Medicare supplements can help reduce out-of-pocket costs for your medical care. They come with a monthly plan premium and may have deductibles or copays.
They also pay 80% of Medicare Part B excess doctor charges that exceed the limiting charge, which is no more than 15% above the Medicare-approved amount. Find out more at Best Medicare supplements WI.
Guaranteed issue right
Medicare supplement guaranteed issue rights are protections that protect individuals from medical underwriting, allowing them to change their plans without having to answer health questions. Guaranteed issue rights work in tandem with Special Enrollment Periods (SEPs) to provide clear windows of opportunity for individuals to adjust their coverage based on life changes.
Most guaranteed issue rights arise in specific circumstances, such as when an individual loses employer-sponsored retiree coverage. In addition, some states have expanded on federal protections, including Missouri and Washington, which allow policyholders to change from like-to-like benefits year-round without underwriting.
In other situations, guaranteed issue rights may apply when a beneficiary cancels a Medicare Advantage plan and switches back to traditional Medicare. The same rule applies to beneficiaries who leave a Medicare Advantage plan for a reason not related to their health.
Open enrollment period
The Medicare Supplement open enrollment period is a six-month window in which you can enroll in a Medigap plan without medical underwriting. This is the best time to compare plans and choose the one that meets your healthcare needs. The open enrollment period starts the first day of the month in which you are both at least 65 and enrolled in Medicare Part B.
Many people miss their Medicare supplement open enrollment window because they delay their Medicare Part B coverage while working to coordinate it with their group insurance. For example, if someone retires in January but their employer’s plan continues to cover them through February, their open enrollment window will be delayed until March of that year.
You may still be able to apply for a Medicare supplement outside of the open enrollment period if you have prior creditable coverage and pass underwriting. The underwriting process varies between insurance companies, so you should consult a qualified independent agent to understand your options.
Guaranteed renewable
Every Medicare supplement policy is guaranteed renewable as long as you pay your premium. This means that insurance companies cannot cancel or refuse to renew your policy unless you made intentional false statements on the application. This doesn’t mean that you can never change your coverage, but it does protect you from being dropped due to changes in health status.
In addition to guaranteed issue rights, some states offer additional protections for Medicare supplement policies outside of the open enrollment period. For example, the state of Wisconsin requires that individual Medicare supplements and Medicare select policies contain benefits that exceed federal requirements, such as colorectal cancer screening. These are called Wisconsin mandated benefits. You can learn more about this by visiting a licensed agent or TDI’s website.
Loss of Medicaid eligibility
After the COVID-19 pandemic ended, states resumed their process of periodically assessing and disenrolling Medicaid eligibility. The unwinding process has left many people without coverage, and some have lost their Medicare supplements. In one case, a family received a notice that their coverage was being terminated and had to quickly find another provider.
The rate of procedural disenrollments varies by state, with the highest rates in Kansas, Connecticut and Iowa. However, the rate is likely to decline as states work to address issues with their systems.
Medicare supplements cover out-of-pocket medical expenses not covered by Medicare Parts A and B, including the annual deductible. They also help pay for foreign travel and some prescription drugs. Premiums are based on the beneficiary’s issue age or attained age, depending on the plan chosen.
Appeal rights
If Medicare or your Medicare Advantage plan denies coverage for a service, supply, item, or drug you think should be covered, you have a right to appeal. There are five levels of appeals, and you can continue appealing if you lose at one level. Each level has a different timeframe, so be sure to file your appeals within the correct timeframe.
Medicare Advantage health plans must tell you in writing how to appeal their decisions. The first level of appeal is called a request for reconsideration. If your health plan doesn’t change its decision, you can go to the second level of appeal, which is an external review by Maximus.
You can also choose to have your case reviewed in federal court if you’re unhappy with the decision of the Appeals Council. Talk to your health care provider or your plan’s grievance and appeals department for more information about the process.