I am turning 65 and do not receive Social Security or Railroad Retirement benefits. When can I enroll in Medicare

I am turning 65 and do not receive Social Security or Railroad Retirement benefits. When can I enroll in MedicareI am turning 65 and do not receive Social Security or Railroad Retirement benefits. Initial Enrollment Period (IEP). You can enroll in Medicare at anytime during this seven-month period, which includes the three months before, the month of, and the three months following your 65th birthday.
The date when your Medicare coverage begins depends on when you signed up.

If you enroll during the first three months of your IEP, coverage begins the month in which you first become eligible for Medicare.
If you enroll during the fourth month of your IEP, coverage begins the month following the month of enrollment.
If you enroll during the fifth month of your IEP, coverage begins the second month following the month of enrollment.
If you enroll during the sixth or seventh month of your IEP, coverage begins the third month following the month of enrollment.
For example, let's say you turn 65 in June. Use the following chart to determine when you can enroll in Medicare and when your coverage would start.

You can enroll anytime in: Your coverage starts:

March June 1st

April June 1st

May June 1st

June July 1st

July September 1st

August November 1st

September December 1st



General Enrollment Period (GEP). If you do not enroll in Medicare or if you refused Medicare when you originally became eligible for it, you can sign up during the GEP, which is from January 1st through March 31st of every year. Your coverage will begin July 1st of the year you sign up. You
will have to pay a Part B premium penalty for every year you delayed enrolling in Medicare Part B.
Special Enrollment Period (SEP). You can delay enrollment in Part B without penalty if you were covered by employer health insurance through your or your spouse’s current job when you first become eligible for Medicare. You can enroll in Medicare without penalty at any time while you have group health coverage and for eight months after you lose your group health coverage or you (or your spouse) stop working, whichever comes first.
For example, let’s say you retire in February. Use the following chart to determine when you can enroll in Medicare and when your coverage would start.

You can enroll anytime in: Your coverage starts:

March April 1st

April May 1st

May June 1st

June July 1st

July August 1st

August September 1st

September October 1st

October November 1st


To avoid a gap in coverage, enroll in Medicare the month before your employer coverage will end

Medicare Insurance Plan Options for Seniors: I am caring for a loved one with Medicare. What are the most important things for me to know

Medicare Insurance Plan Options for Seniors: I am caring for a loved one with Medicare. What are the most important things for me to knowContextual Links

I am caring for a loved one with Medicare. What are the most important things for me to know

To get the information you need, you will need to talk to your loved one and do some research on your own. You may have to bring up some uncomfortable topics with your loved one, such as end-of-life issues and finances. While it may be difficult to have these discussions, it is important that you talk to your loved one before she has a health crisis to ensure that she gets the best possible care.

If you are caring for a loved one with Medicare, you should know:

•How does Medicare work? How does your loved one get her Medicare benefits? What doctors and services does your loved one’s Medicare provider cover
What are your loved one’s health care needs? What conditions does she have? What medications does she take? What conditions and surgeries has she had in the past?
GO TO box.

•Where does your loved one keep important information? Where does she keep documents like her emergency contact list, the names and contact numbers of her doctors, birth certificate, Medicare card and bank statements?

•What are your loved one’s health care preferences? In the event that she can no longer communicate her wishes, what kind of treatment would she want? Has she legally appointed someone to make decisions on her behalf
Are your loved one’s health care needs covered? Can your loved one pay for her current health care needs? Will she be able to in the future? If she needs it, will she be able to afford long-term care (at home or in a living facility)? What kind of health care and prescription drug coverage does your loved one have
Where can you as a caregiver go for help? What is your right to assistance? What support services are available in your area?

Does my state have a program to help me with my prescription drug costs?

Many states offer a state pharmaceutical assistance program (SPAP) to help their residents pay for prescription drugs. Each program works differently.

Many states coordinate their drug assistance programs with Medicare’s drug benefit (Part D). If you do not have Part D but qualify for your state’s SPAP, you will have the chance to sign up for Part D, and may be required to enroll in a Part D plan. If a drug is covered by both your SPAP and your Part D plan, both what you pay for your prescriptions plus what the SPAP pays will count toward the out-of-pocket maximum you have to reach before your Medicare drug costs go down significantly. Your SPAP may also help pay for your Part D plan’s:

premium;
deductible;
copayments; and/or
coverage gap. (Many SPAPs give you coverage during your part D plan’s “coverage gap” or “doughnut hole.”)
Click on the MI Extra chart below to find out if your state has an SPAP, whether you are eligible, how the SPAP works, and how to enroll.

Medicare Enrollment Periods What do they really mean?

You are able to enroll in or change your Medicare plan during one or more of the following enrollment periods:

•Initial Enrollment Period (IEP)
•Medigap Open Enrollment Period
•Annual Coordinated Election Period (AEP)
•Medicare Advantage Disenrollment Period (MADP)
•Special Election/Enrollment Period (SEP)

This is the time to enroll in Medicare for the first time if you are turning 65. It is your birthday month (unless your birthday falls on the first of the month, then your birthday month is the previous month) plus the 3 months prior to your birthday month and the 3 months after your birthday month.
Medigap Open Enrollment Period is the period of time when an insurance company cannot:

•refuse to sell you any Medigap policy it sells;
•make you wait for coverage to start (pre-existing exclusion may apply)
•ask you any health questions to determine your rate
Medigap Open Enrollment lasts for 6 months. It begins on the 1st day of the month in which you are BOTH age 65 and older AND enrolled in Medicare Part B. This period cannot be changed or repeated.
October 15 through December 7 each year. New coverage becomes effective January 1.

You can do the folowing:

Return to Original Medicare from a Medicare Advantage (MA) or Medicare Advantage with Prescription Drug (MAPD) plan.
Enroll in a MA or MAPD plan
Enroll in a Part D Prescription Drug plan
Change MA or MAPD plans
Change Part D Prescription Drug Plan
January 1st thru February 14 each year. Your Original Medicare benefits will become effective the first of the month following disenrollment from your Medicare Advantage plan. Your Prescription Drug coverage will become effective the first of the month after your application has been received.

You can do the following:

Return to Original Medicare from a Medicare Advantage (MA) or Medicare Advantage with Prescription Drug (MAPD) plan.
Enroll in a Part D Prescription Drug plan if disenrolling from a MA or MAPD plan
Apply for a Medigap (Medicare Supplement) policy (medical underwriting may be required

New Preventive Care Benefits From Medicare

Beginning January 1, 2011, you will pay nothing for -- a one-time review of your health, education -- If youʼve had Part B for longer than 12

100% Coverage for*

:

➡

Bone Mass Measurement

➡

Cervical Cancer Screening, including Pap Smear tests and Pelvic Exams

➡

Cholesterol and other Cardiovascular Screenings

➡

Colorectal Cancer Screening (except for barium enemas)

➡

Diabetes Screening

➡

Flu shot, Pneumonia shot, and the Hepatitis B shot

➡

HIV Screening for people at increased risk or who ask for the test

➡

Mammograms

➡

disease

Medical Nutrition Therapy to help people manage diabetes or kidney

A few important notes:

•

“Welcome to Medicare”

and counseling about preventive services, and referrals for other care if needed.

Yearly “Wellness” Exam

months, you can get a yearly wellness visit to develop or update a personalized

prevention plan based on your current health and risk factors.

Decoding Deficit Reduction and Medicare

Decoding Deficit Reduction and Medicare                   

There has been much discussion over the past year about "deficit reduction," but the complexity of the topic and the jargon that is used make it difficult to understand the impact that deficit-reduction proposals would have on real people. Over the next few weeks, the debate will intensify as Congress considers budget legislation that may incorporate or trigger many of these proposals.
                   
Most discussions about deficit reduction go hand in hand with discussions about how to slow spending in "entitlement programs" such as Social Security, Medicare and Medicaid. However, there is a difference between slowing spending, as the Affordable Care Act attempts to do through delivery system reforms, and achieving savings by cutting the funding for these programs and shifting higher costs to consumers. Many of the deficit reduction proposals do exactly that, and while proponents use terms such as "flexibility" and "reform" to describe them, many would result in higher costs for consumers, fewer benefits and decreased access to care. This is especially problematic for people with Medicare, nearly half of whom have annual household incomes of $20,000 or less, and who already spend about 16.2 percent of their annual incomes on health care.
                   
The following materials act as a guide to the deficit reduction debate and serve to help readers interpret the terms that will be used in the coming months. While some proposals sound promising in name, in reality they would have serious effects on Medicare consumers' access to quality, affordable health care, and some would even replace the current Medicare program altogether.

The Medicare Part D Coverage Gap

Whether you’re new to Medicare Part D or not, knowing  how it works can help you better understand your costs.  Each plan that provides drug coverage, whether it’s a stand-alone plan or a Medicare Advantage plan that includes drug coverage, will include cost sharing.
Many Medicare beneficiaries are confused by the Part D coverage gap (also know as the “doughnut hole); this is why it is important to understand how the ‘doughnut hole’ works.

How do the Drug Payment Stages work?

You share costs with the plan, usually as copays until the combined total hits $2,840 (2011).  This figure can vary by plan.  This stage is sometimes called the “initial coverage period.”
After you reach $2,840 (2011) in total drug costs, you pay 93% of the cost of generic drugs and about 50% of the cost of most brand-name drugs until your yearly drug costs hit $4,550 (2011).  During this period you pay most of the costs, your plan pays a little.  This is the Coverage Gap or Doughnut hole.

 You pay a small copay or coinsurance on all your drugs until the year’s end.  The plan pays the rest.  This is known as Catastrophic coverage and there is no limit to the amount the plan pays

What do I do if my Medicare drug plan says no to my request that it pay for a drug? (How do I appeal?)

If you have formally asked your plan to pay for a drug, override a restriction, or move your drug to a lower cost tier (requested an “exception”), and your plan turns you down, you should appeal.

Before you can begin the appeals process, you must have already asked for an exception and been officially denied in writing. A “no” at the pharmacy is not an official denial.

The process for appealing is the same whether you are in a Medicare private health plan with drug coverage (MA-PD) or stand-alone private drug plan (PDP).

How to appeal your plan's decision

• Your plan should send you a written denial titled "Notice of Denial of Medicare Prescription Drug Coverage." The notice should clearly explain why the plan is denying coverage for your prescription and tell you where to send your appeal.
• You have 60 days from the date on the "Notice of Denial" to submit your appeal. (Under certain circumstances, you may be able to appeal after 60 days if you have "good cause"—for example, if you were in the hospital and therefore could not appeal earlier.) By appealing, you are asking for a "redetermination" from the plan.
• The plan must respond no later than seven calendar days from the date it received the request. If it is an emergency, you or your doctor can ask for an "expedited" redetermination. Your plan must respond to an expedited appeal within 72 clock hours.
• If you have to pay for your drug out of pocket since your plan denied your exception request, be sure to to submit receipts and request reimbursement from your plan in your appeal.
  If your doctor submits this appeal on your behalf, you will need to appoint your doctor as your representative by signing an "Appointment of Representative" form. Have your physician submit the form along with the letter of medical necessity.
  A signed "Appointment of Representative" form allows your doctor to represent you throughout the appeals process. A signed form also allows your doctor to represent you in any other Medicare prescription drug appeals over the course of the calendar year.
  Medicare Appeals Council (MAC) review.
  If you disagree with the ALJ's decision, you can appeal within 60 days of the date on the ALJ decision to the MAC. The MAC can also review the ALJ decision on its own initiative.

Medicare, CMS interpretation of off label drug standard

Judge Rules that CMS Misinterpreted Off-Label Drug Coverage Standard                   

This week, as a result of a challenge filed in court by the Medicare Rights Center in 2007, a judge held that the current interpretation of the coverage standard for drugs used off-label under the Medicare prescription drug benefit, also known as Part D, is invalid. Since Part D began, the Centers for Medicare and Medicaid Services (CMS) has not covered drugs used for off-label indications—drugs used for treatments other than those approved by the Food and Drug Administration—if the use is not listed in statutorily identified, privately owned and published drug guides known as compendia. However, Judge Harold Baer of the U.S. District Court in the Southern District of New York ruled, as Medicare Rights Center had argued, that the list of compendia in the Medicare law was not meant to be restrictive, but to be an illustrative example of materials that may be used to determine if coverage of a drug used for off-label purposes is appropriate.
                   
Medicare Rights Center filed suit on behalf of plaintiffs Judith M. Layzer, who recently lost her battle with ovarian cancer, and Ray J. Fischer, who suffers from a rare form of muscular dystrophy. Both plaintiffs used off-label drugs as treatment for their conditions. While these uses were supported by peer-reviewed medical literature, they were not included in the compendia listed in the Medicare statute.
                   
In addition to challenging the interpretation of the Part D statute through litigation, the Medicare Rights Center has pursued a legislative remedy, seeking clarification from Congress that off-label drug treatments can be covered under Part D if there is evidence of efficacy in peer-reviewed literature such as the New England Journal of Medicine.
                   
That effort was successful with respect to anticancer chemotherapy drugs with the passage of the Medicare Improvements for Patients and Providers Act (MIPPA) in 2008, which clarified that peer-reviewed medical literature may be used for coverage decisions of off-label drug treatments of cancer. As a result of MIPPA, Medicare Rights Center secured coverage for Mrs. Layzer of her drug going forward, but her estate still requires reimbursement for thousands of dollars of medication she used before MIPPA took effect.
                   

Does my state have a program to help me with my prescription drug costs?

Many states offer a state pharmaceutical assistance program (SPAP) to help their residents pay for prescription drugs. Each program works differently.

Many states coordinate their drug assistance programs with Medicare’s drug benefit (Part D). If you do not have Part D but qualify for your state’s SPAP, you will have the chance to sign up for Part D, and may be required to enroll in a Part D plan. If a drug is covered by both your SPAP and your Part D plan, both what you pay for your prescriptions plus what the SPAP pays will count toward the out-of-pocket maximum you have to reach before your Medicare drug costs go down significantly. Your SPAP may also help pay for your Part D plan’s:

• premium;
• deductible;
• copayments; and/or
• coverage gap. (Many SPAPs give you coverage during your part D plan’s “coverage gap” or “doughnut hole.”)

What is not covered by Medicare?

Medicare does not cover all health care services. Health care services not covered by Medicare include, but are not limited to:

• alternative medicine, including experimental procedures and treatments, acupuncture, and chiropractic services (except when manipulation of the spine is medically necessary to fix a subluxation of the spine. A subluxation is when one or more of the bones of the spine move out of position);
• most care received outside of the United States;
• cosmetic surgery (unless it is needed to improve the function of a malformed part of the body);
• most dental care;
• hearing aids or the examinations for prescribing or fitting hearing aids (except for implants to treat severe hearing loss in some cases);
• personal care or custodial care, such as help with bathing, toileting and dressing (unless homebound and receiving skilled care) and nursing home care (except in a skilled nursing facility if eligible);
• housekeeping services to help you stay in your home, such as shopping, meal preparation, and cleaning (unless you are receiving hospice care)
• non-medical services, including hospital television and telephone, a private hospital room, canceled or missed appointments, and copies of x-rays;
• most non-emergency transportation, including ambulette services;
• Keep in mind that even for Medicare-covered services, Medicare does not usually pay 100 percent of the cost. Unless you have supplemental insurance, you will usually have to pay deductibles and coinsurances. Most preventive services are covered by Original Medicare with no copays or deductibles.
  If you are in a Medicare Advantage plan (sometimes called a Medicare private health plan), your plan may cover some of these services. Check with your plan to find out what additional benefits they offer.

When does Medicare cover eye care?

Medicare will not generally pay for routine eye care, but it will pay for some eye care services if you have a chronic eye condition, such as cataracts or glaucoma. Medicare will cover:

• Surgical procedures to help repair the function of the eye due to these conditions. For example, Medicare will cover surgery to remove the cataract and replace your eye’s lens with a man-made intraocular lens.
• Eyeglasses or contacts only if you have had cataract surgery during which an intraocular lens was placed into your eye. Medicare will cover a standard pair of untinted prescription eyeglasses or contacts if you need them after surgery. If it is medically necessary, Medicare may pay for customized eyeglasses or contact lenses.
• An eye exam to diagnose potential vision problems. If you are having vision problems that indicate a serious eye condition, Medicare will pay for an exam to see what is wrong, even if it turns out there is not anything wrong with your sight.

Medicare will only pay for routine eye care in the following specific circumstances:

• If you have diabetes, Medicare will pay for an eye exam once every 12 months to check for eye disease due to the condition;
• If you are at high risk for glaucoma Medicare will cover an eye exam by a state-authorized eye doctor once every 12 months. You are considered to be at high risk if you:
  • have diabetes;
  • have a family history of glaucoma;
  • are African American and age 50 or older; or
  • are Hispanic and age 65 or older.

Can I keep my COBRA coverage when I enroll in Medicare

It depends on when you got your COBRA coverage.

COBRA is a federal law that gives you the right, to continue your health insurance once it ends because of job loss, divorce, death or other reasons. You must pay the full premium yourself.

If you already have COBRA coverage when you enroll in Medicare: Your COBRA will probably end. Contact your COBRA benefits manager to find out.
Caution: If you have COBRA and become Medicare-eligible, you should enroll in Part B immediately because you are not entitled to a Special Enrollment Period (SEP) when COBRA ends. Your spouse and dependents may keep COBRA for up to 36 months, regardless of whether you enroll in Medicare during that time.

If you become eligible for COBRA coverage after you are already enrolled in Medicare:
You must be allowed to take the COBRA coverage. It will always be secondary to Medicare (unless you have ESRD). You may wish to take COBRA if you have very high medical expenses and your COBRA plan offers you generous extra benefits, like prescription drug coverage.

If you have drug coverage through COBRA and you want to keep it, you should find out if that coverage is as good as or better than Medicare's drug coverage (creditable). You should have received a letter from the company providing your COBRA coverage letting you know whether your drug coverage is as good as Medicare's. If it is creditable, you may want to keep your COBRA coverage and delay enrolling in Medicare drug coverage. Many COBRA plans will not allow you to drop your drug coverage and keep your other medical coverage. Also, if you enroll in Medicare drug coverage later you will not have to pay a higher premium (premium penalty) as long as you join within 63 days of losing your creditable COBRA drug coverage. When COBRA coverage ends, you will have a Special Enrollment Period to enroll in a Medicare drug plan outside of the standard enrollment periods.

If your COBRA drug coverage is not creditable, you can switch to a Medicare private drug plan at any time. However you will have to pay a premium penalty if you did not enroll in the Medicare drug benefit when you were first eligible and have been without creditable coverage for more than 63 days. You will not have to pay a penalty if you can show you received inadequate information about whether your drug coverage was creditable.

What can I do if my Medicare private health plan refuses to pay for care I already received?

If your plan is refusing to pay for care you already received, you have the right to appeal. There are several stages to the process and deadlines you must meet.

Note: If your plan will not approve care that you need and have not yet gotten, you are entitled to a faster appeal.

Below are the steps you must take to file a “standard” appeal if your plan will not pay for care you already received. Make sure to keep any notices you receive from the plan and write down the names of any representatives you speak to and when you spoke to them.

1. Get a Denial Notice
The plan must send you a written denial notice before you can start the appeal.
The notice will tell you what information you need to send to the plan to start an appeal.
2. Request a Reconsideration
You have 60 days from the date on your denial notice to appeal to the plan (request a reconsideration).
In most cases, you will need to send a letter to the plan explaining why you needed the service. Ideally, you should also include a supporting statement from your doctor explaining why you needed the care (medical necessity).
3. Get the Plan’s Decision
Once you appeal, the Medicare private health plan must make a decision within 60 days. If you do not hear back, call the plan.
If your plan still does not change its decision, it must forward your request to the next level of appeal—the Independent Review Entity (IRE) —automatically. The IRE is an independent group of doctors and other professionals that contracts with Medicare to ensure that you receive quality care.
The IRE must decide your case within 60 days.
Continue to Additional Levels of Appeals
If the IRE says the plan does not have to pay for the care you received (upholds the plan's denial), you must take active steps to continue the appeal.
You can appeal to an Administrative Law Judge (ALJ) (if the cost for the service in dispute is at least $130 in 2011). You must appeal to the ALJ within 60 days of the date on the IRE’s decision.
If you are turned down at the ALJ level, you can appeal to the Medicare Appeals Council (MAC) and then to Federal Court.
If you plan to appeal at the ALJ level or higher, you may want to find an advocate or lawyer to help you.
4. Get an Independent Review

What insurance can I buy to fill gaps in Original Medicare?

You may be able to buy a supplemental coverage policy that is designed to fill gaps in Original Medicare. Such a policy is called a “Medigap.” Medigaps can help cover Original Medicare deductibles, coinsurances and some additional benefits. If you do not have other supplemental coverage, such as a retiree plan, you might want to consider purchasing a Medigap policy.

There are different standardized Medigap plans, labeled by letters. Not all plans are available in all areas.  

The plans that were available before June 1, 2010, are labeled by letters A-L.

Starting June 1, 2010, there will be two new Medigap plans (M and N), and four plans (E, H, I and J) will no longer be sold.

• If you bought a plan before June 1, 2010, you can usually keep it as long as you like. The benefits will not change. 
• In general, if you are happy with your current plan, there is no reason to switch. If you decide to switch, you should get unbiased advice to make sure that the plan you pick fits your needs.
• Remember that plans are not required to sell you a policy if you are not within a time that you have the right to purchase a Medigap.

Note: Massachusetts, Minnesota and Wisconsin have different standardized Medigap plans that you can buy.

Each Medigap plan pays for a particular set of benefits. Plan A offers the fewest benefits and is usually the least expensive. Plans that offer more benefits, like Plan F, are generally more expensive.

The most popular Medigap plans are C and F, because they cover major benefits and are less expensive than many other plans.

Prior to June 1, 2010 all Medigap plans were required to include the following basic benefits:

• Hospital coinsurance coverage
• 365 additional days of full hospital coverage
• Full or partial coverage for the 20 percent coinsurance for doctor charges and other Part B services
• Full or partial coverage for the first 3 pints of blood you need each year

All Medigap plans sold starting June 1, 2010 (including new plans M and N) must offer these basic benefits and also pay all or part of the hospice coinsurance for drugs and respite care.

Depending on which Medigap plan you choose, you can get coverage for additional expenses Medicare doesn't cover, including:

• Hospital deductible
• Skilled nursing facility coinsurance*
• Part B deductible
• Emergency care outside the U.S.
• At-home recovery**
• Preventive care that Medicare does not cover**
• Excess doctor charges. “Excess charges” refer to the amount above the Medicare-approved amount “non-participating doctors” can charge

eligible for Medicare if I am under 65?

There are three ways you can get Medicare coverage if you are under 65 years of age.

You are eligible for Medicare if you are a U.S. citizen or have your resident visa, have lived in the U.S. for five years in a row; and

1. You have a disability and have been receiving Social Security Disability Insurance (SSDI) for more than 24 months. Your eligibility begins during the month you receive your 25th SSDI check. You do not need to contact anyone. Social Security should automatically mail you your Medicare card three months before you become eligible.

Note: If you are receiving railroad disability annuity checks, whether you are eligible for Medicare and when you get it depend on how your disability has been classified by the Railroad Retirement Board.

Or

2. You have been diagnosed with End-Stage Renal Disease (ESRD) and you
• are getting dialysis treatments or have had a kidney transplant;
• apply for Medicare benefits (up to 12 months retroactively);and
• you
• are eligible to receive SSDI;
• are eligible to receive railroad retirement benefits; or
• are otherwise considered to be “fully” or “currently” insured by Social Security, as defined by the length of time you have worked and the amount of money you have made (you need a certain amount of Social Security “work credits” depending on how long you have worked).
• Note: Because Social Security and Medicare eligibility rules are complex, you should call Social Security at 800-772-1213 to get the most accurate information regarding your particular situation.
  Note: If you are a railroad worker with ESRD, you must contact Social Security, not the Railroad Retirement Board, to find out if you are eligible for Medicare because you have been diagnosed with ESRD.
  When your Medicare benefits begin depends on the circumstance.
  • If you are getting dialysis, Medicare begins after a three-month waiting period. For example, if you start dialysis in May, Medicare begins August 1st.
  • If you are getting dialysis and start a self-dialysis training program during the waiting period, Medicare begins the same month as the program. You must be expected to finish the training program and continue to do self-dialysis after it is over.
  • If you are getting a kidney transplant, Medicare begins the month you go into a Medicare-approved hospital for either the transplant or the health care services you need before getting the transplant, as long as you get the transplant within three months. For example, if you go into the hospital in August and want your Medicare to start in August, you must get the transplant by the end of October. If the transplant is delayed more than two months after you go into the hospital, your Medicare coverage is also delayed—Medicare begins two months before the transplant actually happens. So, if you go into the hospital in August but don’t get the transplant until March, Medicare begins in January.
  Or
  3. You have been diagnosed with Amyotrophic Lateral Sclerosis (ALS), commonly known as Lou Gehrig’s Disease. You will automatically be enrolled in Medicare the first month you receive SSDI or, if you are a railroad worker, the first month you receive a railroad disability annuity check.

When can I enroll in Medicare?

If you are eligible for Medicare, but not currently receiving Social Security retirement benefits or railroad retirement benefits, there are three different time periods during which you can enroll in Medicare Parts A and B.

"Home care" and when does Medicare cover it?

Home care is a phrase commonly used to refer to a wide range of health and social services. These services are delivered at home to recovering, chronically or terminally ill persons or people with disabilities in need of medical, nursing, social or therapeutic treatment, and/or assistance with the essential activities of daily living.

Medicare covers various types of home health services under both its home health care benefit and its hospice benefit. Each benefit has very specific eligibility criteria.

Can I keep my COBRA coverage when I enroll in Medicare

It depends on when you got your COBRA coverage.

COBRA is a federal law that gives you the right, to continue your health insurance once it ends because of job loss, divorce, death or other reasons. You must pay the full premium yourself.

If you already have COBRA coverage when you enroll in Medicare: Your COBRA will probably end. Contact your COBRA benefits manager to find out.
Caution: If you have COBRA and become Medicare-eligible, you should enroll in Part B immediately because you are not entitled to a Special Enrollment Period (SEP) when COBRA ends. Your spouse and dependents may keep COBRA for up to 36 months, regardless of whether you enroll in Medicare during that time.

If you become eligible for COBRA coverage after you are already enrolled in Medicare:
You must be allowed to take the COBRA coverage. It will always be secondary to Medicare (unless you have ESRD). You may wish to take COBRA if you have very high medical expenses and your COBRA plan offers you generous extra benefits, like prescription drug coverage.

If you have drug coverage through COBRA and you want to keep it, you should find out if that coverage is as good as or better than Medicare's drug coverage (creditable). You should have received a letter from the company providing your COBRA coverage letting you know whether your drug coverage is as good as Medicare's. If it is creditable, you may want to keep your COBRA coverage and delay enrolling in Medicare drug coverage. Many COBRA plans will not allow you to drop your drug coverage and keep your other medical coverage. Also, if you enroll in Medicare drug coverage later you will not have to pay a higher premium (premium penalty) as long as you join within 63 days of losing your creditable COBRA drug coverage. When COBRA coverage ends, you will have a Special Enrollment Period to enroll in a Medicare drug plan outside of the standard enrollment periods.

If your COBRA drug coverage is not creditable, you can switch to a Medicare private drug plan at any time. However you will have to pay a premium penalty if you did not enroll in the Medicare drug benefit when you were first eligible and have been without creditable coverage for more than 63 days. You will not have to pay a penalty if you can show you received inadequate information about whether your drug coverage was creditable

Medicare Insurance Plan Options for Seniors: Understanding my Medicare health coverage options?

Medicare Insurance Plan Options for Seniors: Understanding my Medicare health coverage options?

Understanding my Medicare health coverage options?

There are different ways to get your Medicare benefits. It is important to understand your Medicare options because the way you choose to get your Medicare benefits will affect the care you get. For example, depending on how you get your Medicare benefits, you may only be able to see certain doctors and you may have to get permission before you can access certain health services.

• If you know more about how Original Medicare and Medicare private health plans can work, you will be better equipped to choose the option that works the best for you.
• If you understand how different plans work, you will be more likely to get your care covered. Plan rules for when and where you can get care can greatly affect how much you pay for services. When exploring your coverage options, it is especially important to check whether you will be covered to go to your preferred hospitals, doctors and pharmacies and whether you need to get official permission from the plan (“prior authorization”) before services will be covered.
• Understanding your Medicare options can save you money. Knowing your options may make it easier for you to find a plan that meets your health needs and is affordable for you.
• If you understand your coverage options and choose well, you will have better coverage over the course of the year. In most cases, you can only change how you get Medicare benefits at certain times of the year. Because of this, it is especially important to make careful coverage choices

Medicare Advantage plan costs

• In a Medicare Advantage plans (private health plans) you generally must pay the Medicare Part B premium. Some Medicare Advantage plans may also charge you an additional premium. In some cases, the plan may pay part of your Part B premium.

• Medicare Advantage plans generally do not make you pay a deductible for doctor visits. However, they may charge a deductible for hospital visits and prescription drugs.

• Medicare Advantage plans usually charge you a copayment—a fixed dollar amount—when you visit a doctor, instead of the 20 percent coinsurance you pay under Original Medicare. 

• All plans must include a limit on the amount of cost-sharing you will pay during the year. These limits include copays and deductibles. These limits may be high, but they will protect you for excessive out of pocket costs if you need a lot of care or expensive treatment. 

• Medicare Advantage plans cannot charge higher copayments than Original Medicare for certain care. This includes chemotherapy, dialysis and durable medical equipment. They can charge you more than Original Medicare for others services, including home health, skilled nursing facility and inpatient hospital services.

• Many Medicare Advantage plans have a network of doctors, hospitals and pharmacies, and provide services only in a certain part of the country. You will have to pay more for your health services if you get care outside of the plan’s network or service area.

• Different plans have different rules for how and where you can get coverage. You may have to pay the full cost of services yourself if you do not follow your Medicare Advantage plan’s rules.

Why should I understand my Medicare health coverage options

There are different ways to get your Medicare benefits. It is important to understand your Medicare options because the way you choose to get your Medicare benefits will affect the care you get. For example, depending on how you get your Medicare benefits, you may only be able to see certain doctors and you may have to get permission before you can access certain health services.

• If you know more about how Original Medicare and Medicare private health plans can work, you will be better equipped to choose the option that works the best for you.
• If you understand how different plans work, you will be more likely to get your care covered. Plan rules for when and where you can get care can greatly affect how much you pay for services. When exploring your coverage options, it is especially important to check whether you will be covered to go to your preferred hospitals, doctors and pharmacies and whether you need to get official permission from the plan (“prior authorization”) before services will be covered.
• Understanding your Medicare options can save you money. Knowing your options may make it easier for you to find a plan that meets your health needs and is affordable for you.
• If you understand your coverage options and choose well, you will have better coverage over the course of the year. In most cases, you can only change how you get Medicare benefits at certain times of the year. Because of this, it is especially important to make careful coverage choices

What will Original Medicare cost in 2011?

As January approaches you may begin thinking about your Medicare costs in 2011. The costs listed below reflect the prices you will pay for Original Medicare beginning January 1, 2011.

For Part A, each month (in 2011) you will pay:

• Nothing if you or your spouse worked and paid Medicare taxes for 10 years or more in the U.S.
• $248 if you or your spouse worked and paid Medicare taxes between 7.5 and 10 years in the U.S.
• $450 if you or your spouse worked and paid Medicare taxes for fewer than 7.5 years in the U.S.

For Part A, (in 2011) your coinsurance will be:

• $0 for days 0-60 each benefit period. A benefit period begins the day you start getting inpatient care. It ends when you’ve been out of the hospital or skilled nursing facility for 60 days in a row.
• $283 each day for days 61-90 each benefit period
• and $566 per day for days 91-150 (lifetime reserve days—total of 60 lifetime reserve days which are non-renewable)

For Part A, (in 2011) your deductible will be:

• $1,132 each benefit period

For Part B, each month (in 2011) you will pay…

If your income is at or below $85,000 ($170,000 for couples)..

• A $96.40 premium each month if have had your premium deducted from your Social Security check starting in or prior to December 2009 and continued to have your premium deducted in 2010 and 2011.
• A $110.50 premium each month if you began having your premium deducted from your Social Security check in 2010 and will continue to have your premiums withheld in 2011. This includes people who are new to Medicare in 2010 who had and continue to have their premiums withheld from their Social Security checks.
• A $115.40 premium each month if you sign up for Part B in 2011, or if you do not have your premium withheld from your Social Security check.

People with high incomes have a higher Part B premium.

Medicare Part B Coverage

Medicare Part B helps pay for many common types of health care:

• Doctors' services.
• Durable medical equipment (DME)¹ if medical in nature and bought or rented from a Medicare-certified provider
• Medicare Part B helps pay for many common types of health care:
  • Doctors' services.
  • Durable medical equipment (DME)¹ if medical in nature and bought or rented from a Medicare-certified provider
  • Outpatient physical, speech, and occupational therapy services provided by a Medicare-certified physical, speech, or occupational therapist.
  • • Chiropractic care when manipulation of the spine is medically necessary to fix a subluxation of the spine. A subluxation is when one or more of the bones of the spine move out of position.
    • Outpatient mental health services.
    • Home health services if you are homebound and have a skilled nursing need
    • X-rays and lab tests.
    • A few prescription drugs, such as immunosuppresant drugs, some anti-cancer drugs, some anti-emetic drugs, some dialysis drugs and physician-administered drugs that persons do not usually administer themselves.
    • Medicare does not cover all health care services. Medicare will only pay for Part B services and items (except most prescription drugs) that are ordered or prescribed by a Medicare-enrolled provider.

Medicare Advantage Change is Coming!

Higher costs are already starting to impact Medicare Advantage plans. A report from research firm Avalere Health found that premiums rose by an average of 14.2% from 2009 to 2010, led by a 31.2% increase in PFFS premiums. The 14.2% average increase assumes that enrollees shopped around for the best deal; Medicare Advantage enrollees who merely stayed in the same plan would have seen rates go up by 22% this year, according to Avalere.
One reason premiums are increasing is because Medicaid will be cutting its payments to Medicare Advantage plans by 3% to 5% in 2010. Even greater reductions in federal spending may be on the way; President Obama has said overpayments to Medicare Advantage plans average 13%. "If a program was supposed to save 5%, compared to original Medicare, but now costs 13% more, something's got to give," says Peter Wetzel, president of American Medicare Counselors, an insurance agency in St. Louis. "Large cuts in federal spending are very possible."
The Medicare Advantage program has become a political football in Washington. The Democratic leadership and the White House have targeted Advantage overpayments-13% more per beneficiary on average than the government pays for seniors in traditional Medicare-as a giveaway to insurance companies that unfairly raises premiums for all Medicare beneficiaries.
Already, there are signs of a pullback. At the end of 2009, insurers Coventry, Health Net, WellCare and Aetna stopped offering individual PFFS Medicare Advantage plans. In 2010, there will be 18% fewer Medicare Advantage plans available to seniors than there were in 2009, according to the Kaiser Family Foundation. Seven percent of the roughly 10 million beneficiaries who are enrolled in these plans will have to switch, according to the federal Centers for Medicare and Medicaid Services.
Ten years ago, large cuts led to fewer people enrolled in Medicare Advantage and more in original Medicare, Senkewicz recalls. "The program was known as Medicare + Choice then. Plans dropped out of Medicare, and many people were displaced." From 1998 to 2002, some 2.4 million Medicare beneficiaries were dropped by HMOs that either left Medicare altogether or reduced their service areas, citing inadequate federal funding. Some of those seniors found other Medicare HMOs, but some moved to original Medicare.
If Medicare Advantage plans lose appeal or availability again, more seniors will turn to original Medicare, which now attracts about three-fourths of all enrollees. Many financial planning clients already prefer original Medicare, which lets participants choose their own doctors. Therefore, planners are likely to find increased interest in Medicare supplement policies, which help fill the gaps in original Medicare coverage, such as the 20% of doctors' bills that are the patient's responsibility.
"Many clients find the selection process extremely confusing," Wetzel says. "Medicare now has Part A (hospital care), B (outpatient medical expenses), C (private plans) and D (prescription drugs). At the same time, Medigap has standardized policies labeled A, B, C, D and so forth."

What insurance can I buy to fill gaps in Original Medicare?

You may be able to buy a supplemental coverage policy that is designed to fill gaps in Original Medicare. Such a policy is called a “Medigap.” Medigaps can help cover Original Medicare deductibles, coinsurances and some additional benefits. If you do not have other supplemental coverage, such as a retiree plan, you might want to consider purchasing a Medigap policy.

There are different standardized Medigap plans, labeled by letters. Not all plans are available in all areas.  

The plans that were available before June 1, 2010, are labeled by letters A-L.

Starting June 1, 2010, there will be two new Medigap plans (M and N), and four plans (E, H, I and J) will no longer be sold.

• If you bought a plan before June 1, 2010, you can usually keep it as long as you like. The benefits will not change. 
• In general, if you are happy with your current plan, there is no reason to switch. If you decide to switch, you should get unbiased advice to make sure that the plan you pick fits your needs.
• Remember that plans are not required to sell you a policy if you are not within a time that you have the right to purchase a Medigap.

Note: Massachusetts, Minnesota and Wisconsin have different standardized Medigap plans that you can buy.

Each Medigap plan pays for a particular set of benefits. Plan A offers the fewest benefits and is usually the least expensive. Plans that offer more benefits, like Plan F, are generally more expensive.

The most popular Medigap plans are C and F, because they cover major benefits and are less expensive than many other plans.

Prior to June 1, 2010 all Medigap plans were required to include the following basic benefits:

• Hospital coinsurance coverage
• 365 additional days of full hospital coverage
• Full or partial coverage for the 20 percent coinsurance for doctor charges and other Part B services
• Full or partial coverage for the first 3 pints of blood you need each year

All Medigap plans sold starting June 1, 2010 (including new plans M and N) must offer these basic benefits and also pay all or part of the hospice coinsurance for drugs and respite care.

Depending on which Medigap plan you choose, you can get coverage for additional expenses Medicare doesn't cover, including:

• Hospital deductible
• Skilled nursing facility coinsurance*
• Part B deductible
• Emergency care outside the U.S.
• At-home recovery**
• Preventive care that Medicare does not cover**
• Excess doctor charges. “Excess charges” refer to the amount above the Medicare-approved amount “non-participating doctors” can charge. New plans M and N will offer some of these additional benefits.  Plan M will cover the basic benefits and also cover half of the Part A deductible, skilled nursing facility coinsurance, and some of the cost of foreign travel emergencies. Plan N will also cover the basic benefits except for $20 copayments for office visits and $50 copayments for emergency room visits. Plan N will also offer foreign travel emergency coverage and cover the full Part A deductible as well as skilled nursing facility coinsurance.

*Note: Medigap plans K and L will only pay for a portion of the cost that Medicare does not cover until you reach a yearly out-of-pocket limit. In some areas, Medigap plans F and J are offered as high-deductible plans, which will only cover you after you have met an annual deductible.  Plans J and high-deductible J will no longer be offered after June 1, 2010. If you currently have plan J or high-deductible J you can keep it as long as you like, and your benefits will usually not change.

**Note: Plans purchased between July 31, 1992, and May 31, 2010, may include the at-home recovery benefit and preventive care that Medicare d

What insurance can I buy to fill gaps in Original Medicare?

You may be able to buy a supplemental coverage policy that is designed to fill gaps in Original Medicare. Such a policy is called a “Medigap.” Medigaps can help cover Original Medicare deductibles, coinsurances and some additional benefits. If you do not have other supplemental coverage, such as a retiree plan, you might want to consider purchasing a Medigap policy.

There are different standardized Medigap plans, labeled by letters. Not all plans are available in all areas.  

The plans that were available before June 1, 2010, are labeled by letters A-L.

Starting June 1, 2010, there will be two new Medigap plans (M and N), and four plans (E, H, I and J) will no longer be sold.

• If you bought a plan before June 1, 2010, you can usually keep it as long as you like. The benefits will not change. 
• In general, if you are happy with your current plan, there is no reason to switch. If you decide to switch, you should get unbiased advice to make sure that the plan you pick fits your needs.
• Remember that plans are not required to sell you a policy if you are not within a time that you have the right to purchase a Medigap.

Note: Massachusetts, Minnesota and Wisconsin have different standardized Medigap plans that you can buy.

Each Medigap plan pays for a particular set of benefits. Plan A offers the fewest benefits and is usually the least expensive. Plans that offer more benefits, like Plan F, are generally more expensive.

The most popular Medigap plans are C and F, because they cover major benefits and are less expensive than many other plans.

Prior to June 1, 2010 all Medigap plans were required to include the following basic benefits:

• Hospital coinsurance coverage
• 365 additional days of full hospital coverage
• Full or partial coverage for the 20 percent coinsurance for doctor charges and other Part B services
• Full or partial coverage for the first 3 pints of blood you need each year

All Medigap plans sold starting June 1, 2010 (including new plans M and N) must offer these basic benefits and also pay all or part of the hospice coinsurance for drugs and respite care.

Depending on which Medigap plan you choose, you can get coverage for additional expenses Medicare doesn't cover, including:

• Hospital deductible
• Skilled nursing facility coinsurance*
• Part B deductible
• Emergency care outside the U.S.
• At-home recovery**
• Preventive care that Medicare does not cover**
• Excess doctor charges. “Excess charges” refer to the amount above the Medicare-approved amount “non-participating doctors” can charge.New plans M and N will offer some of these additional benefits.  Plan M will cover the basic benefits and also cover half of the Part A deductible, skilled nursing facility coinsurance, and some of the cost of foreign travel emergencies. Plan N will also cover the basic benefits except for $20 copayments for office visits and $50 copayments for emergency room visits. Plan N will also offer foreign travel emergency coverage and cover the full Part A deductible as well as skilled nursing facility coinsurance.

*Note: Medigap plans K and L will only pay for a portion of the cost that Medicare does not cover until you reach a yearly out-of-pocket limit. In some areas, Medigap plans F and J are offered as high-deductible plans, which will only cover you after you have met an annual deductible.  Plans J and high-deductible J will no longer be offered after June 1, 2010. If you currently have plan J or high-deductible J you can keep it as long as you like, and your benefits will usually not change.

**Note: Plans purchased between July 31, 1992, and May 31, 2010, may include the at-home recovery benefit and preventive care that Medicare does not cover. Plans purchased on or after June 1, 2010, will no longer include the at-home recovery benefit and the preventive care benefit 

 Before 2006, Medigap plans H, I and J were sold with drug coverage. These plans are no longer sold with drug coverage. If you bought a Medigap plan H, I or J with drug coverage before 2006, you can keep the drug coverage benefit. However, it is not considered as good as the Medicare drug benefit (“creditable”). You may pay a penalty if you do not enroll in a Medicare private drug plan when you are first eligible.  If you do enroll in the Medicare drug benefit, your plan must automatically remove the drug coverage from your benefits and adjust your premium. Plans H, I and J will no longer be offered beginning June 1, 2010. If you purchased one of these plans you can usually keep it for as long as you would like, and your benefits will not change.

oes not cover. Plans purchased on or after June 1, 2010, will no longer include the at-home recovery benefit and the preventive care benefit.

Original Medicare

Original Medicare is the traditional fee-for-service program offered directly through the federal government.

Under Original Medicare, the government pays directly for the health care services you receive. You can see any doctor that takes Medicare (and most do) anywhere in the country. Original Medicare is sometimes called “traditional” Medicare.

Unless you make another choice, you will have Original Medicare. You can also choose to get your Medicare benefits from a Medicare private health plan. Medicare private health plans must offer at least the same benefits as Original Medicare but can do so with different rules, costs and restrictions. You may be automatically enrolled in a Medicare private health plan if your employer sponsors one when you become eligible for Medicare.

In Original Medicare:

• You go directly to the doctor or hospital when you think you need care. You do not need to get permission first.
• You pay a coinsurance for each service you receive ("fee-for-service").

There are limits on how much doctors and hospitals can charge you.

Original Medicare includes:

• Part A (Inpatient coverage)
• Part B (Outpatient coverage)

Part A is sometimes called “hospital insurance” and Part B is sometimes called “medical insurance.” If you want Medicare drug coverage (Part D) with Original Medicare, in most cases you will need to actively choose and join a stand-alone Medicare private drug plan (PDP).

It is a good idea to have supplemental insurance or your out-of-pocket costs with Original Medicare can be very high. You may get supplemental insurance, for example, from an employer or a “Medigap” policy that works specifically with Original Medicare. Supplemental coverage allows you to keep the flexibility of Original Medicare.  If you have low income, you may qualify for “Medicare Savings Programs” (MSPs) that help pay for the out-of-pocket costs of Medicare.

Medicare Part B Coverage

Medicare Part B helps pay for many common types of health care:

•Doctors' services.
•Durable medical equipment (DME)1 if medical in nature and bought or rented from a Medicare-certified provider

Ambulance services if your health requires ambulance transport and you are traveling to or from certain locations.

Many preventive care services

Outpatient physical, speech, and occupational therapy services provided by a Medicare-certified physical, speech, or occupational therapist.

• Chiropractic care when manipulation of the spine is medically necessary to fix a subluxation of the spine. A subluxation is when one or more of the bones of the spine move out of position.
• Outpatient mental health services.
• Home health services if you are homebound and have a skilled nursing need.
• X-rays and lab tests.
• A few prescription drugs, such as immunosuppresant drugs, some anti-cancer drugs, some anti-emetic drugs, some dialysis drugs and physician-administered drugs that persons do not usually administer themselves.
• Medicare does not cover all health care services. Medicare will only pay for Part B services and items (except most prescription drugs) that are ordered or prescribed by a Medicare-enrolled provider.

When can I enroll in Medicare Part D Prescription Plan

If you are enrolled in Medicare Part A and/or Part B and live in your plan’s service area, you can enroll in the Medicare drug benefit (Part D) during your Initial Enrollment Period (IEP).

Your IEP for Part D will usually be the same as for Part B: the seven-month period that includes the three months before the month you become eligible for Medicare, the month you are eligible, and three months after the month you become eligible. For example, if you become eligible for Medicare when you turn 65 on May 15, your IEP will be February 1 to August 31.

Note: If you are disabled and are turning 65 you will qualify for a new Part D IEP.  That IEP will last seven months including the three months before you turn 65, the month you turn 65, and the three months after you turn 65.  If you were paying a Medicare drug benefit premium penalty because you signed up late for Part D before you turned 65, you will no longer have to pay this once your Part D IEP begins.

If you join a Medicare private drug plan during the three months before you are eligible for Medicare, your coverage will start the month you become eligible. If you join a Medicare private drug plan during the month you become eligible, or during the three months afterwards, your drug coverage will start the first of the month after you enroll. You should enroll early during your IEP to make sure that your coverage begins as soon as you are eligible.

If you do not join a Medicare private drug plan during your Initial Enrollment Period, you may not be able to enroll until Fall Open Enrollment (sometimes called the Annual Coordinated Election Period – ACEP), which is November 15 to December 31 of 2010, for coverage beginning January 1. You may also have to pay a premium penalty.

Note: Beginning in October of 2011 Fall Open Enrollment will start earlier and end earlier. Fall Open Enrollment in 2011 and beyond will be from October 15 to December 7. Changes and enrollments made during Fall Open Enrollment will still become effective January 1.

You may also have a Special Enrollment Period to enroll in Part D under special circumstances, including if:

• you get Extra Help; or
• you lose employer drug coverage

What is a Medicare HMO

Medicare Health Maintenance Organizations (HMOs) are private companies that are paid by the federal government to provide individuals with Medicare-covered health benefits. Some HMOs offer additional benefits such as vision and hearing care. Medicare HMOs must cover all Medicare-covered services.

If you join a Medicare HMO, you still have Medicare rights and protections.

You must have both Medicare Part A and Part B to join, and generally must continue to pay your Medicare Part B monthly premium. Some Medicare HMOs will pay part of your Part B premium. You cannot join most Medicare HMOs if you have End-Stage Renal Disease (ESRD) unless it is a "Special Needs Plan" that specifically accepts people with ESRD. (If you were already in an HMO when you developed ESRD, you can stay in that plan. If that HMO leaves your area, you can join another HMO in your area.)

You can also get your Medicare prescription drug benefits (Part D) through a Medicare HMO.

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Medicare 2010

The Social Security Administration advises people to apply for Medicare benefits 3 months before age 65. People do not have to be retired to get Medicare. Unlike Social Security (for which the full retirement age is gradually increasing to 67), people can still receive full Medicare benefits at age 65.

Medicare benefits can begin no earlier than age 65 except for some people with a disability or End-Stage Renal Disease.

People who are already receiving Social Security benefits (for example, getting early retirement) will be automatically enrolled in Medicare without an additional application. They will receive a Medicare card and other information about 3 months before age 65 or their 25th month of disability benefits.

Go Medicare prescription benefits

Compare Medicare Options

Medicare Insurance

In the first part of this module we’ll be talking about the basics of Medigap. The topics we’ll cover are:

•An overview of Medigap

•The benefits of Medigap

•The different standard Medigap plans available

•Medigap costs

•Where to get more information

 

  

What is a Medigap policy?

Original Medicare pays for many health care services and supplies, but it doesn’t pay all of your health care costs. There are costs you must pay, like deductibles, coinsurance, and copayments. These costs are sometimes called “gaps” in Medicare coverage.

A Medigap policy (also called Medicare Supplement Insurance) is a health insurance policy sold by private insurance companies to fill the “gaps” in Original Medicare coverage. The companies must follow Federal and state laws that protect people with Medicare. The front of the Medigap policy must clearly identify it as “Medicare Supplement Insurance"