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    Help Me Choose

    Guaranteed Issue Rights and Medicare Advantage Plans

    During an enrollment period, Medicare Advantage plans are always guaranteed issue for Medicare-eligible individuals who have both Medicare Part A and Part B coverage.

    Guaranteed Issue Rights and Medigap plans

    During your Initial Coverage Enrollment Period (ICEP), Medigap insurance plans are also guaranteed issue meaning you cannot be turned down based on your medical history or pre-existing conditions. So, as long as you enroll during your ICEP and keep your Medigap plan active, you won’t have to worry about being denied coverage.

    However, if you choose not to enroll in a Medigap plan the first time you are eligible, in most states you may lose guarantee issue rights for future Medigap applications and you may be subject to medical underwriting.

    In addition, if you have opted out of your employer sponsored medical coverage or already have an individual Medigap or Medicare Advantage plan, federal law cannot guarantee your coverage for Medigap insurance during this Initial Coverage Enrollment Period.

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    Your Medicare Plan Recommendation

    Based upon your answers entered in Help Me Choose, this is your recommended level of coverage:

    Medicare Advantage Plans Medigap

    Update my answers

    This recommendation is based on your current situation and preferences and does not take into account future health conditions and guaranteed issue rights.

    Guaranteed Issue Rights and Medicare Advantage Plans

    During an enrollment period, Medicare Advantage plans are always guaranteed issue for Medicare-eligible individuals who have both Medicare Part A and Part B coverage.

    Guaranteed Issue Rights and Medigap plans

    During your Initial Coverage Enrollment Period (ICEP), Medigap insurance plans are also guaranteed issue meaning you cannot be turned down based on your medical history or pre-existing conditions. So, as long as you enroll during your ICEP and keep your Medigap plan active, you won’t have to worry about being denied coverage.

    However, if you choose not to enroll in a Medigap plan the first time you are eligible, in most states you may lose guarantee issue rights for future Medigap applications and you may be subject to medical underwriting.

    In addition, if you have opted out of your employer sponsored medical coverage or already have an individual Medigap or Medicare Advantage plan, federal law cannot guarantee your coverage for Medigap insurance during this Initial Coverage Enrollment Period.

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    Out-of-pocket Costs Health or prescription drug costs that you must pay on your own because they aren’t covered by Medicare or other insurance. Close
    Coverage Considerations Not all plans have the same level of coverage. Even if you don't need it now, enrolling today in a plan with more coverage means that you will have the coverage later on when you may need it. Changing to a plan with better coverage later on may require medical underwriting meaning that you can be denied coverage based on your health status. Typically, Plan F will give you the most coverage. Close
    RECOMMENDED COVERAGE
    Explain this

    Medigap plans help to pay the difference between the total costs and the amount Original Medicare pays.

    They generally have:

    • higher monthly premiums
    • low or no copayments required for doctor or hospital visits
    • prescription drug plans not included (purchase prescription drug coverage separately)
    • no network restrictions on physicians—you may see any doctor that accepts Medicare

    Guaranteed Issue Rights

    Medigap insurance plans may not be guaranteed issue and therefore may be subject to medical underwriting.

    Learn More

    Prescription drug Part D plans only cover prescription drugs. You should consider the following:

    • If you select a Medigap plan you can also purchase a Part D plan if you need prescription drug coverage.
    • These plans (sometimes called "PDPs") add coverage to Original Medicare, and can be added to a Medicare Cost Plan, a Medical Savings Account (MSA) Plan, and to some Medicare Private Fee-for-Service (PFFS) Plans.
    RECOMMENDED COVERAGE
    Explain this

    Medicare Advantage plans offer a lower-cost option to those willing to get services within a defined network. This network may not include your current Health Care Provider.

    They generally have:

    • low monthly premiums
    • required copayments for doctor or hospital visits
    • prescription drug plans (usually) included
    • a restricted number of in-plan doctors through HMO or PPO networks

    Guaranteed Issue Rights

    Medicare Advantage plans are always guaranteed issue. You may enroll during a valid enrollment period.

    Learn More

    In most cases, when a person enrolls in Medicare supplemental insurance they will choose between the following options:

    Want to know more? Go to Understanding Medicare

    Health Care Provider A person or organization that's licensed to give health care. Doctors, nurses, and hospitals are examples of health care providers. Close
    Premium: The periodic payment to Medicare, an insurance company, or a health care plan for health or prescription drug coverage. Close
    Out-of-pocket Costs Health or prescription drug costs that you must pay on your own because they aren’t covered by Medicare or other insurance. Close
    Premium The periodic payment to Medicare, an insurance company, or a health care plan for health or prescription drug coverage. Close
    Original Medicare Original Medicare is fee-for-service coverage under which the government pays your health care providers directly for your Part A and/or Part B benefits. Close
    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, hospital outpatient visit, or prescription drug. A copayment is usually a set amount, rather than a percentage. For example, you might pay $10 or $20 for a doctor's visit or prescription. Close
    Guaranteed Issue Rights Rights you have in certain situations when insurance companies are required by law to sell or offer you a Medigap policy. In these situations, an insurance company can't deny you a Medigap policy, or place conditions on a Medigap policy, like exclusions for pre-existing conditions, and can't charge you more for a Medigap policy because of a past or present health problem. Close
    Medical Underwriting The process that an insurance company uses to decide, based on your medical history, whether to take your application for insurance, whether to add a waiting period for pre-existing conditions (if your state law allows it), and how much to charge you for that insurance. Close
    PFFS only Within Medicare Advantage there are three network types: Private Fee-for-Service (PFFS), Preferred Provider Organization (PPO), and Health Maintenance Organization (HMO). The U.S. Government has regulated that only enrollees in a Medicare Advantage plan without prescription drug coverage that are PFFS network type may enroll in a Part D plan. Enrollees looking for prescription drug coverage that do not want to enroll in a PFFS network type Medicare Advantage plan should enroll in a plan that has built in prescription drug coverage. Close
    Medicare Cost Plans A Medicare Cost Plan is a type of HMO. These plans may work in much the same way, and have some of the same rules, as Medicare Advantage Plans. In a Medicare Cost Plan, if you go to a non-network provider, the services are covered under Original Medicare. You would pay the Medicare Part A and Part B coinsurance and deductibles. Close

    Prescription Profiler™

    Medigap plans do not offer prescription drug coverage.

    There are no Prescription Drug (Part D) plans available in your area.
    There are no Medicare Advantage plans available in your area.
    Range for your projected yearly out-of-pocket resposibility In order to estimate how much you will pay annually, add monthly premiums (premium × 12 months), the annual deductible (when applicable - if you will not meet the annual deductible, only the applicable amount is added), and total annual prescription drug costs. Close
    Carriers in your area, sorted by most cost effective plans The carriers listed are those in your area that can provide the most cost-effective (least expensive) coverage for your prescription drugs. Close

    What do these plans cover?

    Medigap:

    HOSPITAL COVERAGE

    Yes

    DOCTORS AND SPECIALISTS

    No provider network.

    DRUG COVERAGE

    Do not have built-in drug coverage.

    Prescription Drug:

    DRUG COVERAGE ONLY

    Medicare Advantage:

    HOSPITAL COVERAGE

    Yes

    DOCTORS AND SPECIALISTS

    Yes, but there are restrictions.

    DRUG COVERAGE

    Some do have built-in drug coverage.

    Hospital Coverage Hospital coverage refers to any coverage this plan may offer related to hospital stays, home health care, skilled nursing facilities, and hospice care. Each plan's specific benefits vary. Close
    Doctors and Specialists A doctor or other health care specialist that agrees to accept a plan's payment terms and conditions as well as additional plan requirements for coverage. Close
    Drug Coverage Drug coverage refers to any coverage this plan may offer related to prescription drugs including co-pays, deductibles and other coverage. Each plan's specific benefits vary. Medigap plans do not include prescription drug coverage. You may purchase a Part D plan in addition to a Medigap plan to ensure prescription drug coverage. Close
    Drug Coverage Only Drug coverage refers to any coverage this plan may offer related to prescription drugs including co-pays, deductibles and other coverage. Each plan's specific benefits vary. Part D plans provide prescription drug coverage and are purchased as an add-on to Original Medicare, Medicare Advantage, or Medigap plans. Close
    Drug Coverage Drug coverage refers to any coverage this plan may offer related to prescription drugs including co-pays, deductibles and other coverage. Each plan's specific benefits vary. Some Medicare Advantage plans have prescription drug coverage included. These plans are referred to as Medicare Advantage Prescription Drug Plans (MAPD). Close

    What are the premiums for these plans?

    There are no Medigap plans available in your area.

    Medigap plans generally have:

    • higher monthly premiums
    • lower out-of-pocket expenses
    PLAN TYPES

    Plans A through N:

    NETWORK TYPES AVAILABLE

    Select:

    Not Applicable:

    There are no Prescription Drug (Part D) plans available in your area.

    Prescription Drug:

      There are no Medicare Advantage plans available in your area.

      Medicare Advantage plans generally have:

      • lower monthly premiums
      • higher out-of-pocket expenses
      PLAN TYPES

      Medicare Advantage with Prescription Drug coverage (MAPD):

      Medicare Advantage only:

      Premium The periodic payment to Medicare, an insurance company, or a health care plan for health or prescription drug coverage. Close
      Plan Types Medigap fills gaps in Original Medicare coverage. There are standardized Medigap plans, labeled Plan A through Plan N. The policies are sold by private insurance companies and are not officially connected to the government Medicare program. All private insurance carriers who offer a given Medigap plan must offer the same coverage levels; however, insurance carriers compete with each other on customer service, monthly premiums, or other features you may care about. Close
      Plan Types There are no specific types of Part D plans, however their benefits vary. In general Part D plans are stand-alone plans that provide prescription drug coverage to Original Medicare, Medicare Advantage and Medigap plans. They are offered by insurance companies approved by Medicare. Close
      Plan Types Some Medicare Advantage plans have prescription drug coverage included. These plans are referred to as Medicare Advantage Prescription Drug Plans (MAPD). Close
      Network Types Available Most Medigap plans do not rely on provider networks. If your provider accepts Medicare Assignment, the Medigap plan will pay benefits according to the outline of coverage. If your provider does not accept Medicare Assignment, you may be responsible for charges in excess of Medicare approved rates. Some Medigap plans cover all or part of these excess charges.

      Medigap Select are network based plans. With few exceptions, members are required to select from a defined network of hospitals in exchange for a lower premium. Close
      Network Types Available Medicare Advantage plans are split into four different types of networks:

      PFFS (Private Fee-for-Service): A type of health insurance plan offered by a private company, also known as a traditional indemnity plan, that covers a set range of services and allows you to choose your doctor or hospital with no (or minimal) restrictions so long as the doctor participates in that plan.

      PPO (Preferred Provider Organization): Sometimes referred to as a participating provider organization, a PPO is an organization of medical doctors, hospitals, and other health care providers who have contracted with an insurer or a third-party administrator to provide health care services at reduced rates to the insurer's or administrator's clients. Members can seek services outside the contracted providers, but generally at a higher cost.

      HMO (Health Maintenance Organization): An insurer offering comprehensive health coverage. HMOs may employ their own staff, or they may contract with a network of preferred providers for health services. HMO members generally need pre-approval from their primary care doctor to see a specialist.

      Cost (§1876 Cost Plan): A Medicare plan that combines an HMO network with the ability to use out-of-network providers through the fee-for-service structure of Original Medicare. Close

      Which insurance companies offer plans in my area?

      There are no Medigap plans available in your area.

      Medigap:

      There are no Prescription Drug (Part D) plans available in your area.

      Prescription Drug:

      There are no Medicare Advantage plans available in your area.

      Medicare Advantage:

      IMPORTANT NOTICES AND DISCLAIMERS
      • Extend Insurance Services LLC is an agent/representative of Medicare Advantage Organizations, Part D sponsors and insurance companies.
      • Medicare Supplement plans are not connected with or endorsed by the U.S. Goverment or the federal Medicare program.
      • If you are not newly eligible for Medicare or you are not eligible for a special enrollment period, the guaranteed issue rates quoted on this website may not be available to you. Extend Insurance Services LLC disclaims making any representation to you regarding your eligibility for any of the products or any of the guaranteed issue rates quoted on this website.
      • You must live in the service area and have both Medicare Part A and Medicare Part B in order to enroll in an MA or MA-PD plan. You must also continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party. Members may enroll in the plan only during specific times of the year. Contact the Medicare Advantage or Part D plan for more information. Limitations, copayments, and restrictions may apply.
      • This is not a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE. TTY users should call 1-877-486-2048, 24 hours a day/7 days a week or consult www.medicare.gov. Medicare beneficiaries may also enroll in Medicare Advantage and Part D plans through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov.
      • Please reference the Evidence of Coverage for information rights and responsibilities upon disenrollment, and any applicable conditions associated with using the plan benefits. This information is available for free in other languages. For more information contact the plan.
      • If you are enrolling in a Preferred Provider Organization (PPO) or Point of Service (POS), the following statement applies: With the exception of emergencies or urgent care, it may cost more to get care from out-of-network providers.
      • You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for getting Extra Help, call:
        • 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week;
        • The Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or
        • Your State Medicaid Office.
      • Although the data found using Extend Health's website have been produced and processed from sources believed to be reliable, no warranty expressed or implied is made regarding accuracy, adequacy, completeness, legality, reliability or usefulness of any information. This disclaimer applies to both isolated and aggregate uses of the information. Extend Health's website provides this information on an "as is" basis. All warranties of any kind, express or implied, including but not limited to the implied warranties of merchantability, fitness for a particular purpose, freedom from contamination by computer viruses and non-infringement of proprietary rights ARE DISCLAIMED. Changes may be periodically made to the data and other information contained herein; these changes may or may not be incorporated and available in any version of Extend Health's website. If you have obtained information from Extend Health's website from a source other than the website itself, be aware that electronic data can be altered subsequent to original distribution. Data can also quickly become out-of-date. It is recommended that careful attention be paid to the contents of any data associated with a file, and that the originator of the data or information be contacted with any questions regarding appropriate use. If you find any errors or omissions, we encourage you to report them to Extend Health.
      • Please refer to the Summary of Benefits for additional details regarding any cost sharing ranges and benefit limitations.
      • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan at the phone number listed in the plan's Summary of Benefits.
      • Eligible beneficiaries must use network pharmacies to access their prescription drug benefit, except under non-routine circumstances, and quantity limitations and restrictions may apply.
      • If the plan has a closed provider network, then you must use plan providers except in emergency or urgent care situations . If you obtain routine care from out-of-network providers neither Medicare nor the plan will be responsible for the costs.
      • Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1 of each year.
      • Available issuing companies will vary by state.
      • You can get the CMS Appointment of Representative form on CMS’s website.
      • You can file a complaint if you have a concern about the quality of care or other services you get from a Medicare provider directly with the Centers for Medicare and Medicaid Services.
      • Coverage recommendations provided by Help Me Choose are based on user provided data and may vary if more information is provided to the Benefit Advisor during your enrollment call. Coverage recommendations are not an endorsement for any specific health plan or health insurance carrier.

      : IMPORTANT NOTICES AND DISCLAIMERS