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Medicare Supplement Insurance
What it protects against
Some costs that Medicare doesn't cover, including coinsurance, copayments and deductibles, health emergencies in foreign countries, at-home recovery, and preventive care.
How it works
Medicare includes Part A, which covers medically necessary treatments in a hospital, and Part B, which covers medically necessary doctors' services and outpatient care as well as Part A deductibles. The Medicare Health Plans, parts C through L, include these basic benefits and addtional coverage. Plans are standardized so buyers can compare provider offerings. Part J offers the most benefits; parts K and L were new in 2005. Insurers are not required to offer all Medicare Supplement, also known as Medigap, plans. Each spouse must buy coverage separately. New in 2006 are Medicare prescription drug plans, which offer alternatives to the original Medicare plan. People in many areas may choose Medicare Advantage Plans, which provide extra benefits and can free an enrollee from needing any Medigap plans. For more information about Medicare and Medigap, go to www.medicare.gov.
Who needs it
Most people eligible for Medicare.
Who may not need it
People with private or other health plans that cover expenses Medigap plans insure. Massachusetts, Minnesota and Wisconsin offer their own Medigap policies. The affluent may choose to self-insure. People with Medicare Advantage Plans or those on Medicaid may not be eligible for Medigap policies.
When to buy it
During your six-month Medigap open enrollment period, which begins the first day of the month in which you are 65 years old and enrolled in Medicare Part B. If you are losing health coverage from another source because you are eligible for Medicare, you can apply for a Medigap policy before your open enrollment period starts in order to assure continuous coverage.
How you pay for it
Monthly premiums.
Terms to Know
Benefit Period
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In health insurance, the number of days for which benefits are paid to the named insured and his or her dependents. For example, the number of days that benefits are calculated for a calendar year consist of the days beginning on Jan. 1 and ending on Dec. 31 of each year.
Creditable Coverage
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Term means that benefits provided by other drug plans are at least as good as those provided by the new Medicare Part D program. This may be important to people eligible for Medicare Part D but who do not sign up at their first opportunity because if the other plans provide creditable coverage, plan members can later convert to Medicare Part D without paying higher premiums than those in effect during their open enrollment period.
Guaranteed Issue Right
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The right to purchase insurance without physical examination; the present and past physical condition of the applicant are not considered.
Lifetime Reserve Days
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Sixty additional days Medicare pays for when you are hospitalized for more than 90 days in a benefit period. These days can only be used once during your lifetime. For each lifetime reserve day, Medicare pays all covered costs except for a daily coinsurance amount.