Medicare Supplement
Medicare supplemental insurance (also called Med Sup or Medigap insurance) is a private insurance that helps pay health care expenses that Medicare covers in part or not at all. Medicare supplements can provide coverage for Medicare deductibles, co-insurance amounts and, on some occasions, expenses not eligible under Medicare.
In North Dakota, consumers can currently purchase one of 10 different standardized supplement plans offered by private companies. The plans have letter designations.
- You should only buy one supplement.
- If you decide to switch plans, do not cancel the old policy until you have received the new one.
- Each beneficiary is offered an open enrollment period where the company cannot turn you down for coverage. The six-month open enrollment period begins when you are 65 or older and are enrolled in Part B of Medicare.
- After this six-month open enrollment period, you can still apply for a supplement; however, you may be subject to underwriting where the company can turn down your application.
- There are other situations that give you a guaranteed issue right to buy a supplement policy outside this open enrollment period. One situation is when you have employer group health coverage that ends; the other involves leaving a Medicare Advantage plan for the first time during the 12-month trial period. There may also be other circumstances.
- Benefits are identical for all Medicare supplement plans of the same type; this is called standardization.
- Premiums vary by company; therefore, it is important to compare companies.
- Know the difference between the attained age at which the premium will increase annually and the issue age where the premium will be based on the age that you purchased your policy. There is another category called no age where everyone pays the same premium regardless of their age.
- The North Dakota Insurance Department monitors and approves rates charged by supplement companies.
Medicare Advantage Plans
Medicare Advantage plans are available from private companies that contract with the Centers for Medicare and Medicaid Services to provide Medicare benefits to enrollees.
Here are some general features of the Medicare Advantage Plans:
- The plan must provide all benefits that are provided by Medicare; however, they can reimburse each benefit at a different level
- The plan may provide additional benefits than Medicare
- Residents must live in the plan's service area
- Members must have Medicare Part A and B
- Members must not have end stage renal disease
- Members may pay the plan a monthly premium
- Members usually charge a co-payment or co-insurance for services rendered
- Some Medicare Advantage plans offer prescription drug coverage
- Claims go directly to the Medicare Advantage company and bypass Medicare
- Medicare Advantage plans are NOT supplements
Is Medicare Advantage right for me?
- Do my doctors and hospitals accept the plans terms and conditions?
- Do I need a referral to see a specialist?
- What costs are involved in the plan?
- Can I afford the annual out-of-pocket limit?
- If I am not satisfied with the Medicare Advantage plan, will my supplement take me back?
As written by North Dakota Department of Insurance
