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Frequently Asked Questions

FAQ

WHAT IS A MEDICARE SUPPLEMENT POLICY?

A Medicare Supplement policy is basically a policy that pays the “gaps” in Original Medicare, like co-payments, coinsurance, deductibles and more.


WHAT IS A MEDIGAP POLICY?

A Medigap policy is just another name for a Medicare Supplement policy.


WHAT IS ORIGINAL MEDICARE?

Original Medicare (Traditional Medicare), is health insurance coverage, provided through the federal government.  Original Medicare includes Part A and Part B. Part A helps pay for inpatient care, which is Care you receive in a hospital when you are admitted by doctor's order and Part B is care normally received out of the hospital, for medical services, like doctor visits, outpatient surgery, etc. 


WHAT IS A MEDICARE ADVANTAGE PLAN?

Medicare Advantage is an alternative way of getting your Original Medicare Benefits.  It is managed health care, provided by private insurance companies and approved by Medicare that serves as a substitute for "Original Medicare" Parts A and B. 


WHAT IS PART C OF MEDICARE?

Part C is not a separate benefit of Medicare.  It is the part of Medicare that allows private insurance companies to provide Medicare benefits, such as HMO’s and PPO’s known as Medicare Advantage plans.


WHAT IS PART D OF MEDICARE?

Medicare Part D is also called Medicare Prescription Drug benefit.  It is a federal-government program to subsidize prescription drug costs for Medicare beneficiaries.  It is sold by private insurance companies.


WHAT IS PART A OF MEDICARE?

Basically Original Medicare consists of two parts:  Medicare Part A (Hospital insurance-like hospital and skilled nursing) and Part B (Medical Insurance).


WHAT IS PART B OF MEDICARE?

Basically Original Medicare consists of two parts:  Medicare Part A (Hospital insurance ) and Part B (Medical Insurance-like doctor and outpatient).


DO I HAVE TO USE PROVIDERS IN A NETWORK WITH A MEDICARE SUPPLEMENT POLICY?

No, there are no provider networks in Medicare Supplement policies.  You can go to any doctor, or hospital that accepts Medicare.


DOES THE ANNUAL OPEN ENROLLMENT PERIOD APPLY TO MEDICARE SUPPLEMENTS?

No, the annual Open Enrollment period (AEP) which takes place every year from Oct 15 thru Dec 7 is only for people who want to change their Part D Prescription Drug plan or their Medicare Advantage to a different plan or company.  Medicare Supplement plans can be changed anytime of the year you want to switch plans.


WHO IS ELIGIBLE TO APPLY FOR A MEDICARE SUPPLEMENT POLICY?

Medicare Supplement policies supplement Original Medicare, so you must be enrolled in Medicare Part A & Part B to be eligible for this type of policy.


WHEN CAN I APPLY FOR A MEDIGAP POLICY?

The best time to apply for a Medigap policy is during your Medigap Open Enrollment Period, which, for most people starts the 1st of the month during which you turn 65 and have Medicare Part B.  This period lasts for six months.  If you enroll during this time, you are guaranteed acceptance to any Medigap policy in your area, regardless of your health conditions.  The insurance company cannot deny your coverage or rate you up.  Actually, you can apply for a Medigap policy anytime you want outside of your Medigap Open Enrollment Period, but you very likely may have to go thru underwriting to get coverage and if you have health problems, you could be declined.  There are additional guaranteed-issue rights you have in certain situations.


WHAT IS CREDITABLE COVERAGE?

Creditable coverage normally is referring to prescription drug coverage.  Basically the Medicare Modernization Act (MMA), requires an entity that offers you drug coverage to notify you whether that prescription drug coverage is “creditable coverage” which means that it will pay, on an average,  as much as a standard Medicare Prescription drug plan.


DOES A MEDICARE SUPPLEMENT POLICY INCLUDE PART D ?

No, a Medicare Supplement policy is designed to fill the “gaps” in Medicare Parts A & B, like copayments, coinsurance, deductibles and more.  


For Part D, you would select a separate plan that offers prescription drug coverage.  This allows you the freedom to change your prescription drug plan every year during the annual Open Enrollment Period without having to change your Medicare Supplement plan.  


HOW OFTEN CAN I CHANGE MY MEDICARE SUPPLEMENT PLAN?

You can switch to a different Medicare Supplement plan anytime you want.  Many people think the annual Open Enrollment Period each year from Oct 15 thru Dec 7 is the only time they can make changes, but this period only applies to Medicare Advantage plans or Part D Prescription Drug plans.  It does not apply to Medicare Supplement plans.  The only thing to remember is you will most likely have to answer some health questions and go thru underwriting.  Never cancel your current Medicare Supplement plan, until you have been approved for coverage by the new company.   We generally shop for our customers every two years to make sure they are not paying more for their plan than they have to.


DOES ORIGINAL MEDICARE COVER EYE EXAMS?

Original Medicare does not usually cover routine vision services, such as eyeglasses and eye exams.  It will pay for some eye care services if you have a chronic eye condition, like cataracts or glaucoma.  If you are a diabetic, or a high risk for glaucoma, Medicare will cover some preventive and diagnostic routine eye care also.


WHAT IS A “GUARANTEE ISSUE PERIOD”?

A Guarantee Issue Period is a certain time period when you can buy a Medigap policy without answering any health questions or going thru underwriting.  This time period is called Medigap Open Enrollment Period.  During this time you are guaranteed acceptance.  You cannot be denied coverage in any Medigap policy in your state.  There are some other times and reasons you might qualify for “Guarantee Issue”, such as if you are retiring and losing group health insurance, or if your previous health insurance plan is being terminated, or if you move out of state or out of your plans service area, etc.


WHEN IS THE MEDIGAP OPEN ENROLLMENT PERIOD?

The Medigap Open Enrollment period is a 6 month window that begins on the first day of the month during which you are both 65 or older and enrolled in Part B.



WHY SHOULD I SIGN UP WITH AN INDEPENDENT BROKER LIKE YOU?

The right insurance broker, can literally save you time, money, and greatly reduce the frustration of making sense of all the Medicare regulations.  First of all, you need to know that you don’t pay the insurance broker…the broker is paid directly by the insurance company.  There is no negotiation with an insurance company to get a lower rate by going direct.  Premiums are the same regardless if you buy direct with an employee of the insurance company, or a broker.  


It is important to know that different insurance companies charge different rates for the exact same Medigap policy and not all insurance companies offer all Medigap plans.  This is why our customers refer so many friends and relatives to us…we make it easy to understand Medicare and your options.  We are contracted with most of the companies in all areas to be able to give you the best rates in a matter of minutes, without you having to go thru the labor intensive process of calling each company and talking to dozens of sales people to find the rates.  We are able to help you with a Medicare Supplement plan, Medicare Advantage plan, and prescription drug plans.  We will help you choose which plan fits your needs as well as your pocket book.  You will have the assurance of knowing we will review your plan and the competition each year, to make sure you never overpay for your coverage.  Our goal is always, to represent your best interest. 


WILL I GET A BETTER PRICE IF I APPLY DIRECTLY WITH THE COMPANY?

There is no negotiation with an insurance company to get a lower rate by going direct.  Premiums are the same regardless of whether you buy direct with an employee of the insurance company, or a broker. 


HOW DO I ENROLL IN MEDICARE PARTS A & B?

You can enroll in Medicare online at:  www.SocialSecurity.gov or by calling the Social Security office at:  1-800-772-1213, Monday – Friday, from 7am to 7 pm.


IS YOUR SERVICE FREE?

Yes, our service is completely FREE to our customers.  We are paid directly by the insurance companies.  Your premium is the same, whether you buy from a broker or direct from the insurance company.  The only thing you get is “personalized” service that is absolutely FREE.


DO I NEED A REFERRAL TO SEE A SPECIALISTS?

No, you do not need to have a referral to see a specialists.  There are no provider networks in a Medigap policy.  Your plan is accepted at any doctor or hospital that accepts Medicare.  


IS MEDIGAP THE SAME THING AS A MEDICARE ADVANTAGE PLAN?

No, it is absolutely not.  Medigap Policies cover the “gaps” in Original Medicare(Part A & B).       A Medicare Advantage plan (known as Part C)  is actually another way to receive your Medicare Benefits.  Medicare Advantage plans are sold by private insurance companies that are contracted with Medicare to provide at least the same benefits as Original Medicare.  If you choose to receive your Medicare benefits thru a Medicare Advantage plan, you cannot buy a Medicare Supplement or Medigap plan.  


WHAT SPECIFIC “GAPS” OF MEDICARE DOES A MEDIGAP POLICY COVER?

All Medigap plans cover these Medicare services:

- Medicare Part A coinsurance and hospital costs

- Medicare Part B coinsurance or copay

- Hospice care coinsurance or copay

- First 3 pints of blood you receive as a patient in the hospital


Some Medigap plans also cover a portion or all of the following:

- Skilled nursing care facility coinsurance

- Medicare Part A deductible

- Medicare Part B deductible

- Medicare excess charges

- Foreign travel emergency


CAN I BUY A MEDIGAP POLICY AT ONLY CERTAIN TIMES OF THE YEAR?

No, the short answer is, you can buy, or switch your Medigap policy anytime you want to, but there are better times to buy a Medigap policy than others. The best time to purchase a Medigap policy is during your one-time Open Enrollment period which is during the 6 month period of which you are 65 or older and covered by Medicare Part B.  During this 6 month window, you are “guaranteed” coverage regardless of your health conditions.  You can’t be denied coverage.  You can buy a Medigap plan at any time, but you will most likely have to go thru underwriting and could be turned down for coverage.  There are some exceptions to this.  To see all the exceptions, go to:  


WHAT IS THE DIFFERENCE BETWEEN A HMO AND A PPO?

HMO (Health Maintenance Organization) is a type of Medicare Advantage plan.  They require you to see doctors, hospitals or other facilities that are in the Plans provider network.  They also usually require you to have a referral to see a specialists, which is given by your Primary Care Physician.  You must select a Primary Cary Physician who you will see before going to a specialists.

PPO (Preferred Provider Organization) do not require you to have a referral before seeing a specialists.  A PPO does utilize a Provider Network of doctors and if you stay in that network, your out-of-pocket costs will generally be lower.  In some plans, you can use out-of-network doctors, but your copayment and coinsurance costs may be higher.


WHAT IS THE DONUT HOLE?

The “donut hole” refers to the coverage gap in most Medicare Prescription Drug plans (Part D).  It is a period when there is a temporary limit on what the drug plan will cover for drugs. 


CAN I ADD A MEDIGAP POLICY TO A MEDICARE ADVANTAGE PLAN?

No.  Since a Medigap policy is designed to cover the “gaps” in Original Medicare, you cannot add a Medigap policy to a Medicare Advantage plan, because the Medicare Advantage plan has replaced Original Medicare.


CAN I HAVE TWO MEDIGAP POLICIES?

No. It is against the law for someone to sell you a second Medigap policy unless you tell the insurance company in writing that you intend to replace your existing Medigap policy.  

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