Know Your Rights About Purchasing Medigap Coverage

Agents owe you a duty of honesty, good faith, and fair dealing. Agents are specifically prohibited from doing the following:

• Using high pressure tactics (selling insurance through threat or undue pressure)
• Twisting (inducing you to give up or replace an existing policy for a new one)
• Overloading (selling you more insurance than you need or want)

Agents are required to give you an outline of coverage during the first presentation of an insurance product. The outline must inform you that HICAP is available for insurance counseling free-of-charge and tell you how to reach your local HICAP office.

If you decide to fill out an application, the agent is prohibited from taking more than one month's premium with the application unless the policy is "field-issued". Field-issued means that the agent has the authority to issue the policy to you at the same time you fill out the application. That is the only time the agent may collect more than one month's premium with the application.

After the policy is mailed or delivered, you have a 30-day free look to examine the policy and to decide if you want to keep it. If you return the policy within 30 days, all of your money must be refunded.

Always document the date you received the policy and the date you return the policy to the insurance company or the agent.

Buy a comprehensive Medicare Supplement policy that has the most benefits for the amount you can afford. Make sure to consider the following before purchasing insurance:

• Comparison shop!
• Call your local Department of Insurance to verify if the agent is properly licensed.
• Decide what you need and want before you sit down with the agent.
• Do not be rushed into buying insurance.
• Set the place, the beginning, and the ending time of your meeting.
• Get a second opinion before you buy or replace insurance.
• Do not buy anything you did not intend to purchase or do not want.
• Do not replace an existing policy unless you can not afford it or the benefits no longer meet your needs.
• Do not pay more than one month's premium when you apply unless the policy is field-issued.
• Do not pay cash. (Do not write a check payable to the agent. Write the check payable to the insurance company).
• Do not be intimidated.
• If you feel unsure or uncomfortable DON'T DO IT!

Standard Medicare Supplement Benefits

Medicare Supplement insurance can be sold in only ten standard plans. The chart below shows the benefits included in each plan. (For more details click here.)

Federal Brochure for Choosing a Medigap Policy

Basic Benefits are included in all plans. They include:

• Hospitalization, Part A coinsurance plus coverage for 365 additional days during your lifetime after Medicare benefits end.
• Medical Expenses, Part B coinsurance generally (20% of Medicare approved expenses).
• Blood, first three pints of blood each year.
• Hospice Care, Covers Part A Coinsurance year.

* Plan F also has a high deductible options, some companies may offer this option.

Standard Medicare Supplement Benefits

The basic benefits (also known as the "core benefits" or Plan A) are the minimum coverage you may buy. These are the only benefits in Plan A. Every other plan contains these three benefits as the "core" and then adds one or more additional benefits.

1. Hospitalization: Medicare Part A pays for hospitalizations for the first 60 days, but only pays a portion of the daily costs from the 61st day through the 150th day. You must pay the coinsurance amounts for those days. This Medicare Supplement benefit pays the coinsurance amount and an additional 365 lifetime days.
2. Blood: Medicare pays for all blood that is medically necessary except for the first three pints in each calendar year. This Medicare Supplement benefit pays for the first three pints of blood not paid for by Medicare.
3. Medical Expenses: Generally Medicare Part B pays for 80% of a predetermined amount (called the "Medicare approved" amount) for each procedure, supply, or service billed by your doctor or other provider that is not a hospital. This Medicare Supplement benefit pays the coinsurance generally (20% of the "Medicare approved" amount) under Medicare Part B.

There are five additional benefits that are combined with the basic benefits in various ways to make up the nine remaining plans called Plan B through Plan N.

1. The Part A Deductible: The Medicare Part A deductible is the expense for which you are obligated to pay when you are admitted to a hospital as an inpatient. Medicare pays eligible benefits above that amount. (The Medicare Part A deductible amount may change yearly, so check the current handbook1). This Medicare Supplement benefit reimburses you the deductible amount, no matter what the amount may be. This benefit is included in Plans B through N.
2. Skilled Nursing Coinsurance: Medicare Part A pays for the first 20 days of care in a skilled nursing facility following hospitalization, but requires you to pay a coinsurance beginning on the 21st day through the 100th day. This Medicare Supplement benefit pays the coinsurance amount beginning on the 21st day. This benefit is included in Plans C through N.
3. Part B Deductible: The Medicare Part B deductible is the amount you must pay each year for medical expenses (such as doctor fees) before Medicare begins paying. (The Part B deductible amount may change per year). This Medicare Supplement benefit reimburses you the deductible amount. This benefit is included in Plan C and Plan F.
4. Part B Excess Charges: Medicare Part B pays 80% of a predetermined amount (called the "Medicare approved" amount) for each procedure performed by your doctor or other medical care provider. If your doctor accepts Medicare "assignment", the provider may only bill you for the difference between the amount paid by Medicare and the amount approved by Medicare.

   If your doctors do not accept Medicare assignment, they may bill you for the difference between the amount paid by Medicare and the amount they can legally charge you (called the "limiting charge"). If you have a Medicare Supplement Policy with the following:

   • Part B Excess Charges (100%) benefit, the policy will pay the full amount billed by your doctors or other providers who do not take Medicare assignment subject to the limiting charge. This benefit is included in Plan F and Plan G.

   (Remember that this coinsurance amount is paid by the Medical Expenses part of the Basic Benefits that are part of every Medicare Supplement insurance policy).

5. Foreign Travel Emergency: The original Medicare plan does not pay for medical care outside of the United States, but some Medicare managed care plans, private Fee-for-Service plans, and some Medicare Supplement plans do. This Medicare Supplement benefit will pay 80% of your expenses for most emergency medical care in a foreign country during the first 60 days of a trip abroad after you pay a $250 deductible. There is a lifetime maximum benefit, so check your current handbook1 for the dollar amount. This benefit is in Plan C, Plan D, Plan F, Plan G, Plan M, and Plan N. Check your insurance coverage before you travel.