NEWS RELEASE
Pearl W. Stanley
Extension Agent
Family and Consumer Sciences, CFCS
Bolivia, NC 28422
September 2002
Purchasing a Medicare supplement policy can be confusing. Many people want to know the best time to purchase a policy and what coverage they need. If they are interested in a policy with prescription drug coverage their choices are limited and so is their enrollment time. Persons who are eligible for Medicare due to a disability and who are younger than 65 have even fewer choices for their Medicare supplement and may pay a higher premium. Knowing the facts about Medicare's Open Enrollment period is critical when choosing a Medicare supplement policy.
Open Enrollment refers to the six-month period after a beneficiary is Medicare eligible and has both Medicare Part A and Medicare Part B. Those older than 65 can purchase any Medicare supplement plan (A through J) from any company that is licensed by the state to sell Medicare supplement insurance during this period. Federal law states that insurers cannot deny coverage or charge more for current or past health problems.
For persons eligible for Medicare due to a disability, Open Enrollment laws are different than for those beneficiaries who are 65 and older. Choices are more limited and prices are significantly higher. In North Carolina, Medicare beneficiaries who are eligible due to a disability and have both Medicare Part A and B are guaranteed the right to purchase Medicare supplement plans A, C or J during Open Enrollment. Again, this decision must be made within the first six months of the disabled Medicare person becoming eligible for Medicare. These companies may have premium rates specifically for disabled beneficiaries, and these rates are usually higher than those rates for persons 65 and older.
When the disabled Medicare beneficiary is 65, he or she then has another Open Enrollment period in which to purchase Medicare supplement plan (A-J). Premium rates at this time will be calculated for persons 65 and older even though the person may still be classified as disabled. As long as the disabled Medicare beneficiary has had previous creditable coverage with no lapse, there will be no new pre-existing condition-waiting period to satisfy.
It is important to note that while Medicare beneficiaries both older and younger than 65 have Open Enrollment periods guaranteeing them coverage, pre-existing condition waiting periods may be imposed unless the beneficiary has "creditable coverage." This means that even if the company is required to offer certain plans within the six-month open enrollment period, medical claims may be denied for up to the first six months of coverage for any pre-existing condition. Pre-existing conditions are determined by any medical condition that the beneficiary has been diagnosed with, treated for or been taking medication for within the six months immediately preceding application. Examples of creditable coverage include employer group health plans, individual health policies, Medicare, Medicaid or a federal/military retiree program.
A list of companies approved to sell Medicare supplement insurance, the plans they sell and current premiums is available through the Medicare Supplement Premium Comparison Database found at www.ncshiip.com.
Because of these limitations of coverage and deadlines for application, it is important to know the laws affecting open enrollment of Medicare supplement policies for Medicare beneficiaries who are 65 and older or disabled. No matter what age you are, whether a baby-boomer or someone several years into retirement, check to see if you have covered all of your options. For answers to your Medicare questions or any senior health insurance questions call SHIIP's toll-free Consumer Line (1-800-443-9354). You may also visit www.ncshiip.com or e-mail shiip@ncdoi.net for answers to your questions. In addition, SHIIP trains volunteers in local communities who are available for free, one-to-one counseling sessions. To reach a SHIIP counselor in your area, contact:
Pearl Stanley
Extension Agent
Family and Consumer Education, CFCS
P. O. Box 109,Bolivia, NC 28422
Telephone: (910) 253-2610
Fax: 910-253-2612
E-mail: pearl_stanley@ncsu.edu
(The Seniors' Consumer Column is written monthly by the SHIIP staff. The column is a service of SHIIP, which is a division of the North Carolina Department of Insurance -- Jim Long, Commissioner.) P. O. Box 26387, Raleigh, NC 27611; 1-800-443-9354, (919) 733-0111; www.ncshiip.com
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URL Address: http://www.ces.ncsu.edu/brunswick/
Date Created 10/3/2002