The Obama health care plan signed this year has caused some confusion among seniors and others about how the Medicare Open Enrollment period in 2011 will be affected by the new health insurance law.  Whether you’re looking for Medigap quotes or Medicare Supplemental Insurance quotes, anyone going through the Medicare Open Enrollment period in 2011 will be affected by the bill that was signed in March.

From the idea that the government will implement death panels, to the untruths that the government will actually take away Medicare benefits, there are many misconceptions about the new rules associated with Medicare Open Enrollment in 2011.  To help clarify confusion, here are a few basic facts.

The health reform bill proposed by President Obama and passed by the Congress in March is called the Affordable Care Act. You will often hear bureaucrats referring to ACA. They mean the new health care law.Among the most immediate changes:

For example, if you had coverage for only 3 months prior to purchasing a Medigap plan, the company must subtract 3 months from any waiting period that applies.  A waiting period is limited to 6 months. Thus, if you had health coverage for 6 or more months before purchasing a Medigap plan, the company cannot impose any waiting period for pre-existing conditions.

Other Open Enrollment rights

In California, in addition to the Open Enrollment period following the effective date of your Medicare Part B, you also have the right to purchase a Medigap policy for 6 months following the events described below.

Event 1.
When you have employer-sponsored group health coverage through your own, your spouse’s, or a family member’s current employment or retirement plan, and the plan terminates, OR you lose your eligibility to continue benefits due to divorce or the death of a spouse or other family member.  The 6- month period to apply for a Medigap policy starts on the date that you receive the notice that your health benefits will end.  If you do not receive a notice in advance, then the 6-month period starts the date the benefits actually end, or the date of your first denied claim. This protection of California law applies regardless of whether your group health benefits were primary or secondary to Medicare.

You are also entitled to this protection when you have used up all the COBRA benefits for which you are eligible.  For more information on COBRA, see our fact sheet “Medicare and Other Health Insurance Coverage” at cahealthadvocates.org.

Event 2.
When you move out of the geographic area served by your Medigap plan.  For instance, if you have a Medigap you bought while living in another state that will not cover you in this state, you have 6 months to replace that policy without health screening.

Event 3.
When your health care coverage ends because of a military base closure, or because a military base no longer offers health care services, you move away from the base, or you are no longer eligible to receive health care services at that base.

Event 4.
When you lose your eligibility for Medi-Cal benefits because of an increase in your income or assets, or you are required to pay a Share of Cost before Medi-Cal will pay for your care.

Note: For the 4 events mentioned above, your choice of Medigap plans depends on your age.  If you are 65 years old or older, you can choose from all of the Medigap plans that are available for sale from any company in your geographical area.  If you are younger than 65 years old (and you do not have ESRD), you can choose A, B, C, or F. You can also choose H, I or J, or K or L, if the company sells any of those plans, but the company has the right to decide which of these plans it will sell you.

Before purchasing a Medicare supplement, visit Insuriffic.com to compare Medicare quotes.

SHIP is not affiliated with any insurance company or agency and does not sell insurance.They are staffed by a crew of volunteer counselors who have completed intensive training to offer  free and objective assistance in complete confidence.

To contact a counselor at SHIP located in Indianapolis, Indiana, call 1-800-452-4800.

The Indiana Department of Insurance has regulated the Medicare supplement industry, allowing 12 different policies to be sold in the state. Companies must be approved by the Indiana Department of Insurance to be allowed to sell Medicare Supplement policies.  To make it easier for citizens of Indiana to compare one Medicare Supplement policy to another, the state allows twelve standard plans to be sold. The plans are labeled with a letter, A through J. Not all companies sell all ten plans. It can be extremely confusing for those in the market for a Medicare Supplement quote in Indiana, as there are large variations in coverage between the twelve policies.  The Indiana Department of Insurance offers lots of detail on their website about the twelve types of policies, but those with questions can call them directly at 317-232-2385.

Here’s a quick overview of the plans sold in Indiana:

Medicare Supplement insurance is sold in 12 standard plans. As of January 1, 2006, Plans H, I, J are no longer sold with drug coverage.

Every company must sell Plan A, which is the basic plan, or the “core benefit” plan. The standard plans are labeled A through L.

Remember, the plans are standardized. So, Plan F from one company will be the same as Plan F from another company.  Then, select the supplement policy which fits your needs, and  purchase that plan from the company which offers the lowest premiums and best customer service. Core Benefit included in all plans:

• Pays Part A Hospital copayment ($275 per day for 61-90 days and $550 per day for 91-150 days in 2010)
• Pays for an additional 365 days of hospitalization after Medicare benefits end.
• Pays Part B copayment (usually 20% of the Medicare approved amount)
• Pays for the first three pints of blood per year.

You will have to pay part of the cost-sharing of some covered services until you meet the annual out-of-pocket limit. Plan K has a $4,000 out-of-pocket limit. Plan L has a $2,000 out-of-pocket limit. Once you meet the annual limit, the plan pays 100% of the Medicare copayments, coinsurance, and deductibles for the rest of the calendar year. These amounts can change each year.

For more information or to get a Medicare supplement quote in Indiana, visit Insuriffic.com.

Before enrolling for Medicare Supplemental insurance, the individual must know the current health plan they have enrolled for. The health plans that the participants will have are Medicare Part A or Part B.

Medicare Part A – Gaps

Since the Part A plan covers expenses incurred due to inpatient care, hospital fees, nursing services, hospice services and home health care, this plan is called the hospital plan. The drawback is that there are a significant number of gaps in this plan, since many costs are not covered under it.

1. There is a hospital deductable for every new illness which during 2009 stood at $1,068
2. There are coinsurance payments applicable for the hospital charges. Once the deductible amount has been paid, the plan will cover the hospital costs for 60 days and post that for the next 30 days, from day 61 to day 90, a coinsurance of $267 had to be paid by the participant as coinsurance in 2009. The payment for the next 60 days, from day 91 to day 150, the coinsurance payment in 2009 was $534.
3. The cost of staying in the hospital after 150 days has to be borne by the participant completely.
4. Skilled nursing facilities also involve coinsurance payments post a certain time limit. While the plan will cover the complete costs for this in full for the first 20 days, a daily coinsurance payment of $133.50 was applicable for this service in 2009.
5. Coverage for full time home health services.
6. Coverage for home health services when not provided by skilled professionals.

Medicare Part B – Gaps

This plan that provides coverage for many outpatient services and physician fees is also called the Supplemental Medicare Insurance. Prosthetic devices, and durable medical equipment are covered under this plan. The gaps in this plan are as follows.

1. There is an annual deductible which has to be paid before availing coverage under Plan B. The annual deductible payment for 2009 was $135.
2. There is a coinsurance payment of 20% applicable since this plan will reimburse only 80% of the total costs incurred under approved services.
3. A portion of the bill which is not covered by the Medicare Plan B should be paid by the participants.

Filling the gaps in Medicare coverage

It is recommended that the participant ensures comprehensive health coverage by opting to close the gaps in the current plan they hold. The options that one has to close the gaps are as follows.

1. Opting for programs like Medicaid, Special Low Income Medicare Beneficiary Program, Qualified Medical Beneficiary Program and Qualified Individual Program, all of which come under the umbrella of Government programs.
2. Group retirement policies which are non-standardized.
3. Medicare Supplement Plans, issued prior to July 31, 1992 which are non- standardized plans.
4. Medicare Supplement Plans, issued post July 31, 1992 which are standardized plans.

It is important for participants to know that people who have Medicaid need not avail Medigap insurance since the former will cover their healthcare expenses. QMB  can be availed by people who are within the 100% poverty level set by the federal government and not eligible for Medicaid. This plan will cover their annual deductibles, coinsurance payments and Medicare premiums.

All people should be aware of the gaps in their policy and avail the best possible option to cover these gaps to ensure they are fully covered in case of medical emergencies.

Get free Medicare Supplemental Insurance quotes now!

Medigap plans took shape in order to cover expenses that were excluded by Medicare. Private insurance providers provide these plans to compensate for the “gaps” in Medicare coverage. If you hold both the Medigap policy and Medicare coverage, then, the expenses covered for health care will be borne by both of them.

There are multiple benefits of holding a Medigap Plan.

1. You will be at liberty to choose you hospitals, health care facilities and physicians.
2. Medicare’s co-payments and deductibles will get coverage
3. Expenses from your end will be minimal

The Medigap open enrollment period is the best time to sign up for this policy. The period of six months starts from the day you reach 65 and have signed up for Medicare Part B.

The open enrollment period for Medigap, which cannot be altered, starts when you enroll for the Medicare Part B. Medical underwriting guidelines cannot be utilized by the insurance providers during this period of six months. Post these six months, the insurance providers will bring the medical underwriting guidelines to use while setting the cost of the policy and approving the coverage. And then, despite getting the coverage approved, you might have minimal options to choose from.

You will still have rights to avail Medigap coverage under certain circumstances despite the expiration of the open enrollment period. If you qualify under this category, then, the insurance companies cannot deny you Medigap coverage due to pre-existing health conditions.

You can also consider enrolling in the Medicare Advantage Plan. These plans which bear resemblance to PPOs and HMOs, are Medicare approved plans which are offered by private insurance providers. Sometimes referred to as MA plans or Part C, they are a part of the Medicare program. Each month, a certain amount is paid by Medicare to these private companies. Medicare Advantage Plans, which are not supplemental insurance, are governed by the rules of Medicare.

Enrolling in Part B and your choice of Medigap plan, once you turn 65 is highly recommended. You can be rest assured that you are well covered in case of any ailments and enjoy your retirement peacefully.

For Medigap Plan Quotes, visit the Insuriffic free quote tool.

Selecting the right plan from the ones available can be a challenging task and hence, many participants engage the services of an insurance agent to help them make the right choice. It is  imperative to have sufficient information in order to enroll in a Medigap plan that will not only offer optimum health coverage but also go easy on your pocket.

Four segments of Medicare

There are four distinct categories in the Medicare system. Medicare Part A, Part B, Part C and Part D are the four parts of this system. Based on their health conditions and financial situation, individuals can make their choice from these four.

Medicare Part A

Commonly known as hospital insurance, this type of policy is devised to reduce many of the expenses incurred during the stay in hospital. The costs incurred due to inpatient care availed, when the participant needs to be hospitalized for a long period of time are covered by Medicare Part A. A small amount of costs incurred due to home care, hospice and nursing services are also covered under this category.

Unskilled care, deductibles, coinsurance and parts of expenses not covered by this policy should be borne by the individuals itself. These “gaps” in coverage offered  by Part A coverage can be compensated by opting for Medigap plans.

Medicare Part B

Commonly referred to as medical insurance, Part B plan covers the costs of outpatient services which are offered by health care providers. Certain preventive services which curb the progress of the ailment and ensure good health of the participants are also covered under this plan. Thanks to the breadth of coverage provided by this plan, it is also referred to as Supplementary Medicare Health insurance plan.

The cost of Part B in 2009 is just $135 as compared to $1,068 for Part A during the same year. Hence, Part B is more affordable, though only the coverage may pay only 80% of the costs incurred leaving the 20% to be paid by the participants.

Medicare Part C

Plans like PPOs and HMOs, termed as Advantage Plans, are provided under Part C. Private insurance providers who have approval from Medicare provide Part C plans. These private companies offer their services directly to the individuals. Prescription drug coverage plan is offered with Part C plan which includes the coverage provided by Part A and Part B plans.

Medicare Part D

The cost of availing prescription drugs is covered under Part D. This plan is best used as a supplemental plan to the other plans provided by Medicare to lower costs of prescription drugs and even prevent them from increasing in future.

Most people find it beneficial to speak to their insurance agents to know more about the options that are available to them including options like Medigap which can cover additional costs not covered by their current plans. The insurance agents can provide them with options that are tailored to their needs and budget.

For Medicare Supplement Quotes, visit our free online quote tool.

The options under Medicare health program that you can choose include:

• Original Medicare Plan: Various services related to health care and specific drugs are covered under this plan which runs on the fee-for-service concept. Any hospital that accepts the Medicare program can be opted for under this plan. You can utilize your blue, white and red Medicare card when you obtain health care.

Though most of the services and health care supplies are covered under the Original Medicare Plan, not all costs related to health care come under its purview. Deductibles, coinsurance and co-payments are some of the costs that must be borne by you. In terms of Medicare coverage, the costs borne by you are termed as “gaps”. Medicare Supplemental Policy or Medigap policy are the options you can choose from to cover these “gaps”. Enrolling in the Medicare
Prescription Drug Plan can get you coverage for prescription drugs.

You can visit the section “What is Medicare?” in order to obtain more information about Original Medicare policy.

• Many areas offer the Medicare Advantage Plans. People who opt for these plans need not worry about availing Medigap insurance. The plans under this section include:
  • HMO (Health Maintenance Organization)
  • PPO (Preferred Provider Organization)
  • PFFS (Private Fee-for-Service) Plans
  • MSA (Medical Saving Account)
  • SMP (Special Needs Plan)

When you opt for this plan, the out-of-pocket expenses are lesser as compared to the Original Medicare Plan. Many more services are also covered under this plan. Prescription drugs are also covered by some variants of this plan. However, the only drawback is that like the HMOs or PPOs, you will have to go to one of the doctor’s or health care facilities in the specified network to keep the out-of-pocket expenses to a minimum.

For original Medicare quotes or Medicare Advantage Quotes, use our fast, free quote finder tool now.

Medicare Advantage Plans are also known as Part C plans and constitute a section of Medicare Programs. Your health care that is covered by Medicare can be availed when you opt for this plan. The coverage for prescription drugs which are a part of Part D plans may also be covered under this plan or you can register in a separate Part D plan to avail the prescription drugs coverage.

The inclusions of the Medicare Advantage Plan are:

• HMO (Health Maintenance Organizations)
• PPO (Preferred Provider Organizations)
• PFFS Plans (Private Fee-for-Service Plans)
• SNP (Special Needs Plan)
• MSA (Medical Savings Account)

You can click here, if you want to get the complete details of this plan.

Excluding Special Needs Plan that has health questions to be answered to qualify for it, there are no questions about health asked for the other plans.

All people who are eligible for Medicare can be sure of being accepted. Regardless of any health ailments, excluding End Stage Renal disease, people can register for this each year when the enrollment period opens. People who have eligibility for Medicaid and Medicare can enroll for this plan anytime during the entire year. Every time you avail medical treatment or visit a hospital or a doctor, there is co-pay involved. There is a cap on the annual put-of-pocket expenses from your end, but this does not always apply.

Health insurance card which you get with your health care plan can be utilized when you join the Medicare Advantage Plan too. Most often than not the benefits and co-payments options are much better as compared to your Original Medicare Plan. People who have opted for HMO or PPO plans should avail the services of the doctor or the hospital that is listed under the net work provided if they want to avoid high out-of-pocket expenses. Under the Private Fee-for-Service Plans, you can avail the services of any doctor or health care provider who accepts Medicare terms, conditions and assignments.

You must possess the Part A and Part B plan of Medicare if you want to enroll in the Medicare Advantage Plan. The Part B plan’s monthly premium also should be paid to Medicare. Added to this, tow avail the additional benefits offered by the Medicare Advantage Plan, you will also have to a pay a monthly premium towards it. Based on where you are located, you can also avail the facility of $0 monthly premium Medicare Advantage Plan and even get a part of your Part B premiums reimbursed. There are certain plans that are designed to cover dental and visual costs for inpatient services, doctor’s tests, hospital fees, skilled nursing, outpatient fees and many others. There are health club memberships also that are included under certain plans.

The Medigap plan will cease to work if you enroll for the Medicare Advantage Plan. There will be no co-payments, cost sharing or deductibles that will be paid by your health plan. Though, as per law you have the right to hold on to your Medigap policy, you might want to consider dropping it when you opt for the Medicare Advantage Plan.

For no-obligation Medicare Advantage Quotes, use our free tool now.

There are two ways in which you can avail benefits from the Part D plan.

• The prescription drug plan, commonly called PDPs, can be availed after you buy the Original Part D plan just to ensure coverage for costs of prescription drugs.
• The second alternative is to opt for the Medicare health plan or Medicare Advantage Plan that cover the cost of prescription drugs. Added to the coverage for prescription drugs, you can also get the Part A and Part B coverage with the Medicare Advantage Plan and are referred to as MA-PDs.

Either of these plans fall under the Medicare Drug Plans. It is recommended that you opt for the prescription drug plan from Medicare even if you do not buy prescription drugs often because people who do not avail Part D and are also not eligible for credible coverage elsewhere face the risk of penalty. In the year 2009, a 1% penalty was levied on people who did not take up the Part D coverage.

You will need to have the Part A and Part B coverage in order to avail the Medicare Prescription Drug plan. Situation when you can drop, switch or join this plan are:

• You get qualified for Medicare first
• When you enroll between November 15 and December 31, which is the annual enrollment period, the coverage commences from the first of the following month.

Beginning from the date of coverage, you have to continue the plan for an entire year. You can switch only during the Special Enrollment period if necessary.

For Medicare Quotes online, visit our free quotefinding tool.

• QMB/Medicaid/SLMB which are government programs
• Non- standardized group retirement policies
• Individual Medigap policies which are non-standardized and issued before July 31, 1992
• Individual Medigap policies which are standardized and issued post July 31, 1992.

Medigap insurance is not required for people by beneficiaries of Medicare who qualify for Medicaid because the latter will cover all their expenses related to health care. The Qualified Medicare Beneficiary program is for people who are within the 100% federal poverty level and are not eligible for Medicaid. The advantages of this program are:

• Premium payments for Medicare
• Payment of annual deductibles for Medicare
• Payment of co-insurance for Medicare

People who are eligible for QMB programs neither need nor should pay for the Medicare Supplement Insurance. Every year, in the month of April, the income figures to qualify for the program change. To know more about eligibility and enrollment for QMB and also for information on Title 19, get in touch with the local office of Department of Social Services.

For people with higher incomes who cannot enroll for QMB programs may be eligible for SLMB (Specified Low-insurance Medicare Beneficiary Program) or QI (Qualified Insurance Program). The eligibility for either QI or SLMB is for people who fall within the range of 120%-135% of federal poverty level. Only Part B program payments are made by these two programs. Hence, people who have either of these policies might also consider opting for the Medicare Supplement Insurance if it is affordable. The income figures to gain eligibility for these two programs also change annually in April and you can contact the local office of the Department of Social Services for more information.

Coverage for health insurance is offered by some employers for their retirees. There is no need for such retirees to opt for individual health insurance plans. Though some retirees may want to opt for individual plans, it is not considered to be a wise choice because they need not pay anything for the group plans which are in fact better than the individual policies. Before such retirees consider buying individual policies, they should compare quotes for Medigap policies from various companies and also think about the stability of their employer. If the retiree feels that the company is unstable or the Medigap policy offers better coverage, then, he can opt for individual policy. When the new policy has been obtained, the old policy will cease to exist.

Many Medicare beneficiaries have to opt for the Medigap Insurance since they are neither eligible for QMBs nor SLMBs and QIs. Nearly 66% of the Medicare beneficiaries purchase the Medigap policy. All Medigap policies within the United States were standardized from July 31, 1992. The 1990 Omnibus Budget Reconciliation Act passed the Congress made the process of standardization compulsory. Ten plans which are approved by the federal law can be offered as Medigap policies. In the year 2006, two more plans were added to this list. The marketing of these plans varies from one state to the other. The “core benefit” plan which is the fundamental benefit package is permissible in all states and companies that sell Medigap insurance should offer it.

There are some elderly people who are covered by non-standardized plans that were issued prior to July 31, 1992. Though such non-standardized policies cannot be purchased any longer, people can opt to retain it, which is the option chosen by most of them. However, people holding such policies should opt for standardized policies.  Any person buying the new policy which has been standardized should drop the non-standardized one to avoid duplication.

For free Medicare quotes, visit our free quote finder now.