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Large Print Edition 2001 Guide To Health Insurance For People With Medicare Choosing A Medigap Policy To Supplement The Original Medicare Plan PUBS RA 412 6 Easy Steps To Buying A Medigap Policy NEW! .3 G853 2001 S*™*-* CENTERS FOR MEDICARE & MEDICAID SERVICES */ Welcome to the 2001 Guide To Health Insurance For People With Medicare: Choosing A Medigap Policy. This Guide has 6 easy steps to buying a Medigap policy and other important tips to help you buy the Medigap policy that's right for you (see pages 41 - 61). Don't feel like you have to read everything in this Guide all at once. Section 3, which starts on page 19, has the basics you need to know about Medigap policies. Look over the list of topics in the "Table of Contents" on pages 3-5, and pick the one that you want to read. Then, work your way through the rest of Section 3 a page at a time. Section 4, which starts on page 62, gives more details about Medigap policies for those who want them. • End of Page R4- How This Guide Can Help You 1 Medicare is a federal health insurance program for people 65 years of age or older, and certain people with disabilities or End-Stage Renal Disease (permanent kidney pays failure). It for much of your health care, but not all of it. There are some costs that you will have to pay yourself. These costs are called your out-of-pocket costs. There are other kinds of health insurance, like Medigap policies, that may help pay the costs that Medicare doesn't. This Guide is about "Medigap Policies," which are also called "Medicare Supplement Insurance." A Medigap policy is a health insurance policy sold by private insurance companies to fill the "gaps" in the Original Medicare Plan coverage. This Guide helps you understand: • What Medigap policies are, • How Medigap policies can help you, and • What to do before you buy a Medigap policy. Whether you need a Medigap policy is a decision only you can make. Depending on your health care needs and finances, you may want to continue your employee or retiree health coverage, or join a Medicare managed care plan or a Private , Fee-for-Service plan You may also want to think about your . long-term care needs (see page 68). Words underlined are defined on pages 6-12. . How This Guide Can Help You (cont.) Read over "A Quick Look At Medicare" on pages 13 - 18. This will help you understand what Medicare does and does not cover. Section 3, which starts on page 19, gives you the basics you need to know about Medigap policies. Section 4, which starts on page 62, has more details for those who want them. you want information about other kinds of health If insurance other than Medigap policies, see pages 62 - 71 End of Page Table of Contents — Section Words You Should Know Pages 6-12 1: Where words underlined are defined. Section 2: A Quick Look At Medicare Pages 13-18 The Two Parts Of Medicare Pages 13-17 Medicare Health Plan Choices Page 18 Section 3: The Basics Pages 19-61 Learning About Medigap Policies Page 19 _ What Is A Medigap Policy? Pages 19-20 What Medicare SELECT? Page 21 is Why Do Need A Medigap Policy? Pages 22 - 23 I What Medigap Policies Cover Page 26 What Medigap Policies Don't Cover Page 26 Who Can Buy A Medigap Policy? Page 27 Your Medigap Plan Choices Pages 28 - 33 How Much Do Medigap Policies Cost? Pages 34 - 37 When The Best Time To Buy A Medigap Policy? Is Pages 38 39 - Should Enroll In Medicare Part B And Start My Medigap I Am Open Enrollment Period Age 65 Or Over And If I Working? Page 40 Still What If Enrolled In Part B and Did Not Use My Medigap I Open Enrollment Period To Buy A Medigap Policy? Page 40 Steps To Buying A Medigap Policy NEW! Pages 41 - 61 Table of Contents (continued) Section 4: If You Want To Know More Pages 62-138 . Other Kinds Of Health Insurance Pages 62 - 71 The Cost Of Medigap Policies: Ways Of Pricing Policies Pages 72 - 74 Medigap Coverage Of Pre-existing Conditions Page 75 Creditable Coverage Pages 76 - 77 Medigap Policies For People Under Age 65 With A Disability Or End-Stage Renal Disease (ESRD) Pages 78 79 - Medigap Compare On The Internet Pages 80 - 81 Your Rights To Buy A Medigap Policy In Certain Situations (Including losing your Medicare managed care plan, or HMO coverage) Pages 82 - 99 Losing Medigap Coverage Pages 100-101 Switching Medigap Policies Pages 102-103 Medigap Coverage You Move Page 104 If How Your Bills Get Paid Pages 105-106 Private Contracts Pages 1 07 - 1 08 You Can Pay On Your Own For Services That Medicare Doesn't Cover Page 109 Watch Out For Illegal Insurance Practices Pages 110-111 Discrimination Page 112 Ways To Check If An Insurance Company Is Reliable Page 113 (Continued on Page 5) • End of Page 5 Table of Contents (continued) Section 4: If You Want To Know More (continued) Pages 62 138 - Medicare Part A and Part B Coverage Charts Page 114 Medicare Part A Chart Pages 115-119 Medicare Part B Charts Pages 120-131 Chart Of Standardized Medigap Plans In Massachusetts Pages 132-134 Chart Of Standardized Medigap Plans In Minnesota Pages 135-136 Chart Of Standardized Medigap Plans In Wisconsin Pages 137-138 Section 5: Where To Call For Help Pages 139-146 A list of phone numbers for each state. Important: At the time of printing, the phone numbers listed were correct. Phone numbers sometimes change. To get the most updated phone numbers, call 1 800 633 - 4227 (TTY/TDD: 1 877 486 - 2048 for the hearing and speech impaired) or look on the Internet at www.medicare.gov and select "Helpful Contacts." Section 6: Index Pages 147 - 151 An alphabetical list of topics in this booklet. The 2001 Guide To Health Insurance For People With Medicare: Choosing A Medigap Policy is not a legal document. The official Medicare program provisions are contained in the relevant laws, regulations, and rulings. Section Words You Should Know 1: A C Letters through A Assignment - In the Original Medicare Plan, a process in which a doctor or supplier agrees to accept the amount Medicare approves as payment. You must pay any full coinsurance amount. B Benefit Period - The way that Medicare measures your A use of hospital and skilled nursing facility services. benefit period begins the day you go to a hospital or skilled nursing facility. The benefit period ends when you have not received hospital or skilled nursing care for 60 days in a row. If you go into the hospital after one benefit period has ended, a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. There is no limit to the number of benefit periods you can have. C Coinsurance - The percent of the Medicare-approved amount that you have to pay after you pay the deductible A for Part and/or Part B. In the Original Medicare Plan, the coinsurance payment is a percentage of the cost of the service (like 20%). 7 Section 1: Words You Should Know (cont.) C G Letters through C (continued) Copayment - In some Medicare health plans, the amount you pay for each medical service, like a doctor visit. A copayment is usually a set amount you pay for a service. For example, this could be $5 or $10 for a doctor visit. Copayments are also used for some hospital outpatient services in the Original Medicare Plan. D Deductible - The amount you must pay for health care, before Medicare begins to pay, either for each benefit period for Part A, or each year for Part B. These amounts can change every year. E End-Stage Renal Disease - Kidney failure that is severe enough to require lifetime dialysis or a kidney transplant. Excess Charges - The difference between a doctor's or other health care provider's actual charge (which may be limited by Medicare or the state) and the Medicare- approved payment amount. G Guaranteed Issue Rights - A right you have in certain situations when insurance companies are required by law to issue you a Medigap policy. 8 Section 1 Words You Should Know (cont.) : G Letters through L G (continued) Guaranteed Renewable - A right you have that requires your insurance company to allow you to automatically renew or continue your Medigap policy, unless you do not pay your premiums. H Home Health Care - Skilled nursing care and certain other health care you get in your home for the treatment of an illness or injury. Hospice Care - Is a special way of caring for people who are terminally and for their family. This care includes ill, physical care and counseling. Hospice care covered is A under Medicare Part (hospital insurance). L Lifetime Reserve Days - Sixty days that Medicare will pay for when you are in a hospital for more than 90 days. These 60 reserve days can be used only once during your lifetime. For each lifetime reserve day, Medicare pays all covered costs except for a daily coinsurance ($396 in 2001). Limiting Charge - The highest amount of money you can be charged for a covered service by doctors and other health care providers who don't accept assignment. The limit is 15% over Medicare's approved amount. The limiting charge only applies to certain services and does not apply to supplies or equipment.