Medicare supplement insurance

Transcription

Kansas Insurance Department
Medicare
supplement
insurance shopper’s guide
effective April 1, 2016
Ken Selzer, CPA
Commissioner of Insurance
Medicare supplement
insurance shopper’s guide
April 2016
Dear Kansas consumer,
If you have picked up this guide, chances are you are somewhat familiar with Medicare
— a federally-funded health insurance program for people with disabilities and people
age 65 and older. Although Medicare may pay a large part of your health care expenses,
it doesn’t cover every service or medical supply. Medicare recipients are responsible for
paying coinsurance and deductibles.
This guide will help you evaluate your health care insurance needs. It will also help you
gather accurate information concerning Medicare, Medicare supplement and other
health insurance options so you can make decisions that will prevent serious, costly
problems.
Toward the middle of this book, you’ll find rate comparisons of companies selling various
Medicare supplement insurance plans. These rates were accurate as of April 2016. For
the most up-to-date rate comparisons, visit our website, www.ksinsurance.org.
If you have questions or need assistance understanding insurance issues, don’t hesitate
to contact the Kansas Insurance Department’s Consumer Assistance Hotline toll-free
at 800-432-2484. Our trained staff is dedicated to helping answer your insurance
questions and finding solutions to your problems.
Sincerely,
Ken Selzer, CPA
Commissioner of Insurance
Table of Contents
Section I: About Medicare Supplement and Medicare SELECT Insurance
2
Overview of Medicare Parts A & B
6
Your Medicare coverage choices at a glance
7
Details of Plans A - N8
Medicare supplement insurance at a glance
28
Section II: Medicare Supplement and
Medicare SELECT Rates 29
Appendix I: About Medicare and
Medicare Advantage Plans
41
How is Medicare divided?
Appendix II: Consumer Protections
and Other Resources
42
Protections when you lose coverage
49
Tips & Warnings
52
Glossary of Terms
54
What you need to know in 2016
56
Customer service phone numbers
inside back cover
49
Section I: About Medicare Supplement and
Medicare SELECT Insurance
What is Medicare
supplement insurance?
How does Medicare
supplement insurance work?
Medicare supplement insurance can help cover
the expenses that come with the gaps in Original
Medicare (described in further detail in Appendix
1). This supplemental insurance is also often called
“Medigap” because it helps pay for these gaps.
Medicare supplement policies can only be purchased with Original Medicare - you may not have a
Medicare supplement policy if you have a Medicare
Advantage plan. The Kansas Insurance Department
is responsible for regulating Medicare supplement
insurance in the state of Kansas.
Medicare supplement insurance is broken down
into plans identified by letters - A, B, C, D, F, G, K, L,
M & N. These plans are standardized and must follow federal and state laws, which have been created
to protect you, the consumer. (Details about each of
these plans is available later in this booklet.) These
plans are sold by private insurance companies, but
all plans identified by the same letter have the
same benefits. That is, plans identified as “Plan A”
in the state of Kansas are identical, regardless of
the company that is selling it. However, the cost of
the plan will vary depending on the company that
provides it.
Costs that you must pay, like coinsurance, copayments and deductibles, are examples of some of the
gaps in Original Medicare coverage. You might want
to consider buying a Medicare supplement policy
to cover these expenses. Some Medicare supplement policies also cover benefits that the Original
Medicare plan doesn’t cover, like emergency health
care while traveling outside the United States. A
Medicare supplement policy may help you save on
out-of-pocket costs.
All companies in the state of Kansas that wish to sell
Medicare supplement insurance must make Plan
A available to their customers. If they want to offer
additional Medicare supplement plans, they must
also offer either Plan C or Plan F. Plan A features the
core benefits of a Medicare supplement policy. All
other plans build upon this.
How are
premium rates determined?
Premium rates for Medicare supplement insurance
policies are determined in one of two ways:
Issue age - The company will not raise your premium just because you are getting older. Your premium will always be based on your age when you purchased the policy, but it will be adjusted for other
factors, like inflation. If you buy a plan at age 65,
you will always pay the current premiums charged
to 65-year old customers, regardless of your current
age. Issue age policies can be more costly up front
but also can save money in the long run.
02 2016 Medicare Supplement Shopper’s Guide
Beneficiaries with disabilities
Disabled Medicare beneficiaries under age 65 have
equal access to all Medicare supplement policies
sold in Kansas.
• Upon enrolling in Medicare Part B, a disabled beneficiary has a 6-month open-enrollment period to buy
supplement coverage. That period begins the day Part
B coverage becomes effective.
• Supplement policies must be sold at the same rate as
for seniors who turn 65 and are eligible for Medicare.
Attained age - For rates determined by attained
age, the premium will increase as you get older. If
you buy a plan at age 65, you may have a premium
increase each year.
Enrollment Periods
Medicare supplement enrollment periods differ
from other Medicare enrollment periods. Insurers
must offer a six-month open enrollment period to
all Medicare beneficiaries. This six-month period
begins with the first month in which the beneficiary
first enrolled for benefits under Medicare Part B
(for many people, this is age 65; for others, it begins when you lose employer- or group-sponsored
health care). During this six-month period, insurers are required to offer any Medicare supplement
policy to all enrollees, regardless of their health status. During this time, the same amount is charged
to both healthy individuals and those with medical
conditions. After this six-month period ends, insurers are allowed to use medical underwriting to
determine whether or not you are accepted into the
plan and, if so, how much you will be charged, so it
is important to evaluate your options carefully
during your first enrollment period. Should you
decide to switch to a different Medicare supplement
policy after this open enrollment period, you may
be subject to medical underwriting.
• Disabled Medicare beneficiaries cannot be turned
down for any Medicare supplement plan being sold
in Kansas during the initial 6-month open-enrollment
period.
• Coverage will be guaranteed issue, but the same
pre-existing condition limitation as applies to age 65
beneficiaries may apply. A second open-enrollment
period will apply when the disabled Medicare beneficiary turns 65.
Medicare SELECT insurance
Medicare SELECT is another option available to
some Kansas Medicare beneficiaries. Medicare
SELECT policies are just like standardized Medicare supplement policies. However, each Medicare
SELECT policy has specific hospitals and, in some
cases, doctors that you must use in order to be eligible for full benefits (except in the case of medical
emergencies).
Because the insurers negotiate directly with specific
providers (sometimes called “preferred providers”),
premium costs for Medicare SELECT plans are generally lower than a standard Medicare supplement
policy. When you choose to use a preferred provider, Medicare pays its share of the approved charges
and the Medicare SELECT policy pays for the full
supplemental benefits provided for in the policy.
The six-month open enrollment period for Medicare
supplement insurance starts on the same day your
Part B Medicare starts. This date is shown on your
Medicare card.
2016 Medicare Supplement Shopper’s Guide 03
facility within 30 days of leaving the hospital. Medicare does not cover coinsurance or coverage after
100 days per benefit period.
Blood - Medicare covers pints of blood you get at a
hospital or skilled nursing facility during a covered
stay after the first three pints. You are responsible
for the cost of the first three pints and the Part B
deductible.
If you do not want to use the preferred provider,
Medicare will still pay its share of approved charges.
However, the Medicare SELECT policy would not be
required to pay any benefits.
A comparison shopper’s guide for both Medicare
supplement policies and Medicare SELECT policies
for premium rates is available in Section II of this
book.
Services provided under
Medicare supplement policies
The following services are provided under Medicare. Medicare supplement plans help pay for
portions of these services not covered by Medicare.
The following details, from www.Medicare.gov, will
help you determine whether or not you will need a
supplement policy.
Hospitalization - Medicare covers a semiprivate
room, meals, general nursing, and other hospital
services and supplies. This includes care in critical access hospitals and inpatient mental health
care. This does not include private duty nursing or
a television or telephone in your room. It does not
include a private room, unless medically necessary.
Medicare does not cover Part A deductible, coinsurance, or coverage after your allotted number of
days have been used each benefit period.
Skilled Nursing Facility Care - Medicare covers a
semiprivate room, meals, skilled nursing and rehabilitative services, and other services and supplies
(after a related 3-day hospital stay). You must have
been admitted to the Medicare-approved nursing
Hospice Care - Medicare covers medical and support services from a Medicare-approved hospice for
people with a terminal illness, drugs for symptom
control and pain relief. Hospice care is given in your
home. However, short-term hospital and inpatient
respite care (care given to a hospice patient by another caregiver so that the usual caregiver can rest)
are covered when needed. You must have a doctor’s
certification of a terminal illness. Medicare does not
cover the copayment or coinsurance.
Medical Expenses - Medicare covers doctor services, outpatient medical and surgical services
and supplies, diagnostic tests, ambulatory surgery
center facility fees for approved procedures, and
durable medical equipment (such as wheelchairs,
hospital beds, oxygen, and walkers). It also covers
second surgical opinions, outpatient mental health
care, outpatient physical and occupational therapy,
including speech-language therapy. Medicare does
not cover the Part B deductible or coinsurance.
Clinical Laboratory Services - Medicare covers
blood tests, urinalysis and other tests for diagnostic
services.
Home Health Care - Medicare covers part-time
skilled nursing care, physical therapy, occupational
therapy, speech-language therapy, home health
aide services, medical social services, durable medical equipment (such as wheelchairs, hospital beds,
oxygen, and walkers) and medical supplies, and
other services. Medicare does not cover the Part B
deductible.
The following services are not covered under
Medicare, but may be covered by some Medicare
supplement plans:
Part B Excess charges - “Excess charges” are not
covered under Medicare. If doctors decide not to
accept the reimbursement rate they receive from
Medicare for providing certain services, they are allowed to charge up to 15% more for those covered
services. If the doctor you visit is one of these, you
will be responsible for paying that 15% above what
Medicare covers. The Medicare supplement policy
may cover some or all of your expenses above the
Medicare approved amounts.
Benefit time frames
Part A of Medicare is based on a “per-benefit period” timeline. According to Medicare, a “benefit
period” begins the day you go into a hospital or
skilled nursing facility (SNF). The benefit period
ends when you haven’t received any hospital care
(or skilled care in a SNF) for 60 days in a row. If you
return to the hospital or SNF before the end of that
60 day period, it will be considered part of the same
benefit period. If you go into a hospital or a SNF
after one benefit period has ended, a new benefit
period begins. You must pay the inpatient hospital
deductible for each benefit period. There is no limit
to the number of benefit periods an enrollee may
have.
Part B benefits are based on the calendar year,
which begins January 1 of each year and ends December 31.
Foreign Travel - Some Medicare supplement policies will cover some of your expenses related to
emergency care while traveling outside the United
States.
Overview of Medicare Parts A & B
A
B
In-patient hospital
$166 deductible
First 60 days
$1,288
Days 61-90 $322 per day coinsurance
Lifetime Reserve
Days 91-150
$644 per day
coinsurance
Skilled nursing facility
First 20 days 100% (no copay)
Days 21-100
$161 per day
coinsurance
Home health hospice
(the amount you must pay before any
coverage from the insurer)
20% coinsurance
80% of costs
(after deductible is met)
Physician’s charges
(in or out of hospital)
Durable medical equipment
Ambulance
Outpatient hospital charges
100% Services
*Benefit period ends when patient is
out of the hospital or skilled nursing
facility for 60 consecutive days.
Amount you pay
Amount Medicare pays
Excess charges
If doctors do not accept Medicare’s
reimbursement rate, they are allowed
to charge up to 15% more for covered
services. If the doctor you visit is one
of these, you will be responsible for
paying that 15% above what Medicare
covers.
Your Medicare Coverage Choices at a Glance
There are two main ways to get your Medicare coverage: Original Medicare (Parts
A and B) or a Medicare Advantage Plan (Part C). Use these steps to help you decide
which way to get your coverage.
Start
Step 1: Decide how you want to get your coverage
ORIGINAL MEDICARE
Part A
Hospital insurance
or
MEDICARE ADVANTAGE
PLAN
(like an HMO or PPO)
Part C
Part B
Medical insurance
Combines Part A, Part B and
usually Part D
Step 2: Decide if you need to add drug
coverage
Step 2: Decide if you need to add drug
coverage
Part D
Part D
Prescription drug coverage
Step 3: Decide if you need to add
supplemental coverage
Medigap
Medicare supplement insurance
END
For more information on Original Medicare
and Medicare Advantage plans, see
Appendix I.
Prescription drug coverage
(if not already included)
END
NOTE: If you join a Medicare Advantage Plan, you don’t need a Medicare
supplement policy. If you already have
a Medicare supplement policy, you can’t
use it to pay for out-of-pocket costs you
have under a Medicare Advantage Plan.
If you already have a Medicare Advantage Plan, you can’t be sold a Medicare
supplement policy.
Medicare Supplement Plans
PLAN A
Benefits if you have Medicare Part A
SERVICES
MEDICARE PAYS
MED SUPP PAYS
YOU PAY
All but $1,288
$0
$1,288 (Part A
deductible)
Day 61 - Day 90
All but $322 per day
$322 per day
$0
Day 91 - 150 (while using
60 lifetime reserve days)
$644 per day
$0
Additional 365 days
$0
100% of Medicare eligible
expenses
$0
After additional 365 days
$0
$0
All approved amounts
$0
$0
Day 21 - Day 100
$0
Up to $161 per day
Day 101 and after
$0
$0
All costs
$0
100%
$0
100%
$0
$0
100%
Medicare copayment/
coinsurance
$0
All but $5
$5
$0
95%
5%
$0
Hospitalization
First 60 days
All costs
Skilled Nursing
Facility Care
First 20 days
Blood (inpatient)
First 3 pints
Additional amounts
Hospice Care
Hospice care
Prescription drugs
Inpatient respite care
PLAN A
Benefits if you have Medicare Part B
SERVICES
MEDICARE PAYS
MED SUPP PAYS
YOU PAY
First $166 of Medicare
approved amounts
$0
$0
$166 (Part B deductible)
Remainder of Medicare
approved amounts
Generally 80%
Generally 20%
$0
First 3 pints
$0
100%
$0
Any unmet Part B
deductible ($166)
$0
$0
Remainder of
Medicare approved
amounts
80%
20%
$0
Clinical Laboratory
Services
100%
$0
$0
Medical Expenses
Blood (outpatient)
Benefits if you have Medicare Part A and Part B
Home Health Care
Medically necessary
skilled care services and
medical supplies
Durable medical
equipment:
Any unmet Part B
deductible ($166)
Remainder of
Medicare approved
amounts
100%
$0
$0
$0
$0
80%
20%
$0
Benefits not covered under Medicare
Part B Excess Charges
$0
$0
All costs
PLAN B
SERVICES
MEDICARE PAYS
MED SUPP PAYS
YOU PAY
All but $1,288
$1,288 (Part A deductible)
$0
Day 61 - Day 90
$322 per day
$0
$644 per day
$0
Additional 365 days
$0
expenses
$0
$0
$0
$0
$0
Day 21 - Day 100
$0
Up to $161 per day
Day 101 and after
$0
$0
All costs
$0
100%
$0
100%
$0
$0
100%
Medicare copayment/
coinsurance
$0
All but $5
$5
$0
95%
5%
$0
Hospitalization
First 60 days
All costs
Skilled Nursing
Facility Care
First 20 days
Blood (inpatient)
First 3 pints
Additional amounts
Hospice Care
Hospice care
Prescription drugs
PLAN B
SERVICES
MEDICARE PAYS
MED SUPP PAYS
YOU PAY
$0
$0
Generally 80%
Generally 20%
$0
First 3 pints
$0
100%
$0
Any unmet Part B
deductible ($166)
$0
$0
Remainder of
Medicare approved
amounts
80%
20%
$0
Clinical Laboratory
Services
100%
$0
$0
Medical Expenses
approved amounts
approved amounts
Blood (outpatient)
Home Health Care
Medically necessary
medical supplies
100%
$0
$0
$0
$0
80%
20%
$0
Durable medical
equipment:
Any unmet Part B
deductible ($166)
Remainder of
Medicare approved
amounts
$0
$0
All costs
PLAN C
SERVICES
MEDICARE PAYS
MED SUPP PAYS
YOU PAY
All but $1,288
$0
Day 61 - Day 90
$322 per day
$0
$644 per day
$0
Additional 365 days
$0
expenses
$0
$0
$0
$0
$0
Day 21 - Day 100
Up to $161 per day
$0
Day 101 and after
$0
$0
All costs
$0
100%
$0
100%
$0
$0
100%
Medicare copayment/
coinsurance
$0
All but $5
$5
$0
95%
5%
$0
Hospitalization
First 60 days
All costs
Skilled Nursing
Facility Care
First 20 days
Blood (inpatient)
First 3 pints
Additional amounts
Hospice Care
Hospice care
Prescription drugs
Medical Expenses
approved amounts
$0
$0
PLAN C
SERVICES
Medical Expenses
approved amounts
Blood (outpatient)
First 3 pints
MEDICARE PAYS
MED SUPP PAYS
YOU PAY
Generally 80%
Generally 20%
$0
$0
100%
$0
Any unmet Part B
deductible ($166)
Remainder of
Medicare approved
amounts
$0
$0
80%
20%
$0
Clinical Laboratory
Services
100%
$0
$0
Home Health Care
Medically necessary
medical supplies
Durable medical
equipment:
Any unmet Part B
deductible ($166)
Remainder of
Medicare approved
amounts
100%
$0
$0
$0
$0
80%
20%
$0
$0
$0
All costs
Foreign Travel
First $250 per
calendar year
$0
$0
$250
Remainder of charges
$0
80% to a lifetime maximum
benefit of $50,000
20% and amounts over
the $50,000 lifetime
maximum
PLAN D
SERVICES
MEDICARE PAYS
MED SUPP PAYS
YOU PAY
All but $1,288
$0
Day 61 - Day 90
$322 per day
$0
$644 per day
$0
Additional 365 days
$0
expenses
$0
$0
$0
$0
$0
Day 21 - Day 100
Up to $161 per day
$0
Day 101 and after
$0
$0
All costs
$0
100%
$0
100%
$0
$0
100%
Medicare copayment/
coinsurance
$0
All but $5
$5
$0
95%
5%
$0
Hospitalization
First 60 days
All costs
Skilled Nursing
Facility Care
First 20 days
Blood (inpatient)
First 3 pints
Additional amounts
Hospice Care
Hospice care
Prescription drugs
Medical Expenses
approved amounts
$0
$0
PLAN D
SERVICES
MEDICARE PAYS
MED SUPP PAYS
YOU PAY
Generally 80%
Generally 20%
$0
Blood (outpatient)
First 3 pints
$0
100%
$0
Any unmet Part B
deductible ($166)
$0
$0
Remainder of
Medicare approved
amounts
80%
20%
$0
Clinical Laboratory
Services
100%
$0
$0
Medical Expenses
approved amounts
Home Health Care
Medically necessary
medical supplies
Durable medical
equipment:
Any unmet Part B
deductible ($166)
Remainder of
Medicare approved
amounts
100%
$0
$0
$0
$0
80%
20%
$0
$0
$0
All costs
Foreign Travel
First $250 per
calendar year
$0
$0
$250
$0
benefit of $50,000
maximum
PLAN F and HIGH DEDUCTIBLE PLAN F
The high deductible Plan F pays the same benefits as Plan F after one has paid a calendar year $2,180 deductible. Benefits from the high deductible Plan F will not begin until out-of-pocket expenses are $2,180. Out-ofpocket expenses for this deductible are expenses that would ordinarily be paid by the policy. This includes the
Medicare deductibles for Part A and Part B, but does not include the plan’s separate foreign travel emergency
deductible.
SERVICES
MEDICARE PAYS
MED SUPP PAYS
YOU PAY
All but $1,288
$0
Day 61 - Day 90
$322 per day
$0
$644 per day
$0
Additional 365 days
$0
expenses
$0
$0
$0
$0
$0
Day 21 - Day 100
Up to $161 per day
$0
Day 101 and after
$0
$0
All costs
$0
100%
$0
100%
$0
$0
100%
Medicare copayment/
coinsurance
$0
All but $5
$5
$0
95%
5%
$0
Hospitalization
First 60 days
All costs
Skilled Nursing
Facility Care
First 20 days
Blood (inpatient)
First 3 pints
Additional amounts
Hospice Care
Hospice care
Prescription drugs
PLAN F and HIGH DEDUCTIBLE PLAN F
SERVICES
MEDICARE PAYS
MED SUPP PAYS
YOU PAY
$0
$0
Generally 80%
Generally 20%
$0
$0
100%
$0
Medical Expenses
approved amounts
approved amounts
Blood (outpatient)
First 3 pints
Any unmet Part B
deductible ($166)
Remainder of
Medicare approved
amounts
$0
$0
80%
20%
$0
Clinical Laboratory
Services
100%
$0
$0
Home Health Care
Medically necessary
medical supplies
Durable medical
equipment:
Any unmet Part B
deductible ($166)
Remainder of
Medicare approved
amounts
100%
$0
$0
$0
$0
80%
20%
$0
$0
100%
$0
Foreign Travel
First $250 per
calendar year
$0
$0
$250
$0
benefit of $50,000
maximum
PLAN G
SERVICES
MEDICARE PAYS
MED SUPP PAYS
YOU PAY
All but $1,288
$0
Day 61 - Day 90
$322 per day
$0
$644 per day
$0
Additional 365 days
$0
expenses
$0
$0
$0
$0
$0
Day 21 - Day 100
Up to $161 per day
$0
Day 101 and after
$0
$0
All costs
$0
100%
$0
100%
$0
$0
100%
Medicare copayment/
coinsurance
$0
All but $5
$5
$0
95%
5%
$0
Hospitalization
First 60 days
All costs
Skilled Nursing
Facility Care
First 20 days
Blood (inpatient)
First 3 pints
Additional amounts
Hospice Care
Hospice care
Prescription drugs
Medical Expenses
approved amounts
$0
$0
PLAN G
SERVICES
MEDICARE PAYS
MED SUPP PAYS
YOU PAY
Generally 80%
Generally 20%
$0
$0
100%
$0
$0
$0
Remainder of
Medicare approved
amounts
80%
20%
$0
Clinical Laboratory
Services
100%
$0
$0
Medical Expenses
approved amounts
Blood (outpatient)
First 3 pints
Any unmet Part B
deductible ($166)
Home Health Care
Medically necessary
medical supplies
Durable medical
equipment:
Any unmet Part B
deductible ($166)
Remainder of
Medicare approved
amounts
100%
$0
$0
$0
$0
80%
20%
$0
$0
100%
$0
First $250 per
calendar year
$0
$0
$250
$0
benefit of $50,000
maximum
Foreign Travel
PLAN K
You will pay half the cost-sharing of some covered services until you reach the annual out-of-pocket limit of $4,960
each calendar year. The amounts that count toward your annual limit are noted with circles (•) in the chart. Once you
reach the annual limit, the plan pays 100% of your Medicare copayment and coinsurance for the rest of the calendar year. However, this limit does NOT include charges from your provider that exceed Medicare-approved amounts
(these are called “Excess Charges”) and you will be responsible for paying this difference in the amount charged by
your provider and the amount paid by Medicare for the item or service. Once you have been billed $166 of Medicareapproved amounts for covered services, your Part B deductible will have been met for the calendar year.
SERVICES
MEDICARE PAYS
MED SUPP PAYS
All but $1,288
$644 (50% of Part A
deductible)
$644 (50% of Part A
deductible)•
$322 per day
$0
$644 per day
$0
Additional 365 days
$0
expenses
$0
$0
$0
$0
$0
Day 21 - Day 100
Up to $80.50 per day (50%
of Part A coinsurance)
of Part A coinsurance)•
Day 101 and after
$0
$0
All costs
$0
50%
50%•
100%
$0
$0
50% of copayment/
coinsurance
50% of Medicare
copayment/
coinsurance•
Hospitalization
First 60 days
Day 61 - Day 90
YOU PAY
All costs
Skilled Nursing
Facility Care
First 20 days
Blood (inpatient)
First 3 pints
Additional amounts
Hospice Care
Hospice care
Prescription drugs
100%
All but $5
95%
PLAN K
SERVICES
MEDICARE PAYS
MED SUPP PAYS
YOU PAY
$0
$0
$166 (Part B deductible)•
Generally 80%
Generally 10%
Generally 10%•
First 3 pints
$0
50%
50%•
Any unmet Part B
deductible ($166)
$0
$0
Remainder of
Medicare approved
amounts
Generally 80%
Generally 10%
Generally 10%•
Clinical Laboratory
Services
100%
$0
$0
Medical Expenses
approved amounts
approved amounts
Blood (outpatient)
Home Health Care
Medically necessary
medical supplies
100%
$0
$0
$0
$0
80%
10%
10%•
Durable medical
equipment:
Any unmet Part B
deductible ($166)
Remainder of
Medicare approved
amounts
$0
$0
All costs (and they do not
count toward annual outof-pocket limit of $4,960)
PLAN L
You will pay one-fourth of the cost-sharing of some covered services until you reach the annual out-of-pocket limit of
$2,480 each calendar year. The amounts that count toward your annual limit are noted with a square (n) in the chart.
Once you reach the annual limit, the plan pays 100% of your Medicare copayment and coinsurance for the rest of
the calendar year. However, this limit does NOT include charges from your provider that exceed Medicare-approved
amounts (these are called “Excess Charges”) and you will be responsible for paying this difference in the amount
charged by your provider and the amount paid by Medicare for the item or service. Once you have been billed $166 of
Medicare-approved amounts for covered services, your Part B deductible will have been met for the calendar year.
SERVICES
MEDICARE PAYS
MED SUPP PAYS
All but $1,288
$966 (75% of Part A
deductible)
$322 (25% of Part A
deductible) n
Day 61 - Day 90
$322 per day
$0
$644 per day
$0
Additional 365 days
$0
expenses
$0
$0
$0
$0
$0
Day 21 - Day 100
Up to $120.75 per day (75%
of Part A coinsurance)
of Part A coinsurance) n
Day 101 and after
$0
$0
All costs
$0
75%
25% n
100%
$0
$0
75% of copayment/
coinsurance
25% of Medicare
copyament/
coinsurance n
Hospitalization
First 60 days
YOU PAY
All costs
Skilled Nursing
Facility Care
First 20 days
Blood (inpatient)
First 3 pints
Additional amounts
Hospice Care
Hospice care
Prescription drugs
100%
All but $5
95%
PLAN L
SERVICES
MEDICARE PAYS
MED SUPP PAYS
YOU PAY
approved amounts
$0
$0
$166 (Part B
deductible) n
approved amounts
Generally 80%
Generally 15%
Generally 5% n
Blood (outpatient)
First 3 pints
$0
75%
25% n
Any unmet Part B
deductible ($166)
$0
$0
Remainder of
Medicare Approved
Amounts
Generally 80%
Generally 15%
Generally 5% n
Clinical Laboratory
Services
100%
$0
$0
Medical Expenses
$166 (Part B
deductible) n
Home Health Care
Medically necessary
medical supplies
100%
$0
$0
$0
$0
$166 (Part B
deductible) n
80%
15%
5% n
Durable medical
equipment:
Any unmet Part B
deductible ($166)
Remainder of
Medicare approved
amounts
$0
$0
All costs (and they do not
count toward annual outof-pocket limit of $2,480)
PLAN M
SERVICES
MEDICARE PAYS
MED SUPP PAYS
All but $1,288
$644 (50% of Part A
deductible)
$644 (50% of Part A
deductible)
Day 61 - Day 90
$322 per day
$0
$644 per day
$0
Additional 365 days
$0
expenses
$0
$0
$0
$0
$0
Day 21 - Day 100
Up to $161 per day
$0
Day 101 and after
$0
$0
All costs
$0
100%
$0
100%
$0
$0
100%
Medicare copayment/
coinsurance
$0
All but $5
$5
$0
95%
5%
$0
Hospitalization
First 60 days
YOU PAY
All costs
Skilled Nursing
Facility Care
First 20 days
Blood (inpatient)
First 3 pints
Additional amounts
Hospice Care
Hospice care
Prescription drugs
Medical Expenses
approved amounts
$0
$0
PLAN M
SERVICES
MEDICARE PAYS
MED SUPP PAYS
YOU PAY
Generally 80%
Generally 20%
$0
$0
100%
$0
Medical Expenses
approved amounts
Blood (outpatient)
First 3 pints
Any unmet Part B
deductible ($166)
Remainder of
Medicare approved
amounts
$0
$0
80%
20%
$0
Clinical Laboratory
Services
100%
$0
$0
Home Health Care
Medically necessary
medical supplies
100%
$0
$0
$0
$0
80%
20%
$0
Durable medical
equipment:
Any unmet Part B
deductible ($166)
Remainder of
Medicare approved
amounts
$0
$0
All costs
Foreign Travel
First $250 per
calendar year
$0
$0
$250
$0
benefit of $50,000
maximum
PLAN N
SERVICES
Hospitalization
MEDICARE PAYS
MED SUPP PAYS
All but $1,288
$0
Day 61 - Day 90
$322 per day
$0
$644 per day
$0
Additional 365 days
$0
expenses
$0
$0
$0
$0
$0
Day 21 - Day 100
Up to $161 per day
$0
Day 101 and after
$0
$0
All costs
$0
100%
$0
100%
$0
$0
100%
Medicare copayment/
coinsurance
$0
All but $5
$5
$0
95%
5%
$0
First 60 days
YOU PAY
All costs
Skilled Nursing
Facility Care
First 20 days
Blood (inpatient)
First 3 pints
Additional amounts
Hospice Care
Hospice care
Prescription drugs
Blood (outpatient)
First 3 pints
$0
100%
$0
Any unmet Part B
deductible ($166)
$0
$0
80%
20%
$0
Remainder of
Medicare approved
amounts
PLAN N
SERVICES
MEDICARE PAYS
MED SUPP PAYS
YOU PAY
100%
$0
$0
approved amounts
$0
$0
approved amounts
Generally 80%
Generally 20% of the balance,
other than up to $20 per office
visit and up to $50 per emergency room visit. The copayment of up to $50 is waived if
the insured is admitted to any
hospital and the emergency
visit is covered as a Medicare
Part A expense.
Up to $20 per office visit and
up to $50 per emergency
room visit. The copayment
of up to $50 is waived if the
insured is admitted to any
hospital and the emergency
visit is covered as a Medicare
Part A expense.
Clinical Laboratory
Services
Medical Expenses
Home Health Care
Medically necessary
medical supplies
100%
$0
$0
$0
$0
80%
20%
$0
Durable medical
equipment:
Any unmet Part B
deductible ($166)
Remainder of
Medicare approved
amounts
Other benefits not covered under Medicare
$0
$0
All costs
First $250 per
calendar year
$0
$0
$250
$0
benefit of $50,000
20% and amounts over the
$50,000 lifetime maximum
Foreign Travel
X
X
X
X
X
X
X
X
X
X
G
*Plan F also offers a high-deductible plan. If you choose this option, this means you must pay for Medicarecovered costs up to the deductible amount of $2,180 in 2016 before your Medicare supplement plan pays
anything.
**After you meet your out-of-pocket yearly limit and your yearly Part B deductible ($166 in 2016), the Medicare supplement plan pays 100% of covered services for the rest of the calendar year.
***Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits
and up to a $50 copayment for emergency room visits that don’t result in an inpatient admission.
X
Foreign Travel Emergency care
(up to plan limits)
X
X
X
X
X
X
X
F*
X
X
X
X
X
X
X
X
D
Part B excess charges
Part B deductible
X
X
Medicare Part A deductible
X
X
X
X
C
X
X
X
X
X
B
Skilled Nursing Facility Care
coinsurance
X
X
Blood (first 3 pints)
Part A Hospice care
coinsurance or copayment
X
X
A
Part B coinsurance or
copayment
Part A coinsurance and hospital costs up to an additional
365 days after Medicare benefits are used up
Benefits
75%
75%
75%
75%
75%
X
L
$4,960 $2,480
Out-of-Pocket
Limit**
50%
50%
50%
50%
50%
X
K
X
50%
X
X
X
X
X
M
X
X
X
X
X
X***
X
N
If an X appears in the chart, the Medicare supplement policy covers 100% of the described benefit. If a row lists a percentage, the policy
covers that percentage of the described benefit. If a row is blank, the policy doesn’t cover that benefit. NOTE: The Medicare supplement
policy covers coinsurance only after you have paid the deductible (unless the supplement policy also covers the deductible).
Medicare supplement insurance at a glance
Section II: Medicare Supplement and
Medicare SELECT Insurance Rates
A note about these rates
Premium quotes listed here are for a nonsmoking man living in the 66612 ZIP code and are broken
into four age categories. Premiums may vary according to your age or the area in which you live.
Additionally, these rates may have changed since April 2016, when these rates were compiled. Annual
costs may be higher if premiums are paid in installments. Contact the insurance company to find
out exact premiums.
Disclaimer
This shopper’s guide does not recommend or endorse any insurance company or policy. It is designed to help you comparison shop for coverage to supplement your Medicare benefits. Contact
the Kansas Insurance Department’s Consumer Assistance Hotline if you have any questions about
how to use this guide: 800-432-2484.
Plan A
Issue age policies - annual premium
Company
Age 65
Age 70
Age 75
Age 80
Bankers Fidelity Life Insurance Company
$1,344.00
$1,500.00
$1,680.00
$1,812.00
Everence Association Inc.
$1,646.15
$1,779.06
$1,866.35
$1,979.05
Old Surety Life Insurance Company
$1,114.43
$1,375.87
$1,619.81
$1,822.37
Transamerica Life Insurance Company
$1,169.37
$1,495.37
$1,861.81
$2,206.81
Attained age policies - annual premium
Company
Age 65
Age 70
Age 75
Age 80
Aetna Health and Life Insurance Company
$1,377.70
$1,485.80
$1,641.05
$1,752.60
Aetna Life Insurance Company
$1,665.28
$1,988.56
$2,291.63
$2,476.66
American Republic Corp Insurance Company
$1,964.36
$2,200.42
$2,621.65
$2,946.75
American Republic Insurance Company
$1,423.56
$1,484.58
$1,799.69
$2,108.63
American Retirement Life Insurance Company
$1,536.81
$1,806.53
$2,078.59
$2,335.16
Americo Financial Life and Annuity Insurance Co.
$1,475.31
$1,659.55
$1,908.70
$2,090.02
Blue Cross & Blue Shield of Kansas City
$1,488.00
$2,040.00
$2,472.00
$2,952.00
Blue Cross and Blue Shield of Kansas, Inc.
$1,286.16
$1,501.20
$1,752.36
$2,046.72
Central States Indemnity Company of Omaha
$1,321.67
$1,499.29
$1,781.39
$2,024.30
Christian Fidelity Life Insurance Co
$1,475.24
$1,747.37
$2,076.79
$2,262.99
Colonial Penn Life Insurance Company
$2,118.55
$2,588.81
$3,150.56
$3,682.51
Combined Insurance Company of America
$1,469.61
$1,736.21
$1,922.16
$2,037.16
Coventry Health and Life Insurance Co
$1,347.60
$1,573.20
$1,836.60
$2,136.84
Plan A
(cont’d)
Company
Age 65
Age 70
Age 75
Age 80
Equitable Life & Casualty Insurance Company
$1,554.80
$1,665.20
$1,821.60
$1,930.85
First Health Life and Health Insurance Company
$1,415.00
$1,619.00
$1,800.00
$1,907.00
Forethought Life Insurance Company
$1,641.48
$1,797.25
$2,012.94
$2,201.48
Gerber Life Insurance Company
$1,747.55
$2,067.22
$2,292.21
$2,434.71
Globe Life & Accident Insurance Co
$946.00
$1,264.00
$1,344.00
$1,349.00
Government Personnel Mutual Life Insurance Co
$1,365.76
$1,495.43
$1,675.41
$1,832.74
Guarantee Trust Life Insurance Company
$1,173.76
$1,367.14
$1,561.87
$1,682.74
Heartland National Life Insurance Company
$1,492.57
$1,823.88
$2,078.90
$2,241.71
Humana Insurance Company
$1,785.01
$2,171.83
$2,642.40
$3,122.79
Individual Assurance Co Life, Health, Accident
$1,572.42
$1,768.78
$2,035.03
$2,268.51
KSKJ Life, American Slovenian Catholic Union
$1,515.30
$1,802.62
$2,139.11
$2,430.81
Liberty National Life Insurance Co
$2,007.90
$2,553.00
$2,773.80
$2,784.15
Loyal American Life Insurance Company
$1,666.49
$1,682.94
$1,854.50
$1,961.47
Manhattan Life Insurance Company (The)
$1,228.70
$1,388.14
$1,641.22
$1,903.16
Medico Corp Life Insurance Company
$1,326.36
$1,398.28
$1,672.97
$1,964.65
Mutual of Omaha Insurance Company
$1,620.35
$1,789.99
$2,142.37
$2,419.72
Order of United Commercial Travelers of America
$1,757.59
$1,949.89
$2,298.44
$2,627.23
Oxford Life Insurance Company
$1,475.50
$1,747.68
$2,077.16
$2,263.39
Pekin Life Insurance Company
$1,355.20
$1,481.04
$1,649.47
$1,823.71
Philadelphia American Life Ins Co
$1,310.87
$1,346.58
$1,574.84
$1,735.87
Physicians Mutual Insurance Company
$2,040.30
$2,348.21
$2,541.30
$2,703.51
Reserve National Insurance Company
$1,421.95
$1,688.57
$1,986.10
$2,301.84
Sentinel Security Life Insurance Co
$1,801.63
$2,060.35
$2,307.59
$2,523.66
Shenandoah Life Insurance Company
$1,375.68
$1,519.86
$1,819.07
$2,054.49
Standard Life & Accident Insurance Co
$2,502.21
$2,894.83
$3,327.22
$3,995.62
State Farm Mutual Automobile Insurance Company
$1,351.12
$1,702.18
$1,971.97
$2,214.67
State Mutual Insurance Company
$1,740.41
$2,069.71
$2,455.88
$2,791.80
Thrivent Financial for Lutherans
$1,150.05
$1,365.95
$1,570.80
$1,675.35
Transamerica Premier Life Insurance Company
$1,039.08
$1,099.32
$1,332.72
$1,540.20
Unified Life Insurance Company
$1,468.58
$1,651.98
$1,900.69
$2,118.86
United American Insurance Company
$1,553.65
$1,973.40
$2,139.00
$2,144.75
United National Life Insurance Company of America
$1,735.83
$1,936.80
$2,230.36
$2,391.94
United World Life Insurance Company
$1,263.51
$1,436.17
$1,670.69
$1,822.01
UnitedHealthcare Insurance Company
$1,062.60
$1,290.24
$1,518.00
$1,518.00
USAA Life Insurance Company
$1,138.32
$1,330.08
$1,585.08
$1,840.08
Plan B
Company
Age 65
Age 70
Age 75
Age 80
$1,543.86
$1,974.43
$2,458.18
$2,913.66
Company
Age 65
Age 70
Age 75
Age 80
$1,559.40
$1,697.40
$1,918.20
$2,125.20
$1,843.94
$2,260.79
$2,688.28
$3,055.15
$1,543.69
$1,751.36
$2,079.16
$2,363.86
$2,073.59
$2,524.09
$3,054.22
$3,572.22
$1,613.00
$1,882.00
$2,143.00
$2,360.00
$1,445.00
$1,794.00
$2,075.00
$2,098.00
$1,942.89
$2,363.47
$2,875.72
$3,398.75
$1,843.05
$2,191.55
$2,602.33
$2,957.40
$2,791.05
$3,602.95
$4,023.85
$4,091.70
$2,049.65
$2,276.04
$2,683.24
$3,066.88
$1,993.34
$2,280.93
$2,586.01
$2,872.76
$2,848.98
$3,296.01
$3,788.32
$4,549.34
$2,031.36
$2,413.56
$2,867.18
$3,257.32
$1,288.60
$1,547.85
$1,825.80
$2,025.55
$2,549.55
$3,289.00
$3,661.60
$3,715.65
$1,988.50
$2,260.07
$2,629.11
$2,867.26
$1,522.44
$1,848.72
$2,175.00
$2,175.00
Age 65
Age 70
Age 75
Age 80
$1,826.62
$2,335.95
$2,908.41
$3,447.23
Plan C
Company
Age 65
Age 70
Age 75
Age 80
Company
$2,088.00
$2,868.00
$3,492.00
$4,152.00
$1,831.80
$2,159.28
$2,605.32
$3,199.32
$1,846.69
$2,097.44
$2,523.19
$2,867.98
$2,173.92
$2,558.88
$3,091.32
$3,868.92
$2,463.08
$2,914.49
$3,276.34
$3,538.20
Plan C (cont’d)
Age 65
Age 70
Age 75
Age 80
Company
$2,162.65
$2,378.75
$2,707.51
$3,022.90
$1,850.91
$2,036.43
$2,319.98
$2,592.98
$1,689.45
$1,962.07
$2,264.24
$2,515.38
$2,282.69
$2,777.06
$3,379.09
$3,993.56
$2,093.23
$2,497.45
$3,005.47
$3,415.15
Manhattan Life Insurance Company (the)
$1,647.55
$1,861.40
$2,200.53
$2,552.31
$2,452.76
$2,726.72
$3,256.10
$3,721.95
$2,111.40
$2,507.74
$2,949.34
$3,418.54
$2,444.31
$2,804.94
$3,196.68
$3,574.67
$3,239.07
$3,747.29
$4,307.03
$5,172.27
$2,036.98
$2,566.81
$2,973.12
$2,266.68
$2,430.75
$2,892.31
$3,478.17
$3,955.60
$1,523.20
$1,804.55
$2,142.85
$2,511.75
$2,852.00
$3,707.60
$4,238.90
$4,612.65
$2,364.71
$2,687.87
$3,126.75
$3,410.14
$1,841.64
$2,236.32
$2,631.00
$2,631.00
Age 65
Age 70
Age 75
Age 80
$1,688.65
$2,159.44
$2,688.54
$3,186.81
Plan D
Company
Age 65
Age 70
Age 75
Age 80
Company
$1,877.39
$2,332.79
$2,734.68
$3,072.81
$1,710.85
$2,034.23
$2,415.52
$2,746.54
$2,148.19
$2,386.53
$2,812.10
$3,215.77
$1,845.56
$2,118.52
$2,420.49
$2,715.25
$1,943.20
$2,258.00
$2,595.25
$3,116.62
$2,129.22
$2,531.26
$3,004.72
$3,414.69
$1,310.70
$1,586.10
$1,916.75
$2,275.45
$2,654.20
$3,513.25
$4,045.70
$4,418.30
$1,939.37
$2,190.77
$2,589.24
$2,881.68
$1,507.93
$1,713.74
$1,993.86
$2,174.51
Plan F
Company
Age 65
Age 70
Age 75
Age 80
Bankers Fidelity Life Insurance Co
$1,872.00
$2,076.00
$2,316.00
$2,520.00
$2,807.43
$3,044.43
$3,228.04
$3,493.71
$1,610.91
$1,887.38
$2,100.01
$2,299.71
$1,837.24
$2,349.58
$2,992.31
$3,467.23
Company
Age 65
Age 70
Age 75
Age 80
$1,818.15
$1,986.05
$2,262.05
$2,532.30
$2,135.31
$2,632.98
$3,152.98
$3,620.88
$2,676.64
$2,998.19
$3,572.10
$4,015.26
$2,033.65
$2,120.84
$2,570.99
$3,012.33
$1,885.20
$2,200.63
$2,563.44
$2,970.88
Americo Financial Life and Annuity Insurance Co
$1,830.01
$2,046.57
$2,382.67
$2,692.06
$2,100.00
$2,868.00
$3,504.00
$4,164.00
$1,904.76
$2,241.72
$2,707.08
$3,324.96
$1,914.60
$2,152.30
$2,576.74
$2,909.77
$1,661.44
$1,976.54
$2,305.96
$2,664.03
$2,592.56
$3,141.12
$3,812.07
$4,547.62
$1,763.79
$2,081.46
$2,520.88
$2,859.37
$2,354.64
$2,771.28
$3,346.56
$4,173.84
$2,334.50
$2,515.05
$2,764.60
$2,946.30
$1,882.00
$2,207.00
$2,532.00
$2,817.00
$2,215.79
$2,437.11
$2,773.80
$3,096.61
$2,466.87
$2,923.72
$3,298.94
$3,582.07
$1,697.00
$2,061.00
$2,422.00
$2,595.00
$1,895.80
$2,085.49
$2,375.52
$2,655.00
$2,193.89
$2,656.12
$3,071.67
$3,409.81
$2,329.36
$2,833.91
$3,448.03
$4,075.17
$1,854.31
$2,073.75
$2,415.13
$2,777.92
$2,180.63
$2,561.91
$3,067.74
$3,463.22
$3,122.25
$4,059.50
$4,651.75
$5,079.55
$2,049.62
$2,153.04
$2,431.57
$2,726.55
$1,639.96
$1,853.81
$2,190.41
$2,539.66
$1,700.46
$1,792.67
$2,144.82
$2,518.79
$2,131.99
$2,355.31
$2,818.94
$3,183.83
$2,542.35
$2,798.61
$3,325.76
$3,778.00
$1,661.73
$1,976.89
$2,306.37
$2,664.50
$1,696.90
$1,896.31
$2,208.98
$2,560.36
$1,881.50
$2,002.74
$2,292.13
$2,507.60
$3,000.74
$3,513.33
$4,211.42
$4,882.43
Plan F (cont’d)
Company
Age 65
Age 70
Age 75
Age 80
$1,800.62
$2,139.55
$2,515.46
$2,916.22
$2,503.27
$2,872.57
$3,273.51
$3,660.24
$1,758.62
$1,942.99
$2,325.51
$2,626.50
$2,663.64
$3,081.57
$3,541.85
$4,253.39
$2,057.57
$2,592.82
$3,003.46
$3,374.02
$2,527.30
$2,969.01
$3,552.23
$4,011.14
$1,530.85
$1,813.05
$2,153.90
$2,523.65
$1,755.72
$1,857.72
$2,252.04
$2,602.68
$1,823.87
$2,040.37
$2,377.72
$2,736.64
$2,840.50
$3,684.60
$4,213.60
$4,582.75
$2,598.12
$2,906.23
$3,395.45
$3,751.44
$2,426.74
$2,757.90
$3,208.77
$3,499.51
$1,852.20
$2,249.04
$2,646.00
$2,646.00
$1,734.00
$2,031.84
$2,423.52
$2,807.04
Plan F (high deductible)
Company
Age 65
Age 70
Age 75
Age 80
$552.00
$624.00
$696.00
$756.00
Company
Age 65
Age 70
Age 75
Age 80
$726.80
$794.65
$903.90
$1,013.15
$853.22
$955.79
$1,138.64
$1,279.98
$813.46
$848.33
$1,028.40
$1,204.94
$466.25
$564.91
$685.62
$817.85
$358.00
$489.00
$617.00
$763.00
$712.18
$866.39
$1,054.23
$1,245.87
$534.75
$731.40
$1,008.55
$1,240.85
$510.13
$537.80
$643.45
$755.63
$695.02
$780.21
$907.02
$1,052.22
$538.11
$608.10
$731.37
$891.09
$559.79
$713.79
$906.98
$1,134.14
$425.04
$504.53
$593.95
$688.34
$387.32
$448.11
$515.03
$618.50
$993.20
$1,167.77
$1,396.56
$1,579.06
$456.45
$561.00
$693.60
$843.20
Plan F (high deductible) (cont’d)
Company
Age 65
Age 70
Age 75
Age 80
$569.84
$664.79
$785.32
$945.27
$433.55
$592.25
$746.35
$923.45
Age 65
Age 70
Age 75
Age 80
$1,687.87
$2,158.43
$2,687.31
$3,185.25
Plan G
Company
Company
Age 65
Age 70
Age 75
Age 80
$1,419.10
$1,551.35
$1,774.45
$1,997.55
$1,935.39
$2,399.03
$2,889.26
$3,344.39
$1,532.94
$1,819.37
$2,148.64
$2,508.94
$1,514.88
$1,714.90
$2,025.24
$2,306.21
$1,296.00
$1,524.00
$1,824.00
$2,064.00
$1,686.60
$1,984.92
$2,397.00
$2,944.08
$1,591.48
$1,591.48
$1,876.46
$2,119.16
$1,854.35
$2,282.78
$2,810.49
$3,389.33
$1,435.20
$1,624.95
$1,919.35
$2,225.25
$1,723.00
$2,028.00
$2,336.00
$2,614.00
$1,715.71
$1,888.18
$2,152.94
$2,409.24
$1,825.54
$2,163.59
$2,447.24
$2,666.17
$1,489.37
$1,639.50
$1,871.27
$2,096.35
$1,943.42
$2,415.90
$2,832.59
$3,176.42
$1,486.29
$1,682.53
$1,987.68
$2,304.24
$1,388.57
$1,651.86
$1,962.13
$2,229.79
$1,741.68
$1,854.98
$2,115.89
$2,392.82
$1,357.77
$1,537.46
$1,817.11
$2,114.48
$1,582.49
$1,674.99
$2,028.81
$2,399.30
$1,751.41
$1,934.86
$2,315.79
$2,615.44
$2,160.71
$2,398.81
$2,827.77
$3,233.28
$1,357.14
$1,518.79
$1,776.28
$2,069.58
$1,578.61
$1,738.48
$2,036.72
$2,259.75
$2,058.87
$2,409.15
$2,889.93
$3,350.20
$1,534.95
$1,822.51
$2,144.35
$2,485.88
$1,343.73
$1,524.69
$1,811.86
$1,983.81
$1,420.88
$1,567.36
$1,875.86
$2,118.59
Plan G (cont’d)
Age 65
Age 70
Age 75
Age 80
Company
$1,966.64
$2,275.21
$2,615.07
$3,140.40
$2,137.16
$2,545.81
$3,023.23
$3,433.21
$1,319.20
$1,595.45
$1,926.95
$2,289.90
$1,396.80
$1,477.92
$1,791.60
$2,070.60
$1,454.37
$1,646.54
$1,945.85
$2,256.89
$2,666.85
$3,524.75
$4,058.35
$4,434.40
$1,928.54
$2,176.46
$2,572.49
$2,860.36
$2,089.13
$2,374.61
$2,762.81
$3,013.04
Age 65
Age 70
Age 75
Age 80
$841.36
$1,075.86
$1,339.52
$1,587.65
Plan K
Company
Company
Age 65
Age 70
Age 75
Age 80
$1,174.00
$1,315.00
$1,566.75
$1,761.09
$768.00
$900.00
$1,080.00
$1,200.00
$945.60
$1,113.00
$1,344.84
$1,651.20
$752.89
$918.09
$1,153.70
$1,425.07
$1,046.89
$1,273.59
$1,549.43
$1,831.32
$1,348.95
$1,802.05
$2,004.45
$2,125.20
$579.60
$703.80
$828.00
$828.00
Age 65
Age 70
Age 75
Age 80
$1,437.40
$1,573.27
$1,678.35
$1,822.70
$1,248.81
$1,597.04
$1,988.39
$2,356.85
Plan L
Company
Plan L (cont’d)
Company
Age 65
Age 70
Age 75
Age 80
$1,598.98
$1,791.03
$2,133.84
$2,398.55
$1,569.64
$1,881.86
$2,298.66
$2,764.19
$1,488.08
$1,810.12
$2,202.51
$2,602.96
$939.25
$1,137.30
$1,375.30
$1,635.40
$1,900.95
$2,530.00
$2,819.80
$2,984.25
$1,077.24
$1,308.12
$1,539.00
$1,539.00
Plan M
Company
Age 65
Age 70
Age 75
Age 80
$1,537.83
$1,966.50
$2,448.34
$2,902.04
Company
Age 65
Age 70
Age 75
Age 80
$1,895.68
$2,350.17
$2,907.08
$3,477.69
$1,734.96
$2,042.28
$2,467.20
$3,087.84
$1,756.71
$2,181.37
$2,553.66
$2,850.80
$1,539.33
$1,831.03
$2,174.07
$2,471.23
$1,914.98
$2,279.99
$2,704.51
$3,074.81
$1,239.30
$1,492.60
$1,793.50
$2,106.30
$1,706.20
$1,939.27
$2,256.26
$2,460.53
Age 65
Age 70
Age 75
Age 80
$1,445.99
$1,849.19
$2,302.33
$2,728.98
Plan N
Company
Company
Age 65
Age 70
Age 75
Age 80
$1,250.05
$1,370.80
$1,573.20
$1,783.65
$1,537.68
$1,914.12
$2,318.21
$2,705.29
$1,220.73
$1,441.36
$1,705.71
$2,007.11
$1,245.33
$1,404.94
$1,662.75
$1,908.22
$1,114.80
$1,257.72
$1,488.84
$1,739.52
Plan N (cont’d)
Company
Age 65
Age 70
Age 75
Age 80
$1,740.00
$2,340.00
$2,892.00
$3,420.00
$1,374.00
$1,617.12
$1,952.88
$2,398.56
$1,294.65
$1,456.16
$1,742.60
$1,967.21
$1,203.11
$1,417.95
$1,690.08
$1,947.89
$1,297.56
$1,676.54
$2,147.04
$2,662.50
$1,507.14
$1,785.94
$2,028.27
$2,217.54
$1,698.24
$1,999.08
$2,415.00
$3,022.56
$1,420.25
$1,534.10
$1,682.45
$1,795.15
$1,345.88
$1,614.23
$1,829.48
$1,997.98
$1,328.00
$1,570.00
$1,818.00
$2,050.00
$1,443.12
$1,589.39
$1,817.40
$2,040.81
$1,300.93
$1,433.52
$1,641.38
$1,846.31
$1,165.70
$1,375.21
$1,619.62
$1,831.82
$1,513.07
$1,868.28
$2,199.58
$2,486.48
$1,374.38
$1,671.78
$2,034.21
$2,404.10
$1,256.41
$1,417.44
$1,678.13
$1,960.57
$1,134.01
$1,331.76
$1,593.96
$1,799.35
$2,396.60
$3,185.50
$3,706.45
$4,112.40
$1,615.81
$1,692.48
$9,180.00
$2,191.41
$1,100.90
$1,270.46
$1,536.20
$1,812.05
$1,204.48
$1,274.88
$1,544.20
$1,826.19
$1,779.64
$1,959.04
$2,328.04
$2,644.59
$1,203.32
$1,418.20
$1,690.38
$1,948.24
$1,132.56
$1,277.76
$1,513.95
$1,776.28
$1,317.11
$1,401.91
$1,604.46
$1,755.32
$1,731.48
$2,110.89
$2,593.22
$3,072.87
$1,336.39
$1,587.00
$1,865.76
$2,163.84
$1,303.85
$1,497.37
$1,714.51
$1,928.50
$1,164.37
$1,284.33
$1,537.08
$1,736.07
$1,284.65
$1,486.22
$1,708.22
$2,051.38
$1,766.86
$2,077.65
$2,486.30
$2,808.99
$1,353.00
$1,431.60
$1,735.44
$2,005.56
$1,222.07
$1,379.03
$1,633.24
$1,908.80
$2,107.95
$2,804.85
$3,254.50
$3,600.65
$1,326.85
$1,495.40
$1,759.04
$1,991.00
$1,999.58
$2,272.61
$2,644.00
$2,883.43
$1,293.60
$1,570.80
$1,848.00
$1,848.00
$1,248.48
$1,462.68
$1,744.20
$2,019.60
SELECT Plan A
Company
Age 65
Age 70
Age 75
Age 80
No plans currently available in Kansas
SELECT Plan B
Company
Age 65
Age 70
Age 75
Age 80
$1,500.00
$2,052.00
$2,508.00
$2,976.00
SELECT Plan C
Company
Age 65
Age 70
Age 75
Age 80
$1,776.00
$2,436.00
$2,964.00
$3,516.00
$1,303.20
$1,533.84
$1,843.32
$2,256.12
Sentinel Security Life Insurance Co.
$1,955.44
$2,243.96
$2,557.33
$2,859.74
$1,528.80
$1,856.40
$2,184.00
$2,184.00
SELECT Plan D
Company
Age 65
Age 70
Age 75
Age 80
$1,476.43
$1,694.81
$1,936.39
$2,172.20
SELECT Plan F
Company
Age 65
Age 70
Age 75
Age 80
$1,788.00
$2,448.00
$2,976.00
$3,528.00
$1,385.16
$1,630.08
$1,959.72
$2,397.72
$2,002.62
$2,298.06
$2,618.80
$2,928.20
$1,537.20
$1,866.60
$2,196.00
$2,196.00
SELECT Plan G
Company
Age 65
Age 70
Age 75
Age 80
$1,226.52
$1,443.24
$1,735.32
$2,123.04
$1,075.01
$1,221.17
$1,449.49
$1,587.09
SELECT Plan K
Company
Age 65
Age 70
Age 75
Age 80
$747.48
$880.20
$1,063.08
$1,305.60
SELECT Plan N
Company
Age 65
Age 70
Age 75
Age 80
$1,416.00
$1,932.00
$2,364.00
$2,808.00
$1,043.03
$1,197.89
$1,371.62
$1,542.79
Appendix I: About Medicare and
Medicare Advantage Plans
What is Medicare?
Medicare is a federally-run health insurance program administered by the Centers for Medicare and
Medicaid Services (CMS). In order to be eligible to
receive Medicare, you must meet at least one of the
following criteria:
• be age 65 or older
• have permanent kidney failure
• have a Medicare-qualified disability
The Kansas Insurance Department has no direct
regulatory authority over Medicare.
How does Medicare work?
There are four separate parts to Medicare: Part A
(Hospital Insurance), Part B (Medical Insurance), Part
C (Medicare Advantage plans) and Part D (Prescription Drug Coverage). Each of these parts covers
specific services (see graph on next page).
When you near your 65th birthday, you should
contact Medicare to see about enrolling in Part A
coverage. You will also have the option to enroll in
Part B and Part D at this time. For most people, enrollment in Part A is automatic and comes without
cost - the Medicare taxes you’ve paid while you’ve
worked take care of this premium. However, most
people will need to pay a monthly premium for Part
B, Part C and Part D.
Medicare enrollment
Some people qualify for automatic enrollment in
Medicare, while others must apply for enrollment.
Applied enrollment - If you are not receiving
Social Security or Railroad Retirement Board (RRB)
benefits (for example, if you are still working), you
will need to apply to receive Part A and Part B. You
can contact the Social Security office 3 months
before your 65th birthday to receive this coverage.
Individuals with End-Stage Renal Disease (ESRD)
should also contact their local Social Security office
to sign up for Parts A and B. If you want Part C and/
or Part D, you must apply for it - there is no automatic enrollment.
Automatic enrollment - Automatic enrollment in
Part A and Part B occurs if you are already receiving
benefits from Social Security or the RRB. This coverage begins the first day of the month that you turn
65 years old. If your birthday falls on the first day of
the month, your coverage will begin the first day of
the month before you turn 65. Individuals under age
65 and disabled will automatically be enrolled in
Part A and Part B after receiving disability benefits
from Social Security (or some other limited sources)
for 24 months.
NOTE: Three months before your 65th birthday you
will receive your red, white and blue Medicare card.
Keeping this card automatically enrolls you in Parts
A and B. If you do not want to receive Part B, follow
the instructions that are included with the card.
Enrollment periods for Parts A, B, C and D vary.
The following are guidelines to help you figure out
when your enrollment period is. There are several
different enrollment periods that you should be
aware of when signing up for Medicare.
Initial enrollment period: Your initial enrollment
period lasts 7 months, beginning three months
before your 65th birthday (or, if you are still covered
under a group health plan, when you first become
eligible for Part B coverage). During this time, you
will enroll in Part A (and, if you choose, Part B) or a
Medicare Advantage Plan (Part C). You will also decide if you want Part D prescription drug coverage.
Your initial enrollment period is the only time that
you can enroll in all Parts of Medicare penalty-free.
Make sure to weigh your options carefully during
this time so that you don’t have to pay late enrollment fees for Part B or Part D later on.
How is Medicare divided?
Medicare has four parts:
Medicare Part A
Medicare Part B
(Hospital Insurance)
(Medical Insurance)
• Helps cover doctor services and outpatient
care.
• Helps cover inpatient care in hospitals
(includes critical access hospitals, inpatient
rehabilitation facilities, and long-term care
hospitals).
• Helps cover some preventive services to
help maintain a person’s health and to keep
certain illnesses from getting worse.
• Helps cover skilled nursing facility (not
custodial or long-term care), hospice, and
home health care services.
• Helps cover durable medical equipment.
Medicare Part C
Medicare Part D
(Medicare Advantage Plans)
(Prescription Coverage)
• A way to get Medicare benefits through
private insurance companies approved by
and under contract with Medicare.
• Run by private companies approved by
Medicare.
• Helps cover the cost of prescription drugs.
• Includes Part A, Part B, and usually other
benefits Medicare doesn’t cover. Some plans
also provide prescription drug coverage for
an additional cost.
• Each plan can vary in cost and drugs
covered.
• Part C takes the place of Parts A and B.
**Some information taken from CMS’s “Medicare Basics.”
General enrollment - Those who did not enroll
in Part A or Part B during their initial enrollment
period may do so between January 1 and March
31 each year. Those who enroll during this time will
begin receiving this coverage on July 1 of the same
year. You may have to pay a late enrollment fee if
you sign up during this time.
Special enrollment - Special enrollment periods
occur for those who chose not to enroll in Part A
and/or B because they were still covered under
employer or other group plan coverage when they
turned 65. Generally this special enrollment period
occurs during the 8-month period following the
end of employment or the end of group health
plan coverage, whichever comes first (for example,
retirement). If you have been continuously covered
under employer or group-sponsored health cover-
age since your 65th birthday, and enroll in Part A
and/or Part B during this special enrollment period,
you will not have to pay a late enrollment penalty.
Late enrollment penalties - Should you choose
not to enroll in Part B or Part D during your initial
enrollment period, then change your mind later, you
may be charged a late enrollment penalty. To avoid
this extra cost, make sure you weigh your options
carefully during the 7-month initial enrollment
period around your 65th birthday.
Gaps in Medicare
Medicare was never intended to pay 100% of medical bills. It forms the foundation for beneficiaries’
protection against heavy medical expenses. There
are gaps in Medicare coverage where the beneficiary must pay a portion of expenses. Medicare
supplement insurance, also called Medigap, can
help cover some of these expenses. The Kansas
Insurance Department is charged with regulating
Medicare supplement insurance (see Section I).
Items and services not covered under Medicare
include:
• Acupuncture
• Deductibles, coinsurance or copayments
when you obtain certain health care
services
• Dental care and dentures
• Cosmetic surgery
• Long-term care, like custodial care (help
with bathing, dressing, using the bathroom
and eating) at home or in a nursing home
• Eye care (routine exam), eye refractions
• Hearing aids and hearing exams
• Orthopedic shoes (with a few exceptions)
• Outpatient prescription drugs (with a few
exceptions)
• Routine foot care, such as cutting of corns
or calluses (with a few exceptions)
• Diabetic supplies (like syringes or insulin,
unless the insulin is used with a pump or it
may be covered by Medicare Part D)
• Chiropractic services except to correct a
subluxation (when bones in your spine
move out of position) using manipulation
of the spine. You are responsible for coinsurance, and the Part B deductible
applies
To find out if Medicare will cover a service, visit
www.medicare.gov/coverage or call 800-Medicare
(800-633-4227).
Medicare supplement insurance was created to help
cover some of these gaps in coverage. See Section I
for more information on what Medicare supplement
insurance covers to help you decide whether it is
right for you.
What is Part A?
Part A of Medicare was created to cover inpatient
care in hospitals, skilled nursing facilities, hospice
and some home health care. Many people do not
have to pay for this portion of Medicare because
they have paid Medicare taxes while working (referred to as “premium-free Part A”). You will not
have to pay a monthly premium for Part A if:
• You already receive retirement benefits
from Social Security or Railroad Retirement
Board benefits.
• You are eligible for Social Security or Rail
road Retirement Board benefits but haven’t
filed for them yet.
• You or your spouse worked in Medicare
covered employment for at least 10 years.
If you do not qualify for premium-free Part A, you
may still be able to purchase Part A coverage, as
long as you meet one of the following requirements:
• Are 65 or older, are eligible to purchase
Part B coverage, and meet residency or
citizenship requirements.
• Are under 65, disabled, and your premium-
free Part A ended because you returned to work.
What is included in Part A?
Generally, the following services are covered under
Part A:
• Inpatient care in hospitals (such as critical access
hospitals, inpatient rehabilitation facilities, and
long-term care hospitals).
• Inpatient care in a skilled nursing facility (not
custodial or long-term care).
• Hospice care services.
• Home health care services.
• Inpatient care in a Religious Nonmedical Health
Care Institution.
For questions about common services covered under Part A, contact Medicare directly. Beneficiaries
enrolled in Part A are subject to coinsurance and a
yearly deductible. In 2016, this deductible is $1,288.
NOTE: Not all overnight hospital stays are considered “inpatient.” It is important to check with your
doctor to find out whether your patient status is inpatient or outpatient. Overnight outpatient hospital
visits are not covered under Part A of Medicare.
What is Part B?
Part B of Medicare covers most doctor services and
some outpatient hospital and home health care
services, including some physical and occupational
therapy.
What is included in Part B?
Generally, Part B covers medically-necessary services and supplies that are needed to diagnose or
treat your medical condition and that meet accepted standards of medical practice.
Enrollment in Part B
Most people will first become eligible to enroll in
Part B around their 65th birthday. If you receive
Social Security benefits, enrollment in Part B is automatic: you must specifically tell Medicare if you do
not want to receive Part B. Information on how to
do this will be sent to your home along with your
Part A Medicare card.
Consider your coverage options carefully during
your intial enrollment period. If you choose not to
enroll in Part B coverage during the initial seven-month enrollment period, then change your
mind later on, you can be charged an extra 10%
for every 12 months that you were eligible for
Part B but did not enroll, and this fee applies for
the rest of your life (See “Medicare Enrollment”,
page 41).
What will I pay for Part B?
If you choose to enroll in Part B you will be charged
a monthly premium. Oftentimes this premium is
taken directly out of your Social Security, Railroad
Retirement or Civil Service Retirement payments
each month. If you do not receive any of these payments, you will be billed directly for the coverage.
Most new enrollees can expect to pay a monthly
premium of $121.80 for Part B coverage in 2016.
Enrollees who have incomes above $85,000 (single)
and $170,000 (married couple) may be charged a
higher monthly premium.
Enrollees covered under Part B are subject to a deductible. In 2016, this deductible is $166.
What is Part C (Medicare
Advantage Plans)?
Medicare Advantage Plans are an alternative way
of receiving Part A and Part B coverage (see graph
on page 7). Choosing a Medicare Advantage Plan
takes the place of Original Medicare - you cannot
have both. The Kansas Insurance Department has
no direct regulatory authority over Medicare Advantage Plans. Private insurance companies manage Medicare coverage for their members, and may
also provide extra benefits not included in Original
Medicare, such as dental, vision or hearing coverage. These plans include all benefits from Part A
and Part B, and some plans also include Part D
prescription drug coverage.
Medicare Advantage plans differ from Original
Medicare because they use provider networks. Using the services of doctors and hospitals outside
of the network may cost you an additional fee. The
types of provider networks included in the Medicare
Advantage plans are Health Maintenance Organizations (HMOs); Preferred Provider Networks (PPOs);
Private Fee-For-Service (PFFS); Special Needs Plans
(SNPs); and Medical Savings Accounts (MSA).
Health Maintenance Organizations (HMOs) Generally, in Kansas, you can only go to doctors,
specialists or hospitals on the plan’s list, except in
emergency situations. This is called the plan’s “network.” You may also have to choose a primary care
doctor and get referrals to see a specialist. You may
pay lower copayments and get extra benefits, such
as coverage for extra days in the hospital.
Preferred Provider Organization Plans (PPOs)
- In most of these plans, you use doctors, specialists and hospitals in the plan’s network. You can go
to doctors, specialists or hospitals not in the plan’s
network, but it may cost extra. You don’t need
referrals to see doctors, specialists, or hospitals who
aren’t part of the plan’s network. You may pay lower
copayments and get extra benefits, such as coverage for extra days in the hospital.
What will I pay
for a Medicare Advantage Plan?
Private Fee-for-Service Plans (PFFS) - These plans
allow you to go to any primary care doctor, specialist or hospital that accepts the terms of the plan’s
payment. The private company, rather than Medicare, decides how much it will pay and how much
you pay for the services you get.
Because Medicare Advantage Plans are run by
private insurance companies, costs will vary. Some
factors that contribute to the costs of Medicare
Advantage plans include the following:
• Whether the plan charges a monthly
premium, and how much that premium is.
• Whether the plan pays any of your monthly
Part B premium.
• Whether the plan charges a yearly
deductible.
• Whether the plan has any copayments
or coinsurance costs, and how much they
are.
• The type of health care services you need
and how often they are needed.
• Whether you follow the rules of the plan
(including extra charges for using out-of
network providers).
• Whether you need extra benefits, and how much the plan charges for those benefits.
• The plan’s yearly limit for out-of-pocket
costs.
Special Needs Plan (SNPs) - Medicare Special
Needs Plans are specially designed for people
with certain chronic diseases and other specialized health needs. These plans must provide all of
the same benefits provided by Part A and Part B.
They also must provide Medicare prescription drug
coverage (Part D). Generally, they offer extra benefits and have lower copayments than the Original
Medicare plan. Special Needs Plans are designed
to meet the needs of people who live in certain
institutions (like a nursing home), are eligible for
both Medicare and Medicaid, or have one or more
specific chronic or disabling conditions.
A Special Needs Plan may help manage and coordinate the many services and providers their
members use to help them stay healthy. They also
help members follow their doctor’s orders related
to diet and prescription drugs, and help coordinate
between Medicare and Medicaid. They may also
identify care provider efforts to meet the patient’s
needs. For example, a Special Needs Plan for people
with diabetes might use a care coordinator to help
members monitor blood sugar, follow their diet,
get proper exercise, get needed preventive services
such as eye and foot exams, and get the right medicines to prevent complications.
Medical Savings Account Plans (MSAs) - Medical
Savings Account Plans (MSAs) are similar to Health
Savings Account plans available outside of Medicare. They have two parts. The first part is a Medicare Advantage health plan with a high deductible.
This health plan won’t begin to pay covered costs
until you have met the annual deductible, which
varies by plan. The second part is a Medical Savings
Account into which Medicare deposits money that
you may use to pay health care costs.
Medicare supplement insurance cannot be used if
you have a Medicare Advantage Plan (see Section
I). If you switch to an Advantage Plan, but already
have a Medicare supplement plan, you cannot use
that coverage to pay for out-of-pocket expenses.
Likewise, if you are enrolled in a Medicare Advan-
If you join a Medicare
Advantage Plan...
• You are still considered part of
Medicare.
• You still have Medicare rights and
protections.
• You get the same covered services
included in Original Medicare.
• You may be able to get extra benefits, such as coverage for extra days in the hospital.
• You are not eligible to purchase
Medicare supplement insurance.
tage Plan, you cannot be sold a Medicare supplement plan.
What is Part D?
Medicare provides prescription drug coverage to
help enrollees pay for the drugs they need to stay
healthy. Everyone with Original Medicare or a Medicare Advantage Plan can choose to enroll in this
voluntary drug coverage regardless of their income,
health, or how they currently pay for their prescriptions.
Like Medicare Advantage Plans, Part D prescription
drug coverage is run by private companies approved by Medicare. Part D can be added to either
Things to consider when
looking at a Medicare
Advantage Plan:
1. Is your doctor included in the
provider network? If not, you may want
to either consider a different plan or find
a new doctor who is included in the plan’s
network.
2. Are the hospitals in the network
convenient for you? Make sure you have
easy access to hospitals in case of an
emergency.
3. Are your prescriptions covered under the plan? This is especially important
if you have a chronic condition that requires medication.
4. What will your out-of-pocket costs
be?
5. Do you trust the insurance company
selling the policy? You should always
buy from experienced companies who
come well recommended.
Original Medicare or a Medicare Advantage Plan
(check to make sure your Advantage Plan doesn’t
already include Part D). You must have Part A or
Part B to receive Part D coverage - it cannot stand
alone.
Enrollment in Part D
You have the option to enroll in Part D during your
initial enrollment period. You must pay a monthly
premium for this coverage. The cost for each Part
D plan varies based on the company selling the
policy, and those individuals with a higher modified
adjusted gross income may pay a higher premium
each month.
Like Part B, if you choose not to enroll in Part D during your initial enrollment period, then change your
mind, you may be charged a late enrollment fee,
so it is important to evaluate your coverage needs
during your initial enrollment period. You will be
charged more for Part D coverage if you enroll
after your initial enrollment period.
How does Part D work?
Medicare prescription drug plans vary. In general,
when you join, you will pay a monthly premium in
addition to any premiums for Medicare Part A and
Part B. You may also pay a deductible for your prescriptions. After you pay the yearly deductible, you
will pay varying coinsurance amounts.
Medicare prescription drug plans can offer more
generous coverage for higher premiums. Joining is
your choice. However, if you don’t join when you
first become eligible, you may have to pay a higher
premium should you decide to join later. You will
have to pay this higher premium for as long as you
have a Medicare prescription drug plan.
Things to remember:
• If you want coverage, you must enroll. Enrollment
is not automatic.
• Once you’re enrolled, you will pay a monthly
premium.
• If you have a low income and limited assets, you
may qualify for the “Extra Help” program to help
with the costs.
Part D Extra Help
Some people qualify for government assistance in
paying for Part D through a program called “Extra
Help.” This program can assist with the costs of
monthly premiums, annual deductibles, and prescription copayments. In order to qualify for this
program, you must meet the following criteria:
• Reside in one of the 50 states or the
District of Columbia;
• Have limited resources of $13,640 (single)
or $27,250 (married couple living together).
In this case, resources include bank
accounts, stocks and bonds, but do not
include things like your home or car;
• Have an annual income of less than
$17,820 (single) or $24,030 (married couple
living together). Even if you make more
each year, you may qualify for some assis-
4 ways to lower your costs
during the Part D coverage gap
1. Consider switching to generics or other
lower-cost drugs. You also might be able to
save money by using mail-order pharmacies.
2. Find a pharmaceutical assistance program. Check www.medicare.gov to find out
whether there’s an assistance program for the
drugs you take.
3. Appy for Extra Help. If you have limited
income and resources, check with your Social
Security office.
4. Explore national and community-based
charitable programs. Groups like the National Patient Advocate Foundation and the
National Organization for Rare Disorders may
be able to help you.
tance. Check with your local Social Security
office for more information.
To find out more about the “Extra Help” program,
contact your local Social Security office or call 800772-1213. You can also get more information, and
even enroll in the program, by visiting Social Security online at www.ssa.gov/prescriptionhelp/.
How does other insurance
work with Part D?
Employer or union
health coverage
This is health coverage based on your, your
spouse’s, or other family member’s current or
former employment. If you have prescription drug
coverage based on employment, the employer or
union will notify you each year to let you know if
your drug coverage is creditable (see Glossary of
Terms for more information). Keep the information
you get. If you join a Medicare drug plan, you, your
spouse, or your dependents may lose your employer or union health coverage. Call your benefits
administrator for more information before making
any changes to your coverage.
COBRA
This is a federal law that may allow you to temporarily keep employer or union health coverage after
the employment ends or after you lose coverage as
a dependent of the covered employee. There may
be reasons why you should take Part B instead of
COBRA. However, if you take COBRA and it includes
creditable prescription drug coverage, you will have
a special enrollment period to join a Medicare drug
plan without paying a penalty when the COBRA
coverage ends.
Medicare supplement policy
with prescription drug coverage
Medicare supplement policies are no longer sold
with prescription drug coverage, but if you have
drug coverage under a current Medicare supplement policy, you can keep it. You may want to join
a Medicare drug plan instead, because supplement
drug coverage isn’t creditable. If you join a Medicare drug plan, your supplement insurance company must remove the prescription drug coverage and
adjust your premiums. Call your Medicare supplement insurance company for more information.
Federal Employee Health
Benefits Program (FEHBP)
If you join a Medicare drug plan, you can keep your
FEHBP plan, and your plan will let you know who
pays first. For more information, contact the Office
of Personnel Management at 800-332-9798. You
can also call your plan if you have questions.
Veterans benefits
You may be able to get prescription drug coverage
through the U.S. Department of Veterans Affairs
(VA) program. You may join a Medicare drug plan,
but if you do, you can’t use both types of coverage
for the same prescription. For more information, call
the VA at 800-827-1000 (TTY call 800-829-4833).
TRICARE
(Military Health Benefits)
People with TRICARE who are entitled to Part A
must have Part B to keep TRICARE prescription drug
benefits. If you have TRICARE, you aren’t required to
join a Medicare drug plan. If you do, your Medicare
drug plan pays first, and TRICARE pays second. If
you join a Medicare Advantage plan with prescription drug coverage, TRICARE won’t pay for your
prescription drugs. For more information, call the
TRICARE pharmacy contractor at 877-363-8779 (TTY
call 877-540-6261).
Appendix II: Consumer Protections
and Other Resources
Protections when you lose coverage
Open enrollment rules protect Medicare beneficiaries who may lose their health coverage. Under
certain circumstances, you have 63 days to purchase Medicare supplement insurance without having
to report your health information. Details for each situation are described below. If you have questions
about your particular situation, please contact our Consumer Assistance Division at 800-432-2484.
Your situation:
You have the right to
buy:
You must apply for a
policy:
You lose your Medicare Advantage coverage
You’re in a Medicare Advantage
Plan, and your plan is leaving
Medicare or stops giving care in
your area, or you move out of
the plan’s service area.
Any Medicare supplement plan
A, B, C, F, K or L that is sold in
Kansas.
You only have this right if you
switch to Original Medicare - not
if you switch to another Advantage plan.
As early as 60 calendar days
before the date your health
care coverage will end, but no
later than 63 calendar days after
your health care coverage ends.
Medicare supplement coverage
can’t start until your Medicare
Advantage Plan coverage ends.
You want to switch from an Advantage plan to Original Medicare
You joined a Medicare Advantage Plan or Programs of
All-inclusive Care for the Elderly (PACE) when you were first
eligible for Medicare Part A at
65, and within the first year of
joining you decide you want to
switch to Original Medicare.
Any Medicare supplement policy
that is sold in Kansas by any
insurance company.
before the date your health care
coverage will end, but no later
than 63 calendar days after your
health care coverage ends.
You lose Medicare supplement coverage
Your Medicare supplement insurance company goes bankrupt
and you lose your coverage, or
your supplement policy coverage otherwise ends through no
fault of your own.
Kansas.
No later than 63 days after from
the date your coverage ends.
Your situation:
buy:
policy:
You move to a Medicare Advantage plan and want to switch back
You dropped a Medicare supplement policy to join a Medicare
Advantage Plan (or to switch to
a Medicare SELECT policy) for
the first time, you have been in
the plan less than a year, and
you want to switch back.
The Medicare supplement policy
you had before you joined the
Advantage or SELECT policy, if
the same insurance company
you had before still sells it. If it
included drug coverage, you can
still get that same policy, but
without the drug coverage.
before the date your health care
coverage will end, but no later
than 63 calendar days after your
health care coverage ends.
If your former policy isn’t available, you can buy any Plan A, B,
C, F, K or L that is sold in Kansas.
You lose employer group health plan benefits
You have Original Medicare and
an employer group health plan
(including retiree or COBRA coverage) or union coverage, but
leave that employer plan.
Kansas.
If you have COBRA coverage,
you can either buy a Medicare
supplement policy right away or
wait until the COBRA coverage
ends.
No later than 63 days after the
latest of these 3 dates:
1. Date the coverage ends.
2. Date on the notice you get
telling you that coverage is ending (if you get one).
3. Date on a claim denial, if this
is the only way you know that
your coverage ended.
You move out of a Medicare SELECT policy’s service area
You have Original Medicare and
a Medicare SELECT policy. You
move out of the Medicare SELECT policy’s service area.
A, B, C, F, K or L that is sold by
any insurance company in Kansas.
You can keep your Medicare
supplement policy, or you may
want to switch to another supplement policy.
before the date your Medicare
SELECT coverage will end, but
no later than 63 calendar days
after your Medicare SELECT coverage ends.
Your situation:
buy:
policy:
You lose Medicaid eligibility
You lose your eligibility for
health benefits under Title XIX
of the Social Security Act (Medicaid).
Any Medicare supplement Your
plan
You leave a Medicare Advantage
Plan or drop a Medicare supplement policy because the company hasn’t followed the rules or
it misled you.
Any Medicare supplement policy
or Medicare Select policy offered
by an company in Kansas.
No later than 63 calendar days
from the date your coverage
ends.
insurance company commits fraud
that is sold in Kansas.
Consumer Rights
Free look period
You are entitled to a 30-day “free look” at your
Medicare supplement insurance policy, beginning
the day you receive the policy. Be sure to keep track
of the date the policy arrived; the postmark date on
the envelope you receive it on can be a good indicator of when this 30-day period began.
No later than 63 calendar days
from the date your coverage
ends.
pre-existing conditions.
• Rights of the insurance company to
change premiums.
• Automatic premium increases based on
age at renewal time.
Outline of coverage
Use this “free look” period to do the following:
• Make sure it provides the benefits you
expect and desire.
• Check for limitations, exclusions or waiting
periods.
• Read the application carefully to make sure
that it has not been changed in any way
and that all medical information is
accurate.
An agent seeking your business must provide an
outline of coverage when giving you an application form. This outline of coverage must do the
following:
• Summarize the major benefit gaps in
Medicare and tell you how much each
benefit package offered by the insurance
company will pay toward filling each gap.
• Disclose the premium for each benefit
package that is offered.
• State the total price of the policy and the
likelihood of future premium increases as
your age increases.
• Declare your right to a premium refund if
you return the policy during the 30-day
“free look” period.
Required disclosures
Guaranteed renewable
If you are dissatisfied for any reason, you can return
the policy within the 30 days and get your money
back, no questions asked.
Your Medicare supplement policy must clearly disclose the existence of any of the following:
• Limitations or exclusion of payments for
All Medicare supplement insurance policies sold
today are guaranteed renewable. The insurance
company cannot refuse to renew your policy unless you do not pay the premiums or you submitted
false information on the application. Older policies
(prior to 1992) may allow the company to refuse to
renew on an class basis.
Tips and Warnings
• Shop carefully before you buy. Policies differ as
to coverage and cost. Companies differ as to service.
• Don’t buy more policies than you need. Insurance agents are prohibited from selling a second
Medicare supplement policy to someone who has a
Medicare supplement policy already in force, unless you intend to cancel the first policy after the
replacement policy goes into effect. You should
use caution in purchasing other types of insurance
which duplicate benefits provided by Medicare and
your supplemental coverage.
• Check for pre-existing condition exclusions and
waiting periods. Medicare supplement policies are
required to cover pre-existing conditions after the
policy has been in effect for six months. Some policies may cover you sooner.
• Beware of replacing existing coverage. Make
sure you have a good reason for switching from one
policy to another. You should only switch for different benefits, better service, or a more affordable
price. If you decide to replace your policy, you must
be given credit for the time spent under the old
policy. In other words, insurance companies must
take into account the amount of time you were under your old policy when applying any pre-existing
condition exclusions or restrictions.
Companies can decline you for coverage if you have
a pre-existing condition and your 6-month initial
open enrollment period is over.
You must sign a statement that indicates your intention to terminate the policy to be replaced. Do not
cancel the first policy until you have been accepted
into the new plan and you are sure that it is what
you want.
• Despite misleading claims made by some insurers and agents, NO Medicare supplement policy
covers every medical expense not covered by
Medicare.
• Be aware that Medicare supplement policies
are not sold or run by any state or federal government agencies.
• Know about the agent and company you are
working with. Call our Consumer Assistance
Hotline at 800-432-2484 to make sure any agent or
company you are considering is licensed in Kansas.
• Take your time. Do not be pressured into buying
a policy. Principled sales people will not rush you.
• If you decide to buy, complete the application carefully. It is against the law for an agent to
suggest you falsify an application. Do not withhold
medical information on the application for insurance. Coverage could be refused for a period of
time, a claim could be denied or your policy canceled if you leave out any of the medical information requested. NEVER sign a blank application.
Don’t let the agent fill it out for you.
• DO NOT pay cash. Pay by check, money order or
bank draft made payable to the insurance company.
Get a receipt for your records.
Protect yourself from
identity theft
Identity theft occurs when someone uses your
personal information (like your name, Social Security, Medicare or credit card number) without your
consent to commit fraud or other crimes. Keep this
information safe. Don’t give your information to
anyone who comes to your home (or calls you) uninvited selling Medicare-related products. Only give
personal information to doctors or other providers
that are approved by Medicare. Call 800-MEDICARE
if you aren’t sure a provider is approved by Medicare.
If you lose your Medicare card or it is stolen, or if
you need a new Social Security number, go to
www.socialsecurity.gov on the web, or call the Social
Security Administration at 800-772-1213. If you
think someone is using your personal information,
call one of the following:
• 800-MEDICARE (1-800-633-4227). TTY
users should call 877-486-2048.
• The Fraud Hotline of the HHS Office of
the Inspector General at 800-447-8477.
TTY users should call 800-377-4950.
• The Federal Trade Commission’s ID Theft
Hotline at 877-438-4338 to make a report
(TTY users should call 866-653-4261). For
more information about identity theft, visit:
www.consumer.gov/idtheft on the web.
NOTE: Medicare can’t ask for your Social Security
Number over the telephone. Report any plans that
ask for your Social Security Number over the telephone by calling 800-MEDICARE.
Kansas Foundation for
Medicare Care (KFMC)
KFMC provides independent medical review and
the monitoring of quality of care. You have a right
to proper diagnosis and treatment under Medicare. KFMC will act on your behalf to protect your
rights, especially relating to hospital confinements
and treatment. These services are free to Medicare
beneficiaries. For more information, call the Topeka
office at (785) 273-2552 or 800-432-0407, or visit
their website, www.kfmc.org.
Insurance fraud
Kansas Department for Aging &
Disability Services (KDADS)
Fraud is not limited to Medicare. People can be
victims of fraud when they are buying supplement
insurance or other specialty insurance products.
Consumers should be wary of agents who fill out
medical history and say it’s okay not to tell the
company certain health information. Also, while it’s
important to shop around for the best price, if it
seems too good to be true, it probably is.
The Kansas Department for Aging & Disability
Services (KDADS) provides many programs and
services for Kansas seniors. These services include,
but are not limited to, nutrition and meal programs;
home health care; homemaker services; housing;
transportation; respite care; support groups; case
management; and information on long-term care.
Services are available through 11 area agencies.
To report suspected insurance fraud, call the Kansas
Insurance Department at 800-432-2484.
KDADS also administers the Senior Health Insurance
Counseling for Kansas (SHICK) program.
Helpful resources
For more information, call the Topeka office at (785)
296-4986 or 800-432-3535 or visit their website,
www.kdads.ks.gov.
Medicare claims service
All calls regarding Medicare claim payments should
be directed to 800-MEDICARE (800-633-4227). This
is an automated system that will direct your call
based upon your responses to a few automated
voice prompts.
Senior Health Insurance
Counseling for Kansas (SHICK)
SHICK provides Medicare, Medicare supplement,
long-term care and other health insurance counseling through a network of volunteers statewide. All
services are free. For more information, call 800860-5260 or visit their website, http://kdads.ks.gov/
commissions/commission-on-aging/medicare-programs/shick.
Centers for Medicare and
Medicaid Services (CMS)
CMS is the federal agency responsible for protecting the rights of Medicare beneficiaries. CMS works
to make Medicare more effective, responsive and
user-friendly. For more information, contact one of
the following:
Toll Free Hotline: 800-633-4227 (24 hours a day)
Provides services in both English and Spanish
TTY users: 877-486-2048
Online at www.medicare.gov
Glossary of Terms
Assignment - An agreement by your doctor or other
supplier to be paid directly by Medicare, to accept
the payment amount Medicare approves for the service, and not to bill you for any more than the Medicare deductible and coinsurance.
Benefit period - The way that Original Medicare
measures your use of hospital and skilled nursing facility (SNF) services. A benefit period begins the day
you go to a hospital or SNF. The benefit period ends
when you haven’t received any inpatient hospital (or
skilled care in a SNF) for 60 days in a row. If you go
into a hospital or a SNF after one benefit period has
ended, a new benefit period begins. You must pay
the inpatient hospital deductible for each benefit
period. There is no limit to the number of benefit
periods a beneficiary can have.
Coinsurance - An amount you may be required to
pay as your share of the cost for services after you
pay any deductibles. Coinsurance is usually a percentage. In a Medicare prescription drug plan (Part
D) or Medicare health plan, the coinsurance will vary
depending on how much you have spent.
Copayment - An amount you may be required to
pay as your share of the cost for a medical service or
supply, like a doctor’s visit or prescription. A copayment is usually a set amount, rather than a percentage.
Cost sharing - The amount you pay for health care
and/or prescriptions. The amount can include copayments, coinsurance, and/or deductibles.
Creditable - Creditable coverage is any coverage
that is offered through an employer or group sponsored health plan, or some other health plan, that is
equal or better than coverage you would receive under Medicare. Providing proof to Medicare that you
have creditable coverage at the time you enroll will
keep you from having to pay a late penalty fee if you
enroll in prescription drug coverage after your initial
open enrollment period.
Deductible - The amount you must pay for health
care or prescriptions, before Original Medicare, your
Medicare drug plan, your Medicare health plan, or
your other insurance begins to pay. These amounts
can change every year.
Extra Help - A Medicare program to help people
with limited income and resources pay Medicare Part
D prescription drug program costs, such as premiums, deductibles, and coinsurance.
Guaranteed Issue Rights - Rights you have in
certain situations when insurance companies are
required by law to sell or offer you a Medicare
supplement policy. In these situations, an insurance
company can’t deny you a Medigap policy, or place
conditions on a Medicare supplement policy, such
as exclusions for pre-existing conditions, and can’t
charge you more for a policy because of past or
present health problems.
Health Maintenance Organization (HMO) - A type
of Medicare health plan that is available in densely
populated areas of the state. Plans must cover all
Medicare Part A and Part B services. Some HMOs
cover extra benefits, like extra days in the hospital. In
most HMOs, you can only go to doctors, specialists,
or hospitals on the plan’s list, except in an emergency.
High deductible Medicare supplement policy - A
type of Medicare supplement policy that has a high
deductible but a lower monthly premium. You must
pay the deductible before the Medicare supplement
policy pays anything. The deductible amount can
change each year.
Medical underwriting - Medical underwriting is the
process an insurance company uses to determine
whether or not to accept you as a beneficiary under
a policy. The company also uses medical underwriting to determine how much of a monthly premium
to charge you. Medical underwriting is based on information you give to the company about your past
and present medical conditions.
Medically necessary - Services or supplies that are
needed for the diagnosis or treatment of your medical condition and accepted standards of medical
practice.
Medicare Advantage Plans - Medicare Advantage
Plans (like an HMO or PPO), also called “Part C,” are
health plans run by Medicare-approved private insurance companies. Medicare Advantage Plans include
Part A, Part B, and sometimes other coverage like
Medicare prescription drug coverage (Part D), sometimes for an extra cost.
Medicare Medical Savings Account (MSA) plan
- A type of Medicare Advantage Plan. MSA plans
combine a high deductible Medicare Advantage Plan
and a bank account. The plan deposits money from
Medicare into the account. You can use the money
in this account to pay for your health care costs,
but only Medicare-covered expenses count toward
your deductible. The amount deposited is usually
less than your deductible amount so you generally
will have to pay out-of-pocket before your coverage
begins.
Medicare Special Needs Plan (SNP) - A special
type of Medicare Advantage Plan that provides
more focused and specialized health care for specific groups of people, such as those who have both
Medicare and Medicaid, who reside in a nursing
home, or have certain chronic medical conditions.
Medicare-approved amount - In Original Medicare,
this is the amount a doctor or supplier that accepts
assignment can be paid. It includes what Medicare
pays and any deductible, coinsurance, or copayment
that you pay. It may be less than the actual amount a
doctor or supplier charges.
Medigap - A Medicare supplement insurance policy.
Open enrollment period (Medicare supplement
insurance) - A one-time only 6-month period when
federal law allows you to buy any Medicare supplement policy you want that is sold in your state. It
starts in the first month that you are covered under
Medicare Part B. During this period, you can’t be
denied a Medicare supplement policy or be charged
more due to a past or present health problem. Kansas regulations allow individuals under age 65 the
same open enrollment period whether they receive
Medicare because of age or disability.
Out-of-network - Generally, an out-of-network benefit provides you with the option to get plan services
out of the plan’s contracted network of providers. In
some cases, your out-of-pocket costs may be higher
for an out-of-network benefit.
Out-of-pocket costs - Health or prescription drug
costs that you must pay on your own because they
are not covered by Medicare or other insurance.
Pre-existing condition - A health problem you had
before the date that a new insurance policy starts.
Preferred Provider Organization (PPO) - A type of
Medicare Advantage Plan available in a local or regional area in which you pay less if you use doctors,
hospitals, and providers that belong to the network.
You can use doctors, hospitals, and providers outside
of the network for an additional cost.
Premium - The periodic payment to Medicare, an
insurance company, a health care plan or a drug plan
for health care or prescription drug coverage.
Private Fee-for-Service plan - A type of Medicare
Advantage Plan in which you may go to any Medicare-approved doctor or hospital that agrees to treat
you under the plan and that accepts the plan’s payment terms. The plan decides how much you must
pay for services.
Referral - A written order from your primary care
doctor for you to see a specialist or get certain
services. In many HMOs, you need to get a referral
before you can get care from anyone except your
primary care doctor. If you don’t get a referral first,
the plan may not pay for your care.
Service area - The area where a health plan accepts
members. For plans that limit which doctors and
hospitals you may use, it’s generally the area where
you can get routine (non-emergency) services. The
plan may disenroll you if you move out of the plan’s
service area.
Skilled Nursing Facility (SNF) - A nursing facility
with the staff and equipment to give skilled nursing
care and, in most cases, skilled rehabilitation services
and other related health services.
What you need to know in 2016
The following are things you should know about Medicare in 2016. See CMS’s
“Medicare & You” book for more information.
Stay healthy with Medicare-covered preventive services
Medicare pays for many preventive services that can help prevent illness or detect
health problems early when they’re easier to treat. Ask your health care provider what
services you need.
Keep track of your personal health information
Medicare’s has expanded its Blue Button to provide better access to your Medicare
claims and personal health information. Visit MyMedicare.gov to use the Blue Button.
Continued help in the prescription drug coverage gap
If you reach the coverage gap in your Medicare prescription drug coverage, you’ll qualify for savings on brand-name and generic drugs.
Mark your calendars for open enrollment
In most cases, this may be your only chance to make changes to your health and
prescription drug coverage:
October 1, 2016
Start comparing your coverage with other options. You
may be able to save money by comparing all of your options.
October 15 December 7, 2016
Change your Medicare health or prescription drug coverage for 2017, if you decide to.
January 1, 2017
New coverage begins if you make a change during
Open Enrollment. New costs and benefit changes also
begin if you keep your existing health or prescription
drug coverage and your plan makes changes.
800-247-2190
800-247-2190
512-451-2224
800-366-6565
800-241-1439
800-892-6048
800-752-6650
866-644-3988
800-386-5202
800-523-4000
800-225-4500
800-990-0345
800-352-5150
800-348-7468
800-445-1425
800-648-0075
800-704-2180
800-801-6831
800-938-4765
800-338-7452
816-478-0120
800-448-6262
800-821-5434
800-843-5755
American Republic Corp Insurance Co.
American Republic Insurance Co.
American Retirement Life Ins. Co.
Americo Financial life and Annuity Insurance Co.
Equitable Life & Casualty Insurance Co
Everence Association Inc
First Health Life and Health Insurance Co
United National Life Insurance Co of America
State Farm Mutual Automobile Insurance Co
Philadelphia American Life Insurance Co
860-273-0123
860-273-0123
Aetna Health and Life Insurance Co.
800-531-8000
855-764-4000
800-847-4836
319-398-8511
800-638-3080
800-237-4463
972-529-5085
800-207-8050
877-845-0892
877-832-7734
Contact Local Agent
205-325-2722
800-633-6752
800-669-9030
800-822-9993
402-351-2775
800-272-5466
800-848-0123
800-308-2318
309-346-1161
800-713-4680
800-228-9100
800-654-9106
888-510-0668
800-848-5433
888-519-5819
Company Customer Service Phone Numbers
Kansas Insurance Department
420 SW 9th Street
Topeka, KS 66612-1678
1-800-432-2484
(785) 296-3071
www.ksinsurance.org
commissioner@ksinsurance.org
(785) 296-7805 (fax)
1-877-235-3151 (TTY/TDD)

Medicare supplement insurance

Transcription

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