Table Of Content

What You Need To Know About And Medicare Supplemental Health Insurance Medicare Medicare is a Federal health insurance program for people 65 or older, people of any age with permanent kidney failure, and certain disabled people under age 65. This leaflet summarizes Medicare coverage and gives information about private health insurance to supplement Medicare. You will soon receive The Medicare Handbook which provides more information about Medicare. The Health Care Financing Admini- stration administers Medicare through private insurance organizations called carriers and intermediaries. Carriers handle medical insurance claims. Inter- mediaries handle hospital insurance claims. The Medicare Handbook gives more information about how to contact your carrier or intermediary. The Social Security Administration does not handle claims for Medicare payment. But, Social Security does take Medicare applications. Hospital Insurance Benefits Medicare hospital insurance helps pay for medically necessary services furnished by Medicare-certified hospitals, skilled nursing facilities, home health agencies, and hospices. The number of days of Medicare protection available for care in hospitals and skilled nursing facilities is measured in benefit periods. In general, a benefit period begins when you enter a hospital and ends when you ; have been out of a hospital or skilled nursing facility for 60 straight days. Then, you begin a new benefit period 2 Employer Group Insurance coverage can sometimes be continued or converted to a suitable individual Medi- care-supplement policy when you reach age 65. Carefully check the price and the benefits, including benefits for your spouse. Usually, employer continued or converted group insurance has no waiting periods or pre-existing condition exclusions. Association Group Insurance is offered by many organizations to their members over age 65. The following types of insurance pro- vide limited coverage: Nursing Home Coverage usually pays a stated amount per day for services furnished in a skilled nursing facility. Improved long-term care or nursing home policies are now available, but if you purchase this coverage, make sure you are not duplicating coverage you have through a supplemental in- HMO. surance policy or Hospital Confinement Indemnity Coverage pays a fixed amount for each day you are hospitalized, up to a designated number of days. Specified Disease Coverage (not available in some States) provides benefits for only a single disease, such as cancer, or a group of specified dis- eases. Benefits are usually limited to payment of a fixed amount for each type of treatment. Benefits are not designed to fill the Medicare gaps. Buying Private Health Insurance? If you decide to buy a private health insurance policy: Complete the application carefully. If it asks for your medical history, do 9 thenexttimeyouenterahospital.There Thehospitalinsurancedeductibleand Medical InsurancePayments (irpeople65orolder, people ipsernioodlsimyitoutoctahnehnauvem.berofbenefit Joathneuraraymo1.unYtosuywoilulpraecyeicvaenachnaotnigceeeifach dEeadcuhctyiebalre,,amfetedricyaoluimnesuertantcheeg$e1n0e0rally InpatientHospital Care willpay80percentoftheapproved idcertain disabled peopfe Medical Insurance Benefits chargesforallcoveredservicesyou •6.S, Thisleaflet; sIfuryaonuceneheedlpisnppaatyiefnotrcuarpe,toho9s0pidtaaylsini-n HospiceCare Medicaremedicalinsurancehelpspay receivefortherestofthatyear.' each benefit period. 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Ifyoualreadyhaveotherhealth insur- Note: Ifyou havelowincome,long- Youareresponsibleforpartofthe OtherMedical And Health Services ance, andyouenrollinMedicare medi- ttehrrmoucgahreyosuerrviScleastemMaeydiaclasoidbeagaevnaciyl.able cpoesrtisodo,fycoouvepraeydstehrevihcoessp.itIanleiancshurbaennceefit Undercertainconditions, medical becomethesecondarypayeronyour HrIMifeneoqsydumuoiircueraaenracHrteeeeraehccoalaosttnnpmhfieptinCanatlaeydrfitoenrhtsoeuayrnfauolnuilclrleanhpeosporsrmomoeverdeaiidnncjdaculorsyt, dtddpraeehaaidsryylueoycrauitvngaiedhbmaaldoie9alsu,0kyyntislahtalmyeddfdooaaoiuurynlnuytutirhsnaseefim.ao2nor1gFhusooentsfraatpcctihihhtfloariosoltropyf,u.itgtcahYhheeneod1c6u6a01a0rs0aettl,hso cipdtaioonlarrslytutyarshttaieeinssortcnasee;p;qyauaolrriatsapinolfmdiccesionusavrlptegerleaesircnymhda;bmspsobauuaupttnlphpdalaointleecioyseege;nystt;lrsapaebhhnroosyvr-s-mai-e- pCdcasrilphniasoevicuecmausmkstsep.es'lwsopOyiylrotcea,uhunrrr,iyrfmoMeybanueaotydrsuieeicbdmanaerspreuolyernooieayunrynmrsooeduuprrnrrepteidr,ommirpvatyalrhyotoyroeuyourpeuirargnyshuetror- on^fuprnmseiidnhigciachlaelrryea,npepyhcypesrsisocavarilydetpdhaerbrtay-ptyai,mheaonsmkdeilled ydrouugspaayndparrtesopfittehcearceo.stofoutpatient minoBsneutrhsaunyrceoeunyrootMuetndoioccwaanrcheealvceoavnueynrtaihgleeatlhbteehgins. 5 6 ShoppingFor Private Health Itisalsounlawfulforcompaniesor ^ EmployerGroupInsurancecoverage Insurance agentstosuggestthattheyrepresent cansometimesbecontinuedorcon- theMedicareprogramoranyFederal vertedtoasuitableindividualMedi- Ifyouarethinkingaboutbuyinghealth agency. care-supplementpolicywhenyou insurancetosupplementMedicare, shop Ifyouthinkyouhavebeenthevictim reachage65. Carefullycheckthe carefully: oftheseoranyotherillegalinsurance priceandthebenefits, including Contactseveraldifferentcompanies salespractices, contactyourState benefitsforyourspouse. Usually, andcomparetheirpolicies. InsuranceDepartment, employercontinuedorconverted Donotbuymorepoliciesthan Note: Peoplewithlowincomeswho groupinsurancehasnowaiting areeligibleforMedicaidgenerallydo periodsorpre-existingcondition Checkfor"pre-existingcondition notneedinsurancetosupplement exclusions. exclusions"(policiesthatwillnotpay Medicare. 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Ifitasksforyourmedicalhistory, do not omit any information that could result in the denial of future claims or cancellations of the policy. Get an outline of the coverage. The agent or company should give you a clearly worded summary of the policy. Companies must give you at least 30 days to review a Medicare Sup- plemental policy. If you decide you do not want to keep the policy, you can send it back within the 30 days and get a full refund of your premi- um. Do not pay cash. Always pay by check, money order, or bank draft made payable to the company. For More Information If you have questions about how to enroll in Medicare, visit or write any Social Security office. If you have questions about what Medicare covers, call the local Medicare carrier. Questions about supplemental health insurance policies can be an- swered by your State Insurance Department. 3 fimS DDLLEfifl 4 U.S. Department of Health and Human Services Social Security Administration SSA Publication No. 05-10014 January 1991 ICN 452300 •iX U.S. GOVERNMENT PRINTING OFFICE 1991: 281-914/40003