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How to Choose a Medigap Company

Information about Medicare Supplement Plans

All About Medicare Supplement Plans (Medigap):

Medigap plans are an insurance policy that helps pay the medical expenses that Original Medicare doesn't cover, like copayments, coinsurance, and deductibles. Medicare Supplement Insurance policies are standardized by the government, which means they offer the same core benefits — no matter which company you choose.

Some insurance carriers of supplement plans we represent (but not limited to):

• Aetna
AllState Health Solutions

• Aflac

• UnitedHealthcare

• Bankers Fidelity

• Blue Cross Blue Shield

Capitol Life

• Cigna

• Humana

• Wellabe

• Mutual of Omaha

• Pan American Life

• Philadelphia American

Every Medigap policy must follow federal and state laws designed to protect you, and it must be clearly identified as "Medicare Supplement Insurance." Insurance companies can sell you only a standardized policy identified in most states by letters. (see chart at the bottom of this page)

Another way of saying this is, the Letter of the Plan (F, G, N) determines the benefits Not the Insurance Company!

Medigap open-enrollment period:

When you sign up for a Medigap plan during the Medigap Open Enrollment Period you can join any plan, and you won’t be charged a higher premium for health reasons.

The Medigap Open Enrollment Period is the 6-month period when you are eligible for Medicare Supplement insurance. This period starts the month you turn 65 and enroll in Medicare Part B. After this enrollment period, if you decide to change your plan, you will have to answer questions about your health.

A carrier can deny you coverage based on your answers. But different carriers also have different underwriting questions, so you may still be able to change your plan. If you are within 6 months of obtaining Medicare part B, no Medicare Supplement Insurance Carrier can deny you coverage.

How Do You Know When You Should Review Your Medigap Plan?

Besides wanting the most affordable plan offered, you may wish to review your plan for other reasons:

• Your health needs have changed:

If you are in good health you can choose a plan that has more basic coverage. If your

health has declined, then you may need a plan that offers more comprehensive

coverage, assuming you can qualify for coverage

• Your financial situation has changed:

If your budget has changed, you may want a plan with a lower premium.

• Your Medicare Supplement Insurer has sent you a notice of a premium increase. If your rates are going up , this is an ideal time to shop your plan!

Keep in mind that some carriers set premiums based on age and your Zip Code. So, the older you are generally the higher the premium will be.

Premium Discounts:

Some insurance companies increase premiums as you get older. Some may increase your rates faster than others.

Ask Golden Years Design Benefits about the rates of the individual Medigap companies to ensure your price is still competitive. Together, we can look at rate trend history. Since most policies have an annual rate increase to keep up with inflation, we can look at what type of rate increase the carrier you are considering has had over the last 3 years. Finally, we can determine if the rate increase is reasonable or higher than the competitors.

Premium Increases:

As mentioned previously, there are times when an insurance company can look at your medical history to determine eligibility for enrollment (usually after the first 6 months you have Medicare Part B.) This can result in a denial of benefits with that carrier. Golden Years Design Benefits has access to over 30 Medicare Supplement Insurance companies, and we are familiar with the different underwriting criteria offered by the different insurance companies.

Some Examples of Underwriting Questions:

Have you been diagnosed with cancer in the last two years?

Have you had a recent heart attack?

Are you taking over 50 units of insulin and have complications with your diabetes?

Ask Golden Years Design Benefits about the rates of the individual Medigap companies to ensure your price is still competitive.

Not included in Medigap coverage:

Prescription drug coverage is not included in Medigap policies. For prescription drug benefits, you will need to enroll in a separate Medicare Prescription Drug Plan (Part D). Our agents can assist you in selecting the best Part D plan based on the prescriptions you take.

To request a personalized analysis to determine which Medigap insurance carrier offers the best pricing, financial rating, and rate trend history, simply fill out our form on our website. A licensed agent will get back to you and walk you through the process and answer any questions you may have.

Tips on buying a Medicare Supplement Plan:

You must have both Medicare Part A and Medicare Part B in order to purchase a Medigap policy. You pay the private insurance company a monthly premium for your Medigap policy in addition to the monthly Part B premium that you pay to Medicare.

You can apply for a Medigap policy at any time of the year (the Medicare Fall Annual Enrollment Period for Part D and Medicare Advantage plans does not apply to Medigaps). However, medical underwriting may be used (see below).

A Medigap policy covers only one person. If you and your spouse both want Medigap coverage, you will have to buy separate Medigap policies.

Application Fee - Some companies may charge a one-time application fee (e.g. $20 or $25). Some companies may also charge a processing feeevery time you pay your premium using a credit card.

Guaranteed Issue Situations – Guaranteed issue rights are rights you have in certain situations when insurance companies are required by law to sell or offer you a Medigap policy even if you have health problems (for example, your Medicare Advantage plan is leaving Medicare or stopsgiving care in your area, or your employer group health plan is ending, etc.).

Medical Underwriting - If you have had Medicare Part B for more than six (6) months, companies do not have to sell you a policy. Once yourMedicare supplement open enrollment period ends, companies can medically underwrite. This means they can look at your medical history todetermine eligibility for enrollment, and you may be turned down. Companies cannot use medical underwriting during your first six months of Medicare Part B, or if you are in a “guaranteed issue” situation.

Non-Tobacco, Non-Smoker, and Preferred Rates will apply if you purchase Medigap within the first six (6) months of the start of your Medicare Part B. This is called your Medigap open-enrollment period. These rates also apply in guaranteed issue situations.

Premium Discounts - Some companies may offer discounts for such things as multiple policies in same household, automatic premium deductions, etc.

Premium Increases – Can occur each year as you age. Ask the company how they use age when determining your annual rate. Overall rate increases can occur at any time during the calendar year with authorization from the New Jersey Department of Banking and Insurance (DOBI).

Prescription Drug Coverage - Medigap policies do not include prescription drug coverage. If you want prescription drug benefits, you will need to enroll in a separate Medicare Prescription Drug Plan (Part D).

Your Licensed Medicare Provider:

55 Schanck Road Suite A-14

Freehold, NJ 07728

Not connected with or endorsed by the United States Government or the Federal Medicare Program.

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