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Help! I Need Information On Medicare Supplemental Insurance

What Is Medicare Supplemental Insurance?

Medicare provides some protection against the high cost of health care. However, it does not pay all of your health care costs. Therefore, people may need additional protection to supplement Medicare.

If you are considering the purchase of additional insurance to supplement your Medicare, make sure you understand what protections the supplemental policy contains.

What Provisions Should I Look For In My Supplemental Policy ?

  1. Coordination of Benefits
    The policy should have a "coordination of benefits" clause which means the policy will not pay when another insurer pays, or each insurer will pay part of the costs, not to exceed the actual cost.

    • Duplicate coverage is costly and often means multiple premiums with no greater protection than a single good policy.

  2. Preexisting Condition
    Generally, the policy will not pay for medical conditions occurring before the policy’s effective date.

    • Make sure you know the effective date, as you are responsible for all medical costs resulting from an illness before this date.
    • Discuss medical conditions which are permanently excluded or are not payable until a future date. You will be responsible for the costs of these conditions.
    • Always get the information in writing.
       
  3. Waiting Period
    • Check to see if there is a waiting period before the new coverage begins to pay. You are responsible for medical costs during the waiting period.
    • Do not keep an inadequate policy just because you have had it a long time. However, if you do replace it, keep your old policy in force until the new one becomes effective.
       
  4. Maximum Benefits
    Discuss the maximum payment amounts under the entire policy or for specific treatments, and the maximum number of days or visits. You are responsible for all medical costs over these maximums.
    • Get the maximums in writing. Make sure the limits meet your needs.
       
  5. Renewal Rights
    • Avoid policies "renewable at company option", as the company could cancel your individual policy for any reason at the end of a policy year or when the premium comes due.
       
  6. Grace Period
    • Make sure the policy gives you at least 10 days after you receive the policy to look it over. During that time, if you decide you don't want it, you can return it for a full refund of your premium.

Is It Okay To Withhold Medical Information?

No! Give all your medical information.

  • Withholding medical information on a policy application may lead to nonpayment for a later claim.
  • Never believe salespersons who say you don't have to furnish such information when the application requests it, or say they will fill in that information later.

Should I Ask For A Written Coverage Description?

  • Yes! Always ask for a written description of the policy you are considering buying - in simple language.
  • A company selling a good policy will always provide a simplified description of the policy.
  • Read the policy carefully. If you have questions, now is the time to ask.

Should I Pay Cash For The Policy?

  • No! Always pay by check, money order, or bank draft made out to the insurance company - Never to the agent or anyone else.
  • Alway write down the name, address, and telephone number of the agent or insurance company, so you can follow up later if there are any problems with your policy.

Take Your Time!

  • Beware of "last chance to enroll" statements. Don't be high pressured.
  • Shop carefully and compare policies for what they cover and what they cost.
  • Buying insurance is an important decision. Take enough time to feel confident about your choice. Consult others, if you can, before you buy.

Disclaimer: This information is not legal advice. If you have a legal problem, you should talk to a lawyer and ask for advice about your options.

Reviewed April 2014

 
Published by Legal Services of North Dakota in conjunction with Department of Aging Services -Title III.