Seniors and disabled individuals on Medicare often discover the need for a supplemental policy to cover the portion of healthcare costs not covered by Medicare.
“Medicare wasn’t set up to cover 100 percent” of health and medical costs, said Carol Beahan, CLAIM program director. The 20 percent that is not covered is considered the “Medicare gap.”
“We want to help them find coverage for that gap,” she said.
CLAIM is the state health insurance assistance program (SHIP) for people on Medicare. The program has staff, volunteers and community partners in over 180 locations throughout the state, from the Bootheel and the Ozarks to St. Louis and Kansas City.
Beahan said CLAIM assists with Medicare enrollment and helps people understand and know how to use their Medicare benefits. The service is funded through a grant from Administration for Community Living through a grant from the Department of Insurance, Financial Institution and Professional Registration.
When it comes to finding coverage for the Medicare gap, Beahan said Medigap plans are the most common form of Medicare Supplements, which are not the same as Medicare Advantage Plans. Medigap or Supplemental plans cover some medical and health care costs not paid for by Medicare. Medigap policies are provided by private insurance companies, not the government.
Medigap policies generally don't cover long-term custodial care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing. The Missouri Department of Insurance offers a more detailed explanation of Medigap (Supplemental) insurance coverage at www.insurance.mo.gov/seniors.
Beahan said the Medigap Rate Guide from the Missouri Department of Insurance can help with comparing the different Medigap policies and prices in Missouri. Individuals also may want to look that company up on the department’s Complaint Index.
“It’s important to compare the different policies, because even though they might provide the same coverage, the cost – the premium price – often varies between companies,” Beahan said.
“When you first enroll in Medicare Part B, you have six months of open enrollment to choose a policy - and you can’t be turned down,” she said, referring to the guarantee issue period for Medigap insurance.
Medicare recipients may switch Medigap companies – but not policy type - each year during their personal open enrollment period. For example, she said, if you have Policy F, the company does not have to let you switch to Policy K.
Also, beneficiaries under age 65 have the right to suspend or turn off their Medigap policy if they become eligible for coverage under an Employer Group Health Plan. In that case, the beneficiary will not pay the Medigap premium and the policy will not pay any benefits. With the loss of the employer group plan, the beneficiary may reactivate the policy within 90 days without any pre-existing condition exclusions or waiting periods.
To learn more about Supplemental polices to Medicare, contact CLAIM at 1-800-390-3330 or visit www.missouriclaim.org. CLAIM does not recommend any insurance and provides unbiased Medicare information.
CLAIM is a program of the Missouri Department of Insurance through a grant from the Administration for Community Living. Services are provided by Primaris Foundation.