Medicare Supplement Insurance Overview

A Medicare Supplement is a private health insurance policy designed to supplement Original Medicare. It covers some of the health care costs that Medicare doesn’t cover such as co-insurance, copayments, and deductibles. Medicare Supplement policies may also cover some services not covered by Medicare. If you are enrolled in Medicare Parts A and B and have a Medicare Supplement policy, Medicare pays its share of the approved amount for a covered heath care costs, and then the Medicare Supplement policy pays its share. Every Medicare Supplement policy must meet State and Federal laws designed to protect consumers and the policy must be clearly identified as “Medicare Supplement Insurance.” Insurance companies can only sell a “standardized” plans identified by letters A through N. All standardized policies must offer the same basic benefits, no matter which insurance company sells it. Since the coverage is the same no matter which insurer you choose, the only difference is the price and the service you receive.

Since January 1, 2006, Medicare Supplement policies do not include prescription drug coverage. If you have a Medicare Supplement policy without prescription drug coverage, you can join a Medicare Prescription Drug Plan (Part D) during the Medicare Advantage Annual Enrollment Period (AEP). Information about Part D plans can be found on the federal government website at www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227).

Medicare Select policies offer the same basic coverage as the standard plans; however, the insurance company normally requires participants to use a specific network of health care providers and/or facilities. The premium for a Medicare Select policy is usually lower than a traditional Medicare Supplement insurance policy.

Except for emergency care, the Medicare Select policy will deny payment or pay less than the full benefit if you go outside the network for services. Medicare, however, will still pay its share of approved charges in such situations.

Medicare Supplement Insurance - Getting Started Guide by CMS

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Free Look Period

Grace Period

Open Enrollment Periods

Age 65 or over: S. 627.6741, Florida Statutes requires companies to provide an open-enrollment period to accept applications and not discriminate in the pricing of the policy, regardless of the enrollee's medical history, health status, or claims experience.

The open-enrollment period for Medicare Supplement insurance begins the first day of the month a person turns 65 and is enrolled in Medicare Part B. If a birthday falls on the first day of the month, Medicare Part B coverage and Medicare supplement insurance open enrollment begins the first day of the previous month.

If the individual did not enroll in Medicare Part B upon becoming age 65 and chooses to do so at a later date, they will have 6 months from the Medicare Part B effective date in which to obtain a guaranteed issue Medicare Supplement policy. In addition, there is a 2-month period following termination of employer-based group health coverage for an individual to have the same guaranteed issue rights.

Under age 65: Effective October 1, 2009, s. 627.6741, Florida Statutes required an open enrollment period for individuals that become eligible for Medicare Part A and B due to disability, including end stage renal disease (ESRD). Once the person is enrolled in Part A and B, regardless of age, they will have 6 months in which to obtain a guaranteed issue Medicare Supplement policy.

In addition, there is a 2-month period following termination of employer based group health coverage for an individual to have the same guaranteed issue rights.

All insurance companies that sell Medicare Supplement policies in Florida must offer their policies to those under age 65.

Individuals on disability or with ESRD that enrolled in a Medicare Supplement plan will have another open enrollment period when they turn 65 years old. They must apply for a new policy in order to receive a lower premium. Medicare Supplement rates for individuals with ESRD or on disability are higher than for those eligible for Medicare due to age. The individual will be eligible for the lower rate once they turn 65 years of age.

Pre-Existing Condition

Premium Issues

Medicare Supplement Tips

Low Income Assistance

Alternative Plans

Medicare Advantage Plans: Medicare Advantage Plans (Medicare Part C) include the following:

Preferred Provider Organization (PPO) Plans: PPOs are similar to HMOs; however, the beneficiaries do not need referrals to see specialist providers outside the network, and they can see any doctor or provider that accepts Medicare. However, out of pocket expenses will be higher if an individual uses an out of network provider instead of an in-network provider.

Health Maintenance Organization (HMO) Plans: HMO plans consist of a network of approved hospitals, doctors, and other healthcare professionals who agree to provide services for a set monthly payment from the Center for Medicare and Medicaid Services (CMS). Subscribers must use in-network providers in order for non-emergency services to be covered. Emergency care is covered regardless of whether or not services are obtained in or out of network.

Private Fee-for-Service (PFFS) Plans: This type of plan offers a Medicare approved private insurance plan. CMS pays the plan for Medicare approved services while the Private-Fee-for-Service (PFFS) plan determines, up to a limit, how much the care recipient will pay for covered services. Beneficiaries can obtain services from any Medicare-approved provider who, before treatment is provided, agrees to accept the PFFS's terms and conditions of payment.

Special Needs Plans (SNP): SNPs provide more focused health care for people with specific conditions. A person who joins one of these plans gets healthcare services as well as more focused care to manage a specific disease or condition.

To be eligible for any of the Medicare Advantage Plans, a beneficiary must be enrolled in both Medicare Part A and B. When an individual is enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan, not through Original Medicare. Medicare Advantage plans may include prescription drug benefits. For more information on Medicare Advantage Plans, call 1-800-MEDICARE (1-800-633-4227) or visit the Center for Medicare and Medicaid (CMS) website at www.medicare.gov.

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