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Frequently Asked Questions

What is Original Medicare?

Standard Medicare, Part A and Part B, is known as Original Medicare. It is a federal health insurance for people age 65 and older, under age 65 with certain disabilities, and any age with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant) who are a US citizen or have been a permanent legal resident for at least 5 continuous years, regardless of your income. Original Medicare (Part A and Part B) covers many health care services and supplies, but there are many costs and co-payments (gaps) it doesn’t cover.

What is Medicare Part A ?

Sometimes referred to as Hospital Insurance, medicare Part A covers inpatient hospital, skilled nursing facility, home health care and hospice care. Part A also pays for all but the first three pints of blood in a calendar year. There is a deductible per benefit period and co pays required after 60 days in the hospital. A Benefit period is the time spent in the hospital and 60 days after your release. It is possible to have to meet more than one deductible within a calendar year which could result in sizable out-of-pocket expenses.

What is Medicare Part B?

Sometimes referred to as Medical Insurance, medicare Part B covers reasonable and necessary medicare medical services, including doctors’ services, laboratory and x-ray services, durable medical equipment (wheelchairs, hospital beds etc.), ambulance services, outpatient hospital care, home health care, blood and medical supplies. In most cases, Medicare Insurance pays 80 percent of the cost of covered services. Medicare Part B also pays for some preventive services. The deductible is less expensive than Part A and is based on a calendar year.

What is Medicare Part D?

Medicare Part D is the name for the Medicare Prescription Drug Program which began in 2006. Under Part D, the Centers for Medicare and Medicaid Services (CMS) contracts with private insurance companies to provide prescription drug benefits to Medicare beneficiaries. In order to get benefits under Medicare Part D, Medicare beneficiaries must enroll in one of the Medicare Part D plans offered by these private insurance companies (there are many plans available to choose from). Beneficiaries must pay premiums, deductibles and co-payments set by the plans.

What is Medigap Insurance and Why do I Need It?

Most Medicare recipients need additional coverage for the items that Medicare does not cover (gaps in coverage). Medigap insurance helps pay some of these health care costs (such as copayments, coinsurance, and deductibles) that Medicare won’t pay. These medicare supplement plans are sold by private insurance companies. Every Medigap insurance policy must follow Federal and state laws designed to protect you. Insurance companies can only sell you a “standardized” Medigap policy designated by letters A through N (non-inclusive). If you are in Original Medicare and you have a Medigap policy, Medicare will first pay its share of the Medicare approved amounts for covered health care costs, after that your Medigap policy pays its share.

What types of Medigap Insurance can Companies sell?

Insurance companies can only sell you a “standardized” Medigap policy. These policies must have specific benefits for easy comparison. Insurance companies that sell Medigap policies don’t have to offer every Plan (A through N). However, they must offer Basic Plan A.

When is the best time to buy a Medigap policy?

The best time to buy a Medigap policy is during your Open Enrollment Period. This period lasts for 6 months and begins on the first day of the month in which you and your spouse are 65 or older and enrolled in Medicare Part B. During this period, an insurance company can’t use medical underwriting. This means the insurance company can’t refuse to sell you any Medigap policy it sells or make you wait for coverage to start. They are not allowed to charge you more for a policy because of your health problems during this open enrollment period.

What is a Guaranteed Issue Right?

Guaranteed issue rights (also called “Medigap protections”) are rights you have in certain situations when insurance companies are required by law to sell or offer you a Medigap Insurance plan even if you have health problems (called “pre-existing conditions”). A pre-existing condition is a health problem you have before the date a new insurance policy starts. In these situations, an insurance company must sell you a Medigap policy and cover all your pre-existing conditions. They can’t charge you more for a policy because of past or present health problems.

Why is it Important to buy a Medigap Policy when I am First Eligible?

If you apply during your open enrollment period you can buy any Medigap policy the company sells, even if you have health problems (pre-existing conditions), 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 policy at all if you don’t meet the medical underwriting requirements.

How do Insurance Companies set Prices for Medigap policies?

Each Medigap insurance company decides how it will set the price, or premium, for its Medigap policies. It is important to ask how an insurance company prices its policies. The way they set the price affects how much you pay now and in the future. Medigap policies can be priced or “rated” in three ways -Community-rated (also called “no-age-rated), Issue-age-rated and Attained-age-rated.

What is Community Rated (no age rated)?

Monthly Premium costs are the same regardless of age. They can increase because of inflation.

What is Issue Age Rated?

Monthly Premiums are based on your age at the time you buy your policy. Premiums are lower for those who buy at a younger age and won’t change as you get older. They can increase because of inflation.

What is Attained Age Rated?

The monthly premiums are based on your current age so your premiums go up as you get older. The cost may be the least expensive at first but they can eventually become the most expensive. Premiums can increase because of inflation.

How can I Compare Medigap Costs ?

The cost of Medigap Insurance policies can vary widely. There can be large variations in the premiums that different insurance companies charge for exactly the same coverage. Fill out the medigap quote form on this page to get precise quotes. Based on the information you provide us, we can target and compare the best Medicare Supplement Plan for you. You will receive a quote in just seconds.

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