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VIRGINIA MEDICARE BUYER'S GUIDE

This Virginia Medicare Buyerís guide was written to help those who are eligible for Original Medicare and are considering purchasing a Medicare Supplement or "Medigap" policy. A Virginia Medicare Supplement or Medigap policy is health insurance sold by private insurance companies to fill gaps in the Original Medicare Plan coverage.

Virginia Medigap policies can help pay your share of your medical expenses such as coinsurance, copayments, and deductibles of Medicare-covered services. Some Medigap policies cover certain costs not covered by the Original Medicare Plan.

Quick Review of the Virginia Medicare Program
Medicare is health insurance for people 65 or older, those under 65 with certain disabilities, and those of any age with End-Stage Renal Disease. Medicare will cover many health care services and supplies, but there are many costs or "gaps" that it wonít cover.

Basic Parts of Virginia Medicare
  • Part A (Hospital Insurance) - helps cover your inpatient care in hospitals, skilled nursing facilities, hospice care, and some home health care if you meet certain conditions.
  • Part B (Medical Insurance) - helps cover medically-necessary services like doctorís services and outpatient care, other medical services that Part A doesnít cover such as physical and occupational therapists, and some home health. Part B also helps cover some preventive services to help maintain your health and to keep certain illnesses from getting worse.
  • Part C (Virginia Medicare Advantage Plans) - private insurers like HMOs and PPOs provide Part A, Part B, and, sometimes, Part D coverage to people who enroll.
  • Part D (Virginia Medicare prescription drug coverage) - helps cover prescription drug costs.

Types of coverage that are NOT Virginia Medigap policies
  • Virginia Medicare Advantage Plans (Part C), like an HMO, PPO, or Medicare Private Fee-for-Service Plans
  • Virginia Medicare Prescription Drug Plans (Part D)
  • Medicaid
  • Employer or union plans, including Federal Employees Health Benefits Program (FEHBP)
  • TRICARE
  • Veteran's benefits
  • Long-term care Insurance policies
  • Indian Health Service, Tribal and Urban plans

What do I need to know if I want to buy a Virginia Medigap policy?
When you buy a Virginia Medigap policy, in most cases you will need to already be enrolled in Medicare Part A and Part B. Therefore, you will have to continue to pay the monthly Medicare Part B premium. You will also have to pay a premium to the Medigap insurance company. You can buy a Medigap policy from any insurance company that is licensed in Virginia to help you enroll.

All new Virginia Medigap policies are guaranteed renewable. This means the insurance company cannot cancel your Medigap policy as long as you pay your premiums. Although some Medigap policies sold in the past covered prescription drugs, no new Medigap policies are allowed to include prescription drug coverage. If you want prescription drug coverage, you may want to join a Medicare Prescription Drug Plan known as Part D, which is offered by private companies approved by Medicare.

When is the best time to buy a Virginia Medigap policy?
The best time to buy a Virginia Medigap policy is during your Medigap open enrollment period. This period lasts for 6 months and begins on the first day of the month in which you are both age 65 or older and enrolled in Medicare Part B. During this period, an insurance company canít use medical underwriting. This means it canít refuse to sell you any Medigap policy it sells, make you wait for coverage to start, or charge you more for a Medigap policy because of your health problems.

While the insurance company canít make you wait for your coverage to start, it may be able to make you wait for coverage of a pre-existing condition. A pre-existing condition is a health problem you have before the date a new insurance policy starts. In some cases, the Medigap insurance company can refuse to cover your out-of-pocket costs for health problems for up to 6 months. This is called a "pre-existing condition waiting period."

If you have a pre-existing condition, and you buy a Virginia Medigap policy during your Medigap open enrollment period and if you recently had creditable health coverage, the insurance company must shorten or eliminate this waiting period.

There are many types of Virginia health care coverage that may count as creditable coverage for Medigap policies, but they will only count if you didnít have a break in coverage. A break in coverage means you are without any creditable health coverage for more than 63 days in a row.

Why is it important to buy a Medigap policy when I am first eligible?
It is important to understand your Medigap open enrollment period. During your Medigap open enrollment period you can buy any Medigap policy the company sells. If you apply for coverage outside of your Medigap open enrollment period, there is no guarantee that an insurance company will sell you a Medigap policy unless you are eligible for other reasons, and even then your choices will most likely be limited. Also, after your Medigap open enrollment period ends, Medigap insurance companies are allowed to use medical underwriting to decide whether to accept your application and how much to charge you for the Medigap policy.


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