 How do I Get Medicare
Choosing any form of coverage involving Medicare can be a daunting task. We hope the information will help you understand Medicare and its programs.
Other things to take into consideration - many people have health insurance - do those people need to apply for Medicare?
Should I apply for Medicare Part D - Prescription Drug Coverage?
Please remember that we are here to help! You may request assistance from one of our Specialists by calling 1-888-777-6851.
What is Medicare?
Medicare is health insurance for people age 65 or older, under age 65 with certain disabilities, and any age with End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant). Getting Social Security is not a qualification for Medicare. Original Medicare covers many health care services and supplies, but there are many costs ("gaps") it doesn't cover. Keep in mind Medicaid and Medicare are two different types of programs.
About Medicare and the Different Parts
The different parts of Medicare help cover specific services if you meet certain conditions. Medicare has the following parts:
Your Medicare Coverage Choices
With Medicare, you can choose how you get your health and prescription drug coverage. Below are brief descriptions of your coverage choices.
Note: If you have other health and/or prescription drug coverage from a former or current employer or union, you may have other coverage choices. This coverage may affect which Medicare coverage choice is best for you.
Medicare Advantage Plans
Medicare Advantage Plans include the following:
Medicare Advantage Plans and Medigap Policies: Please Note: If you have a Medigap policy and you are switching from Original Medicare to a Medicare Advantage Plan, you don't need and can't use the Medigap policy to cover deductibles, copayments, or coinsurance under the Medicare Advantage Plan. You may choose to drop your Medigap policy, but you should talk to your State Health Insurance Assistance Program and your current Medigap insurance company before you do because you may not be able to get it back. If you already have a Medicare Advantage Plan, it is illegal for anyone to sell you a Medigap policy unless you are switching back to Original Medicare.
Medicare Prescription Drug Coverage (Part D)
Medicare offers prescription drug coverage (Part D) for everyone with Medicare. To get Medicare drug coverage, you must join a plan run by an insurance company or other private company approved by Medicare. Each plan can vary in cost and what drugs are covered. If you want Medicare drug coverage, you need to choose a plan that works with your health coverage.
There are two ways to get Medicare prescription drug coverage: 1. Medicare Prescription Drug Plans. These plans (sometimes called "PDPs") add drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service Plans, and Medicare Medical Savings Account Plans. 2. Medicare Advantage Plans (like an HMO or PPO) or other Medicare health plans that have prescription drug coverage. You get all of your Part A and Part B coverage, including prescription drug coverage (Part D), through these plans. Medicare Advantage Plans with prescription drug coverage are sometimes called "MA-PDs."
Medicare Prescription Drug Coverage and Medigap Policies
What Medigap policies don't cover
Medigap policies don't cover long term care (like care in a nursing home), vision or dental care, hearing aids, eyeglasses, and private-duty nursing.
Types of coverage that are NOT Medigap policies
What types of Medigap policies can insurance companies sell?
In most cases, Medigap insurance companies can sell you only a "standardized" Medigap policy, as passed in the Standardization Act of 1990. All Medigap policies must have specific benefits so you can compare them easily. Insurance companies that sell Medigap policies don't have to offer every Medigap policy (Medigap Plans A through N). However, they must off er Medigap Plan A if they offer any other Medigap policy. As of June 1, 2010, if they offer any other Medigap policy, they must also offer either Plan C or Plan F. Each insurance company decides which Medigap policies it wants to sell, although state laws might affect which ones they offer. In some cases, an insurance company must sell you a Medigap policy, even if you have health problems. Listed below are certain times that you are guaranteed the right to buy a Medigap policy:
You may also be able to buy a Medigap policy at other times, but the insurance company is allowed to deny you a Medigap policy based on your health. Also, in some cases it may be illegal for the insurance company to sell you a Medigap policy (such as if you already have Medicaid or a Medicare Advantage Plan).
What do I need to know if I want to buy a Medigap policy?
When is the best time to buy a Medigap policy?
The best time to buy a Medigap policy is during your Medigap open enrollment period. This period lasts for 6 months and begins on the first day of the month in which you are both age 65 or older and enrolled in Medicare Part B, you are also able to enroll 90 days prior to your Medicare Part B effective date. Some states have additional open enrollment periods. During this period, an insurance company can't use medical underwriting. This means the insurance company can't do any of the following:
While the insurance company can't make you wait for your coverage to start, it may be able to make you wait for coverage of a pre-existing condition. A pre-existing condition is a health problem you have before the date a new insurance policy starts. In some cases, the Medigap insurance company can refuse to cover your out-of-pocket costs for these pre-existing health problems for up to 6 months. This is called a "pre-existing condition waiting period." Coverage for a pre-existing condition can only be excluded in a Medigap policy if the condition was treated or diagnosed within 6 months before the date the coverage starts under the Medigap policy. (Remember, for Medicare-covered services, Original Medicare will still cover the condition, even if the Medigap policy won't cover your out-of-pocket costs.) Even if you have a pre-existing condition, if you buy a Medigap policy during your Medigap open enrollment period and if you recently had certain kinds of health coverage called "creditable coverage," it is possible to avoid or shorten waiting periods for pre-existing conditions. Prior creditable coverage is generally any other health coverage you recently had before applying for a Medigap policy. If you have had at least 6 months of prior creditable coverage, the Medigap insurance company can't make you wait before it covers your pre-existing conditions. There are many types of health care coverage that may count as creditable coverage for Medigap policies, but they will only count if you didn't have a break in coverage for more than 63 days. If there was any time that you had no health coverage of any kind and were without coverage for more than 63 days, you can only count creditable coverage you had after that break in coverage. Talk to your Medigap insurance company. It will be able to tell you if your previous coverage will count as creditable coverage for this purpose. You can also call your State Health Insurance Assistance Program. If you buy a Medigap policy when you have a guaranteed issue right (also called "Medigap protection"), the insurance company can't use a pre-existing condition waiting period at all. Note: You can send in your application for a Medigap policy before your Medigap open enrollment period starts. This may be important if you currently have coverage that will end when you turn age 65. This will allow you to have continuous coverage.
Why is it important to buy a Medigap policy when I am first eligible?
It is very important to understand your Medigap open enrollment period. Medigap insurance companies are generally allowed to use medical underwriting to decide whether to accept your application, and how much to charge you for the Medigap policy. However, if you apply during your Medigap open enrollment period you can buy any Medigap policy the company sells, even if you have health problems, for the same price as people with good health. If you apply for Medigap coverage after your open enrollment period, there is no guarantee that an insurance company will sell you a Medigap policy at all if you don't meet the medical underwriting requirements, unless you are eligible because of one of the limited situations listed below (eligibility chart below: "An insurance company can't refuse you."). It is also important to understand that your Medigap rights may depend on when you choose to enroll in Part B. If you are age 65 or over, your Medigap open enrollment period begins when you enroll in Part B, and can't be changed or repeated. In most cases it makes sense to enroll when you are first eligible for Part B, because you might otherwise have to pay a late enrollment penalty. However, if you have group health coverage through an employer or union, either because you are currently working or your spouse is, you may want to wait to enroll in Part B. This is because employer plans often provide coverage similar to Medigap, so you don't need a Medigap policy. When your employer coverage ends, you will get a chance to enroll in Part B without a late enrollment penalty, and your Medigap open enrollment period will start when you are ready to take advantage of it. If you enrolled in Part B while you still had the employer coverage, your Medigap open enrollment period would start, and unless you bought a Medigap policy before you needed it, you would miss your open enrollment period entirely.
Comparing Medigap costs
The cost of Medigap policies can vary widely. There can be big differences in the premiums that different insurance companies charge for exactly the same coverage. As you shop for a Medigap policy, be sure to compare the same type of Medigap policy, and consider the type of pricing used. (For example, compare a Medigap Plan C from one insurance company with a Medigap Plan C from another insurance company.) Although this can't give actual costs of Medigap policies, you can get this information by calling insurance companies or your State Health Insurance Assistance Program or speak with one our Specialists. You can also find out which insurance companies sell Medigap policies in your area by completeing the request form below or call and ask to speak with a Medicare counselor. The cost of your Medigap policy may also depend on whether the insurance company does any of the following:
Offers a "high-deductible option" for Medigap Plans F and J. Remember, Plan J will no longer be for sale after May 31, 2010. If you buy a Medigap Plan F or J high-deductible option, you must pay the first $2,000 (in 2010) in Medicare-covered costs before the Medigap policy pays anything. You must also pay a separate deductible ($250 per year) for foreign travel emergency services. If you bought your Medigap Plan J before January 1, 2006, and it still covers prescription drugs, you would also pay a separate deductible ($250 per year) for prescription drugs covered by the Medigap policy.
How does Medigap pay your Medicare Part B bills?
In most Medigap policies, when you sign the Medigap insurance contract you agree to have the Medigap insurance company get your Medicare Part B claim information directly from Medicare and then pay the doctor directly. Some Medigap insurance companies also provide this service for Medicare Part A claims. If your Medigap insurance company doesn't provide this service, ask your doctors if they "participate" in Medicare. (This means that they accept "assignment" for all Medicare patients.) If your doctor participates, the Medigap insurance company is required to pay the doctor directly if you request.
Can I buy a Medigap policy if I lose (or drop) my health care coverage?
Because you may have a guaranteed issue right to buy a Medigap policy, make sure you keep the following:
You may need to send a copy of some or all of these papers with your Medigap application to prove you have a guaranteed issue right. It is best to apply for a Medigap policy before your current health coverage ends. You can apply for a Medigap policy while you are still in your health plan and choose to start your Medigap coverage the month before or after your health plan coverage ends. This will prevent breaks in your health coverage.
Please note that this is a time sensitive issue and any delay can cause uninsurability. Seek advice from a professional. Start Here.
For more information
If you have any questions or want to learn about any additional Medigap rights in your state, you can do the following:
To receive a free guide on "choosing a Medigap policy" click here
For people who already have a Medigap policy
You should read this section if any of these situations apply to you:
Would like someone to help you? Call 1-888-777-6851 or click here to request a Specialist to help.
Switching Medigap policies
If you're satisfied with your current Medigap policy's cost and coverage and the customer service you receive, you don't need to do anything. If you are thinking about switching to a new Medigap policy, below some common questions about switching Medigap policies. Can I switch to a different Medigap policy? In most cases, you won't have a right under Federal law to switch Medigap policies, unless you are within your 6-month Medigap open enrollment period or are eligible under a specific circumstance for guaranteed issue rights. But, if your state has more generous requirements, or the insurance company is willing to sell you a Medigap policy, make sure you compare benefits and premiums before switching Medigap policies. If you bought your Medigap policy before 1992, it may offer coverage that isn't available in a newer Medigap policy. On the other hand, older Medigap policies might not be guaranteed renewable and might have bigger premium increases than newer standardized Medigap policies currently being sold. If you decide to switch, don't cancel your first Medigap policy until you have decided to keep the second Medigap policy. On the application for the new Medigap policy, you will have to promise that you will cancel your first Medigap policy. You have 30 days to decide if you want to keep the new Medigap policy. This is called your "free look" period. The 30-day free look period starts when you get your new Medigap policy. You will need to pay both premiums for a month.
No. If you have an older Medigap policy that you bought before 1992, you don't have to switch to one of the standardized Medigap policies. If you buy a newer Medigap policy, you won't be able to go back to your old Medigap policy because older Medigap policies can no longer be sold.
No. You should be aware that if you have had your old Medigap policy for less than 6 months, the Medigap insurance company may be able to make you wait up to 6 months for coverage of a pre-existing condition. However, if your old Medigap policy had the same benefits, and you had it for 6 months or more, the new insurance company can't exclude your pre-existing condition. If you've had your Medigap policy less than 6 months, the number of months you've had your current Medigap policy must be subtracted from the time you must wait before your new Medigap policy covers your pre-existing condition. If the new Medigap policy has a benefit that isn't in your current Medigap policy, you may still have to wait up to 6 months before that benefit will be covered, regardless of how long you have had your current Medigap policy.
There may be many reasons why you would want to switch to a different Medigap policy. Some reasons may include the following:
It is important to compare the benefits in your current Medigap policy. To help you compare benefits and decide which Medigap policy you want, call 1-888-777-6851 or click here and we will send you the "Steps to buying a Medigap policy". If you decide to change insurance companies, you can call 1-888-777-6851 or click here to request a Specialist to speak with you. Have your Medigap policy available.
You can keep your current Medigap policy regardless of where you live as long as you are still in Original Medicare. If you want to switch to a different Medigap policy, you will have to check with the new insurance company to see if they will offer you a different Medigap policy. You may have to pay more for your new Medigap policy and answer some medical questions if you are buying a Medigap policy outside of your Medigap open enrollment period. If you have a Medicare SELECT policy and you move out of the policy's area, you have the following choices:
Medigap policies can't work with Medicare Advantage Plans. If you decide to keep your Medigap policy, you will have to pay your Medigap policy premium, but the Medigap policy can't pay any deductibles, copayments, or coinsurance under a Medicare Advantage Plan. So, if you want to join a Medicare Advantage Plan, you may want to drop your Medigap policy. However, if you leave the Medicare Advantage Plan you might not be able to get the same Medigap policy back, or in some cases, any Medigap policy unless you have a "trial right" (see guaranteed issue right). Your rights to buy a Medigap policy may vary by state. You always have a legal right to keep the Medigap policy after you join a Medicare Advantage Plan. Would like someone to help you? Call 1-888-777-6851 or click here to request a Specialist for help.
Can my Medigap insurance company drop me?
If you bought your Medigap policy after 1992, in most cases the Medigap insurance company can't drop you because the Medigap policy is guaranteed renewable. This means your insurance company can't drop you unless one of the following happens:
At the time these Medigap policies were sold, state laws might not have required that these Medigap policies be guaranteed renewable. This means the Medigap insurance company can refuse to renew the Medigap policy, as long as it gets the state's approval to cancel your Medigap policy. However, if this does happen, you have the right to buy another Medigap policy. See guaranteed issue right, or call 1-888-777-6851 or click here to put in a request to speak with a Specialist.
Medigap policies and Medicare prescription drug coverage
Medicare offers prescription drug coverage (Part D) for everyone with Medicare. If you have a Medigap policy with prescription drug coverage, that means you chose not to join a Medicare Prescription Drug Plan when you were first eligible. However, you can still join a Medicare Prescription Drug Plan. Your situation may have changed in ways that make a Medicare Prescription Drug Plan fit your needs better than the prescription drug coverage in your Medigap policy. It is a good idea to review your coverage each fall, because you can join a Medicare Prescription Drug Plan between November 15-December 31 each year. Would like someone to help you? Call 1-888-777-6851 or click here to request a Specialist to help.
Under a Medigap policy, you pay the whole premium for your prescription drug benefit. Also, most Medigap policies have a maximum amount they will pay each year for prescription drugs. In a Medicare Prescription Drug Plan, you may have to pay a monthly premium, but a large part of the cost is paid for by Medicare. There is no maximum yearly amount. However, a Medicare Prescription Drug Plan might only cover certain prescription drugs (on its "formulary" or "drug list"). It is important that you check whether or not your current prescription drugs are on the Medicare Prescription Drug Plan's list of covered prescription drugs before you join. If your Medigap premium, or your prescription drug needs, were very low when you had your first chance to join a Medicare Prescription Drug Plan, your Medigap prescription drug coverage may have met your needs. However, if your Medigap premium, or the amount of prescription drugs you use, has increased recently, a Medicare Prescription Drug Plan might now be a better choice for you.
This will depend on whether or not your Medigap policy includes "creditable prescription drug coverage." (This means that the Medigap policy's drug coverage pays, on average, at least as much as Medicare's standard prescription drug coverage.) If it isn't creditable coverage, and you join a Medicare Prescription Drug Plan now, you will probably pay a higher premium (a penalty added to your monthly premium) than if you had joined when you were first eligible. However, even with a somewhat higher premium it is quite possible that a Medicare Prescription Drug Plan could still better meet your needs at this time. You should also consider that your prescription drug needs could increase as you get older. Each month that you wait to join a Medicare Prescription Drug Plan will make your late enrollment penalty higher.
If you decide to drop the entire Medigap policy, you need to be careful about the timing. For example, you may want a completely different Medigap policy (not just your old Medigap policy without the prescription drug coverage), or you might decide to switch to a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drugs. If you drop your entire Medigap policy and the prescription drug coverage wasn't creditable or you go more than 63 days before your new Medicare coverage begins, you will have to pay a late enrollment penalty. You can join a Medicare Advantage Plan between November 15-December 31 each year. Would like someone to help you? Call 1-888-777-6851 or click here to request a Specialist to help.
Medigap policies for people with a disability or ESRD
Medigap policies for people under age 65 and eligible for Medicare because of a disability or End-Stage Renal Disease (ESRD)
You may have Medicare before age 65 due to a disability or ESRD (permanent kidney failure requiring dialysis or a kidney transplant). If you are a person with Medicare under age 65 and have a disability or ESRD, you might not be able to buy the Medigap (also called "Medicare Supplement Insurance") policy you want, or any Medigap policy, until you turn age 65. Federal law doesn't require insurance companies to sell Medigap policies to people under age 65. However, some states require Medigap insurance companies to sell you a Medigap policy, even if you are under age 65. These states are listed below. Important: These are the minimum Federal standards. For your state requirements, call your State Health Insurance Assistance Program. Would like someone to help you? Call 1-888-777-6851 or click here to request a Specialist to help. The following states required insurance companies to offer at least one kind of Medigap policy to people with Medicare under age 65:
* A Medigap policy isn't available to people with ESRD under age 65. ** A Medigap policy is only available to people with ESRD under age 65.
Even if your state isn't on the list above, some insurance companies may voluntarily sell Medigap policies to people under age 65, although they will probably cost you more than Medigap policies sold to people over age 65, and they can use medical underwriting. Check with your state about what rights you might have under state law. Remember, if you are already enrolled in Medicare Part B, you will get a Medigap open enrollment period when you turn age 65. You will probably have a wider choice of Medigap policies and be able to get a lower premium at that time. During the Medigap open enrollment period, insurance companies can't refuse to sell you any Medigap policy due to a disability or other health problem, or charge you a higher premium (based on health status) than they charge other people who are age 65.
Because Medicare (Part A and/or Part B) is creditable coverage, if you had Medicare for more than 6 months before you turned age 65, you probably won't have a pre-existing condition waiting period. For more information about the Medigap open enrollment period and pre-existing conditions, see above.
For help call 1-888-777-6851 click here to request a Specialist to talk with.
Information on this website was obtained from medicare.gov How do I get my Medicare Card? Contact Social Security. You can either call them at (800) 772-1213 or apply on line by going to www.ssa.gov/medicareonly/ |
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