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Shopping for Medicare Supplement Insurance

1. What is Medicare Supplement Insurance?

2. How Do I Know if I Need Medicare Supplement Insurance?

3. Standard Plans and Basic Benefits

4. What is it Going to Cost?

5. Frequently Asked Questions

6. Where Can I Buy A Policy?

Medicare are costs that you must pay yourself.

• A Medicare Supplement insurance policy may cover some, but not all, of the gaps in

your original Medicare Part A and Part B coverage.

• Medicare Supplement insurance does not cover long-term care (care in a nursing home),

vision or dental care, hearing aids, eyeglasses and private-duty nursing.

• Medicare Supplement insurance policies are sold by private insurance companies.

• Medicare doesn't pay any of the cost for you to get a Medicare Supplement

insurance policy.

A full description of basic and extra benefits covered under Medicare Supplement insurance

policies can be found in Medicare's publication, "Choosing a Medigap Policy." Contact

• New Medicare Supplement insurance policies don't cover drugs, but you can join a

Medicare Prescription Drug Plan (Part D) to add drug coverage.

• Medicare Supplement (or Medigap) insurance is not the same as Medicare Advantage

(Part C). Medicare Advantage plans include Part A, Part B, and usually other coverage

like Medicare prescription drug coverage (Part D), sometimes for an extra cost. Medicare

Advantage plans are run by private insurance companies approved by and under

contract with Medicare. To choose a policy that best meets your needs, first get a full

include text that clearly identifies it as “Medicare Supplement Insurance.” The

standardized Medigap policies that insurance companies offer must all provide the

same benefits. Generally, the only difference between Medigap policies sold by different

insurance companies is the cost.

• For more information, see “Choosing a Medigap Policy”:

https://www.medicare.gov/Pubs/pdf/02110-Medicare-Medigap-guide.pdf

2. How Do I Know if I Need Medicare Supplement Insurance?

You may not need a Medicare Supplement insurance policy if you have any of the following:

Medicaid (Title 19): If you have Medicaid you do not need Medicare Supplement

insurance, because Medicaid will pay for your share of Medicare-covered health care

covered by your working spouse's health insurance, you may not need a Medicare

Supplement insurance policy. Retirees with group health plans from their employers may

consider switching to individual Medicare Supplement insurance policies. If you are in

this situation, it is important to review each option before making a decision. Group

retiree plans may not cost anything, or the cost may be lower than buying an individual

Medicare Supplement insurance policy.

Qualified Medicare Beneficiary (QMB) program: The QMB program was designed to protect

low-income Medicare recipients from some of the burden of Medicare out-of-pocket costs. It

pays Medicare premiums and other out-of-pocket costs.

Other types of health insurance: Medicare Supplement insurance policies may not be needed

period.” A “benefit period” begins the day you go to a hospital or skilled nursing facility (SNF).

The benefit period ends when you haven't received any hospital care (or skilled care in an SNF) for

60 days in a row. If you go into a hospital or an SNF 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. Deductibles for medical bills under Medicare

Part B are applied one time per calendar year.

Co-insurance: The percentage of hospital and medical bills you pay after Medicare pays their

portion and your deductibles have been met. For example, you may pay 20% of the Medicare-

approved amount for some services after you meet the deductible. Some Medicare Supplement

insurance policies will pick up the difference, which can be significant. A Medicare Supplement

Medicare Supplement insurance plans are identified by letters. The plans are "standardized.”

Each plan offers the same basic benefits regardless of which insurance company is offering the

policy. This allows you to compare policies, so you can choose which one best meets your health

care and financial needs.

What are the basic benefits?

All Medicare Supplement Insurance plans cover at least some portion of hospitalization

expenses, medical expenses, blood and cost-sharing for all Medicare Part-A eligible hospice and

respite care expenses.

4. What Does Medicare Supplement Insurance Cost?

The Vermont Department of Financial Regulation reviews and approves rates (also known as

premiums) for each insurance company and each Medicare Supplement insurance policy that

Note: Rates will increase over time.

Rates are different from one insurer to the next for the same Medicare Supplement

insurance plan. Rates change often so you may be charged a rate that differs from the

rate in this publication. For this reason, it is important to call several insurers and have

them send information to you for comparing rates and coverage.

Medicare Supplement insurance policy monthly rates are effective January 1, unless otherwise

noted.

• Medicare Supplement Plans — For people age 65 and Older

• Medicare Supplement Plans — For people who are disabled and under age 65

5. Frequently Asked Questions

Understanding these protections can help you make a more informed choice. You have

the following rights and protections:

• Insurance companies are required by law to sell you a policy if you buy it during your

"Initial Enrollment Period." Your initial enrollment period begins on the first day of the

month in which you are both 65 (or older) and enrolled for benefits under Medicare Part

B. The initial enrollment period lasts for 6 months. This is the case even if you have

health problems.

• Your health information privacy is protected.

• Once you buy a Medicare Supplement insurance policy, the insurance company must

keep renewing it, provided you pay your premium. This is called "guaranteed renewal."

The company cannot change what the policy covers and cannot cancel it unless you

don't pay the premium. The company can increase the premium for everyone, but not

for certain individuals.

• Insurance companies and agents are prohibited from selling you a second Medicare

Supplement insurance policy.

• You have certain rights under state and federal law to appeal Medicare Supplement

insurance coverage decisions you think are wrong.

Medicare Supplement insurance policy within a specific time period.

• Insurers are prohibited from requesting, requiring, or purchasing genetic information.

• To buy a Medicare Supplement insurance policy, you must have Medicare Part A and

Part B.

• A Medicare Supplement insurance policy covers one person. If you and your spouse

both want coverage, you each need to buy separate policies.

• Many Medicare Supplement insurance policies are accepted by health care professionals

throughout the country; this is an advantage if you travel or live part of the year out-of-

countries.

When is the best time to buy a policy?

The best time to buy a Medicare Supplement policy is during your initial enrollment period.