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> Medicare Supplement Insurance 2011
A Consumer's Guide To...Medicare Supplement Insurance
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Your |
Replacing Plan |
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A |
B |
C |
D |
F |
F with High |
G |
K |
L |
M |
N |
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A |
X |
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X |
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B |
X |
X |
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X |
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C |
X |
X |
X |
X |
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X |
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X |
X |
X |
X |
D |
X |
X |
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X |
|
X |
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X |
X |
X |
X |
E* |
X |
X |
|
X |
|
X |
|
X |
X |
X |
X |
F |
X |
X |
X |
X |
X |
X |
X |
X |
X |
X |
X |
F with a High |
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X |
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G |
X |
X |
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X |
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X |
X |
X |
X |
X |
X |
H* |
X |
X |
X |
X |
|
X |
|
X |
X |
X |
X |
I* |
X |
X |
X |
X |
X |
X |
X |
X |
X |
X |
X |
J* |
X |
X |
X |
X |
X |
X |
X |
X |
X |
X |
X |
K |
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X |
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X |
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L |
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X |
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X |
X |
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M |
X |
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X |
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X |
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X |
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N |
X |
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X |
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X |
X |
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X |
* These plans are no longer available to purchase. However, you can keep your current policy for as long as you pay the premium.
The following pages show the medical benefits that are covered by your Medicare supplement policy. If you are not sure what Medicare pays, please read the Federal booklet Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare which is available free from the Maine Bureau of Insurance, from your nearest Social Security Administration, or on-line at www.medicare.gov. You may be responsible for charges that are not paid by either Medicare or your Medicare supplement policy.
Plan A - Basic Core Benefits
The following are the basic benefits for Plan A. These benefits are also included in plans B through N.
The following list describes the additional benefits that may be included in plans B through N. The chart shown later in this brochure shows which benefits are included in each plan.
Prescription drug coverage is available through Medicare Part D. Medicare supplement policies with drug coverage are no longer sold.
Some policies will not cover pre-existing medical conditions for the first six months the policy is in effect. A pre-existing medical condition is a condition for which you received medical advice or treatment was recommended by or received from a physician six months before the policy is issued. Even if you buy a Medicare supplement policy during your "open enrollment" period, the policy may still not pay for pre-existing conditions for up to six months. The premium comparison chart has a column which shows the policies that do not cover pre-existing conditions.
If you had prior health insurance coverage and replace it with a Medicare supplement policy, you cannot be made to satisfy a new pre-existing condition exclusion for similar benefits. This is true whether the prior policy is group coverage through an employer, individual coverage, or another Medicare supplement policy.
The premium comparison chart shows annual premiums at the time this brochure was printed. Semi-annual, quarterly and monthly premiums may be available. These premiums are subject to change and should be verified with the company or producer for accuracy.
The cost for Medicare supplement policies cannot vary based on your age or gender. Some companies charge a higher rate if you smoke. For these companies, both rates are shown in the chart. Some companies offer discounts. Anthem Blue Cross/Blue Shield gives a temporary discount if you purchase a policy no later than three months after either your 65th birthday or your retirement from an eligible group. The rates in this brochure are also on our web site and are updated as they become available at www.maine.gov/insurance under Consumer Information and Services and then Publications, brochures.
Plans C and FFor some companies, the annual premium for Plan C exceeds that for Plan D (or Plan F exceeds the premium for Plan G) by more than the additional benefit provided. This additional benefit covered by Plan C (and Plan F) is the Medicare Part B annual deductible which is $162 in 2011. Therefore, you may want to consider buying Plan D instead of Plan C (or Plan G instead of Plan F) to save money. The company must disclose this rate difference in their outline of coverage when premiums for Plan C exceed Plans D (or Plan F exceeds Plan G).
In addition to the policies listed in the following pages, some insurance companies issue Medicare supplements through association groups. If you are a member of an association you may be able to purchase a group Medicare supplement through that association. Companies such as Monumental, Union Labor Life, Transamerica and Globe Life are licensed and approved to sell group Medicare supplement policies.
IMPORTANT! READ THE EXPLANATORY INFORMATION BEFORE USING THE FOLLOWING CHARTS.
Every effort is made to provide accurate information, rates and information may change.
| COMPANY | PRE-EXISTING EXCLUSION PERIOD | Plan A | Plan B | Plan C* | Plan D | |
|---|---|---|---|---|---|---|
| Anthem Blue Cross/Blue Shield | 3 Months | $1,537.44 | ||||
| Colonial Penn Life | None | Current | $1,976.38 | $2,341.07 | ||
| Effective 1/1/2012 |
Non-smoker $2,040.09 Smoker $2,371.07 |
Non-smoker $2,416.56 Smoker $2,808.52 |
||||
| Columbian Mutual Life | None | Non-smoker $1,642.11 Smoker $1,887.48 |
||||
| Combined | None | $2,177.65 | ||||
| Equitable Life & Casualty | None | Non-smoker $2,122.00 Smoker $2,526.00 |
||||
| Globe Life | 6 Months | $1,041.00 | $1,642.00 | $1,896.00 | ||
| GPM Life | None | Non-smoker $1,648.68 Smoker $1,895.04 |
Non-smoker $2,302.02 Smoker $2,646.00 |
|||
| HPHC Insurance Company | None | $1,428.00 | ||||
| Humana | 3 Months | Non-smoker $1,863.72 Smoker $2,785.56 |
Non-smoker $2,028.36 Smoker $3,031.68 |
Non-smoker $2,338.56 Smoker $3,495.36 |
||
| Humana - Reader's Digest With Dental and Vision | 3 Months | Non-smoker $2,026.08 Smoker $2,971.92 |
||||
| Mutual of Omaha | None | Non-smoker $2,087.69 Smoker $2,399.67 |
Non-smoker $3,441.61 Smoker $3,955.86 |
Non-smoker $2,741.83 Smoker $3,151.53 |
||
| State Farm | None | Current | $1,510.00 | $2,278.00 | ||
| Proposed 1/2012 |
$1,606.00 | $2,422.00 | ||||
| United American | 60 Days | $1,847.00 | $2,790.00 | $3,293.00 | $3,156.00 | |
| United HealthCare (for AARP members) |
3 Months | Non-smoker $1,218.00 Smoker $1,339.80 |
Non-smoker $1,692.00 Smoker $1,861.20 |
Non-smoker $1,944.00 Smoker $2,138.40 |
||
| United of Omaha | None | Non-smoker $1,468.80 Smoker $1,688.28 |
||||
| USAA Life | 6 Months | Non-smoker $1,801.32 Smoker $1,976.76 |
*See above under Cost for an explanation regarding premium differences for Plan C and Plan F.
| COMPANY | PRE-EXISTING EXCLUSION PERIOD | Plan F** | Plan G | Plan K | |
|---|---|---|---|---|---|
| Anthem Blue Cross/Blue Shield | 3 Months | $2,230.56 | $2,107.92 | ||
| Colonial Penn Life | None | Current | $2,553.80 | $2,385.14 | $907.85 |
| Effective 1/1/2012 |
Non-smoker $2,636.27 Smoker $3,063.79 |
Non-smoker $2,462.05 Smoker $2,861.32 |
Non-smoker $937.08 Smoker $1,089.05 |
||
| Columbian Mutual Life | None | Non-smoker $2,478.87 Smoker $2,849.28 |
Non-smoker $2,049.48 Smoker $2,355.72 |
||
| Combined | None | $2,881.78 | |||
| Equitable Life & Casualty | None | Non-smoker $3,111.60 Smoker $3,721.20 |
|||
| Globe Life | 6 Months | $1,916.00 | |||
| GPM Life | None | Non-smoker $2,357.67 Smoker $2,709.96 |
Non-smoker $1,854.35 Smoker $2,131.44 |
||
| HPHC Insurance Company | None | $2,268.00 | |||
| Humana | 3 Months | Non-smoker $2,386.32 Smoker $3,566.64 |
Non-smoker $1,092.96 Smoker $1,633.56 |
||
| Humana - Reader's Digest With Dental and Vision | 3 Months | Non-smoker $2,500.32 Smoker $3,680.64 |
Non-smoker $1,280.76 Smoker $1,857.84 |
||
| Mutual of Omaha | None | Non-smoker $2,898.60 Smoker $3,331.70 |
Non-smoker $2,101.57 Smoker $2,415.60 |
||
| State Farm | None | Current | $2,301.00 | ||
| Proposed 1/2012 |
$2,446.00 | ||||
| United American | 60 Days | $3,355.00 | $3,178.00 | $1,519.00 | |
| United HealthCare (AARP) | 3 Months | Non-smoker $1,968.00 Smoker $2,164.80 |
Non-smoker $732.00 Smoker $805.20 |
||
| United of Omaha | None | Non-smoker $2,040.00 Smoker $2,344.80 |
Non-smoker $1,886.88 Smoker $2,168.88 |
||
| USAA Life | 6 Months | Non-smoker $2,335.80 Smoker $2,570.40 |
** Premium cost for companies offering a high deductible Plan F are shown below.
| COMPANY | PRE-EXISTING EXCLUSION PERIOD | Plan L | Plan M | Plan N | |
|---|---|---|---|---|---|
| Anthem Blue Cross/Blue Shield | 3 Months | $1,539.12 | |||
| Colonial Penn Life | None | Current | $1,540.79 | $2,103.36 | $1,512.86 |
| Effective 1/1/2012 |
Non-smoker $1,590.42 Smoker $1,848.42 |
Non-smoker $2,171.22 Smoker $2,523.36 |
Non-smoker $1,561.62 Smoker $1,814.93 |
||
| Columbian Mutual Life | None | ||||
| Combined | None | ||||
| Equitable Life & Casualty | None | Non-smoker $2,263.20 Smoker $2,706.00 |
|||
| Globe Life | 6 Months | ||||
| GPM Life | None | Non-smoker $1,644.93 Smoker $1,890.72 |
|||
| HPHC Insurance Company | None | $1,644.00 | $1,560.00 | ||
| Humana | 3 Months | Non-smoker $1,553.52 Smoker $2,321.88 |
|||
| Humana - Reader's Digest With Dental and Vision | 3 Months | Non-smoker $1,830.84 Smoker $2,680.08 |
|||
| Mutual of Omaha | None | Non-smoker $1,818.54 Smoker $2,089.89 |
|||
| State Farm | None | ||||
| United American | 60 Days | $2,139.00 | $2,217.00 | ||
| United HealthCare (AARP) | 3 Months | Non-smoker $1,170.00 Smoker $1,287.00 |
Non-smoker $1,353.00 Smoker $1,488.24 |
||
| United of Omaha | None | Non-smoker $1,621.80 Smoker $1,864.08 |
|||
| USAA Life | 6 Months |
Companies offering high deductible Plan F with premiums
| Company | High Deductible Plan F Cost* | Deductible** | |
|---|---|---|---|
| Anthem Blue Cross/Blue Shield | $626.40 | $2,000 in 2011** | |
| Colonial Penn Life | Current | $612.87 | $2,000 in 2011** |
| Effective 1/1/2012 |
Non-smoker $632.61 Smoker $735.27 | $2,000 in 2012** | |
| Humana | Non-smoker $894.84 Smoker $1,337.52 | $2,000 in 2011** | |
| Humana - Reader's Digest With Dental and Vision | Non-smoker $1,095.84 Smoker $1,581.48 | $2,000 in 2011** | |
| United American | $749.00 | $2,000 in 2011** |
* See above for the benefits that are included in this policy. ** Note: The deductible may increase every year.
Proposed rates are those filed by the company but waiting for review and approval by the Bureau. These rates could change before final approval.
Medicare Select Policies
Medicare Select policies are also standardized plans, however, to receive full hospital benefits you must use participating hospitals that are in the network. These select policies generally cost less because of restrictions that affect where you can go to get treatment. Review all policy information carefully to be sure that you understand how the provider network limits and restrictions may affect you. If you do not follow the Medicare Select policy requirements, Medicare will still pay its portion of the bill, however, the Medicare Select company is not required to pay the full benefits under the policy and will deny payment or pay less than the full benefit if you go outside the network for non-emergency services. There are no Medicare Select policies approved for new sales in Maine at this time.
Policies with Innovative Benefits
An insurance company may offer Medicare supplement policies with innovative benefits in addition to the standardized benefits. Humana is offering in addition to their standard Medicare supplement policies, new policies that are marketed with Reader's Digest that cover dental and vision benefits.
Fraternal Benefit Societies
Fraternal benefit societies differ from insurance companies. They are not covered by some provisions of the Maine Insurance Code and a number of consumer protections. For example, coverage sold by a fraternal is not covered by guaranty funds. In addition, fraternal benefit society insurance benefits are legally required to be assessable. This means that if the society's claims paying ability becomes impaired, the members may be required to pay their proportional share of the deficiency. Fraternal benefit societies are subject to significantly reduced capital and surplus requirements, and are not typically rated by A.M. Best or an equivalent. It is not possible to explain here every aspect in which fraternal benefit societies differ from commercial insurers. For further information contact the Bureau of Insurance at 1-800-300-5000 in Maine.
The chart below shows when you will be accepted in Plan A no matter what medical conditions you may have.
We have tried to list toll-free numbers where possible. However, not all companies have 800 numbers available and the numbers we have listed are likely to change without notice. You may want to contact a local company producer before calling the numbers listed here. The month that each insurer chooses to offer Plan A is subject to change from what is listed below.
Medicare Supplement insurance can only be sold in ten standard plans and one high deductible plan - Plan F. (Please see above for an explanation of the benefits covered in this plan.) The chart below shows the benefits included in each plan. Every company must make Plan A available.
See the core benefits for a description of the benefits listed in this chart.
| PLAN A | PLAN B | PLAN C | PLAN D | PLAN F | PLAN G |
|---|---|---|---|---|---|
| Basic Benefits | Basic Benefits | Basic Benefits | Basic Benefits | Basic Benefits | Basic Benefits |
| Skilled Nursing Co-insurance | Skilled Nursing Co-insurance | Skilled Nursing Co-insurance | Skilled Nursing Co-insurance | ||
| Part A Deductible | Part A Deductible | Part A Deductible | Part A Deductible | Part A Deductible | |
| Part B Deductible | Part B Deductible | ||||
| Part B Excess (100%) | Part B Excess (100%) | ||||
| Foreign Travel Emergency | Foreign Travel Emergency | Foreign Travel Emergency | Foreign Travel Emergency | ||
| PLAN K* | PLAN L* | PLAN M | PLAN N |
|---|---|---|---|
| 50% Basic Benefits except 100% Part A Co-insurance | 75% Basic Benefits except 100% Part A Co-insurance | Basic Benefits | Basic, except up to $20 co-payment for office visit and up to $50 co-payment for ER |
| 50% Skilled Nursing Co-insurance | 75% Skilled Nursing Co-insurance | Skilled Nursing Co-insurance | Skilled Nursing Co-insurance |
| 50% Part A Deductible | 75% Part A Deductible | 50% Part A Deductible | Part A Deductible |
| Foreign Travel Emergency | Foreign Travel Emergency | ||
| Out-of-pocket limit $4620; paid at 100% after limit reached | Out-of-pocket limit $2310; paid at 100% after limit reached |
*Plans K and L provide for different cost-sharing for items and services than Plans A through G. Once you reach the annual limit ($4,620 for Plan K and $2,310 for Plan L in 2010), the plans pays 100% of the Medicare co-payments, coinsurance, and deductibles for the rest of the calendar year. The out-of-pocket annual limit does NOT include charges from your provider that exceed Medicare-approved amounts, called "Excess Charges." You will be responsible for paying excess charges. The out-of-pocket annual limit will increase each year for inflation.
“If you are entitled to Medicare and MaineCare, it is important to know your rights about Medicare supplement insurance.”
THINGS TO CONSIDER ABOUT MEDICARE SUPPLEMENT COVERAGE WHEN YOU ENROLL IN MAINECARE
FOR MORE INFORMATION or
TO RECEIVE ASSISTANCE
TO DECIDE WHAT TO DO
CALL ELDERS 1 AT:
1-877-ELDERS1
(1-877-353-3771)
Area Agencies on Aging are the central resource for elder services in your area. They can help you either directly or by referring you to the appropriate agency. Call Elders 1 at 1-877-353-3771 to contact the Area Agency on Aging in your area.
AROOSTOOK AREA AGENCY ON AGING
AROOSTOOK COUNTY
P.O. Box 1288, One Edgemont Drive
Presque Isle, ME 04769
TEL: (207) 764-3396;1-800-439-1789
www.aroostookaging.org
EASTERN AREA AGENCY ON AGING
PENOBSCOT, PISCATAQUIS, HANCOCK
WASHINGTON COUNTIES
450 Essex St.
Bangor, ME 04401
TEL: (207) 941-2865; 1-800-432-7812
www.eaaa.org
SPECTRUM GENERATIONS
KNOX, LINCOLN, WALDO, SOMERSET,
SAGADAHOC, KENNEBEC COUNTIES
TOWNS OF BRUNSWICK AND HARPSWELL
1 Weston Court PO Box 2589
Augusta, ME 04338-2589
TEL: (207) 622-9212; 1-800-639-1553
www.seniorspectrum.com
SENIORSPLUS
ANDROSCOGGIN, FRANKLIN, OXFORD COUNTIES
P.O. Box 659, 8 Falcon Way
Lewiston, ME 04243-0659
TEL: (207) 795-4010; 1-800-427-1241
www.seniorsplus.org
SOUTHERN MAINE AREA AGENCY ON AGING
CUMBERLAND and YORK COUNTIES
136 US Route One.
Scarborough, ME 04074
TEL: (207) 396-6500; 1-800-427-7411
www.smaaa.org
State of Maine Bureau of Insurance
1-800-300-5000 (in Maine) or 207-624-8475
TTY: (888) 577-6690
Last Updated: August 22, 2012
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