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Medicare Supplement FAQ’s

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Do I need cancer insurance?

If you are currently insured under a comprehensive medical policy, you don’t need cancer insurance. Any major medical policy includes coverage for cancer and cancer-related illnesses. If you are covered under Medicare, you won’t need cancer insurance, either.

If you’re thinking about buying cancer insurance, consider the following:

  • Cancer insurance pays only for cancer. It’s less expensive than a major medical plan, but the major medical plan is far more comprehensive in its coverage.
  • You’re not necessarily increasing your coverage if you purchase both a cancer insurance policy and a comprehensive medical policy. Any policy can have a coordination of benefits clause that states it will not pay if you own another policy with the same benefits.
  • Cancer insurance is limited. You’ll want to read the policy carefully to find out exactly what it includes. Does it cover outpatient care? Many types of cancer treatments, including radiation and chemotherapy, are done on an outpatient basis. Does it have fixed dollar limits for certain benefits? Is coverage reduced after you reach a certain age? Does the policy cover illnesses you may get as a result of treatment? You’ll want to know the answers to such questions.

In the past decade, state and federal regulations on the sale of cancer insurance have loosened, and you may hear more from companies that want to sell it to you. Be cautious. Chances are good that you already have coverage under your existing health plan.

How can I pay for nursing home care?

In general, there are three ways to pay for nursing home care. You can pay for it from your own savings, buy long-term care insurance, or use government benefits.

Relying on your savings is risky and works better as a short-term strategy. You may be able to pay for nursing home care out of pocket for a few months, but a few years of nursing home care could wipe you out financially. Before deciding that you can afford to pay for nursing home care from your savings, ask a financial planner to review your total financial picture.

If you can’t afford to pay for nursing home care out of pocket or would prefer to leave an inheritance, and you have time to plan ahead, consider buying long-term care insurance. It’s expensive, but the premium you pay depends on both your age when you buy the policy and the type of benefits you choose. In general, though, it won’t cover the entire cost of nursing home care, because it pays a fixed dollar amount of benefits per day.

Finally, you may qualify for government assistance. If you have little income and few assets, Medicaid may pay for your nursing home care. However, Medicare covers only short-term stays in a nursing home for the purpose of rehabilitation after a period of hospitalization. If you are a veteran, you may be eligible for care in a VA facility, although veterans with service-connected disabilities are more likely to receive care, due to limited space.

No matter which way you choose to pay for nursing home care, it’s wise to plan ahead. You’ll have both peace of mind and time to plan your finances accordingly.

How do I enroll in Medicare?

You’ll be automatically enrolled in Medicare when you turn 65 if you’re already receiving Social Security benefits, or when you apply for Social Security benefits at age 65. In either case, the Social Security Administration will notify you that you’re being enrolled.

Although there’s no cost to enroll in Medicare Part A (Hospital Insurance), you’ll pay a premium to enroll in Medicare Part B (Medical Insurance). If you’ve been automatically enrolled in Part B, you’ll be notified that you have a certain amount of time after your enrollment date to decline coverage. Even if you decide not to enroll in Medicare Part B during the initial enrollment period, you can enroll later during the annual general enrollment period that runs from January 1 to March 31 each year. However, you may pay a slightly higher premium as a result.

If you decide to postpone applying for Social Security past your 65th birthday, you can still enroll in Medicare when you turn 65. The Social Security Administration suggests that you call (800) 772-1213 three months before you turn 65 to discuss your options. You can apply by visiting your local Social Security office. If you are unable to visit your local office, you may be able to enroll over the phone.

How does Medicare Advantage work?

Medicare Advantage permits Medicare beneficiaries to receive health care through managed care plans (e.g., HMOs) and private fee-for-service plans. When you join a Medicare Advantage plan (also known as Medicare Part C), you may be able to save money on your health-care costs, and you may get additional benefits not found in original Medicare. To enroll in Medicare Advantage, you must be covered under both Medicare Part A and Medicare Part B.

Unfortunately, not all plans are available in all areas. To learn about what options are available in your region, call your local senior Health Insurance agent or call (800) MEDICARE or visit the Medicare website at <a href=”http://www.medicare.gov/”>www.medicare.gov</a> for more information.

If I'm covered by Medicare, should I have additional health insurance?

It’s wise to purchase health insurance to supplement your Medicare coverage, because Medicare generally won’t cover all of your medical expenses. Usually, you’ll have to satisfy a deductible before Medicare pays anything, and you’ll also pay a co-payment when you visit a physician or are admitted to the hospital.

Fortunately, you can buy supplemental insurance from private companies that will help you plug the gaps in your Medicare coverage. These Medigap plans are regulated and standardized by the federal government. There are 10 different kinds of plans, although your state may not offer all of them (and three states, Massachusetts, Minnesota, and Wisconsin, have their own standardized plans). If premium cost is a concern, you can purchase lower-cost Medigap plans that only partially cover Medicare deductibles, co-payments and coinsurance costs. Conversely, if you want extensive coverage and don’t mind paying more for it, you can purchase a Medigap plan that covers most of the deductibles, co-payments, and extra charges associated with Medicare. You can compare plans at the Health Care Financing Administration’s website (www.medicare.gov).

Whatever plan you choose, you have the right to cancel it within a certain amount of time (usually 30 days, sometimes longer) if you don’t like the policy after you buy it. In addition, the policy must be guaranteed renewable and cannot duplicate existing coverage, including Medicare.

Another way to supplement Medicare is to keep in effect any employer-sponsored health-care insurance you have. Depending on the type of coverage you have, and whether you’re retired, one plan will pay your health-care costs first, and the other plan will cover some or all of the remaining costs. To make sure claims are properly paid, let your health provider know when you have health insurance in addition to Medicare.

Should I buy long-term care insurance?

As we get older and our health declines, the greater the chances are that we will require home care, nursing home care, or other assisted-living arrangements. This care is quite expensive, and Medicare, HMOs, and Medigap don’t pay for it. You might want to look into purchasing long-term care insurance (LTCI) to protect your assets in case you need long-term care.

Whether or not you should purchase LTCI depends on your age, medical history, assets, and income. Ask a financial professional about whether LTCI is right for you. If you meet some of the following criteria, you might want to seriously consider it:

  • You are between the ages of 40 and 84 (generally, LTCI is not available to those over 84)
  • You have a family history of Alzheimer’s disease
  • You own substantial assets that you’d like to protect
  • You have family members to whom you wish to leave your assets
  • You can afford the cost of LTCI premiums now and will be able to afford them in the future
  • You are in good health and are insurable

What is critical illness insurance?

Critical illness insurance will pay you a lump sum if you become ill from–and then survive–certain illnesses or injuries. Some examples of covered illnesses are heart attack, life-threatening cancer, loss of a limb, and Alzheimer\\\’s disease. Also covered are loss of your sight, a major organ transplant, and paralysis. You can use the lump sum whatever way you want, whether it\\\’s related to your illness or not. The lump sum is tax free.

Ironically, the need for critical illness insurance came about because people are living longer, even with serious diseases. But it also means people have more medical expenses that can deplete their health insurance and personal savings. Critical illness insurance helps pay for uncovered medical bills and household bills. It can even provide capital to start a new home-based business.

If you are considering this type of insurance, it\\\’s vital that you understand exactly what is covered and what is not. The insurance will pay only if you contract the illnesses listed in the policy. Even then, further limitations will be defined in the policy. For example, what does the insurance company consider to be a life-threatening cancer? If you have a family history of a certain illness, will the policy exclude that illness? Are there pre-existing condition limitations? What are the age limitations? How much does it cost? Does the premium increase as you get older? When do you receive the lump sum? Is it really offering you more than your existing health plan? Finally, be aware that if you own one of these policies and never get sick, you won\\\’t get any money back.

Before you purchase critical illness insurance, consult your insurance agent or financial advisor.

What is Medigap?

Medigap is health insurance that supplements the benefits covered under Medicare. It also fills in some of the gaps left by Medicare, such as your deductible and coinsurance contributions. Medigap policies are sold by private insurance companies, and must be clearly identified as “Medicare Supplemental Insurance.” Currently, 10 standardized plans are available (Plans A-D, Plans F and G, and Plans K-N) (except in Massachusetts, Minnesota, and Wisconsin, which have their own standardized plans). Each provides a different level of coverage, but not all plans are available in all states.

Plan A covers the following basic benefits:

Part A coinsurance costs up to 365 extra days of hospital care once Medicare benefits are used up
Part B coinsurance or co-payment
The first three pints of blood you may need in a year (Medicare pays for any additional blood)
Part A hospice care coinsurance or co-payment
Other plans cover the same basic benefits, plus some extra benefits that include different combinations of the following:

Coverage of your Part A deductible
Coverage of your Part B deductible
Coverage of the daily co-payment requirement for skilled nursing care
Medically necessary emergency care needed during the first two months of a trip outside the United States
Medicare Part B excess charges (i.e., the difference between your doctor’s fee and Medicare’s allowance)
Medicare preventive care Part B coinsurance costs
Two plans, Plans K and L may have lower premium costs than other Medigap plans because they require you to pay a portion of Part B coinsurance or co-payment costs, and Part A deductible and hospice care coinsurance or co-payment costs. However, they provide protection against catastrophic illnesses by limiting your annual out-of-pocket expenses.

Some of the benefits not covered by Medigap include long-term nursing home care, and vision and dental care. Medigap will follow Medicare in excluding what is unnecessary or experimental.

If you are covered by your former employer’s health insurance plan, you may not need Medigap.

Will Medicare alone be enough to cover my health-care needs in retirement?

No. Medicare coverage comes with deductibles and significant co-payments or coinsurance costs for many types of treatments, including hospitalizations. Typically, the deductible amounts are increased each year.

If you’re not prepared to pay these expenses out of pocket, you may want to consider a Medigap policy (a supplemental medical insurance policy). Medigap insurance policies are sold by private health insurers. These policies are standardized and regulated by both state and federal law.

There are 10 standard Medigap plans, although not all are available in all states. These plans cover certain specified services, but offer different combinations of coverages. Some cover all or part of your Medicare deductibles, co-payments, or coinsurance costs.

If you’re covered by an employer-sponsored health plan in retirement, you may not need to purchase Medigap insurance. In this case, your primary insurance coverage continues to be your employer’s health plan; for eligible unpaid expenses, Medicare would provide secondary coverage.

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