Medicare Supplement "PLANS" help fill the 'gaps' not covered in Original Medicare "PARTS" A and B. They may cover some or all costs that Medicare Parts A and B do not cover.
When you can join
You can buy a Medicare supplement policy any time after you turn 65 and join Medicare Part B, however, it may be in your best interests to purchase during your Initial Enrollment Period where you can join any plan without medical underwriting.
Open Enrollment Period
Six-month period beginning on the first day of the month in which you are both 65 or older and enrolled in Medicare Part B.
Medicare will guarantee you the right to buy any Medicare supplement policy available where you live during this 6 months.
How you sign up
Each insurance company handles its own enrollment. Once you have selected which plan and company you want, you can contact that company to enroll.
Call or contact us and we will review all of the Medigap plans and companies.
We will assist you in completing all the required enrollment forms for the company you choose and ensure proper submission.
Can you be denied
After your open enrollment period ends, insurers can refuse coverage or charge you a higher premium based on your health, or make you wait to get coverage for an illness you currently have.
There are certain limited situations in which you have the right to buy a policy regardless of your health, after your open enrollment ends.
1. We can review your benefit options and benefits you want, and then decide which of the Medigap plans meets your needs.
2. Show you which insurance companies sell the Medigap policy plan type in West Virginia.
3. Compare costs, rates of the companies and Medigap Plans you are interested in. Remember, Medigap Plan benefits within a plan are identical from company to company. The only difference is the cost the company charges you.
4. Enroll. We will fill out and complete the application ensuring that all documents are submitted properly to the company you have chosen.
MOUNTAIN STATE SENIOR
103 6TH AVE
ST ALBANS, WV 25177
The federal government has 10 different Medicare supplement plans, named with letters from “A” to “N.” (These letters have no relationship to the Medicare Part A, B, C and D designations.) The different types vary in which gaps in coverage they fill. To keep it simple, all policies with the same letter offer the same benefits. Medigap Plan F provides and covers the exact same benefits no matter which company you choose.
Mountain State Senior Insurance Services represents the top Medigap Plans and companies in offering Medicare Supplement plans in West Virginia, including: AARP, UnitedHealthCare; Aetna, Continental Life; Cigna; Mutual of Omaha, Omaha Insurance Company; Highmark; Humana; Central States Indemnity and Medico.
How it works
To help pay the costs that Parts A and B do not cover, many people purchase Medicare supplement policies. These policies cover some or all of the expenses that Medicare Parts A and B do not cover and will be labeled Plan A, B, C, D, F, G, K, L, M or N.
Medicare supplement policies are not a government benefit, like Parts A and B. They are insurance policies sold by private insurance companies. A Medigap policy is different from
a Medicare Advantage Plan (like an HMO or PPO) because those plans are ways to get Medicare benefits, while a Medigap policy only supplements the costs of your Original Medicare benefits.
Which providers you can see
In general, a Medicare supplement policy only helps you with your cost sharing for Parts A and B, like deductibles, copays and coinsurance. They don’t cover long-term care (like nursing home care), routine vision, dental or hearing care, hearing aids, eye glasses, or private-duty nursing.
What you WILL NOT get help with
In general, a Medicare supplement policy only helps you your cost sharing for Parts A and B, like deductibles, copays and coinsurance. They do not cover long-term care, vision, dental, glasses or private duty nursing.
As a general rule, the more generous the coverage, the higher the premium. Plan F for example, offers the greatest coverage and would therefore cost more than the rest of the Medigap Plans. Even for exactly the same coverage, however, premiums for Medicare supplement policies can vary widely from company to company. This is very important to keep in mind as Medicare supplement premiums may also rise over time, after you have bought the policy.
All Medicare supplement policies provide an additional 365 days of hospital care during your lifetime, beyond your Medicare lifetime reserve. No Medicare supplement policy covers days in a skilled nursing facility beyond the 100 days Part A pays for.
As a rule, there are no geographic limits on where you receive the care covered by your Medicare supplement policy, as long as the care is received in the United States. Some policies do offer coverage of some
emergency care outside the United States.
Some companies offer high deductible versions of plan F. With these plans, you’ll pay the plan’s deductible first, before the plan begins covering any of your expenses. Plans C and F pay the Medicare Part B deductible ($147 for year 2014).
Plan N requires Part B copays to cover office visits and trips to the emergency room.
Plans K and L use coinsurance to split costs between you and the insurance company until you reach your out-of-pocket limit.
As we have seen and illustrated above, the cost of Medigap policies can vary widely. There can be big differences in the premiums that different insurance companies charge for exactly the same coverage. As you shop for a Medigap policy, be sure to compare the same type of Medigap policy, and consider the type of pricing used.
In other words, make sure to compare Plan F or G or N from one company to Plan F, G or N from another company. You can find out which insurance companies sell Medigap policies in West Virginia by visiting www.medicare.gov/medigap or the West Virginia Insurance Commissioner's Office.
The cost of your Medigap policy may also depend on whether the insurance company does any of the following:
• Offers discounts (like discounts for women, non-smokers, or people who are married; discounts for paying yearly; discounts for paying your premiums using electronic funds transfer; or discounts for multiple policies).
• Uses medical underwriting, or applies a different premium when you do not have a guaranteed issue right, or are not in a Medigap Open Enrollment Period.
• Offers a “high-deductible option” for Medigap Plan F. If you buy Medigap Plan F with a high-deductible option, you must pay the first $2,140 (in 2014) of deductibles, copayments, and coinsurance not paid by Medicare before the Medigap policy pays anything. You must also pay a separate deductible ($250 per year) for foreign travel emergency services.
• If you bought your Medigap Plan J before January 1, 2006, and it still covers prescription drugs, you would also pay a separate deductible ($250 per year) for prescription drugs covered by the Medigap policy. And, if you have a Plan J with a high deductible option, you must pay a $2,140 (in 2014) deductible before the policy pays anything.
The best time to buy a Medigap policy is during your Medigap Open Enrollment Period. This period lasts for 6 months and begins on the first day of the month in which you’re both 65 or older and enrolled in Medicare Part B (Medical Insurance). Some states have additional Open Enrollment Periods including those for people under 65. During this period, an insurance company can’t use medical underwriting. This means the insurance company can’t do any of these because of your health problems:
• Refuse to sell you any Medigap policy it offers
• Charge you more for a Medigap policy than they charge someone with no health problems
• Make you wait for coverage to start
If you buy a Medigap policy when you have a guaranteed issue right, the insurance company cannot use a pre-existing condition waiting period.
It’s very important to understand your Medigap Open Enrollment Period. Medigap insurance companies are generally allowed to use medical underwriting to decide whether to accept your application and how much to charge you for the Medigap policy. However, if you apply during your Medigap Open Enrollment Period, you can buy any Medigap policy the company sells, even if you have health problems, for the same price as people with good health. If you apply for Medigap coverage after your open enrollment period, there’s no guarantee that an insurance company will sell you a Medigap policy if you don’t meet the medical underwriting requirements, unless you’re eligible because of one of the limited situations listed here.
It’s also important to understand that your Medigap rights may depend on when you choose to enroll in Medicare Part B (Medical Insurance). If you’re 65 or older, your Medigap Open Enrollment Period begins when you enroll in Part B and it can’t be changed or repeated. In most cases, it makes sense to enroll in Part B and purchase a Medigap policy when you’re first eligible for Medicare, because you might otherwise have to pay a Part B late enrollment penalty and you might miss your Medigap Open Enrollment Period. However, there are exceptions if you have employer coverage.
If you have group health coverage through an employer or union, because either you or your spouse is currently working, you may want to wait to enroll in Part B. This is because benefits based on current employment often provide coverage similar to Part B, and you would be paying for Part B before you need it, and your Medigap Open Enrollment might expire before a Medigap policy would be useful.
When the employer coverage ends, you’ll get a chance to enroll in Part B without a late enrollment penalty which means your Medigap Open Enrollment Period will start when you’re ready to take advantage of it.
If you enrolled in Part B while you still had employer coverage, your Medigap Open Enrollment Period would start, and unless you bought a Medigap policy before you needed it, you would miss your Open Enrollment Period entirely. If you or your spouse is still working and you have coverage through an employer, contact your employer or union benefits administrator to find out how your insurance works with Medicare.