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Medicare Supplement Insurance for West Palm Beach, Florida Residents |
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| A Medicare Supplement Insurance Policy (aka Medigap) is private health insurance designed to supplement Original Medicare Insurance. It pays some of the health care costs that Medicare Insurance doesn't cover such as copayments and deductibles. Medigap insurance policies may also cover some services not covered by Medicare Insurance. If you are enrolled in Medicare and you have a Medigap insurance policy, Medicare will pay its share of their approved amount for a covered heath care costs. Then your Medigap insurance policy pays its share. Every Medigap insurance policy must follow State and Federal laws designed to protect you, and it must be clearly identified as "Medicare Supplement Insurance." Insurance companies can only sell a "standardized" plan identified by letters A through L. All standardized insurance policies must offer the same basic benefits, no matter which insurance company sells it. Cost and Service is the only difference between policies sold by different insurance companies. Insurance policies purchased before January 1, 2006 may include prescription drug coverage. If you have a Medigap insurance policy without prescription drug coverage, you can join a Medicare Prescription Drug Plan without changing your Medigap insurance policy. We can help you find the right Medicare Supplement Insurance. We have an insurance office in West Palm Beach, Florida to serve your needs. Contact us today to find the right insurance policy for you. |
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Medical Privacy and The Medical Information Bureau for your Insurance Policy. |
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Medicare Select Insurance Policies |
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| Medicare Select Policies offer the same basic coverage as the standard plans; however, the insurance company normally requires participants to use a specific network of health care providers and/or facilities. The premium for a Medicare Select Policy is usually lower than a Traditional Medicare Supplement Insurance Policy. Except for emergency care, the Medicare Select Policy will deny payment or pay less than the full benefit if you go outside the network for services. Medicare, however, will still pay its share of approved charges in such situation. | |||
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Different types of Medicare Advantage Insurance Plans |
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| Medicare Advantage Plans include the following: | |||
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Information on the Medicare Prescription Drug Improvement and Modernization Act of 2003. |
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| Medicare is an essential health care program for people age 65 and older and people with disabilities. Congress passed legislation in 2003 that changed Medicare health care coverage and health care benefits, and added new prescription drug and preventive benefits. | |||
| The "Medicare Prescription Drug Discount Card and Transitional Assistance Program" is part of this legislation. During 2004-05, the discount card program offered Medicare beneficiaries some relief from the high cost of prescription drugs. This temporary program provided help until the Medicare drug benefit was implemented in 2006. Scam artists still try to take advantage of Medicare beneficiaries by telephone and door-to-door contacts, offering to enroll them in medical discount card "programs" in exchange for Social Security or credit card numbers, or other banking information. They can use this information to make false claims. Medicare always contacts its beneficiaries by mail only. If you have an encounter that you think may be fraudulent, call the Medicare Fraud Hotline at 1-800 447-8477. If you are happy with the Medicare coverage you have, you can keep it exactly the same. No matter what you decide, you are still in the Medicare program. These changes in Medicare coverage and benefits went into effect in January 2006. For more information, visit the Web site at www.medicare.gov. | |||
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What is Medicare supplement insurance? |
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| Medicare is a federally funded health insurance program for
those ages 65 and older, and for the disabled.
Although Medicare may pay a large part of your
health care expenses, it does not pay for them
all. Some services and medical supplies are
not fully covered. You must also pay certain
amounts, called coinsurance and deductibles.
Please contact your local Social Security office
for a free copy of the Medicare handbook and
an explanation of what it covers.
Private insurers offer Medicare supplement policies under 12 different standard plans, which fill some of the gaps not covered by Medicare. Two of the standard plans have an additional option. All companies selling Medicare supplement insurance in Florida must provide Plan A. In addition, they may provide any of the remaining standard plans, but do not necessarily have to. Discuss the combination of benefits for each plan with your agent. These are the only plans that may be sold as Medicare supplement insurance policies in Florida. Insurers may offer "group" and/or "individual" policies. Group insurance covers a number of people or groups under one policy, usually through employers or associations. Individual insurance covers one person. Both types of policies are sold by agents and through the mail. Coverage and prices vary widely among policies. Federal and state governments do not sponsor Medicare supplement insurance. Do not believe agents or insurance advertisements that imply otherwise. |
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Do I really need Medicare supplement insurance? |
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| Not everyone needs Medicare supplement insurance. You may have other options.
For example:
You may not need any insurance. Your savings may cover health care expenses that exceed what Medicare will pay. You may qualify for full Medicaid benefits. If your income falls below a certain level, you may qualify for Medicaid, a federal and state health care program. If you fully qualify, you probably should not buy Medicare supplement insurance. You should enroll in the federal Medicare program because the two programs combined will cover most of your health care costs. If you qualify for both Medicare and standard Medicaid benefits, an insurance company cannot sell you a Medicare supplement policy unless the state pays your premiums. In addition to the standard Medicaid program, the state Medicaid offices offer two other programs to help certain low-income Medicare beneficiaries meet health care costs. |
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Other information on Medicare supplement insurance for West Palm Beach Florida Residents. |
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Simplification: Insurance companies that
sell Medicare supplement policies in Florida
can provide only the standard plans for you to
choose from. Remember, you can buy only one
Medicare supplement policy.
Consistency: All companies must consistently label their plans. The benefits for each plan are identical from company to company. For example, Plan B offered by one company has the same coverages and benefits as Plan B offered by another company. Only the companies' services and premiums may vary. Protection from premium increases: For policies currently being issued in Florida, premiums are established on an issue-age basis. Issue age means the premiums depend on the policyholder's age at the time of purchase. Premiums may increase due to benefit changes or overall premium adjustments, but not due to advancing age. Before Oct. 1, 1993, however, Floridians could buy policies on an attained or uniform age basis. This meant the premiums depended on their age at the latest policy anniversary, or on other factors. Insurance companies no longer use such methods to calculate premiums, except for policies sold before this date that remain intact. Most companies will reserve the right to adjust premiums because of inflation, claims experience and benefit adjustments in your policy as Medicare benefits change. For example, when the Medicare Part A deductible increases, a company usually raises its premiums to pay for the increased deductible it covers in your policy. When a company increases its premiums, it must do so for an entire policy class. It cannot single you out and raise your premiums based on your health or the number of claims you have filed. Protection against duplicate coverage: Duplicate coverage is expensive and unnecessary. Therefore, companies and their agents may provide you, by law, only one policy. Agents may not sell you a Medicare supplement policy if you already have one and do not want to replace it. Limits on pre-existing conditions: A pre-existing condition is an illness diagnosed or treated, or an illness for which an ordinary, prudent person would have sought treatment or diagnosis within six months before a policy's issue date. Florida law limits the reduction or limitation of coverage for these conditions to six months. Credit for continuing coverage: Florida law protects consumers changing from one policy to another. If a Medicare supplement policy replaces another Medicare supplement policy or other creditable coverage, the replacing insurer must waive any time periods applicable to a pre-existing conditions clause by the length of time under the previous coverage. Most major medical insurance will qualify as creditable coverage. One Medicare supplementary policy is all the coverage you'll need. But some unscrupulous agents will try selling you multiple policies. It's called stacking and it's illegal. Therefore, if an individual has six months or more of continuous coverage when applying for a new policy, the insurer would not apply the pre-existing condition exclusion. If the individual has three months of previous continuous coverage, the insurer would reduce the preexisting condition exclusion from a six-month period to three months Guaranteed renewal: All individual Medicare supplement plans sold in Florida must be guaranteed renewable. This means Florida law prohibits companies from canceling these policies except for nonpayment of premium or for a "material misrepresentation" on your original application. Material misrepresentation means deliberately providing false information or leaving out key facts. Open enrollment periods: Many companies offering Medicare supplement policies reserve the right to underwrite your application-to ask you questions about your health and habits-when deciding whether to issue you one of their policies. Although underwriting is a legal and acceptable business practice, federal law requires all companies to provide residents with an open enrollment period during which the company must accept your application and cannot discriminate in the pricing of the policy, regardless of your medical history, health status or claims experience. Your open enrollment period for Medicare supplement insurance begins the first day of the month in which you turn 65 and are enrolled in Medicare Part B. If your birthday falls on the first day of the month, however, your Medicare Part B coverage and your Medicare supplement insurance open enrollment begin the first day of the previous month. In addition, if you are 65 or older and enrolled in Medicare Part B, you have a two-month open enrollment period when you are changing from a group health insurance policy to a Medicare supplement insurance policy. Usually, you can determine whether you are in your open enrollment period by checking your Medicare card for your Part B coverage effective date. Add six months to that date. If the current date falls within that six-month period, you may participate in open enrollment. During open enrollment, a company cannot refuse to issue you any of its Medicare supplement policies or discriminate in the pricing of these benefits because of health status, claims experience, receipt of health care or medical condition. Although this provision guarantees that your policy will be issued, Medicare supplement insurance companies may impose the same waiting period for preexisting conditions that they apply to policies sold outside the open enrollment period. |
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The Two Types of Medicare Advantage Insurance options for West Palm Beach Florida Residents |
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| There are two Medicare Advantage options. These plans provide health care services to members under a contract with Medicare. These plans offer care in return for regular payments from Medicare, and may reduce your out-of-pocket expenses or provide additional benefits. | |||
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Other Types of Insurance Benefit Plans for West Palm Beach, Florida Residents |
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| Religious fraternal benefit plans:
Only members of a particular society may join one of these plans. The society must meet Medicare and federal tax standards. Medicare medical savings accounts (MSAs) You obtain a health insurance policy with a high yearly deductible. Medicare pays a regular premium, which it deposits into your medical savings account. You can build up this account to pay for extra medical costs. However, you must pay a "high deductible," which often costs several thousand dollars for covered services. In addition, providers can charge you any amount beyond what your plan will pay. "High deductible" plans: Some beneficiaries may like controlling costs through a high deductible, but may not want to obtain an MSA. The law allows-but does not require-insurance companies to offer two new Medicare supplement plans. These "high deductible" options that fall under plans F and J, like the remaining standard plans, fill some costs not covered by Medicare. For 2008, the policyholder must pay a $1,900 deductible annually for covered services. This amount will increase in future years. |
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More Information Medicare Select Insurance for West Palm Beach, Florida residents. |
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| Medicare Select offers the same basic coverage as the standard plans available through traditional Medicare supplement insurance. However, companies might require consumers who obtain Medicare Select policies to use a specific network of health care providers and/or facilities. Except for an emergency case, it depends upon the company policy whether your coverage will include care from a physician outside the network. Insurance companies usually charge lower premiums for Medicare Select policies than for traditional Medicare supplement policies. When a Medicare Select policyholder receives covered services from a network provider, Medicare will pay its share of the approved charges. The Medicare Select plan will cover the rest up to the limits of the policy. In general, Medicare Select policies will deny payment or pay less than the full benefit if you go outside the network for non-emergency services. Medicare, however, will still pay its share of approved charges in such situations. | |||
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Medicare Part D Insurance (prescription drug coverage) |
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| You might have heard about the new prescription drug coverage program for Medicare recipients, commonly called Medicare Part D, which first became available January 1, 2006. You also may have seen or received advertisements from Medicare-approved prescription drug companies. Medicare D could provide you with improved drug coverage and save you significantly on premiums. Under Medicare Part D, you and Medicare share your drug costs. This benefit covers generic and brand-name prescription drugs at participating pharmacies in your area. As you may now select this new prescription drug coverage, the time is right to weigh your options and decide on the plan that best meets your needs. Remember: Though you may not now use a lot of prescription drugs, you should still think about enrolling. By choosing not to act, you are in fact making a decision that may impact you in the near future. | |||
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Eligibility for Medicare Part D Insurance |
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| If you qualify for Medicare Part A (hospital insurance) and/or are enrolled in Part B (medical insurance), you are eligible to enroll in the new Medicare Part D. Those eligible for both Medicare and Medicaid (dual-eligible) will be enrolled, with some exceptions. You are eligible for this coverage regardless of your health status, income and resources, or current prescription drug costs. | |||
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Initial Eligibility and Late Enrollment for Medicare Part D Insurance |
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| Enrollment is voluntary, but you should keep
these important facts in mind: Initial Enrollment: You may sign-up when you first become eligible for Medicare (three months before the month you turn 65 until three months after you turn 65). Note: If you get Medicare due to a disability, you can join from three months before to three months after your 25th month of cash disability payments. If you don't sign up when you are first eligible, you may pay a penalty.Generally, enrollment is for the calendar year. To be able to enroll during other times, you must have a qualifying circumstance, such as a change of address that takes you out of your plan's service area. |
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Do you have questions about Medicare Part D Insurance? |
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| The two basic options are:
Original Medicare and a Prescription Drug Plan (PDP-adds prescription drug coverage
to the traditional Medicare plan with a "stand alone" plan) or Medicare Advantage Plan
with Prescription Drug Coverage (MAPD), including regional PPOs (drug and Medicare
coverage similar to an HMO or PPO-usually provides more coverage at a lower cost through a
provider network).
Please note: Though they must meet Medicare requirements, plans may change their lists of covered drugs (formularies) after you have already enrolled in their plans. Your plan must give you a 60-day notice before it removes your drug from its formulary, or if it is changing your costs. If you already have a prescription drug plan, you should talk to your insurer or plan benefits administrator before making any changes. Extra Help If your income and resources (including savings and stocks, but not your car or home) meet certain requirements, you may be eligible for additional savings on your prescription drug coverage. The amount of extra help you receive will depend upon your income and resources. |
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What are the effects of other insurance coverage on your Medicare Supplement Insurance Policy? |
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| In addition to your Medicare supplement policy, you may be considering or have already bought other health coverage, such as a major medical plan, indemnity plan or a limited benefit plan, such as a cancer-expense plan. Although a Floridian may own any of these plans, this may create a duplication of coverage when combined with Medicare and a Medicare supplement policy. This means you may pay twice for the same coverage. Federal law now requires that a statement appear on the policy that discloses this information. Policyholders who obtain Medicare supplement insurance usually do not need other coverage. If these requirements are satisfied, this benefit will pay actual charges up to $40 per visit for visits received under the Medicare-approved treatment plan. | |||
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Do you need Medicare Part B Insurance? |
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| You may not need to buy Medicare Part B if
you work and otherwise qualify for Medicare,
as long as you maintain coverage under your
employer's group health insurance.
Before you obtain Part B, you should review what your group plan covers and how it coordinates with what Medicare pays. Most enrollees will pay a monthly premium of $96.40 for 2008. Most will have this premium deducted from their monthly Social Security checks. (Note: Some higher income enrollees will pay a higher premium.) Except for the time you are covered by your employer's group plan, your Part B premiums increase 10 percent for each year you delay enrollment past the year of your 65th birthday. If this situation applies to you, contact your local Social Security office before your 65th birthday. |
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Explanation Of Standard Medicare Supplement Insurance Plans Basic Benefits (Plans A-J) |
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| Basic benefits must be covered in all standard plans and include:
Blood - The first three pints, when provided during a covered stay;
Hospitalization (Part A) - The coinsurance for Part A is $256 per day for days 61 to 90, and $512 per day for day 91 up to day 150, depending upon the lifetime-reserve days you use. You may use up to 60 of these days on a nonrenewable basis. Coverage is for a lifetime maximum of 365 additional days after Medicare benefits end; Medical Expenses (Part B) - Part B coinsurance is generally 20 percent of Medicare-approved expenses after you satisfy a $135 deductible. |
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| Optional Benefits: The standard plans carry a variety of optional benefits, including: At-Home Recovery (Plans D, G, I, J) - Medicare provides coverage for certain home health services. This coverage applies to patients who are confined to their homes and no longer need hospitalization, but still require intermittent skilled medical care, physical therapy or speech therapy. A physician must recommend and monitor the treatment plan in order for Medicare to approve and cover these medically necessary services. This coverage does not include personal care, such as assistance with activities of daily living (i.e., bathing, dressing, eating and housekeeping services). Medicare supplement plans, however, with the at-home recovery benefit, do provide coverage on a short-term basis to help a person with activities of daily living. To receive this benefit, you must be recovering from injuries or surgery. You must also currently receive care under a Medicare approved home health care plan, or you must have received care within the past six weeks. If these requirements are satisfied, this benefit will pay actual charges up to $40 per visit for visits received under the Medicare-approved treatment plan. Maximum benefits include no more than seven visits in any one week (four hours constitute one visit), and $1,600 in any one calendar year. These benefits can be used up to eight weeks after your Medicare-covered home health care visits stop. Basic Drugs ($1,250 Limit) (Plans H, I) (Not available in policies issued after Dec. 31, 2005)– This benefit pays for 50 percent of the actual charges for prescription drugs after you satisfy the $250 outpatient calendar-year deductible. The maximum benefit is $1,250 each calendar year. Extended Drugs ($3,000 Limit) (Plan J) (Not available in policies issued after Dec. 31, 2005) – This benefit pays for 50 percent of the actual charges for prescription drugs after you satisfy the $250 outpatient calendar year deductible. Plan J "High Deductible" does not cover the separate prescription drug deductible. The maximum benefit is $3,000 each calendar year. Foreign Travel Emergency (Plans C-J) – This benefit covers emergency medical care. Coverage begins during the first 60 days of your trip outside the United States. Your Medicare supplement policy will pay 80 percent of the actual billed charges for covered care after you satisfy the $250 emergency medical care calendar year deductible. This benefit deductible is not covered under Plans F or J "High Deductible." Part A Deductible (Plans B-J) – The 2008 deductible for Part A (hospitalization) is $1,024 per benefit period. Medicare supplement plans with the Part A deductible benefit will pay this deductible. Part B Deductible (Plans C, F, J) – The 2008 deductible for Part B (medical) is $135 in a calendar year. Plans covering the Part B deductible will pay the $135 deductible. Part B Excess (100 Percent) (Plans F, I, J) – Plans with this benefit will pay 100 percent of the difference between the actual charges and the Medicare-approved amount for Part B services. Such plans will pay for physician expenses that exceed the Medicare-approved amount, but still fall within charge limitations established by Medicare. Part B Excess (80 Percent) (Plan G) – Plans with this benefit will pay 80 percent of the excess charges (described above). Preventive Care (Plans E, J) –This option pays up to $120 per year for procedures not covered by Medicare, but determined by your physician to be medically appropriate. Examples include hearing tests, diabetes screenings, physical examinations, serum cholesterol screenings and thyroid function tests. Skilled Nursing Coinsurance (Plans C-J)– Medicare pays 100 percent of approved skilled nursing care for days one to 20, and then it pays all but $119 per day (the coinsurance) for days 21 to 100. Medicare supplement plans with this benefit pay the $114 per day coinsurance for days 21 to 100. Plans K & L – The benefits of these plans are structured differently. |
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Annual Premiums for your Medicare Insurance Policy |
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| Many companies sell Medicare supplement insurance in Florida, and premiums may vary
depending on a variety of factors. In addition to age, premiums depend on place of residence,
gender, smoking habits and whether you buy the policy through an agent or directly from the
company. Some companies charge less for direct sales, but a few charge more. You should check
with each company for more information.
In addition, a company may be licensed to sell Medicare supplement insurance in Florida, but may
not write coverage. Some companies sell policies based on you meeting extensive underwriting criteria. This means you will be required to answer questions concerning your health or take a medical exam to qualify for coverage. A pre-existing condition provision may still apply. However, all policies issued during the open enrollment period are sold on a guaranteed-issue basis. Other companies offer policies based on you meeting limited-underwriting (L/U) criteria. You may be required to answer a few questions concerning your health to qualify for coverage. A pre-existing condition provision may apply. Finally, some companies sell policies on a guaranteed-issue (G/I) basis, which means you will not be required to answer health questions or take a medical exam to qualify for benefits. A pre-existing condition provision may still apply. Individual companies may have different requirements and conditions regarding guaranteed issue. Call the company for more information. |
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Your Rights & Responsibilities with regards to your Insurance Policy |
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| When you buy Medicare supplement insurance,
you have certain rights and responsibilities. Your rights You have the right to receive an outline written in easy-to-understand language. The outline explains your policy's benefits, exclusions and limitations. You have the right to receive copies of all forms and applications signed by you or the agent You have the right to receive your policy within 30 days. If you do not, contact the company and request a written explanation. If you haven't received an explanation within 60 days, contact the DFS Consumer Helpline toll-free at 1-877-MY-FL-CFO (1-877-693-5236). Follow the same process if you return a policy and do not receive a refund. You have the right to take up to 30 days to review a Medicare supplement insurance policy. This is called a free-look period. If you decide you do not want to keep the policy, return it to the company by certified or registered mail with a return receipt requested. You must do this within 30 days of receiving the policy to be eligible for a full refund. You have the right to have your policy renewed unless you don't pay your premiums or deliberately give misleading information on your application. Your rate may change, but only if the company changes everyone else's premium in your policy class. Your policy will state the conditions under which the company may raise your premiums. You have the right to appeal any claim denied as not medically necessary to a licensed physician designated by your insurer. You have the right to receive a free copy of the federally approved buyer's publication Guide to Health Insurance for People with Medicare from the agent who sells the policy. This guide explains the Medicare program, Medicare supplement insurance, HMOs and other health insurance options for Medicare beneficiaries. You have the right to have your claims paid promptly. If you use a participating Medicare physician or provider, he or she must file your Medicare and Medicare supplement claims for you. If you use a nonparticipating Medicare physician or provider, he or she must file your Medicare claim, but is not obligated to file your Medicare supplement claim. The physician or provider cannot charge you for filing claims. You have the right to obtain a prompt refund of unearned premiums if you or your company cancels your policy. You have the right to have pre-existing conditions excluded for no more than six months after your policy goes into effect. |
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Other Insurance for Seniors |
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| Private insurance companies offer a variety of other options for seniors. These include long term care, home health care and nursing home care policies, as well as life insurance and membership in a continuing care retirement community (CCRC). The Department of Financial Services offers a number of guides to help you choose which might be right for you, including: Health Insurance, Life Insurance and Annuities, and Long-Term Care and Other Options for Seniors. For a free copy of any of these guides, call our Consumer Help Line toll-free at 1-877-MY-FL-CFO (1-877-693-5236). | |||
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Medical Privacy and The Medical Information Bureau for your Insurance Policy |
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| The Medical Information Bureau (MIB) is a data
bank of medical and nonmedical information on
nearly 15 million Americans, collected from the
MIB's 800 insurance company members.
The companies send the MIB information
you have written on applications, enrollment
forms, and requests for upgrading coverage for
health, life or disability insurance. The MIB also
records information from medical exams, blood
and lab tests, and hospital reports, when such
information is legally obtainable.
If you have been denied life or disability
insurance and wonder why, your file at the MIB
may be the answer. You have the right to make
sure the information in your MIB file is correct.
Call the MIB at (866) 692-6901 and ask for a
copy of your records, or access its Web site
at www.mib.com.
You have the right to a 30-day grace period to pay premiums. When this period expires, your insurance company may only cancel your policy for nonpayment of premium, effective on the date the premium was due. |
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| Your Responsibilities You are responsible for reading and understanding your insurance policy. You are responsible for reading and understanding any "explanation of benefits" forms sent by your insurance company. Such a form will usually state: "This is not a bill." However, you still should closely study it to find out whether you actually received the services described. You should contact your company for help if you don't understand the form or have trouble reading or speaking English. If your company doesn't send such forms, call to ask why. Careful scrutiny of these forms can help you and the insurer detect and fight fraud. You are responsible for making sure your application is correct. This includes information on pre-existing conditions. If you make a fraudulent misstatement, the company may cancel your policy or refuse to pay a claim. You are responsible for knowing what your policy covers and excludes. You are responsible for maintaining continuous coverage. Do not cancel your old policy before the company has accepted your application and your new policy is in force. You are responsible for paying your premiums, even while involved in a dispute with your company. You are responsible for paying the deductibles outlined in your policy. |
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