What is covered by AARP Medicare Supplemental Insurance?

You can be certain that when you get a Medicare quote for AARP plans, you’re getting the standard coverage provided by Medigap companies.  In fact, you’ll have several to choose from.  Including:

– Medigap Plan F, which is chosen by the greatest number of Seniors and also offers the deepest, most comprehensive coverage anywhere.

– AARP offers Medicare Plan N, the newest of the Medigap plans, which offers reduced premiums.

– Medigap Plan C, which offers roughly the same coverage as Plan F, but many find to be cheaper.

Of course, not all plans are available in all areas, you when you get a Medicare supplement quote, you’ll want to ask your provider for details.

AARP Medicare Supplements are perfect for those who want set out-of-pocket costs that remain flat each year, as well as for those who want very low out-of-pocket expenses.

The other good news is that AARP Medicare Supplemental Insurance Plans have lower requirements than many other plans, so even if you’ve been denied by others, you’ll be happy to discover that AARP may accept you.

To get quotes on an AARP Medigap plan, use the free Insuriffic quote finder at the top of this page.

Medicare supplement policies typically will only reimburse you for what Medicare says is entirely necessary, and the amount that is paid are usually based on what Medicare says it will pay.  There are differences in plans, however, with some plans offering care for emergency needs if you are overseas..

Seniors can choose from 10 standardized Medicare supplement insurance plans. Each plan is represented by a letter, and offers a varied menu of benefits. Plans F, K, and L offer a high-deductible option. Plans K, L, and M have a cost-sharing component.

Medicare supplement policies are sold by private insurance companies that are licensed and regulated by the Texas Department of Insurance (TDI). Medicare supplement benefits, however, are set by the federal government. Medicare supplement policies are automatically renewed each year.

Medicare Select

Medicare Select is a type of Medicare supplement policy that generally requires you to use doctors and providers in the plan’s network for your routine care. If you use out-of-network providers, you’ll have to pay more of the cost. Insurance companies and Medicare HMOs can issue Medicare Select coverage. If you leave a Medicare Select plan, the company must offer you any Medicare supplement plan it has on the market with comparable or lesser benefits.

When Can You Join a Medicare Prescription Drug Plan?
People who have Medicare Part A and/or Part B can join a Medicare prescription drug plan between November 15, 2005 and May 15, 2006. If you don’t enroll in Medicare prescription drug coverage when first eligible and later choose to enroll, in most cases, you will pay 1% more a month in premium for every month you were eligible and did not enroll. This additional amount will be based on the current monthly premium at the time of enrollment and will be required as long as you are enrolled. People with current drug coverage considered as good as or better than the standard Medicare prescription drug coverage will not pay this higher premium penalty.

What Does Standard Medicare Prescription Drug Coverage Look Like?

• On average, you pay a $32 monthly premium for standard Medicare prescription drug coverage. Some Medicare prescription drug plans will cost less than $32 and some will cost more. *

• You pay the first $250 in drug costs also know as the annual deductible.

• After the deductible, you pay 25% of drug costs up to $500 out-of-pocket and Medicare pays 75% of drug costs up to $1,500.

• You pay 100% of drug costs up to an additional $2,850 in drug costs. This is sometimes called the
coverage gap.

• Once your total out-of-pocket expenses reach $3,600 ($250 + $500 + $2,850), Medicare pays 95% of the drug costs and you pay the greater of 5% of drug costs or $2 for generics or $5 for brand name.

*All drug plans will have to provide at least the standard level of coverage set by Medicare. Some plans
might offer more coverage and/or additional drugs.

What is Extra Help?
Individuals with limited income and resources can get extra financial help to pay for drug costs under the Medicare prescription drug coverage. People who qualify for extra help will have either reduced premiums or no premiums, reduced cost sharing amounts, and no coverage gap. The amount of extra help you receive depends upon the amount of income and assets you have.

Who Qualifies for Extra Help?
People with Medicare who also receive full Medicaid benefits, SSI recipients, and individuals enrolled in QMB, SLMB, and QI will automatically receive extra help to pay for prescription drug costs under the Medicare prescription drug coverage.

Illinois Insurance Facts
Medicare Prescription Drug Coverage and Illinois Cares Rx

Individuals at or below 150% of poverty also qualify for extra help, but must apply through the Social Security Administration (SSA) to get this help. If you need an application, call 1-800-772-1213 or TTY 1-800-325-0778. Fill it out and send it back to the Social Security Administration in the envelope they give you.

What if I have SeniorCare or Circuit Breaker Pharmaceutical Assistance?

Former Governor Blagojevich signed a law that creates a new, improved program called Illinois Cares Rx, combining and improving Circuit Breaker Pharmaceutical Assistance and SeniorCare. In order to continue to receive state prescription assistance through Illinois Cares Rx and also be eligible for Medicare prescription drug coverage, you must:
1. Apply for Extra Help from the Social Security Administration AND
2. Enroll in a Medicare prescription drug plan that is coordinating with the state.
Which Medicare prescription drug costs will Illinois Cares Rx pay for people with Medicare?
Illinois Cares Rx will pay 100% of the standard premium (not including any late enrollment fee/penalty) and the deductible for covered drugs. The participant pays $2 co-payment for generic and $5 co-payment for brand name drugs. Once the State and Medicare pays $1750 in drug costs, you pay 20% per prescription plus any required co-payments. After $5100 of total drug costs, you pay 5% co-insurance and Medicare pays 95% of the drug costs.

What if I don’t qualify for Medicare, will I still be able to have Circuit Breaker Pharmaceutical
Assistance and/or SeniorCare?
Yes, Illinois Cares Rx will provide benefits very similar to benefits currently covered by SeniorCare and CircuitBreaker Pharmaceutical Assistance for people not eligible for Medicare. Participants pay $2 co-pay for  generic drugs and $5 co-pay for brand name drugs. Once Illinois Cares Rx has paid $1,750 in benefits, you pay  20% of the cost of each prescription in additional to any required co-pays.

Cigna, Harvard Pilgrim Health Care, a number of Blue Cross Blue Shield plans as well as others are not renewing hundreds of Medicare Advantage plans.  If you are new to the Medicare world, Medicare Advantage plans are simply Medicare policies – aka, senior health plans – that are administered by private insurance companies rather than by the government.  Nearly three quarters of a million seniors will be affected by these changes, according to a consulting firm that tracks senior health statistics.  For 2011, the Kaiser Family Foundation said there will be a 13% decline in the number of Medicare Advantage plans.

Why are these companies closing down plans that covered hundreds of thousands of seniors?  You can thank a piece of legislation from 2008 that made it mandatory for these private plans to offer networks of preferred doctors.  The thought behind the law was that with a doctor network, these companies culled offer lower cost plans and, in turn, that they could reduce some of the questionable marketing tactics in which they have been engaged.  However, it has had the opposite effect:  instead of making the investment in their physicians, insurers simply decided to close down the plans and focus their efforts elsewhere.  According to several experts, the recent federal changes to the health care landscape also played a part, since the new laws include $150 billion in Advantage reimbursement costs between now and 2021.

For the next six months, though, consumers who are already enrolled in plans that will not be closed down will actually find that their premiums will stay low and that, in fact, they may have more coverage than ever before because of the government mandated changes to health care.

“It is hard to imagine these cuts to Medicare Advantage and nothing is going to change,” said Michael McCallister, chief executive of Humana. That company shuttered 31 Medicare advantage plans for 2011, but he believes that his company will continue to thrive because the firm is still offering many choices that would appeal to seniors.

Medicare Advantage is expected to bring in more than $51 billion in revenue for major health plans this year, according to an estimate provided by one reputable Wall Street firm. That revenue could fall to as low as $37 billion in the next few years as the cuts kick in,but insurers certainly will find new ways to bring in business, and sales should climb back to $51 billion by 2018.

Humana, where the program accounts for more than half of the company’s sales, says that its continued growth depends on reducing costs 15% below traditional Medicare’s payment rates.

But consumers can continue to save money on Medicare when they search for Medicare quotes online. We believe the best place to do that is at Insuriffic.com, where consumers can compare up to 4 plans in just 5 minutes.

First, a little history.  Congress created the Medicare program in 1965 in a piece of legislation called the Social Security Act.  The Medicare program is a public-run social program that ensures seniors are covered with health insurance during the point in their lives when they most need it.  In general, Americans become eligible for Medicare when they turn 65.  However, this is not set in stone, as there are several exceptions to this and people may find that they need to get Medicare Quotes online before turning 65.

If you’re not paying for Medicare coverage, who is?  Obviously, the doctors who take care of Medicare patients are getting paid from somewhere.  In this case, financing comes in the form of payroll taxes paid by companies and staff who are still working.   In addition, some of the financing is derived from premiums deducted each month from Social Security payouts.

Medicare is not actually one program – it is, in fact, broken into 4 parts:  Specifically, Part A covering hospitalization; Part B that offers medical insurance; Part C which are Medicare Advantage plans; and Part D which offers coverage for prescription drugs.

It is extremely important to note that seniors must be enrolled in medicare before they turn 65 years and 3 months old.  Because of this, experts generally suggest that seniors get quotes for Medicare and then apply for coverage three months before they turn 65 years old.   This ensures that they are covered by Medicare in the chance that you need medical coverage right around your 65th birthday.

In general, any American age 65 is eligible for Medicare if they:

- Receive Social Security benefits; or
- Receive Railroad Retirement Benefits;
- Worked in a public job where Medicare taxes were paid:
- Or if the person is a dependent parent of a deceased child who was fully insured.

If you have not yet reached the age of 65, you may still be eligible for Medicare Part A (which covers hospitalization) if:

-  You have gotten Railroad Retirement Board disability benefits for more than 2 years.
- You have  end-stage renal disease.

If you fall into either of these categories, you will not need to pay the premium for Medicare Part A.  However, you would still need to pay the premium for Medicare Part B.

Anyone who meets Medicare eligibility requirements for Part A (hospital insurance) can enroll in Medicare Part B (medical insurance) by paying a monthly premium.

Any participant who has Medicare hospital insurance (Part A), medical insurance (Part B) or a Medicare Advantage plan (Part C) is eligible for prescription drug coverage (Part D). No senior is required to pay for Medicare Part D.  However, many find that it is an investment that pays off, since prescription drug bills can add up in your later years.

If you are nearing Medicare age, you should start comparing Medicare Quotes online as soon as possible.  Insuriffic works with some of the best Medicare Supplemental insurance companies out there and has worked to negotiate the best rates and service available anywhere.  Don’t sign up for senior health policies until you have compared quotes online with Insuriffic.com.

If you are eligible, you can enroll in The Tennessee Plan coverage, commonly known as Medigap Coverage. The Tennessee Plan is a standard Medicare supplemental policy designed to fill in the coverage gaps in your Medicare Part A & B coverage.

What Kind of Gaps Do  Medicare Parts A & B Have?

In 2010, some of the charges Medicare requires you to pay include the following: •  A $1,100 deductible out of your own pocket each time you are hospitalized. •  Then $275 a day for the 61st to the 90th day in the hospital and $550 a day thereafter up to a 60 day lifetime reserve maximum.   Plus a $155 deductible for approved doctors’ bills and outpatient expenses and then you must pay an additional 20% of the Medicare approved charges after that.

You may be responsible for any amount over the Medicare approved charges from providers who do not accept Medicare assignment. Even with Medicare coverage, your out- of-pocket expenses can add up fast and cause financial difficulty. Coverage under The Tennessee Plan can help fill some of these gaps. There are 10 standard approved (by federal law) Medicare supplemental policies that can be offered. The Tennessee Plan offers benefits comparable to the Medicare Supplemental Standard Plan D.

Who is Eligible to Enroll?

Any retired State of Tennessee employee or Local Education certified teaching staff receiving a monthly retirement allowance from the Tennessee Consoli- dated Retirement System (TCRS), or higher education optional retirement plan who is eligible for Medicare Part A may apply for coverage under this Plan. Retired Local Education support staff and Local Government participants eligible for Medicare Part A who receive a monthly retirement allowance from the TCRS are also eligible to apply for coverage. Your legal married spouse and eligible dependents may also apply. If you qualify and enroll for coverage within 60 days of your initial eligibility, you cannot be denied coverage because of your age or health.

Who Administers  The Tennessee Plan?

The Tennessee Plan features Medicare supplemental coverage sponsored by the State of Tennessee with claims administered by POMCO. The Plan offers you quality coverage at lower group premium rates. Since the monthly premiums are not based on age, they will not increase just because you get older. Premium rates may increase due to increasing costs, which would happen with any plan. Best of all, if you have more than 15 years of service as a State of Tennessee employee or teacher, the State of Tennessee will pay part of your cost for your Plan coverage.

Less Paperwork – Because  Providers File Claims With The Plan, you don’t need to worry about paperwork! Most claims are filed for you by your doctors and hospitals if they have your Medicare and The Tennessee Plan member identification numbers. Claims are then sent directly to POMCO after Medicare has completed their part. This works out well for everyone. The providers are paid quickly and you avoid all the paperwork.

Of course, you should compare Medicare Supplemental Insurance quotes in Tennessee at Insuriffic.com.

Others choose to sign up for Medicare Advantage plans.  Before you hit your one-year anniversary in one of these plans you have the option of ending that coverage and returning to a Medicare plan.  The six-month clock starts running again when you re-enroll in Medicare.  If you have a pre-existing condition, you can sign up for a guaranteed issue Medicare Supplement without responding to a questionnaire about prior health history.

Different providers of Medicare Supplements have different rules around how long you can be enrolled in Medicare Advantage for before they will let you enroll in a guaranteed issue Supplement plan.  For example, although most companies will only let you switch out of your Medicare Advantage plan within the first year, several companies give you a two year window to switch back from Medicare Advantage.  As with all senior health plans, it helps to compare Medicare quotes before enrolling.

Although you may not be particularly happy if your insurer cancels your Medicare Advantage plan, one piece of good news that may come out of it is that you will be allowed to enroll in a Supplemental plan that, like those above, allows you to enroll in the plan for six months with a guaranteed issue provision, offering you coverage without a medical exam.  Regardless of your age or health, you will be covered.

If you drop group coverage involuntarily or voluntarily, you can get a Medicare Supplement with no questions asked. Some retirement health plans or group Medicare Supplement plans get expensive and people decide on their own to drop this coverage.  A person in this situation can apply for a Medicare Supplement and check of the box for “guaranteed issue”. There is some other information on the application that must be filled in correctly, so it can be helpful to have a knowledgeable insurance agent’s help.  A letter from the group plan documenting the end of coverage under that plan should be submitted with the Med Supp application.

If you have been enrolled in a Medicare Advantage plan and you move out of the plan’s service area, you can get enroll in a new Advantage plan in your new county of residence – or you can apply for a Medicare Supplement and get guaranteed issue.

The new Medicare Plan N became available on June 1st, and seniors should be thrilled.  The new plan costs about 1/4 what you would pay for Plan F, one of the plans that fills in the gaps in Medicare.  Why does Supplement Plan N cost less than other Medigap plans out there?  Because seniors will be required to pay a small $20 co-pay when they visit the doctor’s office.  Seniors also need to be prepared to pay $50 as a co-pay for emergency room visits.

Moreover, the $155 Part B deductible is not covered in Plan N, and the plan does not cover excess charges, though this won’t affect most people since their doctors charge what Medicare allows.  Other than that, all of your typical treatments (stays in the hospital, lab tests, chemotherapy, radiation, etc) are covered.  As you know, Medicare will pay the primary piece of the charge and your Medicare Supplement Plan N will cover the rest.

Insuriffic has asked representatives from several companies about when seniors are able to enroll in Medicare Supplement Plan N, and each said they plan to maintain an open policy for enrollment.  This will benefit people enrolled in Medicare Advantage Plans, who can opt out of their programs during open enrollment and switch to Plan N.  For seniors with serious preexisting conditions, this may be their only option.

When you turn 65, or when you first get Part B, you have a six month “guaranteed issue period” during which you can sign up for a Medicare Supplement without answering medical questions. This is very important for people with pre-existing conditions because they cannot  be refused a Medicare Supplement during their guaranteed issue period.

Beginning last June Medigap plans E, H, I, and J will be eliminated as the “Preventive Care Benefit” and the “At-home-Recovery” benefit are removed and these plans become identical to other lettered Medicare Supplement plans.  Medicare has deemed these two benefits unnecessary in the current Medicare structure. In addition to these changes, a hospice care benefit Co-insurance coverage will be added to all new Medicare Supplement Plans.

Current Medicare Supplement policy holders will be permitted to keep existing Medicare Supplement Insurance policies, however as of June, 2010 enrollment will cease into ALL current plans.  It is not necessarily beneficial to purchase one plan over another (purchase the one that fits) because all plans purchased after June 1st will be in the “New” Medicare Supplement Plan policy design. Existing Medicare Supplemental Insurance policies (Policy holders) will be partitioned into one group, and plans purchased after June will be partitioned into new policy groups.