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A Consumer's Guide To Medicare Supplement Insurance 2009

(comparison chart)

A Publication of The Maine Bureau of Insurance

John Elias Baldacci
Governor

Mila Kofman
Superintendent

 

MEDICARE SUPPLEMENT INSURANCE

Medicare Supplement insurance is available from several insurance companies and insurers. These policies cover some of the expenses not paid by Medicare. Medicare Advantage plans and Medicare Part D are not Medicare Supplement coverage. Medicare Advantage plans are offered by companies that contract with Medicare to provide you with all of your Medicare Part A and Part B benefits and some plans cover prescription drugs. For more information on these plans or information on what Medicare does and does not pay, read the Federal booklet, "Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare". The booklet is available free from the Maine Bureau of Insurance or your nearest Social Security Administration Office. A more detailed source of information about Medicare is "Medicare & You" available from the Social Security Administration or on-line at www.medicare.gov.

Since January 1, 1992, Medicare supplement insurance products have been required to be standardized in Maine. Insurers may sell 10 standard plans plus one high deductible plan which are required to be identified by letter. The plans are labeled: "A", "B", "C", "D", "E", "F", "G", "J", "K", and "L" plans. Plan "F" also has an option called High Deductible Plan F. Companies offering this product are listed in the premium comparison chart. See below for details regarding benefits under the high deductible plan.

Plan "A" is the one plan that must be offered by all insurers. Insurers may sell any or all of the other plans. The comparison chart is to help you to compare the policies approved for sale in Maine. Policy benefits are the same for all plans with the same letter. So price and service will be important to think about when you buy a policy.

Medicare supplement policies are guaranteed to be renewed each year, as long as you pay the premium. However, the premium may go up each year.

All Medicare supplement policies sold in Maine must have a 30-day Free Look period. This means that if for any reason you are not happy with the policy you bought, you can return it to the agent or the insurance company and all money paid will be returned to you. The policy will be treated like it was never issued.

CHANGES IN MEDICARE SUPPLEMENT COVERAGE
DUE TO THE NEW MEDICARE PART D PRESCRIPTION DRUG COVERAGE

Beginning January 1, 2006 prescription drug coverage became available through Medicare Part D. Medicare Supplement policies with drug coverage will no longer be sold. Plans H and I will no longer be sold. Plan J will be sold but without the drug benefit.

If you have Plans H, I, or J (or coverage purchased before 1992) that has prescription drug coverage and you enroll in Medicare Part D, you should notify your insurer to remove the drug coverage from your plan and adjust the premium. When you enroll in Medicare Part D you will also have the option of changing to another Medicare Supplement Plan that is currently offered by insurance companies.

If you do not enroll in Medicare Part D and you want to keep the prescription drug coverage under your Medicare Supplement policy, you must renew the policy with the drug coverage. If you decide later that you want to enroll in Part D, you may be subject to late enrollment penalties.

 

IF YOU ARE TURNING AGE 65
OR
IF YOU ARE ENTITLED TO MEDICARE DUE TO A DISABILITY

 

Your OPEN ENROLLMENT Period

If you apply for Medicare supplement coverage during the six-month period beginning with the first month in which you enroll for Medicare Part B, any insurer you apply to must insure you and must give you the plan you choose. This is called your open enrollment period. It does not matter what your medical condition is, you cannot be turned down.

Insurers may ask you medical questions during the open enrollment period. However, even if you have medical problems, you cannot be refused coverage during open enrollment.

Disabled Medicare beneficiaries have an additional six-month open enrollment period when they turn age 65. If you are 65 and still working, you should check with Medicare about whether to sign up for Medicare Part B.

APPLYING FOR A POLICY
OTHER THAN IN THE OPEN ENROLLMENT PERIOD

If you are buying a Medicare supplement policy and you are not in the "open enrollment" period, some policies may still be available to you. Each insurer must hold a one-month guaranteed issue period each year when any applicant will be accepted in Plan A. (The insurer decides which month. See the Guaranteed Issue Chart further along in the brochure) Insurers are not required to offer other Medicare supplement plans during this period.

In Maine, if you are careful never to go without coverage that supplements Medicare (such as individual health insurance coverage, group health insurance coverage, MaineCare coverage, or Medigap coverage) for more than 90 days, Medigap insurers must offer you a Medigap policy. It is best not to leave a gap in coverage because many states have time periods shorter than 90 days.

In Maine, you generally have the right to change Medigap plans as long as you change to a plan with the same benefits or a plan with lesser benefits from the same or a different insurer and you have never had a gap in coverage of 90 days.

If you buy a lower benefit Medigap plan, you may not be able to enroll in the higher benefit plan you want later on. See the following chart to determine which plans you can change to in the future. The X shows the plans that are available to you. For example, a person who currently has Plan C can change to Plans A, B, D, E, and High Deductible Plan F. Note that once you buy Plans K or L, you may only be able to switch to another Plan K, L, or High Deductible F due to the level of benefits that are covered.

If you have Medicare supplement coverage issued before January 1, 1992 you can replace the policy that you have with any plan offered by the same insurer. You may also switch to another insurer as long as you change to a plan with the same benefits or a plan with lesser benefits and you have never had a gap in coverage of 90 days. The insurer can't refuse to give you the coverage.

For more information about Medigap coverage, you may call the Bureau of Insurance toll free (in state) at 1-800-300-5000.

If you are enrolled in a Medicare Advantage plan for the first time and decide to disenroll during the first 36 months of your enrollment, you have a right to return to your prior Medigap plan, if you had one or to get a new Medigap plan. After 36 months, insurers must offer you a Medigap policy only if you are disenrolled from the Advantage plan involuntarily for reasons such as if the plan is discontinued in your area or if you move out of the area serviced by the plan.

Chart for Replacing an Existing Medicare Supplement Plan

Your Current Plan	Replacing Plan
	A	B	C	D	E	F	F with high deductible	G	J*	K	L
A	X						X
B	X	X					X
C	X	X	X	X	X		X			X	X
D	X	X		X	X		X			X	X
E	X	X		X	X		X			X	X
F	X	X	X	X	X	X	X	X		X	X
F with a high deductible							X
G	X	X		X	X		X	X		X	X
H*	X	X	X	X	X		X			X	X
I*	X	X	X	X	X	X	X	X		X	X
J*	X	X	X	X	X	X	X	X	X	X	X
H+	X	X	X	X	X		X			X	X
I+	X	X	X	X	X	X	X	X		X	X
J+	X	X	X	X	X	X	X	X	X	X	X
K							X			X
L							X			X	X

+These plans include prescription drug coverage and will not be available after December 31, 2005.

*These plans exclude prescription drug coverage.

 

The following shows the medical benefits that are covered by your Medicare supplement policy. If you're not sure what Medicare pays, please read the Federal booklet, "Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare" which is available free from the Maine Bureau of Insurance, from your nearest Social Security Administration, or at www.medicare.gov. You may be responsible for charges that are not paid by either Medicare or your Medicare supplement policy.

EXPLANATION OF CORE BENEFITS INCLUDED IN ALL PLANS

PLAN "A" - Basic Core Benefits

The following are the basic benefits for Plan "A". These benefits are also included in plans "B" through "L".

• Medicare Part A co-insurance for the 61st through the 90th day in the hospital ($267 a day in 2009);

• Medicare Part A co-insurance for any hospital confinement beyond the 90th day, up to an additional 60 days during the policyholder’s lifetime ($534 a day in 2009);

• After using all the Medicare hospital inpatient coverage, including the lifetime reserve days, all Medicare-eligible hospital charges will be covered up to 365 additional days during the policyholder’s lifetime;

• The reasonable cost of the first three pints of blood each year under Medicare Part A and Part B (doctor and other medical bills);

• The 20% co-insurance amount under Medicare Part B (doctor and other medical bills) after the policyholder pays the Medicare Part B deductible which is $135 in 2009. For outpatient mental health services, the 50% co-insurance amount after the deductible is paid.

 

ADDITIONAL BENEFITS FOUND IN PLANS "B" THROUGH "L"

The following list describes the additional benefits that may be included in plans "B" through "J". The chart shown later in this brochure shows which benefits are included in each plan.

• Medicare Part A Deductible:
  Payment for all of the Medicare Part A inpatient hospital deductible. The Medicare Part A deductible is $1,068 in 2009.
• Skilled Nursing Facility Care:
  Coverage up to the co-insurance amount from the 21st day through the 100th day in a Medicare benefit period for post-hospital skilled nursing facility care. ($133.50 in 2009)
• Medicare Part B Deductible:
  Coverage for all of the Medicare Part B deductible ($135 in 2009). Medicare Part B covers doctor and other medical bills.
• Eighty Percent of the Medicare Part B Excess Charges:
  Coverage for 80% of the difference between the actual Medicare Part B charge as billed and the Medicare-approved Part B charge, not to exceed any charge limit set by the Medicare program or state law.
• One Hundred Percent of the Medicare Part B Excess Charges:
  Coverage for all of the difference between the actual Medicare Part B charge as billed and the Medicare-approved Part B charge not to exceed any charge limit set by the Medicare program or state law.
• Medically Necessary Emergency Care in A Foreign Country:
  Coverage for 80% of the billed charges for Medicare-eligible expenses for medically necessary emergency care received in a foreign country. Care must have started during the first 60 days in a row of each trip outside the United States. This benefit has a $250 calendar year deductible and a lifetime maximum benefit paid of $50,000.
• Preventative Medical Care Benefit:
  Coverage for the following preventive health service: An annual physical exam that may include tests and services and patient education. Reimbursement is for the actual charges up to 100% of the Medicare-approved amount for each service up to a maximum of $120 each year.
• At Home Recovery Benefit:
  Coverage for services for short term, at home help with activities of daily living if you are recovering from an illness, injury or surgery. The total number of at home recovery visits cannot exceed the number of Medicare approved home health care visits. Actual charges for each visit are reimbursed up to a maximum of $40 per visit and up to a total maximum of $1,600 each calendar year.
• High Deductible Plan "F":
  Plan "F" also has an option called High Deductible Plan "F". This high deductible plan offers the same benefits as the regular Plan "F" but the benefits do not start until after you pay a calendar year deductible of $2,000 (this deductible can go up every year). Some of the expenses you will have to pay to satisfy this high deductible include the Medicare deductibles for Parts A and B, but does not include the Plan "F" Foreign Travel Emergency deductible. The Foreign Travel Emergency deductible must be paid regardless of whether you have met the $2,000 deductible. Also, you cannot count the Foreign Travel Emergency deductible toward the $2,000 high deductible.

PRE-EXISTING CONDITIONS

Some policies will not cover pre-existing medical conditions for the first six months the policy is in effect. A pre-existing medical condition is a condition for which you received medical advice or treatment was recommended by or received from a physician six months before the policy is issued. Even if you buy a Medicare supplement policy during your "open enrollment" period, the policy may still not pay for pre-existing conditions for up to six months. The comparison chart has a column which shows the policies that do not cover pre-existing conditions.

If you had prior health insurance coverage and replace it with a Medicare supplement policy, you cannot be made to satisfy a new pre-existing condition exclusion for similar benefits. This is true whether the prior policy is group coverage through an employer, individual coverage, or another Medicare supplement policy.

COST

The premium comparison chart shows annual premiums. Semi-annual, quarterly and monthly premiums may also be available. These premiums are also subject to change and should be verified with the company or producer for accuracy.

The cost for Medicare supplement policies cannot vary based on your age or gender. Some companies charge a higher rate if you smoke. For these companies, both rates are shown on the chart.

For some companies, the annual premium for Plan C exceeds that for Plan D or E by more than the additional benefit provided. This additional benefit covered by Plan C is the Medicare Part B annual deductible which is $135 in 2009. Therefore, you may want to consider buying Plan D or E instead of Plan C to save money. The company must disclose this rate difference in their outline of coverage when premiums for Plan C exceed Plans D and E.

IMPORTANT! READ THE EXPLANATORY INFORMATION BEFORE USING THIS CHART.
Although we make every effort to provide accurate information, rates may change.

 

COMPANY	PRE-EXISTING CONDITION EXCLUSION PERIOD		Plan A	Plan B	Plan C*	Plan D
American Network - Penn Treaty	3 MONTHS		Nonsmoker in zip code beg 039-042, 044 $1,953.00 Nonsmoker all other zip codes $1,736.00	Nonsmoker in zip code beg 039-042, 044 $2,252.00 Nonsmoker all other zip codes $2,002.00	Nonsmoker in zip code beg 039-042, 044 $2,651.00 Nonsmoker all other zip codes $2,357.00	Nonsmoker in zip code beg 039-042, 044 $2,253.00 Nonsmoker all other zip codes $2,002.00
			Smoker in zip code beg 039-042, 044 $2,298.00 Smoker all other zip codes $2,042.00	Smoker in zip code beg 039-042, 044 $2,650.00 Smoker all other zip codes $2,355.00	Smoker in zip code beg 039-042, 044 $3,119.00 Smoker all other zip codes $2,772.00	Smoker in zip code beg 039-042, 044 $2,650.50 Smoker all other zip codes $2,356.00
American Progressive	3 MONTHS		$2,367.20	$3,242.52	$3,908.92	$3,783.53
Anthem Blue Cross/Blue Shield	3 MONTHS	Current	$1,392.36	$1,754.16	$2,200.20	$2,040.12
		Effective 1/1/10	$1,410.48	$1,776.96	$2,228.76	$2,066.64
Bankers Life	NONE	Current	$2,780.38	$2,823.79	$3,275.54	$3,084.52
		Effective 1/1/10	$2,933.32	$2,979.14	$3,455.64	$3,254.15
Combined (Agency)	NONE		$2,131.92	$2,177.65	$2,660.67	Nonsmoker $1,878.51 Smoker $2,170.02
Conseco Health	NONE	Current	Nonsmoker $2,076.40 Smoker $2,392.20		Nonsmoker $2,895.70 Smoker $3,298.30	Nonsmoker $2,755.40 Smoker $3,151.50
		Effective 4/1/10	Nonsmoker $2,076.40 Smoker $2,392.20		Nonsmoker $3,185.20 Smoker $3,628.20	Nonsmoker $3,031.00 Smoker $3,466.80
Continental General	NONE		$1,784.17			$1,905.23
Genworth Life & Annuity Insurance Company	NONE		Nonsmoker in zip code beg 039-042, 044 $2,569.50 Nonsmoker all other zip codes $1,986.40	Nonsmoker in zip code beg 039-042, 044 $3,133.80 Nonsmoker all other zip codes $2,422.40	Nonsmoker in zip code beg 039-042, 044 $3,699.90 Nonsmoker all other zip codes $2,860.00
			Smoker in zip code beg 039-042, 044 $2,486.70 Smoker all other zip codes $2,210.40	Smoker in zip code beg 039-042, 044 $3,027.60 Smoker all other zip codes $2,691.20	Smoker in zip code beg 039-042, 044 $3,575.70 Smoker all other zip codes $3,178.40
Globe Life (Direct Response )	6 MONTHS		$958.00	$1,510.00	$1,745.00
Guarantee Trust Life	3 MONTHS		$2,188.36			$2,802.73
Humana	3 MONTHS		Nonsmoker $1,856.76 Smoker $2,561.76	Nonsmoker $1,957.44 Smoker $2,936.16	Nonsmoker $2,274.00 Smoker $3,396.72
Mutual of Omaha	NONE		Nonsmoker $1,620.89 Smoker $1,863.09		Nonsmoker $2,672.07 Smoker $3,071.34	Nonsmoker $2,448.05 Smoker $2,813.85
State Farm	NONE		$1,573.00		$2,373.00
United American	60 DAYS	Current	$1,793.00	$2,617.00	$3,089.00	$2,960.00
		Proposed 1/1/10	$1,847.00	$2,696.00	$3,182.00	$3,049.00
United HealthCare (for AARP members)	3 MONTHS	Current	$1,146.00	$1,638.00	$1,884.00	$1,758.00
		Effective 1/1/10	$1,182.00	$1,686.00	$1,944.00	$1,812.00
United Teacher Associates	6 MONTHS		Nonsmoker $2,444.01 Smoker $3,055.50	Nonsmoker $2,936.71 Smoker $3,694.25	Nonsmoker $3,308.67 Smoker $4,066.21	Nonsmoker $2,938.65 Smoker $3,696.20
USAA Life	6 MONTHS		Nonsmoker $1,505.52 Smoker $1,654.44			Nonsmoker $2,023.68 Smoker $2,223.60

*See under Cost for an explanation regarding premium differences for Plan C.

COMPANY	PRE-EXISTING CONDITION EXCLUSION PERIOD		Plan E	Plan F	Plan G
American Network - Penn Treaty	3 MONTHS			Nonsmoker in zip code beg 039-042, 044 $2,728.00 Nonsmoker all other zip codes $2,425.00
				Smoker in zip code beg 039-042, 044 $3,208.00 Smoker all other zip codes $2,851.00
American Progressive	3 MONTHS		$3,766.99	$3,967.69 **High Deductible Plan F cost $1,587.65	$3,775.40
Anthem Blue Cross/Blue Shield	3 MONTHS	Current		$2,201.88**High Deductible Plan F cost $783.00
		Effective 1/1/10		$2,230.56**High Deductible Plan F cost $783.00
Bankers Life	NONE	Current	$3,084.52	$3,301.83**High Deductible Plan F cost $535.85	$3,093.25
		Effective 1/1/10	$3,254.15	$3,483.46 **High Deductible Plan F cost $565.30	$3,263.43
Combined (Agency)	NONE			$2,619.80
Conseco Health	NONE	Current	Nonsmoker $2,755.80 Smoker $3,170.80	Nonsmoker $2,919.10 Smoker $3,322.70	Nonsmoker $2,775.70 Smoker $3,155.80
		Effective 4/1/10	Nonsmoker $3,031.50 Smoker $3,487.90	Nonsmoker $3,211.10 Smoker $3,655.20	Nonsmoker $3,053.30 Smoker $3,471.30
Continental General	NONE		$2,086.95	$1,935.64**High Deductible Plan F cost $599.00
Genworth Life & Annuity Insurance Company	NONE			Nonsmoker in zip code beg 039-042, 044 $3,815.10 Nonsmoker all other zip codes $2,948.80 **High Deductible Plan F Nonsmoker in zip code beg 039-042, 044 $1,501.20 Nonsmoker all other zip codes $1,160.00	Nonsmoker in zip code beg 039-042, 044 $3,230.10 Nonsmoker all other zip codes $2,496.80
				Smoker in zip code beg 039-042, 044 $3,685.50 Smoker all other zip codes $3,276.00 **High Deductible Plan F Smoker in zip code beg 039-042, 044 $1,449.90 Smoker all other zip codes $1,288.80	Smoker in zip code beg 039-042, 044 $3,121.20 Smoker all other zip codes $2,774.40
Globe Life (Direct Response)	6 MONTHS			$1,763.00
Guarantee Trust Life	3 MONTHS				Nonsmoker $2,121.28 Smoker $2,757.66
Humana	3 MONTHS			Nonsmoker $2,288.40 Smoker $3,425.64 **High Deductible Plan F cost Nonsmoker $906.84 Smoker $1,353.00
Mutual of Omaha	NONE			Nonsmoker $2,635.11 Smoker $3,028.86	Nonsmoker $1,928.06 Smoker $2,216.16
State Farm	NONE			$2,397.00
United American	60 DAYS	Current		$3,148.00 **High Deductible Plan F cost $998.00	$2,982.00
		Proposed 1/1/10		$3,242.00 **High Deductible Plan F cost $998.00	$3,071.00
United HealthCare (AARP)	3 MONTHS	Current	$1,758.00	$1,896.00	$1,770.00
		Effective 1/1/10	$1,812.00	$1,956.00	$1,824.00
United Teacher Associates	6 MONTHS			Nonsmoker $3,322.29 Smoker $4,079.85	Nonsmoker $2,948.40 Smoker $3,709.83
USAA Life	6 MONTHS			Nonsmoker $2,060.40 Smoker $2,268.48	Nonsmoker $1,995.12 Smoker $2,188.92

 

COMPANY	PRE-EXISTING CONDITION EXCLUSION PERIOD		New Plan J**	Plan K	Plan L
American Network - Penn Treaty	3 MONTHS
American Progressive	3 MONTHS
Anthem Blue Cross/Blue Shield	3 MONTHS	Current	$2,208.12
		Effective 1/1/10	$2,236.80
Bankers Life	NONE	Current	$2,365.94	$1,099.52	$1,588.02
		Effective 1/1/10	$2,496.09	$1,159.95	$1,675.40
Combined (Agency)	NONE
Conseco Health	NONE
Continental General	NONE
Genworth Life & Annuity Insurance Company	NONE
Globe Life (Direct Response)	6 MONTHS
Guarantee Trust Life	3 MONTHS
Humana	3 MONTHS			Nonsmoker $1,093.92 Smoker $1,633.80	Nonsmoker $1,587.24 Smoker $2,370.96
Mutual of Omaha	NONE		Nonsmoker $1,733.72 Smoker $1,992.78
State Farm	NONE
United American	60 DAYS	Current		$1,519.00	$2,139.00
		Proposed 1/1/10		$1,519.00	$2,139.00
United HealthCare (AARP)	3 MONTHS	Current	$2,244.00	$825.00	$1,176.00
		Effective 1/1/10	$2,358.00	$825.00	$1,176.00
United Teacher Associates	6 MONTHS
USAA Life	6 MONTHS

+ Available only in Androscoggin, Kennebec, and Penobscot counties.
**No prescription drug benefit.

Note: Fraternal benefit societies differ from insurance companies. They are not covered by some provisions of the Maine Insurance Code and a number of consumer protections. For example, coverage sold by a fraternal is not covered by guaranty funds. In addition, fraternal benefit society insurance benefits are legally required to be assessable. This means that if the society's claims paying ability becomes impaired, the members may be required to pay their proportional share of the deficiency. Fraternal benefit societies are subject to significantly reduced capital and surplus requirements, and are not typically rated by A.M. Best or an equivalent. It is not possible to explain here every aspect in which fraternal benefit societies differ from commercial insurers. For further information contact the Bureau of Insurance at 1-800-300-5000 in Maine.

Proposed rates are those filed by the company but waiting for review and approval by the Bureau. These rates could change before final approval.

 

MEDICARE SELECT POLICIES

Medicare Select policies are also standardized plans, however, to receive full hospital benefits you must use participating hospitals that are in the network. These select policies generally cost less because of restrictions that affect where you can go to get treatment. Review all policy information carefully to be sure that you understand how the provider network limits and restrictions may affect you. If you do not follow the Medicare Select policy requirements, Medicare will still pay its portion of the bill, however, the Medicare Select company is not required to pay the full benefits under the policy and will deny payment or pay less than the full benefit if you go outside the network for non-emergency services. The Medicare Select policies currently available are noted in the premium chart by the word (Select) after the company name. These Medicare Select policies are available only in the following Maine counties: Androscoggin, Kennebec, and Penobscot.

 

COMPANY	PRE-EXISTING CONDITION EXCLUSION	Plan A	Plan B	Plan C*	Plan D	Plan E	Plan F	Plan G	Plan J
American Progressive	3 MONTHS		$2,019.21	$2,498.96	$2,427.60	$2,416.97	$2,514.14	$2,439.75

 

GUARANTEED ISSUE PERIOD FOR PLAN "A"

The chart below shows the guaranteed issue period when you will be accepted in Plan "A" no matter what medical problems you may have.

We have tried to list toll-free numbers where possible. However, not all companies have 800 numbers available and the numbers we have listed are likely to change without notice. You may want to contact a local company producer before calling the numbers listed here. AARP (United Healthcare) sells policies directly and does not use producers.

COMPANY	GUARANTEED ISSUE PERIOD For Plan "A"	TELEPHONE NUMBER
American Network - Penn Treaty	July	800-362-0700 ext. 3190
American Progressive	July	800-332-3377
Anthem Blue Cross/Blue Shield	All Year	800-585-0099 (in state) 207-822-7878 (out of state)
Bankers Life	December	800-621-3724 ext. 4900
Combined	December	773-275-8000
Conseco Health	June	800-759-7007
Continental General	February	866-459-4272
Genworth Life & Annuity Insurance Company	January	877-825-9337
Globe Life	December	800-801-6831
Guarantee Trust Life	May	800-338-7452
Humana	July	800-872-7294
Mutual of Omaha	June	800-775-6000
State Farm	January	Contact a local State Farm producer
United Healthcare (AARP)	May	800-245-1212
United American	December	972-529-5085
United Teacher Associates	April	800-880-8824
USAA Life	July	800-531-8000

 

Medicare Supplement insurance can only be sold in ten standard plans and one high deductible plan - Plan "F". (Please see page 7 for an explanation of the benefits covered in this plan.) The chart below shows the benefits included in each plan. Every company must make Plan "A" available.

BASIC BENEFITS:

The basic benefits are included in all plans. See the core benefits in this brochure for a listing of the benefits.

PLAN A	PLAN B	PLAN C	PLAN D	PLAN E	PLAN F
Basic Benefits	Basic Benefits	Basic Benefits	Basic Benefits	Basic Benefits	Basic Benefits
		Skilled Nursing Co-Insurance	Skilled Nursing Co-Insurance	Skilled Nursing Co-Insurance	Skilled Nursing Co-Insurance
	Part A Deductible	Part A Deductible	Part A Deductible	Part A Deductible	Part A Deductible
		Part B Deductible			Part B Deductible
					Part B Excess (100%)
		Foreign Travel Emergency	Foreign Travel Emergency	Foreign Travel Emergency	Foreign Travel Emergency
			At-Home Recovery
				Preventive Care

 

BASIC BENEFITS:

The basic benefits are included in all plans. See the core benefits in this brochure for a listing of the benefits.

PLAN G	PLAN J	PLAN K*	PLAN L*
Basic Benefits	Basic Benefits	50% Basic Benefits except 100% Part A Co-insurance	75% Basic Benefits except 100% Part A Co-insurance
Skilled Nursing Co-Insurance	Skilled Nursing Co-Insurance	50% Skilled Nursing Co-Insurance	75% Skilled Nursing Co-Insurance
Part A Deductible	Part A Deductible	50% Part A Deductible	75% Part A Deductible
	Part B Deductible
Part B Excess (80%)	Part B Excess (100%)
Foreign Travel Emergency	Foreign Travel Emergency
At-Home Recovery	At-Home Recovery
	Preventive Care

*Plans K and L provide for different cost-sharing for items and services than Plans A through J. Once you reach the annual limit ($4,620 for Plan K and $2,310 for Plan L in 2009), the plans pays 100% of the Medicare co-payments, coinsurance, and deductibles for the rest of the calendar year. The out-of-pocket annual limit does NOT include charges from your provider that exceed Medicare-approved amounts, called "Excess Charges." You will be responsible for paying excess charges. The out-of-pocket annual limit will increase each year for inflation.

MEDICARE and MAINECARE ELIGIBLE?

THINGS TO CONSIDER ABOUT MEDIGAP COVERAGE WHEN YOU ENROLL IN MAINECARE

• MaineCare provides more comprehensive benefits than a Medicare supplement plan (also known as a Medigap plan).
  
• In some cases MaineCare may prefer to have you keep your Medigap plan and pay for or subsidize your insurance premium, rather than have the Medigap plan cancelled.
  
• If you lose your MaineCare eligibility, you have the right to enroll in any Medigap plan you choose that is offered by any Maine Medigap insurance carrier, as long as you do so within 90 days of losing your MaineCare coverage.
  
• If you have an individual Medigap plan, you may wish to “suspend” your Medigap plan during the time you are eligible for MaineCare. “Suspending” the plan protects your right to re-enroll even if you move to another state. Some states require that you reinstate coverage in the same Medigap plan and with the same insurance company within 60 days of losing MaineCare eligibility. (Non-standardized Medicare supplement plans issued prior to 1991 cannot be “suspended” and may have better benefits than standardized “Medigap” plans. If coverage under one of these plans is cancelled, you cannot re-enroll.)
  
• Before you consider whether to cancel a group Medigap plan, or any other group medical plan (through an employer, retirement plan or other type of group), check with the employer or retirement plan to determine whether the group will allow you to re-enroll (some don’t).
  
• Now that the Medicare changes have gone into effect, prescription drug coverage will be provided through Medicare Part D.
• For personal counseling about whether or not to keep your Medigap policy when you enroll in MaineCare, or about getting a Medigap policy when you lose MaineCare, you can reach a local State Health Insurance Assistance Program counselor by calling 1-877-Elders1 (1-877-353-3771).

 

Area agencies on Aging are the central resource for elder services in your area. they can help you either directly or by referring you to the appropriate agency. Call Elders 1 at 1-877-353-3771 to contact the Area Agency on Aging in your area.

AROOSTOOK AREA AGENCY ON AGING
AROOSTOOK COUNTY
P.O. Box 1288, 33 Davis Street
Presque Isle, ME 04769
TEL: (207) 764-3396;1-800-439-1789
www.aroostookaging.org

EASTERN AREA AGENCY ON AGING
PENOBSCOT, PISCATAQUIS, HANCOCK
WASHINGTON COUNTIES
450 Essex St.
Bangor, ME 04401
TEL: (207) 941-2865; 1-800-432-7812
www.eaaa.org

SPECTRUM GENERATIONS
KNOX, LINCOLN, WALDO, SOMERSET,
SAGADAHOC, KENNEBEC COUNTIES
TOWNS OF BRUNSWICK AND HARPSWELL
1 Weston Court PO Box 2589
Augusta, ME 04338-2589
TEL: (207) 622-9212; 1-800-639-1553
www.seniorspectrum.com

SENIORSPLUS
ANDROSCOGGIN, FRANKLIN, OXFORD COUNTIES
P.O. Box 659, 8 Falcon Way.
Lewiston, ME 04243-0659
TEL: (207) 795-4010; 1-800-427-1241
www.seniorsplus.org

SOUTHERN MAINE AREA AGENCY ON AGING
CUMBERLAND and YORK COUNTIES
136 US Route One.
Scarborough, ME 04074
TEL: (207) 396-6500; 1-800-427-7411
www.smaaa.org

 

Since 1870, the Bureau of Insurance has overseen and regulated the business activities of insurance companies, producers and adjusters in our state.

To ensure that the marketing of insurance is lawful and honest, policies and premiums are reasonable and just, and the payment of legitimate claims is dependable and timely, the Bureau is organized into the following work units: Property and Casualty, Consumer Health Care, Life and Disability, Market Conduct, Legal, Examination, Financial Analysis, Self-Insurance, Workers’ Compensation, Licensing and Administration.

 

Other publications are available through:
The Bureau of Insurance
34 State House Station
Augusta, ME 04333
(207) 624-8475
(800) 300-5000 (Maine only)

For other information and consumer brochures visit our Internet page at:
www.maine.gov/insurance

 

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