some

Medicare Cost Plans, some Medicare Private-Fee-or-Service Plans, and Medicare Medical SavingsAccount Plans. I you have a Medigap policywithout prescription drug coverage, you can alsoadd a Medicare Prescription Drug Plan. heseplans are o ered by insurance companies andother private companies approved by Medicare.Medicare Advantage Plans may also o erprescription drug coverage that ollows the same

rules as Medicare Prescription Drug Plans.


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51Section 9: Denitions

Medicare SELECTA type o Medigap policythat may require you to use hospitals and, insome cases, doctors within its network to beeligible or ull benets.

Open Enrollment Period (Medigap) Aone-time-only, 6-month period when Federal lawallows you to buy any Medigap policy you wantthats sold in your state. It starts in the rst monththat youre covered under MedicarePart B, and youre 65 or older. During this period,you cant be denied a Medigap policy or chargedmore due to past or present health problems. Somestates may have additional open enrollment rights

under state law.Original Medicare Original Medicare isee- or-service coverage under which thegovernment pays your health care providersdirectly or your Part A and/or Part B benets.

Pre-existing Condition A health problem youhad be ore the date that a new insurance policystarts.

Premium Te periodic payment to Medicare, aninsurance company, or a health care plan or healthcare or prescription drug coverage.

State Health Insurance Assistance Program(SHIP) A state program that gets money romthe Federal government to give ree local healthinsurance counseling to people with Medicare.

State Insurance Department A state agencythat regulates insurance and can providein ormation about Medigap policies and otherprivate health insurance.


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SECTION

List of Topics

10An alphabetical list of whats in this guide

AAttained-age-rated policies 1718, 28 BBlood 11, 4244 CChanging (switching) Medigap policies 3235 Claim iling 20 COBRA (Consolidated Omnibus Budget Reconciliation Act) 22 Coinsurance 5, 9, 11, 14, 19, 35, 42, 43, 44, 49 Comparing cost 19 Copayment 5, 9, 11, 14, 19, 35, 42, 43, 44, 49 Creditable coverage 37, 38, 40DDeductible 5, 9, 11, 19, 28, 35, 42, 43, 44, 49 Disability 15, 3940


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54 Section 10: List of Topics

EEmployer group health plan 22 End-stage renal disease (ESRD) 6, 3940 Excess charges 11, 44 FFinding reliable insurance companies 27 Foreign travel emergency 19, 42, 43, 44 GGuaranteed issue rights 15, 24, 30, 32, 50 Guaranteed renewable 13, 32, 36, 38, 50 H

High-deductible option 11, 19, 28, 43, 44 Hospice care 6, 11, 42, 43, 44 IIllegal insurance practices 29 Inspector generals o ice 29 Issue-age-rated policies 17, 18, 28 LLong-term care insurance 12, 24, 47, 50 M

Medicaid 5, 12, 13, 24, Medical savings account plan 51Medical underwriting 14, 16, 17, 19, 28, 40, 50 Medicare advantage plan 5, 6, 7, 9, 12, 13, 22, 23, 29, 35, 38, 50 Medicare-approved amount 43, 44, 50 Medicare cost plan 51 Medicare part A (hospital insurance) 6, 11, 13, 42, 43, 44 Medicare part B (medical insurance) 6, 11, 14, 16, 20, 40, 42, 43 Medicare prescription drug plan 5, 6, 7, 12, 14, 3638, 51 Medicare SELEC 9, 19, 20, 22, 23, 24, 28, 35, 51 Medicare supplement insurance (see Medigap)


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55Section 10: List of Topics

M (continued) Medigap

Best time to buy 1415 Claim iling 20 Steps to buying 2530 Under 65 3940 What it is 9 Whats covered and whats not cove red 1012

Medigap bene its chartPlans A through N 11 Massachusetts 42 Minnesota 43 Wisconsin 44

Medigap policies and Medicare prescription drug coverage 3638 Medigap protections (Guaranteed Issue Rights) 24, 30, 32, 50 Moving 35 NNo-age-rated policies 1718 OOpen enrollment period

(Medigap) 1316, 19, 21, 28, 30, 32, 35, 36, 40, 43, 51 Original Medicare 57, 14, 22, 23, 25, 29, 35, 51 PPACE (Programs o All-Inclusive Care or the Elderly) 23, 24 Pre-existing condition 1415, 21, 28, 33, 40, 51 Premium 13, 17, 18, 19, 26, 28, 30, 32, 34, 35, 36, 37, 40, 51 Prescription drug coverage (Medicare) 5, 6, 7, 12, 14, 3638 Preventive care 6, 43 Pricing policies 1718 R

Right to buy a Medigap policy 2124


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56 Section 10: List of Topics

SSkilled nursing acility (care) 6, 11, 42, 43, 44

State health insu

cms medigap policy

Documents