Is Ahcccs Medicare?
You have to go through a prior authorization process for any Medicare supplement plan you select, which means that your claims will be rejected for reimbursement if you purchase a plan that Medicare doesn't approve.
That doesn't mean that you can't buy the plan you want. It just means that you'll have to contact the insurance company that offers the plan you want to buy to get approval for it before you buy it.
What kind of Medicare supplement insurance do most people choose?
Most people purchase the so-called "Medigap" plans sold through private insurance companies. These plans are standardized by the federal government, and they come with two very important features:
Guaranteed Renewability: If you have a serious illness or injury and your Medigap coverage costs more than you can afford, the insurance company is required to continue to sell you the plan at the same premium you paid when you first purchased the plan. So, going forward, you'll never have to pay a new premium. This is known as guaranteed issue.
If you have a serious illness or injury and your Medigap coverage costs more than you can afford, the insurance company is required to continue to sell you the plan at the same premium you paid when you first purchased the plan. So, going forward, you'll never have to pay a new premium. This is known as guaranteed issue. Guaranteed Renewability: If you are laid off from your job or you lose your employer-sponsored insurance and your Medigap coverage costs more than you can afford, the insurance company is required to continue to sell you the plan at the same premium that you paid when you first purchased the plan. So, going forward, you'll never have to pay a new premium. This is known as guaranteed renewability.
Is all Medicare supplement insurance the same?
No. There are a few different types of Medicare supplement insurance:
Medicare supplement insurance sold by private insurance companies (like the ones listed in the chart above), known as "Medigap" insurance
Medicare Advantage plans, which are offered through private insurers but are administratively and medically integrated with Medicare
Medicare Medical Savings Account plans, which allow you to put money into a tax-free savings account to pay for out-of-pocket medical expenses
Medicare Prescription Drug Plans (Part D), which help pay for prescription drugs
Medicare Advantage plans are not standardized, and there is a lot of variation among them.
The federal government has a lot of control over how Medicare supplement insurance is priced and sold, and the federal government has created regulations to ensure that private insurance companies are offering standardized plans. But the federal government does not regulate Medigap plans.
Why would I purchase a Medigap plan instead of a Medicare Advantage Plan?
The only difference between a Medigap and Medicare Advantage plan is that a Medicare Advantage plan is administered by a private insurance company, while a Medigap plan is administered by a private insurance company but its coverage is standardized by the federal government.
Most Medicare Advantage plans include prescription drug coverage. People with Medicare typically don't have to buy a separate prescription drug plan, so they choose Medicare Advantage plans because they include prescription drug coverage.
People who only need supplemental coverage to pay for the services that Medicare doesn't cover, such as the cost of long-term care, can buy a Medigap plan and save money.
Do Medicare Advantage plans compete with private Medigap insurance companies?
Yes. Medicare Advantage plans are offered through private insurers. Therefore, a Medicare Advantage plan has to compete with private Medigap insurance companies.
Many people who have a Medicare Advantage plan also purchase a Medigap plan.
How do I compare Medicare supplement insurance plans?
Medicare supplement insurance plans are standardized, so they offer similar coverage. They are also regulated by the federal government, so they have to offer the same type and amount of information to potential buyers. When you are comparing Medicare supplement insurance plans, be sure to compare the quality of the insurance company and the premium. The premiums for Medicare supplement insurance plans can vary significantly, even among similar plans.
How do I pay my Medicare supplement insurance premiums?
Check your application carefully. If you received a booklet of private Medicare supplement insurance plans, you'll have to pay your premiums by mail. If you received a card or a paper application, you may be able to pay your premiums by phone, online or by mail.
What can I do if I am rejected for Medicare supplement insurance?
You can request a review of your application by the federal government's Medicare administrative contractors. You'll have to send an explanation of your circumstances to the Medicare administrative contractors and you might have to provide supporting documentation.
If you are turned down by a Medicare program administrator and you disagree with their decision, you can complain to the Centers for Medicare & Medicaid Services.
What happens if I have Medicare supplement insurance and I get sick or injured?
If you have Medicare supplement insurance, Medicare will pay first, and Medicare supplement insurance will pay second. Medicare will pay up to the amount of money that you pay in premiums for the Medicare supplement plan. The Medicare supplement insurance will pay for the rest.
How will Medicare supplement insurance help me?
Medicare supplement insurance will help you pay for extra services that Medicare doesn't cover, such as prescription drugs, medical equipment and certain services provided in a nursing home.
Will having Medicare supplement insurance affect my eligibility for other types of health insurance?
For the most part, no. Some insurance providers will require you to have Medicare supplement insurance before they sell you other types of insurance, such as long-term care insurance. But having Medicare supplement insurance will not prevent you from getting additional health insurance.
You should also know that Medicare Advantage plans don't affect your ability to get other types of health insurance.
What should I do if I get a Medicare supplement insurance denial letter?
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