14 May 2012

25 FAQs for Medicare Beneficiaries, Part 1

Posted by Jody under: Alternative Medicine .

You may be able to use your Medigap policy for certain non-Medicare covered services, if your Medigap policy covers them. Generally, however, a Medigap policy will be of little use to you while you are in a managed care plan or private fee-for-service plan.

In addition to the questions and answers below, for a copy of the Guide to Health Insurance for People with Medicare. This guide gives information on buying a Medigap policy, using Medigap insurance and other kinds of health insurance, and your rights and protections.

11.) If I choose to return to the Original Medicare Plan, can I purchase a Medigap policy?

In most cases, yes. When a managed care plan leaves Medicare, you have certain rights but must apply for a Medigap policy within certain time frames. These rights apply to all beneficiaries over age 65. If you are under age 65, these rights apply to you to the extent that Medigap policies are made available in your State to beneficiaries under age 65.

These rights are sometimes referred to as “guaranteed issue” rights. This is a good name because it means that you are guaranteed the right to buy (or “be issued”) a policy.

To get these rights, you must apply for a Medigap policy within:

63 calendar days from the date on your Final Notification Letter (which should be dated October 2, 2011); OR
63 calendar days after your managed care plan coverage ends on December 31, 2011.
If you voluntarily disenroll from your managed care plan before December 31, 2011, your 63-day guaranteed issue period will end 63 days after the date on your final notification letter, or December 4, 2011. If you remain in your plan until you are automatically disenrolled on December 31, 2011, your 63-day guaranteed issue period will end on March 4, 2012.

CAUTION: If you disenroll any time before December 4, 2011, you will still only have until December 4 to apply for a Medigap policy. If you disenroll any time after December 4, but before coverage automatically ends on December 31, you will have no Medigap protections. You should consider your options carefully if you are considering disenrolling before December 31, 2011.

If you apply for a Medigap policy within one of these two guaranteed issue periods, the seller or insurer of that policy:

Cannot deny you Medigap coverage or place conditions on the policy;
Cannot charge you more for a policy because of past or present health problems; and
Must cover you for all pre-existing conditions.
You must keep your copy of the Final Notification from your Medicare managed care plan (October 2, 2000 letter) and show it to the Medigap

Insurer as proof of your guaranteed issue rights.

Further information is available from each State?s Insurance Department or State Health Insurance Assistance Program (SHIP). The telephone number for the SHIP in your state is available.

12.) How soon will I need to make a decision about Medigap coverage?
The answer depends on your individual circumstances. Most beneficiaries should wait to make a decision until after they receive the Final Notification Letter from their managed care plan (which should be dated October 2, 2011). These beneficiaries then have 2 guaranteed issue periods to choose from, as described in Question # 11.

However, if you are getting your Medicare benefits in a managed care plan for the first time, and you enrolled within the last year, you may want to act sooner.

While you are still in the first 12 months of your first enrollment in managed care, you are entitled to broader choices of Medigap policies than are generally available to other beneficiaries who are being affected by their Medicare managed care plan withdrawals or service area reductions. (See Question #13)

CAUTION: If anyone who is NOT in their first 12-month period in managed care disenrolls and returns to the Original Medicare Plan before October 2, 2011, he/she will not have any guaranteed issue rights to purchase a Medigap policy.

13.) What are the special circumstances under which I might want to apply for a Medigap policy sooner than waiting until October, November or December?

Two groups of beneficiaries in their first 12 months of managed care enrollment are entitled to broader Medigap protections than are generally available to other beneficiaries who are being disenrolled by their managed care plan:

People who were formerly in the Original Medicare Plan with a Medigap policy that they dropped when they joined a Medicare managed care plan for the first time and are within their first 12 months of enrollment in the plan.

People who joined a managed care plan as their first choice when they first became entitled to Medicare at age 65 and are within their first 12 months of enrollment in the plan.

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