CENTERS FOR MEDICARE & MEDICAID SERVICES 2015

1 2015 choosing a medigap policy :A Guide to Health Insurance for People with MedicareCENTERS FOR MEDICARE & MEDICAID SERVICESThis official government guide has important information about:t MEDICARE Supplement Insurance ( medigap ) policies t What medigap policies covert Your rights to buy a medigap policyt How to buy a medigap policyThis guide can help if you re thinking about buying a medigap policy or already have jointly by the CENTERS for MEDICARE & MEDICAID SERVICES (CMS) and the National Association of Insurance Commissioners (NAIC) Who should read this guide? This guide helps people with MEDICARE understand MEDICARE Supplement Insurance policies (also called medigap policies).

2 A medigap policy is a type of private insurance that helps you pay for some of the costs that Original MEDICARE doesn t cover. Important information about this guideThe information in this booklet describes the MEDICARE program at the time this booklet was printed. Changes may occur after printing. Visit , or call 1-800- MEDICARE (1-800-633-4227) to get the most current information. TTY users should call 2015 choosing a medigap policy : A Guide to Health Insurance for People with MEDICARE isn t a legal document. Official MEDICARE Program legal guidance is contained in the relevant statutes, regulations, and of ContentsSection 1: MEDICARE Basics 5A brief look at 's MEDICARE ?

3 6 The different parts of MEDICARE ..6 Your MEDICARE coverage choices at a glance ..7 medigap Basics 9 What's a medigap policy ? ..9 What medigap policies cover ..10 What medigap policies don t of coverage that are NOT medigap types of medigap policies can insurance companies sell? ..12 What do I need to know if I want to buy a medigap policy ?..13 When's the best time to buy a medigap policy ? ..14 Why is it important to buy a medigap policy when I'm first eligible? ..16 How do insurance companies set prices for medigap policies? ..17 What this pricing may mean for you ..18 Comparing medigap costs ..19 What's MEDICARE SELECT? ..20 How does medigap help pay my MEDICARE Part B bills?

4 20 Your Right to Buy a medigap policy 21 What are guaranteed issue rights? ..21 When do I have guaranteed issue rights? ..21 Can I buy a medigap policy if I lose my health care coverage? ..24 Steps to Buying a medigap policy 25 Step-by-step guide to buying a medigap policy ..25If You Already Have a medigap policy 31 Switching medigap policies ..32 Losing medigap coverage ..36 medigap policies and MEDICARE prescription drug coverage ..36 Section 4:Section 5:Section 2:Section 3:4 Table of ContentsSection 6: medigap Policies for People with a Disability or ESRD 39 Information for people under 65 ..39 medigap Coverage in Massachusetts, Minnesota, and Wisconsin 41 Massachusetts benefits.

5 42 Minnesota benefits ..43 Wisconsin benefits ..44 For More Information 45 Where to get more information ..45 How to get help with MEDICARE and medigap questions ..46 State Health Insurance Assistance Program and State Insurance 49 Where words in BLUE are 7:Section 8:Section 9:15 SECTION1 MEDICARE BasicsA brief look at MedicareA medigap policy is health insurance sold by private insurance companies to fill gaps in Original MEDICARE coverage. medigap policies can help pay your share (like coinsurance, copayments, or deductibles) of the costs of MEDICARE -covered SERVICES . Some medigap policies also cover certain benefits Original MEDICARE doesn t cover like emergency foreign travel expenses.

6 medigap policies don t cover your share of the costs under other types of health coverage, including MEDICARE Advantage Plans, stand-alone MEDICARE Prescription Drug Plans, employer/union group health coverage, MEDICAID , Department of Veterans Affairs (VA) benefits, or TRICARE. Insurance companies generally can t sell you a medigap policy if you have coverage through MEDICAID or a MEDICARE Advantage you learn more about medigap policies, the next few pages provide a brief look at MEDICARE . If you already know the basics about MEDICARE and only want to learn about medigap , skip to page in blue are defined on pages 49 1: MEDICARE BasicsWhat's MEDICARE ?

7 MEDICARE is health insurance for:r People 65 or olderr People under 65 with certain disabilities r People of any age with End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant) The different parts of MEDICARE The different parts of MEDICARE help cover specific SERVICES : MEDICARE Part A (Hospital Insurance) helps coverr Inpatient care in hospitals r Skilled nursing facility, hospice, and home health care MEDICARE Part B (Medical Insurance) helps coverr SERVICES from doctors and other health care providers, hospital outpatient care, durable medical equipment, and home health care r Preventive SERVICES to help maintain your health and to keep certain illnesses from getting worse MEDICARE Part C ( MEDICARE Advantage) r Includes all benefits and SERVICES covered under Part A and Part Br Run by MEDICARE -approved private insurance companies r Usually includes MEDICARE prescription drug coverage (Part D)

8 As part of the plan r May include extra benefits and SERVICES for an extra cost MEDICARE Part D ( MEDICARE Prescription Drug Coverage) r Helps cover the cost of outpatient prescription drugs r Run by MEDICARE -approved private insurance companiesr May help lower your prescription drug costs and help protect against higher costs in the future7 Section 1: MEDICARE Basics Your MEDICARE coverage choices at a glance There are 2 main ways to get your MEDICARE coverage Original MEDICARE or a MEDICARE Advantage Plan. Use these steps to help you decide which way to get your coverage. See page 35 for information about MEDICARE Advantage Plans and medigap policies.

9 Part AHospital InsurancePart BMedical InsuranceMedicare Supplement Insurance ( medigap ) policy Part D Prescription Drug Coverage Part CCombines Part A, Part B, and usually Part D ORIGINAL MEDICAREMEDICARE ADVANTAGE PLANPart C (like an HMO or PPO)Step 2: Decide if you need to add drug coverage. STEP 3: Decide if you need to add supplemental END STEP 1: Decide how you want to get your coverage. Part D Prescription Drug Coverage (Most MEDICARE Advantage Plans cover prescription drugs. You may be able to add drug coverage in some plan types if not already included.) orSTART If you join a MEDICARE Advantage Plan, you can t use and can t be sold a medigap policy .

10 See page 2: Decide if you need to add drug 2: Decide if you need to add drug 1: MEDICARE BasicsMedicare and the Health Insurance MarketplaceThe Health Insurance Marketplace is a way for qualified individuals, families, and employees of small businesses to get health coverage. MEDICARE isn t part of the I have MEDICARE , do I need to do anything?As long as you have MEDICARE Part A coverage, you re considered covered and you don t have to get any additional coverage. If you only have MEDICARE Part B, you aren t considered to have minimum essential coverage. This means you may have to pay a fee for not having I get a Marketplace plan instead of MEDICARE , or can I get a Marketplace plan in addition to MEDICARE ?