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					ohio shopper’s guide series



Medicare Supplement Insurance
& Medicare Options
This guide:
Describes how & when to apply for Medicare
Explains options for health plans used with Medicare
Includes sample premiums for supplements
Shows selected Medicare Advantage offerings
Lists company names and phone numbers


1-800-686-1578
w w w. o h i o i n s u r a n c e . g o v


Bob Taft – Governor
Ann Womer Benjamin – Director
         From Ohio Governor Bob Taft and
Department of Insurance Director Ann Womer Benjamin:

The Ohio Department of Insurance has produced this Ohio Shopper’s Guide for Medicare
Supplemental Insurance & Medicare Options to help you learn about the health care
options available to you as a person with Medicare. This guide provides an overview of
the Medicare program in general, and details the specifics of your Medicare Supplemental
(MedSup) insurance choices.

Among the choices now available are prescription drug benefits. The Medicare
Prescription Drug, Improvement and Modernization Act (MMA) of 2003 became law on
December 8, 2003. This legislation, signed into law by President George W. Bush, provides
seniors and people living with disabilities a prescription drug benefit, different choices
and benefits under Medicare.

The different choices in MedSup policies available to Ohio residents sometimes seem
overwhelming. This guide details the underlying factors that go into the coverage and
pricing available to you in a simple, easy to understand manner. You will also find
information on ways to choose the correct MedSup plan that fits your health-related
needs and your budget.

The Ohio Department of Insurance has taken information from insurance companies and
is providing sample premiums in this guide, based on the type of plans and the amount
of coverage included in each. These samples and other comparisons are designed to give
you guidance in choosing and comparing your policy coverage and cost.

If you have questions or need additional information, the Ohio Senior Health Insurance
Information Program (OSHIIP) of the Ohio Department of Insurance is ready to help you.
Most questions or issues can be addressed by one of OSHIIP’s counselors or referred for
proper assistance. You can reach OSHIIP at 1-800-686-1578 or by logging onto
www.ohioinsurance.gov.

Sincerely,                 Sincerely,



Bob Taft                   Ann Womer Benjamin
Governor                   Director, Ohio Department of Insurance
How This Guide Can Help You
This guide is designed to help you understand your Medicare options.
Choosing the right plan is an important decision. Experts at the Ohio
Senior Health Insurance Information Program (OSHIIP) can be reached
at 1-800-686-1578 to help answer your questions. OSHIIP is a service of
the Ohio Department of Insurance.


What’s New in 2004?
In 2003, Congress passed the Medicare Modernization Act. The recently
enacted law introduces several new benefits for seniors, some of which
take effect in 2004. Medicare Advantage replaces the Medicare private
health plan option known as Medicare + Choice. Prescription drug
discount cards will also be available for immediate savings. This guide
will help you understand these and other new benefits contained in the
law.                                                                      Editor’s Note:


            Remember, no matter which option you choose,                  Words in green
               you are still in the Medicare program.
                                                                            are defined

Medicare Supplemental Insurance
                                                                          in the glossary
This guide also contains information about Medicare Supplement
Insurance, also called "MedSup" or "Medigap" policies. These plans
are designed to help you pay some of the medical costs that the              on pages
Original Medicare Plan (fee-for-service) doesn't cover. A MedSup
policy is a health insurance policy sold by private insurance companies
(or insurers).                                                               63 - 64



                Medicare Supplement Insurance
                   (or MedSup) = Medigap
     These two terms have the same meaning. Be careful not to
      let the different terms confuse you. This guide calls these
         policies Medicare Supplement Insurance, or MedSup.
       Other references may call the same plans Medigap. You
   don’t need a MedSup policy if you enroll in Medicare Advantage.


The information in this guide was accurate when it was printed. Changes
may have occurred after printing. For more information contact the Ohio
Department of Insurance at 1-800-686-1578 or visit
www.ohioinsurance.gov for additional insurance information.

                                                2
           Chapter 1: A Quick Look at Medicare                         p. 4
                       Medicare Health Plan Choices
                       Medicare Part A
                       Medicare Part B
                       When and How to Enroll in Medicare

           Chapter 2: Medicare Modernization Act of 2003:              p. 8
                       Overview of Changes and Added Benefits
                       Prescription Drug Discount Cards

           Chapter 3: Medicare Supplement Insurance Policy Basics      p. 9
                       Standard Medicare Supplement Plans
                       Open Enrollment
                       Steps to Buying a Medicare Supplement Insurance Policy

           Chapter 4: More Detailed Medicare Supplement
           Chapter 4: Policy Information                              p. 25
                       Changing Medicare Supplement Policies
 TABLE                 Medicare Supplement Premium Rate Factors
                       Guaranteed Issue Rights
   OF                  Private Contracts
                       Medicare Supplement Insurance and Medicaid Illegal
                       Practices
CONTENTS
           Chapter 5: Medicare Advantage                              p. 37
                       Types of Medicare Advantage Plans
                       Joining a Medicare Advantage Plan
                       Open Enrollment

           Chapter 6: Coverage Charts                                 p. 44
                       Covered Services and Premium Information
                       for Medicare Part A and Part B
                       Monthly Medicare Supplement Insurance Premiums
                       Medicare Select Company Listings
                       Medicare Advantage Plans by County

           Chapter 7: Resources                                       p. 59
                       OSHIIP Counseling Directory
                       Rating Firm Information
                       Ohio Medicare Partners

           Chapter 8: Glossary of Terms                               p. 63

                                3
                         Chapter 1
                 A Quick Look at Medicare
Medicare is a health insurance program, administered by the Centers for
Medicare and Medicaid Services (CMS), for individuals who are 65 or
older, disabled or who suffer from End-Stage Renal Disease (ESRD).
Medicare has two parts:
• Part A Hospital Insurance, see below. Most people don't have to pay
• for Part A.
• Part B Medical Insurance, see pages 6-7. Most people pay a monthly
• premium for Part B.

Medicare Health Plan Choices
   •   Original Medicare plan (Part A&B)
   •   This is a "fee-for-service" plan. You are charged a fee for each
   •   covered health care service or supply you receive. You will stay in
   •   the Original Medicare Plan unless you choose to enroll in a
   •   Medicare Advantage plan.
         Note: Many people in the Original Medicare Plan also buy a
                                                                             Medicare
         MedSup (Medicare Supplement Insurance) policy to help pay
         health care costs the plan doesn't cover.
                                                                               Part

              MedSup policies only help pay healthcare costs
                if you are in the Original Medicare Plan.                       A



   • Medicare Advantage (replacing Medicare + Choice in 2004)
   • These private health plans provide care under contract to
   • Medicare. The new law changes the way Medicare pays these plans
   • to help ensure that beneficiaries have access to health plans that
   • offer a wide variety of benefits.

Medicare Part A
Medicare Part A (Hospital Insurance) helps pay for the following:
   • Inpatient hospital care,
   • Skilled nursing facility care,
   • Hospice care, and
   • Some home health care.
You will not pay a monthly payment (called a premium) for Medicare
Part A if you or your spouse paid enough Medicare taxes while working.
You will have premium-free Medicare Part A.
Even if you (or your spouse) didn’t pay Medicare taxes while you worked
and you are age 65, you may be able to buy Medicare Part A.

                                                  4
           Medicare Part B
           Medicare Part B (Medical Insurance) helps pay for the following:
               • Doctors' services,
               • Outpatient hospital care,
               • Some other medical services that Medicare Part A doesn't cover
               • (like some home health care including durable medical
               • equipment), and
               • Preventive Care
           Medicare Part B helps pay for medically necessary services and supplies.
           If you choose to enroll in Medicare Part B, you pay the Medicare Part B
           premium of $66.60 per month (in 2004).


                         For more information on what Medicare Part A
                           covers, see the coverage chart on page 41.

                        For more information on what Medicare Part B
                        covers, see the coverage charts on pages 42-44.
Medicare

           How and When To Enroll in Medicare
  Part
           Before your 65th birthday, you must decide whether or not to enroll in
           Medicare. If you are already getting Social Security or Railroad
   B       Retirement, Medicare will enroll you automatically.
              • Your Medicare enrollment period begins three months before the
              • month you turn 65.
              • Your Medicare enrollment period continues through your birthday
              • month.
              • Your Medicare enrollment period ends three months after your
              • birthday month.


                               MEDICARE ENROLLMENT EXAMPLE
             If your 65th birthday is 4/10/2004,            But, if you miss your
              and you apply for Medicare in . . .     enrollment period and apply . . .
              January, February or March                         after July
                  Medicare starts April 1      • You can’t enroll until next January;
                                               • your coverage starts the following
            April    May       June       July • July
                     Medicare starts           • You’ll pay a 10% penalty each year
            May 1 July 1 Sept. 1 Oct. 1 • you wait.




                                      5
It is better to apply before your birth month! If you apply before your
birth month, your Medicare coverage begins on the first day of your
birth month. If you apply during your birthday month or the next three
months, coverage may be delayed for up to 6 months. To apply for
Medicare, call your local Social Security office, or call the Social Security
Administration at 1-800-772-1213.

The cost of the Medicare Part B monthly premium will go up 10% for
each 12-month period that you were eligible for Medicare Part B but
didn't sign up for it, unless you or your spouse are currently employed
and covered by that employer’s group health plan. This exception
qualifies you to enroll during a Special Enrollment Period without
penalty.

If you didn't sign up for Medicare Part B when you were first eligible, you
may sign up during two enrollment periods:

1. The General Enrollment Period For Medicare Part B
This period runs from January 1 through March 31 of each year. During
                                                                                 Medicare
this time, you can sign up for Medicare Part B at your local Social
Security office. If you get benefits from the Railroad Retirement Board
(RRB), call your local RRB office or 1-800-808-0772.                               Part
If you enroll during the general enrollment period, your Medicare Part B
coverage will start on July 1 of the year you sign up.                              B

2. The Special Enrollment Period For Medicare Part B
                                                                                Enrollment
This period is available if you waited to enroll in Medicare Part B
because you or your spouse were working and had group health
coverage through an employer or union based on current employment.
Most people who sign up for Medicare Part B during a Special
Enrollment Period don't pay higher premiums.

If this exemption applies to you, you can sign up for Medicare Part B:
• Any time you are still covered by an employer or union group health
• plan, through your or your spouse's current or active employment, or
• During the eight months following the month that the employer or
• union group health plan coverage ends, or when the employment ends
• (whichever is first).
Note: When you sign up for Medicare Part B, you automatically begin
your MedSup open enrollment period. Once your MedSup open
enrollment period begins, it cannot be changed or restarted.

See pages 17-18 to learn more about your MedSup open enrollment
period.

                                                   6
                     If you are disabled and working (or you have coverage
                      from a working family member), the Medicare Part B
                         Special Enrollment Period rules may also apply.



             IMPORTANT: If you are eligible but don't sign up for Medicare Part B
             during the Special Enrollment Period, you will only be able to sign up
             during the General Enrollment Period, and the cost of Medicare Part B
             may go up.



                   For more information about signing up for Medicare Part A
                       and Part B, call the Social Security Administration at
                      1-800-772-1213. TTY users should call 1-800-325-0778.
 Medicare          If you get benefits from the Railroad Retirement Board, call
                             your local RRB office or 1-800-808-0772.
   Part
                       Note: If you have End-stage renal disease (ESRD),
                            different rules for enrollment may apply.
    B


Enrollment   Your Rights as a Medicare Enrollee

             Whether you are enrolled with Original Medicare or another Medicare
             option, you are entitled to certain rights and protections:

                • Protection from discrimination in marketing and enrollment
                  practices;
                • Information regarding what is covered and what your costs will be;
                • Information about what treatment options are available to you;
                • Appeal decisions denying or limiting payments for care;
                • Know how doctors are paid by your health plan;
                • Choose a women’s health specialist;
                • Receive a treatment that includes direct access to a specialist for
                  serious or complex conditions;
                • Receive emergency care;
                • Be admitted to the hospital; and
                • Remain in the hospital.




                                    7
                  Chapter 2
       Medicare Modernization Act of 2003
How Does The New Law Change Medicare?

The new law will bring people with Medicare more choices in health care
coverage and improved health care benefits. New preventive benefits
(starting in 2005), such as a one-time physical exam and screening tests
for diabetes and cardiovascular diseases and coverage for prescriptions
(starting in 2006) bring in features of more modern insurance plans.

How Does The Law Change Coverage For Prescription Drugs?

Starting in 2004, Discount Cards will be available for immediate savings
on prescription drugs. Private companies will offer drug discount plans
approved by Medicare. Each discount card can cost up to $30 per year.
Savings are estimated to be 10-20% or more on many drugs. Discount
cards are being offered in May 2004, with discounts effective beginning
in June 2004 and continuing through December 31, 2005.                       Overview of
Individuals with incomes no more than $12,569 a year or married
couples with incomes no more than $16,862 may qualify for a $600             Changes and
credit on their discount card to help cover the cost of their prescription
drugs.
                                                                               Added
Starting in 2006, the discount card program will terminate but the
Prescription Drug Benefit (Medicare Part D) will be added to Medicare.
                                                                               Benefits
All people with Medicare will be able to enroll in plans that cover
prescription drugs. Beneficiaries will pay a $35 monthly premium for
prescription drug benefits that will provide coverage of 75% of drug
costs up to $2,250 after a $250 deductible is met. Beneficiaries will pay
100% of drug costs between $2,250 and $5,100. Medicare will pay 95% of
drug costs above $5,100.

What Are Medicare Advantage Plans?

In 2004, Medicare Advantage replaces the Medicare private health plan
options known as Medicare + Choice. These plans are designed to
offer beneficiaries access to more health plan choices and better bene-
fits. There are three types of Medicare Advantage plans available to
Medicare beneficiaries living in Ohio. They are:

   • Health Maintenance Organizations (HMOs),
   • Private Fee-For-Service Organization (PFFS), and
   • Preferred Provider Organization

See Chapter 5 for more information about Medicare Advantage. (Page 37)

                                                  8
                                    Chapter 3
                       Medicare Supplemental Insurance Policy
                    What Is A Medicare Supplemental Insurance Policy?

                    A Medicare Supplemental Insurance policy, also called a MedSup or
                    Medigap policy, is a health insurance policy sold by private insurance
                    companies to help pay health costs that the Original Medicare Plan
                    doesn’t cover.

                    Before 1992, every insurance company designed its own MedSup
                    benefit plans. Consumers were faced with many plans offering different
                    coverages, with no easy way to compare the plans and determine the
                    best plan for their needs.

                    To eliminate confusion, there are now ten standardized MedSup plans
                    called "A" through "J." The plans are standardized to offer the same
                    benefits regardless of what company offers them. The only differ-
    What Is
                    ences between companies are cost and customer service. Plan A
                    covers only the basic (core) benefits (listed on page 11). These basic
   A Medicare       benefits are included in all the plans, A through J. Plan J offers the most
                    benefits.

 Supplemental

                    When you buy a MedSup policy, you will pay a premium to the insurance
Insurance Policy?   company. This premium is in addition to the Medicare Part B premium
                    you must also pay. As long as you pay your premium, your MedSup
                    policy is guaranteed renewable, which means it is automatically
                    renewed each year.




                                If you buy a MedSup policy, it only covers your
                               health care costs. It doesn't cover any health care
                                             costs for your spouse.



                    IMPORTANT: MedSup policies only help pay health care costs if you
                    have the Original Medicare Plan. You don't need to buy a MedSup policy
                    if you are in a Medicare Advantage plan. It is illegal for anyone to sell
                    you a MedSup policy if they know you are in one of these plans. It is
                    also illegal for an insurance company to sell you a MedSup policy if you
                    have Medicaid except in certain situations.


                                            9
    Before you buy a MedSup policy, find out if you are a Qualified
   Medicare Beneficiary (QMB). People on Medicare are eligible for
   QMB if they meet certain limits for income and assets. Generally,
individuals or families at or below 100% of the federal poverty level do
  not need a MedSup policy because Medicaid will pay the Medicare
Part A and Medicare Part B deductible, all Medicare co-payments and
              the Medicare Part B premium. See page 61.

Why Might I Want To Buy A MedSup Policy?

You may want to buy a MedSup policy because the Original Medicare
Plan doesn't pay all of your health care expenses. The chart below gives
some examples of these gaps.

If you are in the Original Medicare Plan, a MedSup policy may help you:
   • Lower your out-of-pocket costs (deductibles and co-payments), and
   • Provide more health insurance coverage.
What you pay out-of-pocket in the Original Medicare Plan will depend
on the following:
   • How often you need health care,                                        Why Might I
   • What type of health care you need,
   • Whether you buy a MedSup policy,
   • Which MedSup policy you buy, and                                      Want To Buy A
   • Whether you have other health insurance.
                                                                           MedSup Policy?
Some Examples of Gaps in Medicare covered services
What YOU pay in 2004

Hospital Stays      • $876 for the first 60 days
                    • $219 per day for days 61-90
                    • $438 per day for days 91-150

Skilled Nursing     • Up to $109.50 per day for days 21-100
Facility Stays

Blood               • Cost of the first 3 pints

Medicare            • $100 per year
Part B yearly
Deductible

Medicare            • 20% of Medicare-approved amount for
Part B                most covered services
covered             • 50% of the Medicare-approved amount for
services              outpatient mental health treatment*
                    • Co-payment for outpatient hospital
                      services
                                                  10
     The Standard MedSup plans - A through J
                      Plan A       Plan B      Plan C       Plan D       Plan E       Plan F*      Plan G        Plan H        Plan I      Plan J*

                       Basic       Basic        Basic        Basic        Basic        Basic        Basic        Basic         Basic        Basic
                      Benefits    Benefits     Benefits     Benefits     Benefits     Benefits     Benefits     Benefits      Benefits     Benefits

                                               Skilled      Skilled      Skilled      Skilled      Skilled      Skilled       Skilled      Skilled
                                               Nursing      Nursing      Nursing      Nursing      Nursing      Nursing       Nursing      Nursing
                                                Copay        Copay        Copay        Copay        Copay        Copay         Copay        Copay

                                   Part A       Part A       Part A       Part A       Part A       Part A       Part A       Part A        Part A
                                 deductible   deductible   deductible   deductible   deductible   deductible   deductible   deductible    deductible


                                                Part B                                 Part B                                               Part B
                                              deductible                             deductible                                           deductible

                                                                                      Part B       Part B                     Part B        Part B
                                                                                      excess       excess                     excess        excess
                                                                                       100%         80%                        100%          80%

                                               Foreign      Foreign      Foreign      Foreign      Foreign      Foreign      Foreign       Foreign
                                                travel       travel       travel       travel       travel       travel       travel        travel




11
                                              emergency    emergency    emergency    emergency    emergency    emergency    emergency     emergency

                                                           At home                                At home                    At home       At home
                                                           recovery                               recovery                   recovery      recovery

                                                                                                                  Basic        Basic      Extended
                                                                                                                  Drugs        Drugs        Drugs
                                                                                                               $1,250 limit $1,250 limit $3,000 limit

                                                                        Preventive                                                        Preventive
                                                                           Care                                                              Care

     ➜   Only the plans shown here can be sold                                  *Separate versions of Plan F & Plan J have $1,690 deductibles.
     ➜   Every company must have a chart like this in its sales material
     ➜   Every company must offer Plan A
     ➜   The basic benefits listed below must be part of every plan
         • Hospitalization: Part A coinsurance plus coverage for 365 additional days after Medicare benefits end
         • Medical expenses: Part B coinsurance plus coverage for 365 additional days after Medicare benefits end
         • Medical expenses: Part B coinsurance (20% of Medicare-approved expenses)
         • Blood: first 3 pints of blood each year
Plan A:Basic Benefits
Plan A is very basic. It has the fewest benefits and the lowest prices.
Plan A addresses the biggest gaps in coverage by Medicare.

Hospitalization (Medicare Part A)
After you pay the $876 (2004) deductible, Plan A combines with
Medicare to cover all Medicare-approved hospital charges for at least
515 continuous days in a hospital.

Blood
Plan A combines with Medicare to cover all blood expenses (except the
Part B deductible of $100) both in and out of the hospital.

Medical Bills (Medicare Part B)
After you pay the $100 annual deductible, you’re covered for 100% of
Medicare-approved medical expenses (Medicare pays 80%, Plan A pays
20%).

MedSup Plans B thru J have different combinations of the extra
benefits below

Part A deductible ($876 per benefit period in 2004): Plans B thru J
                                                                                 What Do
Part B deductible ($100 per calendar year in 2004): Plans C & F
                                                                              MedSup Policies
Excess charges under Part B: pays either 80% or 100% of the amount a
doctor can legally add to a Medicare approved charge. Plans F, G, I, &J
                                                                                  Cover?
At-home recovery: pays up to $1,600 per year to help with “activities of
daily living” (known as ADLs) while you recover at home from an illness.
You must qualify for Medicare home health care to collect on this bene-
fit. Plans D, G, I, &J

Preventive Care: annual limit of $120 for physical exam, cancer screen-
ing, etc. Plans E & J

Other Benefits

Prescription Drugs
The Original Medicare Plan doesn’t cover prescription drugs except in a
few cases, like certain cancer drugs. If you are eligible to get drugs that
are covered, you should ask if the pharmacy is enrolled in the Medicare
program. If the pharmacy isn’t enrolled, Medicare won’t pay. Some
MedSup policies and programs like Medicaid also cover prescription
drugs.

Foreign Travel
The Original Medicare Plan doesn’t cover health care when you travel
outside the United States, except for some emergency situations in
Mexico and Canada.
                                                  12
MedSup policy extra benefits         Do I need or want
Reasons you might need or            these extra benefits?
want these extra benefits?
Skilled Nursing Coinsurance          You may need this benefit if you have to go to a Skilled
Up to $109.50 a day (in 2004)        Nursing Facility (SNF) after a hospital stay and stay in the
for days 21-100 in a skilled         SNF longer than 20 days.
nursing facility.
Part A Deductible                    You may need this benefit if you have to stay in the hospital.
                                     You have to pay the Medicare Part A deductible each benefit
                                     period.

Medicare Part B Deductible           You may want to think about this benefit if you have Medicare
$100 per year in 2004.               Part B. Each year you must pay the Medicare Part B deductible
                                     before Medicare starts to pay its share. If you have this
                                     benefit, the MedSup policy would pay this amount each year.
Medicare Part B Excess               Under federal law, doctors who don't take Medicare's approved
Charge                               amount as payment in full, may charge up to 15% more than
This is the difference between       the approved amount. However, this practice is BANNED IN
your doctor's actual charge and      OHIO. This coverage is only useful if you spend a lot of time
Medicare's approved amount, if       in a state that has no ban on excess charges.
your doctor doesn't accept
assignment. Plans F, I, and J
pay all of the excess charges.
Plan G pays 80% of the excess
charges. (See box.)
Foreign Travel Emergency             You may want to think about this benefit if you travel outside
80% of the cost of emergency         the United States. This benefit could save you money if you
care during the first 60 days of     need emergency care.
each trip (after the $250
deductible). Up to $50,000 in
your lifetime.
At-Home Recovery                  This benefit covers additional care at home if you are already
This is the cost of at-home help getting Medicare-covered home health services. This benefit
with activities of daily living,  may add to the cost of the policy.
like bathing and dressing, if you
are already getting Medicare-        Excess charges (or balance billing) are BANNED IN OHIO. Ohio law
covered home health visits.           prohibits medical practitioners and their employers from charging
                                          more than Medicare approves. MedSup Plans F,G,I and J include
Up to eight weeks of at-home           coverage for excess charges. Unless you spend a lot of time in another
help after skilled nursing care is       state that allows excess charges, this coverage is not useful to you.
no longer needed.                       Excess charges coverage often increases your annual premium for a
                                          MedSup policy. Look at the chart on page 11. Take away excess
Will pay up to $40 each visit           charges coverage and note that Plan F is just like Plan C and Plan G
                                                    is just like Plan D. Pay only for what you need.
and $1,600 each year.
                                                If you feel you have been overbilled by a health care
                                               practitioner, contact the Ohio Department of Health at
                                                                   1-800-899-7127

                                                   13
     *Prescription Drugs                You may want to think about
     50% of the drug costs that         this benefit if you have high
     Medicare doesn't cover (after      prescription drug costs. It
     you pay a $250 per year            covers half your drug costs
     deductible).                       after the yearly deductible up
                                        to a maximum amount.

     Up to $1,250 each year under       Therefore, to get the full benefit
     Plans H and I (Basic drug          under Plans H and I, you should
     benefit).                          have at least $2,750 in drug
                                        costs in a year (you pay $1,250
                                        plus $250; plan pays $1,250).

     Up to $3,000 each year under       To get the full benefit under
     Plan J (Extended drug benefit).    Plan J, you should have at least
                                        $6,250 in drug costs in a year
                                        (you pay $3,000 plus $250; plan
                                        pays $3,000).
                                                                               Steps To
     Preventive Care                    This benefit helps pay for
     Such as routine yearly check-      routine yearly check-ups and
     ups, serum cholesterol screen-     tests that may be important            Buying A
     ing, hearing tests, diabetes       to keep you healthy.
     screening and thyroid function
                                                                             MedSup Policy
     tests. Up to $120 each year.




*Starting in 2006, the Original Medicare Plan will include a
prescription drug benefit. All people with Medicare will be able to
enroll in plans that cover prescription drugs. At that time, people
enrolled in a MedSup policy with drug coverage (plans H, I, J) will
be able to either keep their current MedSup plan with drug benefits
or enroll in the new Medicare Part D plan (prescription drug benefit
plan). If you choose to enroll in Medicare Part D (available in 2006),
you can either change to another MedSup policy without drug
coverage, or keep your current MedSup policy but drop its drug
benefits and pay a lower premium. After 2006, MedSup Plans H, I
& J will no longer be sold with a drug benefit.




                                                14
                                A MedSup policy is not:
                                • Coverage you get from your employer or union,
                                • A Medicare Advantage plan,
                                • Medicare Part B, or
                                • Medicaid.



               MedSup Policies Do Not Cover The Following:

                  • Long-term care,
                  • Vision or dental care,
                  • Hearing aids,
                  • Private-duty nursing, or
                  • Unlimited prescription drugs.

               Who Can Buy A MedSup Policy?
  Who Can      To buy a MedSup policy, you generally must be enrolled in Medicare
               Part A and Part B. If you are under age 65 and you are disabled or have
Buy A MedSup   End-stage renal disease (ESRD), you may not be able to buy a MedSup
               policy until you turn 65.

   Policy?     More information about MedSup policies for people under age 65 starts
               on page 33.

               Can I Keep Seeing The Same Doctor If I Buy A MedSup Policy?

               In most cases, yes. If you are in the Original Medicare Plan and you
               have a MedSup policy, you can go to any doctor, hospital, or other
               health care provider who accepts Medicare. However, if you have the
               type of MedSup policy called Medicare Select, you must use specific
               hospitals and, in some cases, specific doctors to get your full insurance
               benefits.

               What Is Medicare Select?

               Medicare Select is a type of MedSup policy. If you buy a Medicare
               Select policy, you are buying one of the ten standardized MedSup plans
               A through J. However, with a Medicare Select policy, you must use spe-
               cific hospitals and, in some cases, specific doctors to get full insurance
               benefits (except in an emergency). For this reason, Medicare Select
               policies generally cost less than other MedSup policies.



                                       15
How Much Do MedSup Policies Cost?

The amount you pay for a MedSup policy depends on certain factors.
The cost can vary;

   • By your age,
   • By where you live
   • By insurance company, and
   • By the plan you choose

Insurance companies have three different ways of pricing policies: age of
issue, attained age, and community pricing. For details about these
three ways, see page 26.

The price of premiums that different insurance companies charge
for exactly the same coverage can vary widely. When you compare
premiums, be careful you are comparing the same MedSup policies.




Other Factors That May Affect Your Cost                                       How Much Do

   • Whether you are male or female (Some companies offer discounts
     for females)                                                             MedSup Policies

   • If you smoke or use tobacco products (Some companies offer                   Cost?
     discounts for non-smokers)

   • Whether you are married (Some companies offer discounts for
     married couples)

   • Whether the insurance company uses medical underwriting. This is
     a process that an insurance company uses to review your health
     and medical history and decide whether to accept your application
     for insurance, how much to charge you and whether to make you
     wait for some benefits

     Insurance companies may "medically underwrite" any MedSup
     policy unless you are in your MedSup open enrollment period (see
     page 17) or you have special rights to buy a MedSup policy (see
     page 27)

   • Whether you buy a High Deductible Option Policy. Insurance
     companies may offer a "high deductible option" on MedSup Plans
     F and J (see chart on page 11). High deductible option policies
     often cost less, but if you get sick, your out-of-pocket costs will be
     higher

                                                 16
                      • If you have a Medicare Select policy and you don't use a Medicare
                      • Select hospital or doctor for non-emergency services, you will have
                      • to pay some or all of what Medicare doesn't pay. Medicare will pay
                      • its share of approved charges no matter what hospital or doctor
                      • you choose.

                   When Is The Best Time To Buy A MedSup Policy?

                   The best time to buy a MedSup policy is during your MedSup open
                   enrollment period.

                   Your MedSup open enrollment period lasts for six months. It starts on
                   the first day of the month in which you are both

                      • Age 65 or older, and
  When Is The         • Enrolled in Medicare Part B.

Best Time To Buy
                                Once the six-month MedSup open enrollment
                                     period starts, it can't be changed.
A MedSup Policy?


                   During an open enrollment period, an insurance company can't

                      • Deny you insurance coverage because of your health,
                      • Place conditions on a policy (like making you wait for coverage to
                      • start), or
                      • Charge you more for a policy because of past or present health
                      • problems.

                   If you buy a MedSup policy during your MedSup open enrollment
                   period, the insurance company must shorten the waiting period for
                   pre-existing conditions by the amount of previous health coverage you
                   have. This is called creditable coverage.




                                          17
    See page 27 for more information about pre-existing conditions.
If you want to know more about creditable coverage, see pages 27-28.
    If you are disabled or have End-stage renal disease (ESRD), see
                              pages 33-34.


What If I Missed My MedSup Open Enrollment Period?

If you apply for a MedSup policy after your open enrollment period has
ended, the MedSup insurance company is allowed to use medical
underwriting to decide whether to accept your application. If you are in
good health, the insurance company is likely to accept your application,
but there is no guarantee that you will get the policy.

Should I Enroll In Medicare Part B And Start My MedSup Open
Enrollment Period If I Am Age 65 Or Older And Still Working?
                                                                             Steps To
You may want to wait to enroll in Medicare Part B if you or your spouse
are working and have group health coverage through an employer or
union. Your MedSup open enrollment period won't start until you sign         Buying A
up for Medicare Part B. (Remember, once you are age 65 or older and
enrolled in Medicare Part B, the MedSup open enrollment period starts
                                                                           MedSup Policy
and can't be changed.)

Steps To Buying A MedSup Policy

The decision to buy a MedSup policy is very important and should be
considered carefully. You must look for an affordable policy that gives
you the coverage you need most. You must remember that different
insurance companies may charge different amounts for the same
MedSup policy.

Step 1.   Look at how much you are spending on health care each
          year.

Use the worksheet on page 20 to write down your yearly expenses for
health care. If you don't know your yearly expenses, use the worksheet
to check off the health care costs and services you paid for in the past
(called out-of-pocket costs). This worksheet will help you decide which
MedSup policy benefits you need.




                                                18
                  Important: If you are currently in a health plan that pays for the cost
                   of these services, you may not know how much these services cost.
                  However, you should think about your current and future health care
                 needs, and place a check mark next to those items you think you may
                       need. As you get older, your health care costs may increase.



                How To Use The Worksheet

                Column 1

                   • This column lists types of health care services that you may
                   have paid for over the last year. Use the row marked "other"
  Steps To         to add other health care services that you paid for in the past
                   that you want to consider when choosing a MedSup policy.
  Buying A
                Column 2

MedSup Policy      • Write down the cost for the services you used and paid for over
                   the last few years, or place a check mark for health care costs
                   you paid for.

                   • Look at the amounts in Column 2. Rows with the largest dollar
                   or cost amounts are most likely the benefits you may need in a
                   MedSup policy right now. Remember, you should also think
                   about your future health care needs (see pages 21-22). For
                   example, maybe you didn't have a hospital stay last year, so you
                   didn't have to pay a Medicare Part A hospital deductible. Next
                   year, or sometime in the future, you may end up in a hospital.
                   If you didn't buy a MedSup policy that covers the Medicare Part
                   A hospital deductible, you will have to pay this cost for each
                   benefit period ($876 in 2004).




                                       19
Yearly Health Care Cost Worksheet

Column 1                                        Column 2

Health Care Services                            How Much You Paid Last Year
                                                Write down dollar amount (or
                                                check if you paid last year.)

Skilled Nursing Coinsurance                           $
Up to $109.50 a day (in 2004) for days
21-100 in a skilled nursing facility.

Medicare Part A Hospital Deductible                   $
This amount ($876 in 2004), for days 1-60 of
a hospital stay, can change every year.

Medicare Part B Deductible                            $
$100 per year (in 2004).

Foreign Travel Emergency                              $
Any emergency care you received outside of
the United States.

At-Home Recovery                                      $
Help you receive at home with activities of
daily living, like bathing and dressing, when
you are already getting Medicare-covered
home health visits.

Prescription Drugs                                    $

Preventive Care                                       $
Such as serum cholesterol screening,
diabetes screening, and thyroid
function tests.

Other                                                 $




                                          20
                Step 2:       Think about your future health care needs,
                              review the MedSup plans, and decide which
                              plan has the benefits you need or want.

                If you decide to buy a MedSup policy, make sure it covers the benefits
                you want or you may need in the future. Consider your medical history,
                your family medical history, and health risks when thinking about future
                health care costs.

                The worksheet on pages 13-14 can help you determine the benefits you
  Steps To      need in a MedSup policy. The worksheet includes a list of extra benefits
                the different policies cover. For each benefit there is a reason why you
  Buying A      may want or need that benefit.

                1. Put a check mark in the column "Do I need or want these extra
MedSup Policy      benefits?" next to the extra benefits you need or want.

                2. Turn to the chart on page 11 that lists all the MedSup plans and their
                   benefits. On that chart, circle the benefits you checked on the
                   worksheet.

                3. Look at the benefits you circled on page 11, and find the plan that
                   has most, if not all, of the benefits you need or want. Remember, all
                   of the plans cover the basic benefits. The plan you choose may not
                   match your needs exactly. You may have to give up or buy extra
                   benefits to get a plan that is close to what you want.




                                       21
People on Medicare in 2004 will have the option of purchasing
prescription drug discount cards.




     If you need more information about which MedSup policy is
    best for you, call the Ohio Senior Health Insurance Information
   Program (OSHIIP) at (800) 686-1578. Housed at the Department
     of Insurance, OSHIIP is staffed by Medicare experts who can
          offer free, unbiased information about your options.



Step 3.      Find out which insurance companies are licensed to sell
             MedSup policies in Ohio (see pages 45-56 for premium
                                                                            Steps To
             information).

                                                                            Buying A

Step 4.      Call the insurance companies and compare costs.
                                                                          MedSup Policy
Call different insurance companies and ask questions (see pages 45-56).
Shop around for the best MedSup policy for you at a price you can
afford.

If you aren't in your MedSup open enrollment period or in another
situation where you have a guaranteed issue right to buy a MedSup
policy (see pages 17-18), it is important to ask each insurance company
the questions listed on page 23.




      Use the comparison worksheet on page 23 to write down the
   insurance company answers. This will help you compare the costs
                  and benefits you are considering.




                                               22
MedSup Policy Comparison Worksheet
Ask each insurance company                  Insurance   Insurance   Insurance
                                            Company 1   Company 2   Company 3
Which MedSup policies do you sell?
(Make sure they sell the plan you want.)




What is the cost, this year, of the
MedSup policy I am interested in? What
has been the cost of this MedSup policy
for the past few years?




How is the price decided?
  • What type of pricing does this
    insurance company use?
  • Does it make a difference if I
    am male or female?
  • Does it make a difference if I
    smoke or don't smoke?
  • Does it make a difference if I
    am married or single?




Are there any additional ("innovative")
benefits or discounts included in this
policy?




If you aren't in your MedSup open
enrollment period or in another situa-
tion where you have a guaranteed issue
right, ask:
    • Will you accept my application?
    • Do you review my health records
      or application to decide how much
      to charge me for a MedSup policy?
    • Will I have to wait for my pre-
      existing conditions to be covered
      if I already have a health problem?




                                               23
Step 5.       Choose the best MedSup policy for you.

After you call the insurance companies and compare their costs, choose
the company to which you will apply for a MedSup policy. Before making
a final decision make sure

   • You carefully review the MedSup policy benefits.
   • You can afford the cost of the policy.
   • The policy covers the benefits you need and want.
   • You feel good about and trust the insurance company and/or the
     insurance agent.
   • You talk with someone you trust, like a family member, friend,
     doctor, or insurance agent about your choice.

Step 6.       Buy the MedSup policy.

Remember the following when you buy your MedSup policy:

   • Fill out your application carefully and completely. Answer honestly
     all of the medical questions. If the insurance agent fills out the
     application, review it to make sure it's correct before you sign it.
                                                                                   What is
   • Do not buy more than one MedSup policy. If you already have a
     MedSup policy, it is illegal for an insurance company to sell you a
     second policy unless you put in writing that you are going to                A Medicare
     cancel the first MedSup policy. However, don't cancel your first
     MedSup policy until the second one is in place, and you decide to
     keep the second MedSup policy. You have a 30 day "free look"               Supplemental
     period, to decide if you want to keep the new policy. (See page 25
     for more information about changing your MedSup policy.)
                                                                               Insurance Policy?
   • Do not pay cash. Pay for your policy by check, money order, or bank
     draft. Make it payable to the insurance company, not the agent.

   • Ask for your MedSup policy to become effective when you want
     coverage to start, or when your previous policy coverage ends. If,
     for any reason, the insurance company won't give you the start
     date you want, call the Ohio Department of Insurance at
     1-800-686-1578.

   • Get a premium receipt with the insurance company's name,
     address, and telephone number for your records.

   • If you buy a policy from an agent, ask for his/her business card.

   • Be sure to get a copy of your policy within 30 days. Read it
     carefully. If you don't get your policy in 30 days, call your insurance
     company. If you don't get your policy in 60 days, call the Ohio
     Department of Insurance at 1-800-686-1578.


            You do not need more than one MedSup policy!

                                                 24
                                        Chapter 4
                                A Closer Look at Medicare
                                 Supplemental Insurance
                 What Should I Know If I Want to Change My MedSup Policy?

                 If you bought your MedSup policy before 1992, it is likely to differ from
                 one of the standard policies described here. Your insurance company
                 may offer to replace your old policy with a new one. However, you do
                 NOT have to switch. Most pre-1992 MedSup policies are guaranteed
                 renewable, which means the insurance company must renew your
                 policy as long as you pay your premium.

                 Your old policy may offer better benefits than the benefits you can
                 buy today. Other, older MedSup policies may have bigger premium
 What Should
                 increases than standardized MedSup policies. Compare what you have
                 now with what you are thinking of buying before making a decision. If
  I Know If I    you drop a pre-1992 plan, you cannot get it back. Some benefits that are
                 not sold now include:

   Want to          • 100% coverage for prescription drugs (compare your old policy with
                      Plans H, I and J)
                    • Skilled nursing care after 100 days
 Change My          • Private hospital room
                    • Private nursing duty
MedSup Policy?      • Any other benefit that is not on the chart of standard plans (see
                      page 11)

                 What Is a "Free Look Period"?

                 After purchasing your MedSup policy, you have 30 days to return the
                 policy and receive a full refund. During the free look period, continue to
                 make payments on the old policy until you receive and carefully review
                 the new policy. Once you are sure that you are completely satisfied with
                 the new policy, cancel your old policy.


                   Beware of postcards or phone callers that don’t mention insurance
                    but promise to give you "important information about Medicare,"
                    or say "it’s time for your annual Medicare review." Unscrupulous
                     agents sometimes use these tactics to get into your living room
                                           (and your bank account)!




                                         25
             Remember, one MedSup policy is all you need.



How Are MedSup Policies Priced?

Insurance companies have three different ways of pricing MedSup
policies based on your age:

1. No-age-rated (also called community-rated) policies

These policies charge everyone the same rate regardless of age.

2. Issue-age-rated policies

The monthly premium for these policies is based on your age when you
first buy the policy. The cost doesn't go up automatically as you get
older. Your premium will be the same as anyone your age buying this            How Are
policy for the first time.

3. Attained-age-rated policies                                              MedSup Policies

The monthly premiums for these policies are based on your age each              Priced?
year. These policies generally cost less at age 65, but their costs go up
automatically as you get older.



      Caution: In general, attained-age-rated policies are cheaper
      than issue-age-rated policies the first few years you own the
     policy. However, rate increases for attained-age-rated policies
        are usually larger than rate increases for issue-age-rated
     policies. After a period of time, the premiums for an attained
     age-rated policy will be higher than what the premiums would
             have been if you had an issue-age-rated policy.



         Remember, all monthly premiums may change and go
          up each year because of inflation, rising health care
                 costs or the number of claims filed.




                                                 26
                  Will My Pre-existing Condition Be Covered If I Buy A MedSup Policy?

                  A pre-existing condition is a health problem you had prior to the
                  starting date of a new policy. An insurance company can refuse MedSup
                  coverage for those health problems for up to six months. This delay is
                  called a "pre-existing condition waiting period." The insurance company
                  can only use this kind of waiting period if your health problem was
                  diagnosed or treated during the six months before the policy started.

                  Open enrollment period

   Will My        If you buy a policy during your MedSup open enrollment period, and
                  you had at least six months of previous health coverage that qualifies
                  as "creditable coverage" (see below), the company cannot give you any
  Pre-existing
                  pre-existing condition waiting period. If you had less than six months of
                  creditable coverage, this waiting period will be reduced by the number
   Condition      of months of creditable coverage you had.

                  Special MedSup Protections (Guaranteed issue rights)
Be Covered If I
                  If you buy a MedSup policy when you have special MedSup protections
    Buy A         or guaranteed issue rights, the insurance company can't use a
                  pre-existing condition waiting period. To find out if you will have a
                  pre-existing condition waiting period if you switch MedSup policies, see
MedSup Policy?    the next page.

                  What Is Creditable Coverage?

                  Creditable coverage is any previous health coverage you have that can
                  reduce the time you have to wait before your pre-existing health
                  conditions will be covered by a new policy.

                  Note: Whether you can use creditable coverage depends on whether you
                  had any "breaks in coverage." If at any time you had no health coverage
                  of any kind for more than 63 days in a row, you can only count creditable
                  coverage that you had after that break in coverage.




                                         27
                     Example: Creditable Coverage

  Mr. Smith is 65 and has heart disease. His Medicare Part A and
  Part B started November 1, 2003. Before this date, he had no
  health insurance coverage. On March 1, 2004, Mr. Smith buys a
  MedSup policy. His MedSup insurance company refuses to cover
  his heart disease condition for six months (the pre-existing
  condition waiting period). However, since Mr. Smith had Medicare
  Part A and Part B from November 1 to March 1, the insurance
  company must use his four months of Medicare coverage as
  creditable coverage to shorten this six-month waiting period. Now
  his waiting period will only be two months instead of six months.
  During these two months, after Medicare pays its share, Mr. Smith
  will have to pay the rest of the costs for the care of his heart
  disease. He will also have to pay his MedSup premiums.


What Are Guaranteed Issue Rights?                                           What Are

In some situations, you have the right to buy a MedSup policy outside      Guaranteed
of your MedSup open enrollment period without regard to your health
status. These rights are called guaranteed issue rights because the law
says that insurance companies must sell you a MedSup policy.               Issue Rights?

In these situations, an insurance company

   • Can't deny you MedSup coverage or place conditions on a policy
     (like making you wait for coverage to start),

   • Must cover you for all pre-existing conditions, and

   • Can't charge you more for a policy because of past or present
     health problems.

In many cases, these rights also apply when your health coverage is
changed. Remember, it is best not to wait until your current health
coverage has almost ended before you apply for a MedSup policy. You
can apply for a MedSup policy early (for example, while you are still in
your health plan) and choose to start your MedSup coverage the day
after your health plan coverage ends. Doing so will prevent gaps in your
health coverage.




                                               28
                                If you drop your MedSup policy, you may not be
                                able to get it back except in very limited cases.


                    What Events Trigger a Guarantee Issue Opportunity And What Are
                    My Options?

                    A variety of situations trigger a guaranteed issue opportunity. If such
                    an event occurs, you have the options outlined below available to
                    you for 63 days after the plan terminates.
  What Events       Situation 1: You are enrolled in an employer group health plan, and
                    the plan terminates or ceases to provide all health benefits to you as a
    Trigger a       Medicare beneficiary.

                    Situation 2: You are enrolled in a Medicare Select plan and your
   Guarantee        policy is terminated because

                       • You move from the service area;
Issue Opportunity
                       • The plan terminates or ceases to provide Medicare services; or
                       • The plan substantially violates a contract provision or is
      And                misrepresented in marketing materials.

                    Situation 3: You are enrolled in a MedSup plan and it ends because:
   What Are
                       • The company is bankrupt;
                       • Coverage is terminated involuntarily; or
  My Options?
                       • The plan substantially violates a contract provision or is
                         misrepresented in marketing materials.

                    Options for Situations 1-3: You must be allowed to enroll in any
                    MedSup plan A, B, C or F – including a high deductible Plan F—from
                    any company selling those plans.


                                Remember, you only have 63 days from the date
                                 the plan was terminated to take advantage of
                                         your guaranteed issue rights.




                                           29
Situation 4: You are enrolled in a Medicare Advantage (formerly
Medicare + Choice) plan or Medicare Cost plan and your policy is
terminated because

   • You move from the service area;
   • The plan terminates or ceases to provide Medicare services; or
   • The plan substantially violates a contract provision or is
   • misrepresented in marketing materials.

Options:       You must be allowed to enroll in any MedSup plan A, B, C
or F – including a high deductible Plan F—from any company selling
those plans.

   • Note: If the Medicare Advantage plan terminates or ceases to
   • provide Medicare services, the company must notify the enrollee by        What Events
   • October 2 that it plans to terminate on December 31. In this event
   • the enrollee will have from Oct. 2 until 63 days after the policy
   • terminates to apply for MedSup plans A, B, C or F.                          Trigger a

Situation 5: You are enrolled in a MedSup policy and you terminate the
                                                                                Guarantee
policy to enroll in a Medicare Advantage, Medicare Cost or Medicare
Select plan for the first time, then you terminate the enrollment in the
new plan within the first 12 months.                                         Issue Opportunity

Options: You must be allowed to enroll in the MedSup policy you were
most recently enrolled in, if available from the same company; or if it is         And
not available, any MedSup plan A, B, C or F—including a high
deductible plan F—from any company selling those plans.                       What Are My
Situation 6*: Upon first becoming enrolled under Medicare Part B at
age 65 or older, you enroll in a Medicare Advantage (formerly Medicare           Options?
+ Choice) plan for the first time and terminate the policy within 12
months.

Option: You must be allowed to enroll in any standardized MedSup
plan (A-J) offered by any company

* If the trial period is interrupted because the Medicare Advantage
or Medicare + Choice plan terminates and you join another Medicare
Advantage plan, you receive a second 12-month trial period (cannot
exceed 24 months total).


            Remember: Medicare + Choice Plans are being
              replaced by Medicare Advantage in 2004.



                                                 30
            Important: In some situations, you have a guaranteed issue right to buy
            a MedSup policy because you lost certain kinds of health coverage. You
            should keep a copy of any letters, notices, and claim denials you get.
            Be sure to keep anything that has your name on it. Also, keep the post-
            marked envelope these papers come in. You may need to send a copy of
            some or all of these papers with your application for a MedSup policy to
            prove you lost coverage and have the right to these MedSup protections.

            Can My MedSup Insurance Company Drop Me?

            In most cases, no. If you bought your MedSup policy after 1990, the law
            says that your insurance company must let you renew your MedSup
            policy as long as you pay your premium. Your policy is guaranteed
            renewable. However, your insurance company can drop you if you
            commit fraud under the policy or fail to pay the monthly premiums.
            Otherwise, there is only one situation in which you may lose a MedSup
            guaranteed renewable policy: if the insurance company goes bankrupt.
            You then have the right to buy another MedSup plan.

Can My      Does The MedSup Insurance Company Pay My Doctor Or Provider
            Directly?
MedSup
            When you have a MedSup policy, the insurance company must pay your
            doctor or provider under the following conditions:
Insurance
               • If a doctor bills the MedSup secondary, it will pay the doctor
                 directly.
Company
               • If a doctor does not bill secondary insurance, the patient must
Drop Me?         gather all information unless the policy has a crossover agreement.

               • If your insurance company has a Medicare crossover contract,
                 Medicare will send all claims directly to the MedSup insurance
                 company, even if the doctor does not have a participating contract
                 with Medicare.




                         Over 95% of Ohio doctors accept assignment.


            When these conditions are met, the Medicare carrier will process the
            claim and may send it to the MedSup insurance company. A Medicare
            carrier is a private company that has a contract with Medicare to pay
            Part B bills. The carrier will send you a Medicare Summary Notice.

            Your MedSup insurance company may pay your doctor or provider
            directly and then send you a notice. If you don't get this notice, you may
            ask your MedSup insurance company for it.
                                   31
What Is A Private Contract?

A private contract is an agreement between you and a doctor who has
decided not to give services through the Medicare program. The private
contract only applies to the services you get from the doctor who asked
you to sign it.

If I Sign A Private Contract With My Doctor, Will Medicare And My
MedSup Policy Pay?

No, Medicare and MedSup policies will not pay for the services you
get from the doctor with whom you have a private contract. You can't
be asked to sign a private contract in an emergency or urgent health
situation.

Note: You still have the right to see other Medicare doctors for services.


If you sign a private contract with your doctor
                                                                             What Is A
   • Medicare health plans will not pay any amount for the services you
     get from this doctor.
                                                                              Private
   • You will have to pay whatever this doctor or provider charges you
     for the services you get. Medicare's approved amounts won't apply.
                                                                             Contract?
   • No claim should be submitted to Medicare and Medicare won't
     pay if one is submitted.

   • Your MedSup policy, if you have one, won't pay anything for this
     service.

   • Many other insurance plans, such as benefits from a retirement
     plan through an employer, won't pay for the services either.

   • Your doctor must tell you whether Medicare would pay for the
     service if you get it from another doctor who participates in
     Medicare.

   • Your doctor must tell you if he or she has been excluded from the
     Medicare program.



           It may be helpful to talk with someone at OSHIIP
           before signing a private contract. 1-800-686-1578



                                                  32
                 If I Have Medicare But Am Under 65, Can I Buy a MedSup Policy?

                 You may have Medicare before age 65 due to the following:

                    • A disability, or

                    • ESRD (permanent kidney failure requiring dialysis or a kidney
                      transplant).

                 If you are under age 65 and disabled or have ESRD, you may not be
   If I Have     able to buy the MedSup policy you want until you turn 65. Federal law
                 doesn't require insurance companies to sell MedSup policies to people
                 under age 65, although currently two Ohio companies offer MedSup
   Medicare      insurance to residents who fall under this category.

                 During the first six months after you turn age 65 and are enrolled in
   But Am
                 Medicare Part B, you will enter your MedSup open enrollment period.
                 It doesn't matter that you have had Medicare Part B before you turned
  Under 65,      age 65. During this time:

                    • You can buy any MedSup policy (including those policies that help
 Can I Buy a          pay the cost of prescription drugs), and

MedSup Policy?      • Insurance companies cannot refuse to sell you a MedSup policy
                      due to a disability or other health problem, or charge you a higher
                      premium than they charge other people who are 65 years old.

                 When you buy a policy during your MedSup open enrollment period, the
                 insurance company must shorten the waiting period for pre-existing
                 conditions by the amount of creditable coverage you have. If you had
                 Medicare for more than six months before you turned 65 years old, you
                 won't have a pre-existing condition waiting period because Medicare
                 counts as creditable coverage. (See page 27 for more information about
                 creditable coverage.)




                                         33
Right to suspend a MedSup policy for disabled people with
Medicare.

If you are under 65, have Medicare, and have a MedSup policy, you have
a right to suspend your MedSup policy while you are enrolled in your or
your spouse's employer group health plan. If, for any reason, you lose
your employer group health plan coverage, you can get your MedSup             If I Have
policy back. You must notify your MedSup insurance company that you
want your MedSup policy back within 90 days of losing your employer
group health plan coverage.                                                   Medicare

Your MedSup benefits and premiums most likely will start again on the
day your employer group health plan coverage stops. The MedSup policy         But Am
must have the same benefits and premiums it would have had if you
had never suspended your coverage. Your MedSup insurance company             Under 65,
can't refuse to cover care for any pre-existing conditions you have. So,
if you are disabled and working, you can enjoy the benefits of your
employer's insurance without giving up your MedSup policy.                  Can I Buy a


                                                                           MedSup Policy?

          Choosing the right health coverage is an important -
           but sometimes difficult - decision. Let the experts
            at OSHIIP help answer your Medicare questions.
                  Call (800) 686-1578 for assistance.




                                               34
                 What Should I Do If I Have a MedSup Policy and Then Get
                 Medicaid?

                 You have the right to suspend the MedSup policy, rather than drop it,
                 while you have Medicaid. However, in some cases, it may not be a good
                 idea to suspend your MedSup policy. Call OSHIIP at 1-800-686-1578 to
                 help you with this decision.

                 While your MedSup policy is suspended, you don't pay premiums and it
                 won't pay benefits. You can only suspend a MedSup policy for up to two
                 years. At the end of the suspension, you can start it again without new
What Should I
                 medical underwriting or pre-existing condition waiting periods. Call
                 your insurance company to find out how to suspend a policy.
Do If I Have a
                 Can An Insurance Company Sell Me A MedSup Policy If I Already
                 Have Medicaid?
MedSup Policy
                 If you have Medicaid, an insurance company can sell you a MedSup
                 policy only in certain situations.
     and


  Then Get
                   If Medicaid pays:                   The insurance company can:
                   your MedSup policy premium          legally sell you any MedSup
  Medicaid?
                                                       policy

                   your Medicare premiums,             legally sell you MedSup plans
                   deductibles or coinsurance          H, I or J

                   all or part of your Medicare Part   legally sell you any MedSup
                   B premium                           policy


                 In any other situation, it is illegal for an insurance company to sell
                 you a MedSup policy if you have Medicaid.




                                        35
Watch Out for Illegal Insurance Practices

It is illegal for anyone to do the following:

   • Pressure you into buying a MedSup policy, or lie to you or mislead
     you to get you to switch from one company or policy to another.

   • Sell you a second MedSup policy when they know that you already
     have one, unless you tell the insurance company in writing that
     you plan to cancel your existing MedSup policy.

   • Sell you a MedSup policy if they know you have Medicaid, except
     in special circumstances (see page 35).                              Watch Out

   • Sell you a MedSup policy if they know you are enrolled in a
     Medicare Advantage Plan.                                             for Illegal

   • Claim that a MedSup policy is part of the Medicare program or any
                                                                          Insurance
     other Federal program. Remember, MedSup is private health
     insurance.
                                                                           Practices
   • Sell you a MedSup policy that can't legally be sold in Ohio. Some
     MedSup insurance companies use direct mail advertising to sell
     policies. Check with the Ohio Department of Insurance
     1-800-686-1578 to make sure that the MedSup plan you are
     interested in can be sold here.

   • Misuse the names, letters, symbols, or emblems of the U. S.
     Department of Health and Human Services (DHHS), Social Security
     Administration (SSA), Centers for Medicare & Medicaid Services
     (CMS), or any of their various programs like Medicare.

If you believe that an insurance company or agent has done any of the
above, call the Ohio Department of Insurance at (800) 686-1578.




                                                36
                                   Chapter 5
                             Medicare Advantage
                         (Formerly Medicare + Choice)
             Medicare offers you different ways to get your Medicare benefits. One
             option is the Original Medicare Plan, which is administered by the
             Federal Government. Many people who are enrolled in the Original
             Medicare Plan purchase a Medicare supplemental insurance policy,
             described in Chapters 3 and 4.

             Some private companies contract with the Medicare program to offer
             Medicare health plans, giving Medicare beneficiaries other options.
             These choices are called Medicare Advantage plans.

             What is Medicare Advantage?

             Medicare Advantage is the new name for Medicare + Choice plans.
             These plans are offered by private companies that contract with CMS to
             replace Original Medicare and MedSup. The Medicare + Choice
             program was created by Congress as part of the Balanced Budget Act of
             1997 (BBA). The program had the dual intention of increasing health
 What is
             plan offerings for Medicare Beneficiaries, while slowing growth in
             Medicare spending. Changes made to the way Medicare pays these
 Medicare    Medicare Advantage plans will help ensure beneficiaries access to
             more health plan choices and additional benefits. Medicare
             Advantage plans must offer the benefits offered by Original Medicare,
Advantage?   but may also offer additional benefits.

             Who Can Enroll in a Medicare Advantage Plan?

             Any person with Medicare who

                • lives in the plan’s service area;
                • is covered under Medicare Part A and Medicare Part B; and
                • does not have permanent kidney failure (ESRD)

             How Much Does It Cost to Enroll in a Medicare Advantage Plan?

             People who choose to enroll in a Medicare Advantage plan must pay the
             Medicare Part B premium ($66.60 per month in 2004), and may pay an
             additional premium. You may also be required to pay the provider any
             co-payment amounts outlined in the contract. If you choose a Medicare
             Advantage plan, your co-payments and deductibles will be different
             than those under Original Medicare.




                                    37
What Are The Different Types of Medicare Advantage Plans?

Three types of Medicare Advantage plans are available to Medicare
beneficiaries living in Ohio. They are

   • Health Maintenance Organizations (HMOs),
   • A Private Fee-For-Service Organization (PFFS), and
   • Preferred Provider Organization (PPO)

What is a Medicare Advantage HMO?

A Medicare Advantage HMO plan is offered by a private insurance
company that has a contract with Medicare. HMOs agree to contract
with Medicare for one year at a time. Medicare pays the HMO a set
amount every month for each member in the plan. Medicare HMOs
submit the terms of their coverage, premiums and co-payments to the
federal government each year. Medicare decides whether an HMO may
serve the county in which you live. Most HMOs with Medicare                 What Are
contracts for Ohio are called Medicare Advantage HMOs (formerly called
Risk HMOs). Other types of HMOs, known as "Cost" HMOs, may also
contract with Medicare, but are not Medicare Advantage plans. Benefits     The Different
and cost can change each year.
                                                                              Types
How do Medicare Advantage HMOs Work?

If you enroll in a Medicare Advantage HMO, you must use the HMO’s           of Medicare
doctors and facilities for all of your health care, unless it is an
emergency situation. If you go outside of the network (except in
emergencies), you will be required to pay the entire bill.               Advantage Plans?

Medicare Advantage HMOs must offer minimum coverage equal to the
original medicare plan. Most Medicare HMO plans offer "comprehensive
care" including physical exams and other services not covered by
Original Medicare or standard MedSup policies.

How Much Does It Cost to Enroll in a Medicare Advantage HMO?

Medicare Advantage HMOs may charge a monthly premium. Premium
amounts vary from plan to plan. You may also have a co-payment for
each doctor’s visit or health care service.


      If you divide your time between Ohio and another location,
   Medicare Advantage HMO plans may not be for you. HMOs must
  cover you for emergency or urgent care while you travel for up to 6
  months. However, coverage for other types of care is not required.


                                              38
                  Questions to Ask Before You Join a Medicare Advantage HMO

                     • Which plans will my primary doctor accept?
                     • Do my other doctors participate in the plan?
                     • How much is the monthly premium?
                     • What are the co-payment amounts for office calls, inpatient days,
                       outpatient procedures, therapy?
                     • Is there a prescription drug benefit?
                     • Is there an annual (or quarterly) limit on how much the plan will
                       pay for prescriptions? If so, how does it work?
                     • Are the specific drugs I take covered under the plan?
                     • Which hospitals, skilled nursing facilities, etc. are in the plan’s
                       network?

                  What is a Private Fee-For-Service Plan (PFFS)?

                  A PFFS plan is a Medicare Advantage plan offered by a private
  What is a
                  insurance company in a contract with Medicare. People who enroll in a
                  PFFS must live in the plan’s service area, but can receive care from any
    Private       Medicare doctor that agrees to the plan’s terms. The plan chooses the
                  counties where service is available and the service is subject to change
                  each year.
Fee-For-Service
                  How do PFFS Plans Work?
Plan (PFFS)?
                  Medicare pays a PFFS Plan a set amount every month for each
                  beneficiary enrolled in the plan. The plan pays providers on a fee-for-
                  service basis. A PFFS plan offers the same benefits (medically
                  necessary care) covered under Original Medicare. The plan may
                  provide extra benefits, but you may have to pay more to receive those
                  benefits.

                  What is a Preferred Provider Organization (PPO)?

                  A PPO is a Medicare Advantage Plan in which you use doctors,
                  hospitals and providers that belong to a network. You can use doctors,
                  hospitals and providers outside of the network for an additional cost.
                  You must live in the PPO’s service area to enroll in the plan.

                  A PPO plan contracts annually with Medicare to serve beneficiaries.
                  Medicare pays the plan a set amount every month for each beneficiary
                  enrolled in the plan. The plan decides where to make its service
                  available. The benefits, cost and service area can change annually.



                                         39
       Remember, you can not purchase a MedSup policy if you
      enroll in a Medicare Advantage plan (HMO, PPO, or PFFS)
       because Medicare Advantage takes the place of Original
      Medicare and a MedSup policy. But, whatever option you
                 choose, you are enrolled in Medicare.



What if I Move Out of My Medicare Advantage Plan’s Service Area?
                                                                           What if I
If you move, you can disenroll from the HMO, PFFS or HMO Medicare
Advantage plan and buy a MedSup policy (you will then be in the
Original Medicare Plan). Or, you can join a Medicare Advantage plan          Move
in your new county, if one is offered.
                                                                           Out of My
When and How Often Can I Switch My Plan?

You can change Medicare Advantage plans or move between Medicare           Medicare
Advantage and Original Medicare on a monthly basis. You can generally
join a Medicare Advantage plan anytime, as long as the plan is
accepting new members. If you have a MedSup policy but want to          Advantage Plan’s
switch to a Medicare Advantage plan, cancel the policy only when you
have confirmed your membership in the Medicare Advantage plan and        Service Area?
you are sure that you are keeping it.

Is There An Open Enrollment Period for Medicare Advantage Plans?

Every Medicare Advantage plan must be open for enrollment from
November 15 through December 31. During that period, you can select
a plan that will start the following January 1.

Most Medicare Advantage plans have a continual open enrollment and
you can join anytime throughout the year.




                                             40
                                      Chapter 6
                           Covered Services and Premium
                      Information for Medicare Part A & Part B
                   COVERED SERVICES IN MEDICARE PART A
                   Medicare Part A (Hospital                   What YOU Pay in 2004 in the
                   Insurance)                                  Original Medicare Plan:
                   Helps Pay For: Hospital Stays;              For each benefit period:
                   Semiprivate room, meals, general            • A total of $876 for a hospital
                   nursing, and other hospital services          stay of 1-60 days.
                   and supplies. This includes inpatient       • $219 per day for days 61-90
                   care you get in critical access               of a hospital stay.
                   hospitals and mental health care.           • $438 per day for days 91-150
                   This doesn't include private duty             of a hospital stay (See
                   nursing, or a television or telephone         Lifetime Reserve Days on
                   in your room. It also doesn't include         page 63.)
                   a private room, unless medically            • All costs for each day beyond
                   necessary. Inpatient mental health            150 days.
                   care in a psychiatric facility is limited
                   to 190 days in a lifetime.
                   Skilled nursing facility (SNF) Care:        For each benefit period:
Covered services   Semiprivate room, meals, skilled            • Nothing for the first 20
                   nursing and rehabilitative services,        • Up to $109.50 per day for
                   and other services and supplies (after      • days 21-100
  in Medicare      a related 3- day hospital stay).            • All costs beyond the 100th
                                                               • day of the benefit period.
                   Home health care: Part-time skilled         • Nothing for home health care
    Part A
                   nursing care, physical therapy, occu-         services
                   pational therapy, speech-language           • 20% of the Medicare -
                   therapy, home health aide services,           approved amount for durable
                   durable medical equipment (such               medical equipment
                   as wheelchairs, hospital beds, oxy-
                   gen, and walkers), medical supplies
                   and other services.
                   Hospice Care: For people with a             • A co-payment of up to $5 for
                   terminal illness, includes drugs for          outpatient prescription drugs
                   symptom control and pain relief,              and 5% of the Medicare-
                   medical and support services from a           approved amount for inpa-
                   Medicare-approved hospice, and                tient respite care. The
                   other services not otherwise covered          amount you pay for respite
                   by Medicare. Hospice care is usually          care can change each year.
                   given in your home. However,                  Room and board are generally
                   Medicare covers some short-term               not payable by Medicare in
                   hospital and inpatient respite care           certain cases.
                   (care given to a hospice patient so
                   that the usual caregiver can rest).
                   Blood: Pints of blood you get at a          • For the first three pints of
                   hospital or skilled nursing facility          blood, unless you or some-
                   during a covered stay.                        one else donates blood to
                                            41                   replace what you use.
COVERED SERVICES IN MEDICARE PART B

Medicare Part B (Medical             What YOU pay in 2004 in
Insurance) Helps Cover:              Original Medicare Plan

Medical and Other Services:          • $100 deductible (once per
Doctors' services (not routine         calendar year).
physical exams), outpatient          • 20% of the Medicare-approved
medical and surgical services          amount after the deductible
and supplies, diagnostic tests,        (if the doctor or provider
ambulatory surgery center facility     accepts "assignment."
fees for approved procedures and     • 20% for all outpatient
durable medical equipment.             physical, occupational and
Also covers second surgical            speech language therapy
opinions, outpatient mental            services.
health care and outpatient           • 50% for outpatient mental
physical and occupational              health care.
therapy, including speech-
language therapy.

                                                                          Covered services
Clinical Laboratory Service:       • Nothing for Medicare-
Blood tests, urinalysis, and more.   approved services.
                                                                            in Medicare
Home health care:                    • Nothing for Home Health
Part-time skilled approved             services.                              Part B
nursing care, physical, occupa-      • 20% of the Medicare- amount
tional, and speech-language            for durable medical equipment.
therapy, home health approved
aide services, medical social
services, durable medical
equipment, medical supplies
and other services.


Outpatient Hospital Services:        • A coinsurance or co-payment
Hospital services and supplies         amount, which may vary
received as an outpatient as part      according to the service.
of a doctor's care.


Blood:                               • For the first three pints of
Pints of blood you get as an           blood, then 20% of the
outpatient or as part of a Part B      Medicare-approved amount for
covered service.                       additional pints of blood (after
                                       the deductible), unless you are
                                       someone else donates blood to
                                       replace what you use.
                                                 42
MEDICARE PART B PREVENTIVE SERVICES

Medicare Part B Covered                                             What YOU pay in the
Preventive services                Who is covered                   Original Medicare Plan


Bone Mass Measurements:            Discuss with your doctor to      20% of the Medicare-approved
Once every 24 months for           determine if you are a quali-    amount (or a co-payment
(or a qualified individuals and    fied individual.                 amount) after the yearly Part B
more frequently if medically                                        deductible.
necessary.


Colorectal Cancer Screening:       All people with Medicare age     Nothing for the fecal occult
Occult Blood Test – Once every     50 and older, except there is    blood test. For all other
12 months                          no minimum age for having a      tests, 20% of the Medicare-
Flexible Sigmoidoscopy – Once      colonoscopy.                     approved amount after the
every 48 months.                                                    yearly Part B deductible.
Colonoscopy – Once every 24
months if you are at high risk                                      For flexible sigmoidoscopy or
for colon cancer. If you are not                                    colonoscopy, you pay 25% of
at high risk for colon cancer,                                      the Medicare-approved
once every 10 years, but not                                        amount if the test is done in
within 48 months of a screen-                                       a hospital outpatient depart-
ing flexible sigmoidoscopy.                                         ment.
Barium Enema – Doctor can
use this instead of flexible
sigmoidoscopy or colonoscopy.


Diabetes Services and              All people with Medicare who     20% of the Medicare-approved
Supplies:                          have diabetes (insulin users     amount after the yearly Part B
• Coverage for glucose             and non-users). Certain peo-     deductible.
  monitors, test strips and        ple with Medicare who are at
  lancets.                         risk for complications from
• Diabetes self-management         diabetes. Your doctor or other
  training                         health care provider must
                                   request these services.


Mammogram Screening:               All women with Medicare age      20% of the Medicare-approved
• Once every 12 months             40 and older. You can also get   amount with no Part B
• Medicare also covers new         a baseline Mammogram             deductible.
  digital technologies for         between ages 35-39.
  mammogram screenings.




                                                    43
Pap Test and Pelvic Exam            All women with Medicare.          Nothing for the Pap lab test. For
(Includes a clinical breast                                           Pap test collection, and pelvic
exam):                                                                and breast exams, 20% of the
Once every 24 months. Once                                            Medicare-approved amount
every 12 months if you are at                                         (or a co-payment amount) with
high risk for cervical or vaginal                                     no Part B deductible.
cancer, or if you are of child-
bearing age and have had an
abnormal Pap test in the past
36 months.


Prostate Cancer Screening:          All men with Medicare age         Generally, 20% of the Medicare-
Digital Rectal Exam – Once          50 and older (coverage begins     approved amount for the digital
every 12 months                     the day after your 50th birthday. rectal exam after the yearly Part
Prostate Specific Antigen (PSA)                                       B deductible. No coinsurance
Test – Once every 12 months.                                          and no Part B deductible for the
                                                                      PSA Test.


Shots (vaccinations):         All people with Medicare. All           Nothing for flu and pneumococ-
Flu Shot – Once a year in the people with Medicare.                   cal pneumonia shots if the
fall or winter.                                                       health care provider accepts
Pneumococcal Pneumonia Shot –                                         assignment
One shot may be all you will
ever need. Ask your doctor.                                           For Hepatitis B shots, 20% of
Hepatitis B Shot.             Certain people with Medicare            the Medicare-approved amount
                              at medium to high risk for              (or a co-payment amount) after
                              Hepatitis B.                            the yearly Part B deductible.


Glaucoma Screening:                 People with Medicare who          20% of the Medicare-approved
Once every 12 months. Must          are at high risk for glaucoma,    amount after the yearly Part B
be done or supervised by an         including people with diabetes,   deductible.
eye doctor who is legally           a family history of glaucoma or
allowed to do this service.         African-Americans who are age
                                    50 and older.




        Note: Starting in 2005, Preventive Benefits coverage will expand to
     include a one-time physical exam for new enrollees, blood screenings for
    early detection of cardiovascular diseases and a diabetes screening test for
                     those with high-risk factors for the disease.



                                                 44
Monthly MedSup premiums for age 65
               COMPANY                     Phone                 Internet Address      M    X? ZIP   Age
American Family Mutual                 1-800-333-6886               amfam.com          A    Y Z      AA
American Pioneer                       1-800-538-1053                uafc.com          A    Y        AA
American Republic (Group)              1-800-943-2121                aric.com          A    Y Z      AA
Anthem BC/BS                           1-800-467-8065              anthem.com          A    Y        AA
Anthem BC/BS (Group)                   1-800-467-8065              anthem.com          A    Y         AI
Bankers Life and Casualty              1-800-621-3724             bankerslife.com      A        Z    AA
Central States Health & Life           1-800-541-2363                cso.com           A    Y Z       AI
Central States Health & Life (Trust)   1-800-541-2363                cso.com           A    Y Z       AI
Combined                               1-800-544-5531                aon.com           A    Y Z     AI/AA
Conseco Health                         1-800-541-2254              conseco.com         A    Y Z      AA
Constitution Life                      1-800-789-6364                uafc.com          A    Y        AA
Continental General                    1-877-291-5434        continentalgeneral.com    A    Y Z      AA
Continental Life                       1-800-264-4000              cont-life.com       A    Y Z      AA
Equitable Life & Casualty              1-800-352-5170              equiLife.com        A    Y Z      AA
Globe Life and Accident                1-800-654-5433          globeontheweb.com       M    Y        AA
Golden Rule                            1-800-474-4467             goldenrule.com       A        Z    AA
Guarantee Trust Life                   1-800-338-7452                gtlic.com         A        Z    AA
HomeTown                               1-877-236-2290        hometownhealthnet.com    A/M/I          AA
Medical Mutual                         1-800-722-7331            medmutual.com         A    Y Z      AA
Medico Life                            1-800-228-6080         mutualprotective.com     A    Y Z      AA
Mennonite Mutual Aid                   1-800-348-7468             mma-online.org       A    Y Z       AI
Mutual of Omaha                        1-800-316-0842          mutualofomaha.com       A    Y Z      AA
Mutual Protective                      1-800-228-6080         mutualprotective.com     A    Y Z      AA
National States                        1-314-878-8118                                  A              AI
Nationwide Health Plans (Group)        (614) 246-8272    nationwidehealthplans.com     A    Y        AA
Oxford Life                            1-888-627-4282           oxfordlife.com         A    Y Z      AA
Pennsylvania Life                      1-800-275-7366              uafc.com            A    Y        AA
Philadelphia American Life             1-800-713-4680           neweralife.com         A    Y Z      AA
Physicians Life                        1-800-228-9100      physiciansmutual.com       A/M Y Z        AA
Pyramid Life                           1-800-777-1126          pyramidlife.com        A/M/I Y Z      AA
Reserve National                       1-800-654-9106        reservenational.com       A             AA
Standard Life & Accident               1-888-350-1488             slaico.com           A    Y Z      AI
State Farm Mutual Automobile           1-888-588-0683           statefarm.com          A    Y Z      AA
State Mutual                           1-800-321-0102    statemutualinsurance.com      A    Y Z      AA
Sterling Life                          1-800-688-0010         sterlingplans.com       A/M Y Z        AA
Thrivent Financial for Lutherans       1-800-847-4836            thrivent.com          A    Y Z       AI
UNICARE Life &Health                   1-800-459-1732            unicare.com          A/M Y Z        AA
United American                        1-800-331-2512        unitedamerican.com        A    Y      *AI/AA^
United Commercial Travelers            1-800-848-0123               uct.org            A    Y Z      AA
United Healthcare (AARP)               1-800-523-5800        aarphealthcare.com        M    Y         S
United Teacher                         1-800-880-8824              utaic.com           A    Y Z      AA
USAA Life                              1-800-531-8000              usaa.com            M    Y        AA




How to use the MedSup charts

M (how policies are sold)
M = Policies sold by mail;
A = Policies sold by agents;
I = Policies sold on the Internet (note: can use any or all three sales means)

X? = "Y" means the company has a crossover contract with Medicare

Zip Prices for policies marked with a "Z" differ by zip code
                                                        45
Monthly MedSup premiums for age 65                                  continued

 Pre-ex    A       B       C         D           E          F       *F       G     H      I     J   *J
   0      $239            $390      $82                    $429             $96
   6      $89     $125    $155      $132                   $161     $45
   0      $64             $97                              $98
   0      $73     $99     $113      $110       $110        $117            $110   $173 $185
   0      $72             $120                             $125                        $206
   0      $125    $143    $160      $127       $134        $139     $41    $118
   6      $107    $103    $121      $116                   $137     $52    $119
   6      $79     $94     $99       $98                    $119
   0      $110    $146    $184      $137                   $191            $118
   0      $103    $119    $142      $101        $99        $127            $100
   6      $100    $136    $155      $149                   $180
   0      $108    $96     $129      $96                    $117     $38    $100
   3      $56     $73     $91       $71        $82         $93             $72
  0/6     $85     $137    $158      $143       $149        $172     $78    $153   $285 $304 $348 $157
   2      $65     $98     $113                             $114
   6      $83             $107                             $102            $85
   0      $110    $166    $194      $147                   $190     $37    $153
   6      $81
   0      $80             $115
   0      $119            $187                             $198            $180
  0/2     $60                                   $89        $103                          $207
   6      $100            $120      $111                   $122
   0      $119            $187                             $198            $180
   0      $101    $165    $238                             $149
   6      $76             $116                             $116     $36           $185
   0      $73     $95     $114                             $118                          $171
   6      $77     $100    $118      $109                   $122     $49    $101
   0      $69     $86     $99       $88                    $106     $46
   0      $82     $92                                      $115            $112
   6      $104    $100    $133      $100                   $130     $35    $107                     $82
   6      $83     $135    $160                             $192
   2      $105    $131    $151       $99        $94        $152     $42    $100
   0      $79             $120                             $138
   0      $111    $151    $180      $167                   $187
   0      $156    $194    $248                                      $63
   0      $105            $145       $111                  $146                   $213 $239
   0      $83     $119    $138       $96                   $139
   2     #$127   ^$143   ^$163      ^$155                 #$170           #$210
   0      $95     $123    $147       $134                  $151
   3    $66(GI) $91(GI) $107(GI)   $100(GI)   $100(GI)   $108(GI)         $101(GI) $163 $163 $210
   6      $80     $96     $110       $91                   $110             $92
   0      $87                        $132                  $151             $144




Age                                                      A through J standard monthly premium amounts
AI = age at issue; noted by #                            (note: versions of Plans F and J with a $1,690
AA = attained age; noted by ^                            deductible are noted with an *)
S = Same premium, any age
                                                         (GI) means the policy is Guaranteed Issue; you
                                                         cannot be turned down for the policy because of
Pre-ex (page27)                                          poor health.
The number of months before the policy will pay
for your pre-existing conditions; may vary by plan

                                                  46
Monthly MedSup premiums for age 70
               COMPANY                     Phone                 Internet Address      M    X? ZIP   Age
American Family Mutual                 1-800-333-6886               amfam.com          A    Y Z      AA
American Pioneer                       1-800-538-1053                uafc.com          A    Y        AA
American Republic (Group)              1-800-943-2121                aric.com          A    Y Z      AA
Anthem BC/BS                           1-800-467-8065              anthem.com          A    Y        AA
Anthem BC/BS (Group)                   1-800-467-8065              anthem.com          A    Y         AI
Bankers Life and Casualty              1-800-621-3724             bankerslife.com      A        Z    AA
Central States Health & Life           1-800-541-2363                cso.com           A    Y Z       AI
Central States Health & Life (Trust)   1-800-541-2363                cso.com           A    Y Z       AI
Combined                               1-800-544-5531                aon.com           A    Y
Conseco Health                         1-800-541-2254              conseco.com         A    Y Z      AA
Constitution Life                      1-800-789-6364                uafc.com          A    Y        AA
Continental General                    1-877-291-5434        continentalgeneral.com    A    Y Z      AA
Continental Life                       1-800-264-4000              cont-life.com       A    Y Z      AA
Equitable Life & Casualty              1-800-352-5170              equiLife.com        A    Y Z      AA
Globe Life and Accident                1-800-654-5433          globeontheweb.com       M    Y        AA
Golden Rule                            1-800-474-4467             goldenrule.com       A        Z    AA
Guarantee Trust Life                   1-800-338-7452                gtlic.com         A        Z    AA
HomeTown                               1-877-236-2290        hometownhealthnet.com    A/M/I          AA
Medical Mutual                         1-800-722-7331            medmutual.com         A    Y Z      AA
Medico Life                            1-800-228-6080         mutualprotective.com     A    Y Z      AA
Mennonite Mutual Aid                   1-800-348-7468             mma-online.org       A    Y Z       AI
Mutual of Omaha                        1-800-316-0842          mutualofomaha.com       A    Y Z      AA
Mutual Protective                      1-800-228-6080         mutualprotective.com     A    Y Z      AA
National States                        1-314-878-8118                                  A              AI
Nationwide Health Plans (Group)        (614) 246-8272    nationwidehealthplans.com     A    Y        AA
Oxford Life                            1-888-627-4282           oxfordlife.com         A    Y Z      AA
Pennsylvania Life                      1-800-275-7366              uafc.com            A    Y        AA
Philadelphia American Life             1-800-713-4680           neweralife.com         A    Y Z      AA
Physicians Life                        1-800-228-9100      physiciansmutual.com       A/M Y Z        AA
Pyramid Life                           1-800-777-1126          pyramidlife.com        A/M/I Y Z      AA
Reserve National                       1-800-654-9106        reservenational.com       A             AA
Standard Life & Accident               1-888-350-1488             slaico.com           A    Y Z       AI
State Farm Mutual Automobile           1-888-588-0683           statefarm.com          A    Y Z      AA
State Mutual                           1-800-321-0102    statemutualinsurance.com      A    Y Z      AA
Sterling Life                          1-800-688-0010         sterlingplans.com       A/M Y Z        AA
Thrivent Financial for Lutherans       1-800-847-4836            thrivent.com          A    Y Z       AI
UNICARE Life &Health                   1-800-459-1732            unicare.com          A/M Y Z        AA
United American                        1-800-331-2512        unitedamerican.com        A    Y      *AI/AA^
United Commercial Travelers            1-800-848-0123               uct.org            A    Y Z      AA
United Healthcare (AARP)               1-800-523-5800        aarphealthcare.com        M    Y         S
United Teacher                         1-800-880-8824              utaic.com           A    Y Z      AA
USAA Life                              1-800-531-8000              usaa.com            M    Y        AA




How to use the MedSup charts

M (how policies are sold)
M = Policies sold by mail;
A = Policies sold by agents;
I = Policies sold on the Internet (note: can use any or all three sales means)

X? = "Y" means the company has a crossover contract with Medicare

Zip Prices for policies marked with a "Z" differ by zip code
                                                        47
Monthly MedSup premiums for age 70                               continued

 Pre-ex    A        B       C        D        E        F       *F      G      H      I     J   *J
   0      $258             $424     $93               $467            $109
   6      $104    $148     $179     $156              $186     $47
   0      $78              $116                       $118
   0      $87     $121     $138     $134     $134     $143            $135   $208 $226
   0      $88              $147                       $153                        $252
   0      $142    $169     $188     $152     $159     $169     $49    $145
   6      $127    $123     $143     $141              $163     $62    $145
   6      $94     $111     $118     $119              $142
   0      $116    $154     $194     $137              $201            $150
   0      $121    $140     $164     $121     $118     $148            $120
   6      $112    $154     $176     $170              $204
   0      $131    $116     $156     $117              $142     $45    $122
   3      $63      $83     $102     $81      $93      $104            $84
  0/6     $100    $164     $191     $175     $181     $208     $94    $187   $324 $346 $392 $177
   2      $87     $123     $138                       $139
   6      $94              $121                       $114            $96
   0      $130    $195     $228     $172              $224     $44    $179
   6      $103
   0      $96              $138
   0      $151             $237                       $250            $235
  0/2     $67                                $103     $117                          $241
   6      $118             $143     $131              $145
   0      $151             $237                       $250            $235
   0      $113    $184     $262                       $165
   6      $85              $128                       $128     $40           $206
   0      $87     $112     $135                       $140                          $199
   6      $91     $119     $138     $130              $142     $57    $119
   0      $71      $88     $101     $90               $108     $47
   0      $93     $109                                $137            $123
   6      $130    $125     $165     $125              $162     $40    $133                     $95
   6      $97     $155     $189                       $226
   2      $107    $148     $155     $101     $96      $156     $43    $102
   0      $99              $150                       $172
   0      $154    $211     $247     $234              $256
   0      $180    $227     $293                                $79
   0      $109             $151     $119              $153                   $226 $256
   0      $83     $139     $164     $110              $164
   2     #$137   ^$189    ^$215    ^$206             #$186           #$231
   0      $118    $153     $181     $169              $186
   3    $90(GI) $126(GI) $147(GI) $138(GI) $138(GI) $148(GI)         $138(GI) $224 $225 $289
   6      $91     $109     $125     $104              $126             $104
   0      $96                       $146              $167             $159




Age                                                  A through J standard monthly premium amounts
AI = age at issue; noted by #                        (note: versions of Plans F and J with a $1,690
AA = attained age; noted by ^                        deductible are noted with an *)
S = Same premium, any age
                                                     (GI) means the policy is Guaranteed Issue; you
                                                     cannot be turned down for the policy because of
Pre-ex (page 27)                                     poor health.
The number of months before the policy will pay
for your pre-existing conditions; may vary by plan

                                                48
Monthly MedSup premiums for age 75
               COMPANY                     Phone                 Internet Address      M    X? ZIP   Age
American Family Mutual                 1-800-333-6886               amfam.com          A    Y Z      AA
American Pioneer                       1-800-538-1053                uafc.com          A    Y        AA
American Republic (Group)              1-800-943-2121                aric.com          A    Y Z      AA
Anthem BC/BS                           1-800-467-8065              anthem.com          A    Y        AA
Anthem BC/BS (Group)                   1-800-467-8065              anthem.com          A    Y         AI
Bankers Life and Casualty              1-800-621-3724             bankerslife.com      A        Z    AA
Central States Health & Life           1-800-541-2363                cso.com           A    Y Z       AI
Central States Health & Life (Trust)   1-800-541-2363                cso.com           A    Y Z       AI
Combined                               1-800-544-5531                aon.com           A    Y
Conseco Health                         1-800-541-2254              conseco.com         A    Y Z      AA
Constitution Life                      1-800-789-6364                uafc.com          A    Y        AA
Continental General                    1-877-291-5434        continentalgeneral.com    A    Y Z      AA
Continental Life                       1-800-264-4000              cont-life.com       A    Y Z      AA
Equitable Life & Casualty              1-800-352-5170              equiLife.com        A    Y Z      AA
Globe Life and Accident                1-800-654-5433          globeontheweb.com       M    Y        AA
Golden Rule                            1-800-474-4467             goldenrule.com       A        Z    AA
Guarantee Trust Life                   1-800-338-7452                gtlic.com         A        Z    AA
HomeTown                               1-877-236-2290        hometownhealthnet.com    A/M/I          AA
Medical Mutual                         1-800-722-7331            medmutual.com         A    Y Z      AA
Medico Life                            1-800-228-6080         mutualprotective.com     A    Y Z      AA
Mennonite Mutual Aid                   1-800-348-7468             mma-online.org       A    Y Z       AI
Mutual of Omaha                        1-800-316-0842          mutualofomaha.com       A    Y Z      AA
Mutual Protective                      1-800-228-6080         mutualprotective.com     A    Y Z      AA
National States                        1-314-878-8118                                  A              AI
Nationwide Health Plans (Group)        (614) 246-8272    nationwidehealthplans.com     A    Y        AA
Oxford Life                            1-888-627-4282           oxfordlife.com         A    Y Z      AA
Pennsylvania Life                      1-800-275-7366              uafc.com            A    Y        AA
Philadelphia American Life             1-800-713-4680           neweralife.com         A    Y Z      AA
Physicians Life                        1-800-228-9100      physiciansmutual.com       A/M Y Z        AA
Pyramid Life                           1-800-777-1126          pyramidlife.com        A/M/I Y Z      AA
Reserve National                       1-800-654-9106        reservenational.com       A             AA
Standard Life & Accident               1-888-350-1488             slaico.com           A    Y Z       AI
State Farm Mutual Automobile           1-888-588-0683           statefarm.com          A    Y Z      AA
State Mutual                           1-800-321-0102    statemutualinsurance.com      A    Y Z      AA
Sterling Life                          1-800-688-0010         sterlingplans.com       A/M Y Z        AA
Thrivent Financial for Lutherans       1-800-847-4836            thrivent.com          A    Y Z       AI
UNICARE Life &Health                   1-800-459-1732            unicare.com          A/M Y Z        AA
United American                        1-800-331-2512        unitedamerican.com        A    Y      *AI/AA^
United Commercial Travelers            1-800-848-0123               uct.org            A    Y Z      AA
United Healthcare (AARP)               1-800-523-5800        aarphealthcare.com        M    Y         S
United Teacher                         1-800-880-8824              utaic.com           A    Y Z      AA
USAA Life                              1-800-531-8000              usaa.com            M    Y        AA




How to use the MedSup charts

M (how policies are sold)
M = Policies sold by mail;
A = Policies sold by agents;
I = Policies sold on the Internet (note: can use any or all three sales means)

X? = "Y" means the company has a crossover contract with Medicare

Zip Prices for policies marked with a "Z" differ by zip code
                                                        49
Monthly MedSup premiums for age 75                             continued

 Pre-ex    A        B       C        D        E        F      *F      G       H      I     J    *J
   0      $297             $497     $112              $547          $131
   6      $119    $173     $206     $182              $214   $49
   0      $92              $134                       $136
   0      $105    $146     $166     $161     $161     $172          $162     $250 $272
   0      $96              $160                       $167                        $275
   0      $166    $203     $227     $187     $193     $205   $58    $179
   6      $150    $146     $170     $172              $194   $74    $176
   6      $112    $132     $140     $145              $168
   0      $138    $183     $231     $179              $239          $184
   0      $134    $160     $191     $142     $139     $173          $142
   6      $129    $181     $207     $204              $240
   0      $151    $134     $179     $134              $164   $52    $140
   3      $74      $98     $119     $98      $110     $121           $99
  0/6     $112    $187     $225     $210     $213     $245   $110   $224     $367 $392 $442 $199
   2      $92     $141     $163                       $164
   6      $109             $140                       $133          $111
   0      $149    $223     $261     $198              $257   $50    $205
   6      $109
   0      $116             $167
   0      $170             $269                       $284          $269
  0/2     $70                                $111     $127                          $267
   6      $137             $166     $153              $169
   0      $170             $269                       $284          $269
   0      $117    $191     $273                       $172
   6      $98              $149                       $149   $46             $240
   0      $96     $126     $153                       $159                          $221
   6      $106    $140     $178     $154              $166   $67    $139
   0      $77      $95     $111     $97               $118   $54
   0     $100     $120                                $156          $140
   6      $143    $140     $184     $140              $180   $48    $149                       $112
   6      $110    $175     $219                       $259
   2      $123    $154     $178     $117     $110     $179   $49    $117
   0      $119             $180                       $207
   0      $179    $250     $288     $277              $299
   0      $197    $251     $331                              $90
   0      $113             $158     $125              $161                   $237 $270
   0      $95     $153     $218     $125              $220
   2     #$137   ^$205    ^$237    ^$228             #$194         #$240
   0      $137    $181     $212     $201              $218
   3    $90(GI) $126(GI) $147(GI) $138(GI) $138(GI) $148(GI)      $138(GI)   $224 $225 $289
   6      $107    $131     $150     $125              $151          $126
   0      $103                      $157              $180          $171




Age                                                  A through J standard monthly premium amounts
AI = age at issue; noted by #                        (note: versions of Plans F and J with a $1,690
AA = attained age; noted by ^                        deductible are noted with an *)
S = Same premium, any age
                                                     (GI) means the policy is Guaranteed Issue; you
                                                     cannot be turned down for the policy because of
Pre-ex (page 27)                                     poor health.
The number of months before the policy will pay
for your pre-existing conditions; may vary by plan

                                                50
Monthly MedSup premiums for age 80
               COMPANY                     Phone                 Internet Address      M    X? ZIP   Age
American Family Mutual                 1-800-333-6886               amfam.com          A    Y Z      AA
American Pioneer                       1-800-538-1053                uafc.com          A    Y        AA
American Republic (Group)              1-800-943-2121                aric.com          A    Y Z      AA
Anthem BC/BS                           1-800-467-8065              anthem.com          A    Y        AA
Anthem BC/BS (Group)                   1-800-467-8065              anthem.com          A    Y         AI
Bankers Life and Casualty              1-800-621-3724             bankerslife.com      A        Z    AA
Central States Health & Life           1-800-541-2363                cso.com           A    Y Z       AI
Central States Health & Life (Trust)   1-800-541-2363                cso.com           A    Y Z       AI
Combined                               1-800-544-5531                aon.com           A    Y
Conseco Health                         1-800-541-2254              conseco.com         A    Y Z      AA
Constitution Life                      1-800-789-6364                uafc.com          A    Y        AA
Continental General                    1-877-291-5434        continentalgeneral.com    A    Y Z      AA
Continental Life                       1-800-264-4000              cont-life.com       A    Y Z      AA
Equitable Life & Casualty              1-800-352-5170              equiLife.com        A    Y Z      AA
Globe Life and Accident                1-800-654-5433          globeontheweb.com       M    Y        AA
Golden Rule                            1-800-474-4467             goldenrule.com       A        Z    AA
Guarantee Trust Life                   1-800-338-7452                gtlic.com         A        Z    AA
HomeTown                               1-877-236-2290        hometownhealthnet.com    A/M/I          AA
Medical Mutual                         1-800-722-7331            medmutual.com         A    Y Z      AA
Medico Life                            1-800-228-6080         mutualprotective.com     A    Y Z      AA
Mennonite Mutual Aid                   1-800-348-7468             mma-online.org       A    Y Z       AI
Mutual of Omaha                        1-800-316-0842          mutualofomaha.com       A    Y Z      AA
Mutual Protective                      1-800-228-6080         mutualprotective.com     A    Y Z      AA
National States                        1-314-878-8118                                  A              AI
Nationwide Health Plans (Group)        (614) 246-8272    nationwidehealthplans.com     A    Y        AA
Oxford Life                            1-888-627-4282           oxfordlife.com         A    Y Z      AA
Pennsylvania Life                      1-800-275-7366              uafc.com            A    Y        AA
Philadelphia American Life             1-800-713-4680           neweralife.com         A    Y Z      AA
Physicians Life                        1-800-228-9100      physiciansmutual.com       A/M Y Z        AA
Pyramid Life                           1-800-777-1126          pyramidlife.com        A/M/I Y Z      AA
Reserve National                       1-800-654-9106        reservenational.com       A             AA
Standard Life & Accident               1-888-350-1488             slaico.com           A    Y Z       AI
State Farm Mutual Automobile           1-888-588-0683           statefarm.com          A    Y Z      AA
State Mutual                           1-800-321-0102    statemutualinsurance.com      A    Y Z      AA
Sterling Life                          1-800-688-0010         sterlingplans.com       A/M Y Z        AA
Thrivent Financial for Lutherans       1-800-847-4836            thrivent.com          A    Y Z       AI
UNICARE Life &Health                   1-800-459-1732            unicare.com          A/M Y Z        AA
United American                        1-800-331-2512        unitedamerican.com        A    Y      *AI/AA^
United Commercial Travelers            1-800-848-0123               uct.org            A    Y Z      AA
United Healthcare (AARP)               1-800-523-5800        aarphealthcare.com        M    Y         S
United Teacher                         1-800-880-8824              utaic.com           A    Y Z      AA
USAA Life                              1-800-531-8000              usaa.com            M    Y        AA




How to use the MedSup charts

M (how policies are sold)
M = Policies sold by mail;
A = Policies sold by agents;
I = Policies sold on the Internet (note: can use any or all three sales means)

X? = "Y" means the company has a crossover contract with Medicare

Zip Prices for policies marked with a "Z" differ by zip code
                                                        51
Monthly MedSup premiums for age 80                             continued

 Pre-ex    A       B        C        D        E        F      *F     G        H      I     J    *J
   0      $346             $577     $133              $634          $155
   6      $129    $190     $225     $200              $234   $51
   0      $104             $151                       $153
   0      $121    $168     $190     $185     $185     $197          $186     $287 $312
   0      $104             $174                       $181                        $298
   0      $196    $248     $280     $234     $238     $251   $69    $223
   6      $178    $173     $202     $207              $230   $88    $212
   6      $133    $157     $166     $175              $200
   0      $156    $207     $261     $204              $271          $216
   0      $139    $170     $211     $159     $155     $190          $158
   6      $138    $198     $229     $231              $265
   0      $165    $146     $197     $147              $179   $57    $153
   3      $81     $110     $132     $113     $122     $135          $114
  0/6     $115    $199     $248     $236     $234     $265   $120   $252     $401 $430 $482 $217
   2      $92     $142     $175                       $176
   6      $126             $162                       $154          $129
   0      $167    $250     $292     $221              $288   $56    $229
   6      $112
   0      $140             $202
   0      $193             $326                       $342          $334
  0/2     $71                                $118     $133                          $290
   6      $158             $191     $176              $194
   0      $193             $326                       $342          $334
   0      $159    $214     $306                       $193
   6      $102             $155                       $158   $49             $252
   0      $102    $136     $166                       $172                          $238
   6      $116    $156     $197     $172              $184   $74    $154
   0      $90     $108     $135     $110              $143   $68
   0     $107     $134                                $177          $158
   6      $151    $151     $198     $151              $194   $54    $161                       $124
   6      $130    $204     $256                       $303
   2      $147    $184     $212     $139     $131     $213   $59    $139
   0      $119             $180                       $207
   0      $197    $279     $320     $310              $332
   0      $208    $271     $376                              $103
   0      $113             $158     $125              $161                   $237 $270
   0      $99     $160     $241     $145              $242
   2     #$137   ^$207    ^$253    ^$244             #$199         #$246
   0      $151    $203     $237     $225              $244
   3    $90(GI) $126(GI) $147(GI) $138(GI) $138(GI) $148(GI)      $138(GI)   $224 $225 $289
   6      $118    $146     $169     $142              $170          $142
   0      $110                      $167              $190          $182




Age                                                  A through J standard monthly premium amounts
AI = age at issue; noted by #                        (note: versions of Plans F and J with a $1,690
AA = attained age; noted by ^                        deductible are noted with an *)
S = Same premium, any age
                                                     (GI) means the policy is Guaranteed Issue; you
                                                     cannot be turned down for the policy because of
Pre-ex (page 27)                                     poor health.
The number of months before the policy will pay
for your pre-existing conditions; may vary by plan

                                                52
Monthly MedSup premiums for people under 65 with disabilities
      COMPANY            Phone          Internet Address    M X? ZIP   Age   Pre-ex   A     B
 Sterling Life       1-800-688-0010    sterlingplans.com   A/M Y Z     AA      0     $288
 United American     1-800-331-2512   unitedamerican.com    A  Y     *AI/AA^   6    *$229 ^$274
                                                    * = AI - Age at Issue     ^ = AA - Attained Age


How to use the chart on this page

The companies that market MedSup to people under age 65 offered only standard plans A and B
at the time of our survey.

These MedSup premiums are for individuals not yet age 65, but who are eligible for Medicare due to
a disability. If you are in this group, your choice in buying MedSup is limited to the company shown.

When applying for coverage, you may be asked questions about your health before a policy is issued
to you. If you don’t meet the company's guidelines, it could deny coverage. This process of asking
health and medical questions is called underwriting. Each company establishes its own underwrit-
ing guidelines.

MedSup open enrollment for people with disabilities does not start until age 65. If you cannot buy
coverage from the company shown above, you may be eligible to join one of the Medicare
Advantage plans available where you live (see pages 56-57).

M (how policies are sold)
M = Policies sold by mail;
A = Policies sold by agents;

X? (page 31)
"Y" means yes, the company has a crossover contract with Medicare

Zip
Prices for policies marked with a "Z" differ by zip code

Age (page 26)
AI = age at issue;
AA = attained age;

Pre-ex (page 27)
The number of months before the policy will pay for your pre-existing
conditions; may vary by plan




                                                    53
                           Medicare Select (MedSelect)

     AGE 65
                 COMPANY                 Phone             Internet Address         M      X? ZIP Age Pre-ex  A    B           C       D     E    F   *F    G
     American Pioneer                 1-800-538-1053              uafc.com          A       Y     AA    6         $95        $123     $101       $129
     Anthem BC/BS (Group)             1-800-467-8065            anthem.com          A       Y Z AA      0                     $90                $95
     Bankers Life and Casualty        1-800-621-3724          bankerslife.com       A          Z AA     0    $104 $111       $124     $108       $146
     Central States Health & Life     1-800-541-2363               cso.com          A       Y Z    AI   6                     $99
     Continental General              1-877-291-5434      continentalgeneral.com    A       Y Z AA      6         $78        $104     $79        $100      $82
     Continental Life                 1-800-880-8824            cont-life.com       A       Y  Z AA     3    $46 $50          $65     $49        $69
     HomeTown                         1-877-236-2290     hometownhealthnet.com     A/M/I          AA    6    $80             $111     $104       $110
     Medical Mutual                   1-800-722-7331          medmutual.com         A       Y     AA    0                     $97
     Mutual of Omaha                  1-800-316-0842       mutualofomaha.com        A       Y Z AA      6    $100 $96        $101     $98 $110 $105        $96
     Pyramid Life                     1-800-777-1126          pyramidlife.com      A/M/I    Y Z AA      6         $77        $109     $81      $112        $91
     Standard Life & Accident         1-888-350-1488             slaico.com         A       Y  Z AI     2                    $127     $86      $128        $87
     State Mutual                     1-800-321-0102    statemutualinsurance.com    A       Y Z AA      0         $108       $129     $119     $134
     Sterling Life                    1-800-688-0010         sterlingplans.com     A/M      Y Z AA      0    $133 $135       $160
     UNICARE Life &Health             1-800-459-1732            unicare.com        A/M      Y Z AA      0                    $105                $106
     United Healthcare (AARP)         1-800-523-5800        aarphealthcare.com      M      Y       S    3                   $80(GI)
     United Teacher                   1-800-880-8824             utaic.com          A       Y  Z AA     6         $80         $94     $77        $94       $77

     AGE 70




54
     American Pioneer                 1-800-538-1053              uafc.com          A      Y       AA   6           $111     $141     $119       $148
     Anthem BC/BS (Group)             1-800-467-8065            anthem.com          A      Y   Z   AA   0                    $112                $118
     Bankers Life and Casualty        1-800-621-3724          bankerslife.com       A          Z   AA   0    $118 $130       $145     $127       $176
     Central States Health & Life     1-800-541-2363               cso.com          A      Y   Z   AI   6                    $117
     Continental General              1-877-291-5434      continentalgeneral.com    A      Y   Z   AA   6           $95      $126     $96        $120      $100
     Continental Life                 1-800-880-8824            cont-life.com       A      Y   Z   AA   3    $54    $58       $75     $56        $79
     HomeTown                         1-877-236-2290     hometownhealthnet.com     A/M/I           AA   6    $101            $144     $135       $143
     Medical Mutual                   1-800-722-7331          medmutual.com         A      Y       AA   0                    $114
     Mutual of Omaha                  1-800-316-0842       mutualofomaha.com        A      Y   Z   AA   6    $118 $115       $118     $118 $128 $123       $115
     Pyramid Life                     1-800-777-1126          pyramidlife.com      A/M/I   Y   Z   AA   6         $96        $135     $101      $139       $107
     Standard Life & Accident         1-888-350-1488             slaico.com         A      Y   Z   AI   2                    $130     $88       $131       $89
     State Mutual                     1-800-321-0102    statemutualinsurance.com    A      Y   Z   AA   0         $151       $176     $167      $183
     Sterling Life                    1-800-688-0010         sterlingplans.com     A/M     Y   Z   AA   0    $154 $157       $187
     UNICARE Life &Health             1-800-459-1732            unicare.com        A/M     Y   Z   AA   0                    $120                $121
     United Healthcare (AARP)         1-800- 523-5800       aarphealthcare.com      M      Y        S   3                  $111(GI)
     United Teacher                   1-800-880-8824             utaic.com          A      Y   Z   AA   6           $91      $107     $88        $107      $88


                                    See “How to Use MedSup Charts” (page 51) to understand the information here.
                             Medicare Select (MedSelect)
     AGE 75
                 COMPANY                Phone            Internet Address         M    X? ZIP Age Pre-ex   A   B       C           D     E    F   *F    G
     American Pioneer                1-800-538-1053             uafc.com          A    Y      AA    6         $130   $162         $139       $170
     Anthem BC/BS (Group)            1-800-467-8065           anthem.com          A    Y Z AA       0                $132                    $139
     Bankers Life and Casualty       1-800-621-3724         bankerslife.com       A        Z AA     0    $138 $154   $173         $154       $213
     Central States Health & Life    1-800-541-2363              cso.com          A    Y Z     AI   6                $139
     Continental General             1-877-291-5434    continentalgeneral.com     A    Y Z AA       6         $109   $146         $110       $139      $115
     Continental Life                1-800-880-8824           cont-life.com       A    Y Z AA       3     $63 $69     $88          $65        $93
     HomeTown                        1-877-236-2290    hometownhealthnet.com     A/M/I        AA    6    $108        $162         $153       $161
     Medical Mutual                  1-800-722-7331         medmutual.com         A    Y      AA    0                $136
     Mutual of Omaha                 1-800-316-0842      mutualofomaha.com        A    Y Z AA       6    $137 $135   $136         $138 $146 $141       $135
     Pyramid Life                    1-800-777-1126         pyramidlife.com      A/M/I Y Z AA       6         $114   $158         $120      $155       $126
     Standard Life & Accident        1-888-350-1488            slaico.com         A    Y   Z   AI   2                $149         $101      $151       $102
     State Mutual                    1-800-321-0102   statemutualinsurance.com    A    Y Z AA       0         $178   $206         $198      $214
     Sterling Life                   1-800-688-0010        sterlingplans.com     A/M Y Z AA         0    $167 $172   $209
     UNICARE Life &Health            1-800-459-1732           unicare.com        A/M Y Z AA         0                $157                    $158
     United Healthcare (AARP)        1-800-523-5800      aarphealthcare.com       M Y          S    3              $111(GI)
     United Teacher                  1-800-880-8824            utaic.com          A    Y Z AA       6         $107   $127         $105       $127      $105

     AGE 80
     American Pioneer                1-800-538-1053             uafc.com          A    Y       AA   6           $142     $178     $154       $186




55
     Anthem BC/BS (Group)            1-800-467-8065           anthem.com          A    Y   Z   AA   0                    $153                $160
     Bankers Life and Casualty       1-800-621-3724         bankerslife.com       A        Z   AA   0    $163 $186       $211     $191       $258
     Central States Health & Life    1-800-541-2363              cso.com          A    Y   Z   AI   6                    $165
     Continental General             1-877-291-5434    continentalgeneral.com     A    Y   Z   AA   6           $120     $160     $121       $152      $126
     Continental Life                1-800-880-8824           cont-life.com       A    Y   Z   AA   3     $74    $81     $104      $77       $109
     HomeTown                        1-877-236-2290    hometownhealthnet.com     A/M/I         AA   6    $110            $180     $171       $179
     Medical Mutual                  1-800-722-7331         medmutual.com         A    Y       AA   0                    $162
     Mutual of Omaha                 1-800-316-0842      mutualofomaha.com        A    Y   Z   AA   6    $158 $156       $154     $159 $165 $160       $156
     Pyramid Life                    1-800-777-1126         pyramidlife.com      A/M/I Y   Z   AA   6         $125       $171     $132      $167       $138
     Standard Life & Accident        1-888-350-1488            slaico.com         A    Y   Z   AI   2                    $177     $120      $179       $122
     State Mutual                    1-800-321-0102   statemutualinsurance.com    A    Y   Z   AA   0         $200       $229     $222      $237
     Sterling Life                   1-800-688-0010        sterlingplans.com     A/M Y     Z   AA   0    $176 $183       $234
     UNICARE Life &Health            1-800-459-1732           unicare.com        A/M Y     Z   AA   0                    $178                $174
     United Healthcare (AARP)        1-800-523-5800      aarphealthcare.com       M    Y        S   3                  $111(GI)
     United Teacher                  1-800-880-8824            utaic.com          A    Y   Z   AA   6           $119     $141     $117       $142      $118
Medicare Plans in Ohio
M/A HMO's

On County list
appears as       Company                                  Medicare plan name           Customer phone
ASA              Anthem                                   Senior Advantage            800-467-1199
HAH              Carelink Health Plan                     Health Assurance Advantra   800-896-9612
HHP              Home Town Health Plan                    SecureCare                  877-236-2290
M                Mt. Carmel Healthplan                    MediGold                    800-964-4525
PM               Paramount                                Paramount Elite             888-891-0707
PT               PrimeTime                                PrimeTime Health Plan       800-577-5084
Q                Qualchoice Health Plan                   Qualchoice Medicare Prime   800-206-7279
SC               SummaCare                                SummaCare Secure            330-996-8885
HPU              The Health Plan of the Upper OH Valley   The Health Plan             800-624-6961
UHC              United HealthCare of Ohio                Medicare Complete           800-504-4848

Cost HMO's
On County list
appears as       Company                                  Medicare plan name           Customer phone
K                Kaiser Permanente Health Plan            Medicare Plus               800-551-5353
HPU              The Health Plan of the Upper OH Valley   The Health Plan             800-624-6961
                                                                                      ext. 7656

M/A PPO's
On County list
appears as       Company                                  Medicare plan name           Customer phone
H                Carelink Health Plan                     Advantra PPO                800-896-9612
E                United HealthCare                        Evercare                    800-393-0993
U                United Healthcare                        Medicare Complete Choice    800-350-5230


M/A PFFS
On County list
appears as       Company                                  Medicare plan name           Customer phone
S                Sterling Life                            Sterling Option I           888-858-8551




                                                    56
Ohio County List of Plans
Find your county. The letters shown next to the county name stand for the Medicare plans available
to people who live in that county, in addition to Original Medicare.

   COUNTY         M/A         COST     M/A       M/A                        M/A         COST    M/A      M/A
                                                              COUNTY
                  HMO         HMO      PPO      PFFS                        HMO         HMO     PPO     PFFS
 Adams                                                      Licking          M
 Allen                                                      Logan
 Ashland                                                    Lorain          (ASA)        K
 Ashtabula                                                  Lucas            PM
 Athens                                                     Madison      ASA, M, UHC
 Auglaize                                                   Mahoning      (ASA), UHC             U
 Belmont                      HPU                           Marion
 Brown           ASA                                        Medina       ASA, HHP, SC    K
 Butler        ASA, UHC               AMP,U                 Meigs
 Carroll          PT                                        Mercer
 Champaign                                                  Miami            ASA
 Clark            UHC                  U                    Monroe                      HPU
 Clermont         ASA                 AMP                   Montgomery    ASA, UHC             AMP,U
 Clinton                                                    Morgan
 Columbiana       ASA                                       Morrow
 Coshocton                                                  Muskingum        HPU
 Crawford                                                   Noble                       HPU
 Cuyahoga     (ASA), Q, UHC    K       E, U                 Ottawa                                       S
 Darke            *ASA                                      Paulding                                     S
 Defiance                                        S          Perry
 Delaware          M                                        Pickaway          M
 Erie                                            S          Pike
 Fairfield         M                                        Portage      ASA, HHP, SC    K
 Fayette           M                                        Preble           ASA
 Franklin     ASA, M, UHC               E                   Putnam                                       S
 Fulton                                          S          Richland
 Gallia                                                     Ross              M
 Geauga          (ASA)         K                            Sandusky                                     S
 Greene           ASA                  AMP                  Scioto
 Guernsey                     HPU                           Seneca
 Hamilton      ASA, UHC              AMP,E, U               Shelby           ASA
 Hancock                                                    Stark        ASA,HHP, PT
 Hardin                                                     Summit       ASA, HHP, SC    K       E
 Harrison                     HPU                           Trumbull      ASA, UHC
 Henry                                           S          Tuscarawas     HHP, PT
 Highland                                                   Union          ASA, M
 Hocking                                                    Van Wert                                     S
 Holmes         HHP, PT                                     Vinton
 Huron                                                      Warren        ASA, UHC             AMP, U
 Jackson                                                    Washington
 Jefferson                    HPU       H                   Wayne          HHP, PT
 Knox                                                       Williams                                     S
 Lake             ASA          K                            Wood             PM                          S
 Lawrence                                                   Wyandot




* Indicates coverage only in certain zip codes in the county
Italics and underline indicates capacity waver limitations
( ) indicates plan is only open from 11/15 to 12/31 Annual Enrollment Period
M/A - Medicare Advantage




                                                       57
             Medicare Advantage Plans Comparison Worksheet
 This worksheet is designed for you to gather specific information regarding Medicare
 Advantage plans available in your area. First, identify what plans are available in the
 county you live in using the charts on the facing page. Write down the plan name/
 phone number in the spaces provided. Second, Call the plans for information. Verify
 that the doctors and medical facilities that you prefer are part of the plan’s network
 and circle yes or no. Find out what your financial responsibilities are. Write down the
 out of pocket expenses in the spaces provided. Third, choose which plan (if any) is
 right for you!



     Plan Name
      Phone #
 My Dr’s/Hospitals
  are in network            yes        no         yes        no         yes        no

         Monthly
         Premium

        Copays
Hospital
Emergency
Urgent Care
Office Visit
     Primary Care
       Specialist
Physical Exam
Preventive Care
Therapy
Ambulance
     Additional
      Benefits
Drugs
Vision
Hearing
Dental
      Additional
  Plan Information
 Do I need referrals?
 Wellness programs?
Disease management?
   Other benefits?

Notes:



                                            58
                                      Chapter 7
                                      Resources

OSHIIP Counseling Directory
OSHIIP has counseling sites in many Ohio counties. If you cannot reach a phone number shown
here, please notify OSHIIP at 1-800-686-1578.



    County        Phone                            County        Phone

    Allen         419-228-5135                     Madison       740-869-4207
    Ashland       419-281-1477                     Mahoning      330-782-1173
    Athens        740-594-3535                     Marion        740-387-2761
    Auglaize      419-394-8252                     Medina        800-828-1789 ext. 2829
    Belmont       740-425-9101                                   330-334-2829
    Carroll       330-627-7017                     Meigs         740-992-2161
    Champaign     937-653-5352                     Mercer        419-586-1644
    Clark         937-323-6059                     Monroe        740-472-1312
    Clermont      513-528-5317                     Montgomery    937-223-8246 ext. 126
    Columbiana    330-385-4732                                   937-223-8246 ext. 127
    Coshocton     800-458-8853                                   800-395-8267
    Crawford      419-562-3050                     Muskingum     800-458-8853
    Cuyahoga      440-885-2231                     Noble         800-458-8853
    Darke         937-548-5970                     Ottawa        419-627-8733
    Defiance      419-784-5401                     Paulding      419-399-3650
    Delaware      740-363-6677                     Perry         800-458-8853
    Erie          419-621-7052                     Pickaway      740-986-9229
                  419-625-3441                     Pike          740-941-0306
    Fairfield     740-681-5050                     Preble        937-456-4947
    Fayette       740-333-3554                     Putnam        419-523-4121
    Franklin      614-645-8557                     Richland      419-747-7481
    Fulton        800-686-9217                     Ross          740-775-3167
    Geauga        440-285-2222 ext. 5020           Sandusky      419-334-6613
    Greene        937-223-8246                     Scioto        740-456-6239
    Hamilton      513-345-3306 ext. 126 or 127     Seneca        419-448-3122
    Hancock       419-423-8496                     Shelby        937-492-5266
    Hardin        419-673-1102                     Stark         330-877-0924
    Henry         419-748-8242                     Summit        330-848-7814
    Holmes        330-276-3921                     Trumbull      330-583-2793
    Huron         419-499-4064                     Tuscarawas    330-343-2792
    Jackson       740-286-0623                     Van Wert      419-238-5011
    Lake          440-205-8111                     Vinton        740-596-4706
    Licking       740-345-0821                     Warren        513-695-2210
    Logan         937-592-4015                     Washington    740-373-3914
    Lorain        440-326-4811                     Williams      419-485-5923
    Lucas         419-382-7060                     Wood          800-367-4935
                                                   Wyandot       419-294-5733




                                             59
Insurance Company Rating Firms
There are several private firms that specialize in evaluating the finances and services of insurers. The Ohio
Department of Insurance regulates insurance companies. The Department does not rate insurers. Keep in
mind, there may be a charge for getting the firm’s report. Also, each firm has its own grading system. Be sure
you understand the rating firm’s system before you rely on any report you get.

        A.M. Best Company                      908 - 439 - 2200                  www.ambest.com
        Fitch Investors Service                800 - 893 - 4824                  www.fitchibca.com
        Moody’s Investor Service               212 - 553 - 0377                  www.moodys.com
        Standard & Poor                        212 - 208 - 1527                  www.standardandpoor.com
        Weiss Ratings, Inc.                    800 - 289 - 9222                  www.weissratings.com



The Ohio Medicare Partners                                 OSHIIP is a state office with information about:
                                                               • Medicare supplemental insurance
                                                               • Medicare Advantage plans
Medicare Part A provides information on:
                                                               • Long-term care insurance
   • Inpatient hospital services
                                                               • Medicaid, QMB and SLMB programs
   • Skilled nursing facility services
                                                           Call OSHIIP: 1-800-686-1578
   • Outpatient facility services/procedures
                                                           E-mail: oshiipmail@ins.state.oh.us
   • Rehabilitation services
                                                           www.ohioinsurance.gov

Medicare Part B handles claims for:                        Ohio Department of Aging provides information on:
   • Medical/professional services given in office,            • Ohio Aging Network
     inpatient or outpatient settings                          • BenefitsCheckUp
   • Lab tests, X-rays and diagnostic tests                    • PASSPORT program, Care Choice Ohio
   • Ambulance transportation                                  • Golden Buckeye Card
                                                               • Long-Term Care Ombudsman
                                                           Call ODA: 1-800-282-1206
                                                           www.goldenbuckeye.com

DMERC processes claims for durable medical                 Ohio Department of Health, Division of Quality
equipment and supplies including:                          Assurance handles complaints against:
   • Home dialysis equipment                                   • Licensed and certified health care providers,
   • Immunosuppressive and oral anti-cancer drugs                including long term and non-long term
   • Therapeutic shoes for diabetics                             facilities
   • Wheelchairs, walkers, canes, etc.                     Call ODH: 1-800-342-0553
   • Power-operated vehicles                               www.odh.state.oh.us

Quality Improvement Organization handles quality           Ohio Department of Job and Family Services process
of care issues including:                                  claims for:
    • Inpatient hospital                                       • Medicaid, Spend-down and QMB programs
    • Skilled nursing facility                             Call ODJFS: 1-800-324-8680
    • Home health care                                     www.state.oh.us/odhs/medicaid
Your rights as a patient, including:
    • Premature discharge issues                           Social Security Administration will help with:
    • Care through a Medicare HMO                              • Medicare eligibility and enrollment
To contact Medicare call 1-800-MEDICARE                        • Changing your address for Medicare
or visit www.medicare.gov                                      • Replacing a Medicare card
                                                               • Questions on Medicare premiums
                                                           Call SSA: 1-800-772-1213
                                                           www.ssa.gov
                                                      60
Financial Resources for                                   QMB: Qualified Medicare
Medicare Beneficiaries                                    Beneficiary
Beneficiaries who need financial assistance may           If you are eligible for QMB, you do not need
qualify for government help with certain health           Medicare supplemental insurance because this
 insurance expenses. To be eligible, your finances        program is like having a free MedSup policy.
cannot be more than established limits for
incomes and assets.                                       QMB pays:
                                                            • Your deductibles and coinsurance that are
These figures are in effect for the first quarter             not paid by Medicare
of 2004, but are subject to change from year to             • Your Medicare Part B premium ($66.60
year. If you are unsure about whether you                     in 2004)
qualify for assistance, call the Department of
Job and Family Services at 800-324-8680.                  QMB Eligibility      Single      Married
                                                          Monthly income:      $796        $1,061
Medicaid pays:                                            Total assets:        $4,000      $6,000
For dental bills, prescriptions, medical bills,
eyeglasses and homemaker services.
Depending on your income, Medicaid will pay
all or part of these expenses.

Medicaid Eligibility     Single       Married
Monthly income:          $510         $866
Total assets:            $1,500       $2,250              SLMB: Specified Low Income
Spend-down                                                Medicare Beneficiary
Spend-down means that you are eligible for
Medicaid except that your income exceeds                  Because the incomes limits for SLMB are higher,
Medicaid eligibility limits. In order to get              there are fewer benefits to those who qualify.
Medicaid, you must use your medical costs to get
your income at or below income limits.                    The SLMB program pays:
                                                             • Your Medicare Part B premium
Example: Jane’s monthly income is $750. She                  • Retroactive Part B premiums for each of the
pays $180 per month for insurance. Her net                     past three months
income is still $60 above the Medicaid limit, but
Jane can qualify for spend-down. She becomes              SLMB Eligibility     Single       Married
eligible monthly by spending $60 for medical              Monthly income:      $951         $1,269
expenses like prescriptions or dental work.               Total assets         $4,000       $6,000




                                            What are assets?
      Assets are savings and other things you own. The government does not take into account
      your home, furnishings, one car, burial plots, personal jewelry or the cash value of $1,500
                    or less from a life insurance policy when counting your assets.



                                                     61
BenefitsCheckUp
The Ohio Department of Aging offers a free, confidential online service that can help you determine if you
qualify for a range of state and federal assistance programs.

Use BenefitsCheckUp on the Internet at:
www.goldenbuckeye.com/benefits.html

For help using the site, call the Elder Rights Helpline at 1-800-282-1206, or email to:
elderrights@age.state.oh.us




How to Apply for Government Assistance
1. Get an application from your County Department of Job and Family Services.
   Complete the form and return it in person or by mail.
2. Next you will be interviewed to show that you are qualified to receive benefits.
3. If you wish, you can take someone with you to the interview or appoint an authorized
   representative to go to the interview for you. Your authorized representative can be a
   friend, neighbor, an OSHIIP volunteer or anyone you pick.
4. You cannot be denied benefits if you are unable to attend the interview.
5. To apply for benefits under the QMB or SLMB programs, you may be able to complete
   a new, shorter application form. No interview is required.
6. If for some reason you are dissatisfied, or feel you are entitled to a higher level of
   benefits, you can ask for a hearing. Another may have someone go with you to the
   hearing, or you may appoint an authorized representative to go for you.




                Not satisfied? Contact the Ohio Department of Job and Family Services


                                     Office of Human Resources
                                     30 East Broad Street, 32nd Floor
                                     Columbus, Ohio 43266-0423
                                     800-686-1556




                                                     62
Chapter 8:                            Assignment: In the Original Medicare Plan, this means a doctor agrees
                                      to accept the Medicare approved amount as payment. You pay your
Glossary of Terms                     share of the cost of the doctor's visit. Ohio law prohibits medical
                                      practitioners and their employers from charging more than Medicare
                                      approves.
Benefit Period: The way that Medicare measures your use of hospital and skilled nursing facility services. A
benefit period begins the day you are admitted to a hospital. The benefit period ends when you haven't
received any skilled services at a hospital or skilled nursing facility for 60 days in a row. If you go into the
hospital after one benefit period has ended, a new benefit period begins. You must pay the inpatient hospital
deductible for each benefit period. There is no limit to the number of benefit periods you can have.
Coinsurance: The percent of the Medicare approved amount that you have to pay for items and services
under Part A and/or Part B. In the Original Medicare Plan, the coinsurance payment is a percentage of the
approved amount for the service (like 20%).
Co-payment: In some Medicare health plans, the amount that you pay for each medical service, like a
doctor's visit. A co-payment is usually a set amount you pay for a service. For example, this could be $5 or
$10 for a doctor's visit. Co-payments are also used for some hospital outpatient services in the Original
Medicare Plan.
Deductible: The amount you must pay for Medicare covered services, before Medicare begins to pay, either
for each benefit period for Part A, or each year for Part B. These amounts can change every year.
Durable Medical Equipment (DME): Medical equipment ordered by a doctor for use in the home. These
items must be reusable, such as walkers, wheelchairs, or hospital beds.
End-Stage Renal Disease (ESRD)*: Kidney failure severe enough to need lifetime dialysis or a kidney
transplant.
Excess Charges: Any amount that the doctor or supplier charges you that is more than what Medicare
approves (see "Medicare-approved amount").
Guaranteed Issue Rights (also called "Medigap Protections"): Rights you have in certain situations when
insurance companies are required by law to sell or offer you a Medigap policy. In these situations, an
insurance company can't deny you insurance coverage or place conditions on a policy, must cover you for all
pre-existing conditions, and can't charge you more for a policy because of past or present health problems.
Guaranteed Renewable: A right you have that requires your insurance company to automatically renew or
continue your MedSup policy, unless you commit fraud or don't pay your premiums.
Home Health Care: Skilled nursing care and certain other health care you get in your home for the treatment
of an illness or injury.
Hospice Care: A special way of caring for people who are terminally ill and their families. This care includes
physical care and counseling. Hospice care is covered under Medicare Part A (Hospital Insurance).
Lifetime Reserve Days: Sixty days that Medicare will pay for when you are in a hospital for more than 90
days. These 60 reserve days can be used only once during your lifetime. For each lifetime reserve day,
Medicare pays all covered costs except for a daily payment ($438 in 2004).
Long-Term Care: A variety of services that help people with health or personal needs and activities of daily
living over a long period of time. Long-term care can be provided at home, in the community or in various
types of facilities, including nursing homes and assisted living facilities. Most long-term care is custodial
care. Medicare doesn't pay for this type of care.
Medicaid: A joint federal and state program that helps with medical costs for some people with low incomes
and limited resources. Medicaid programs vary from state to state, but most health care costs are covered if
you qualify for both Medicare and Medicaid.
Medical Underwriting: The process that an insurance company uses to decide whether or not to take your
application for insurance, whether or not to add a waiting period for pre-existing conditions (if your state law
allows it), and how much to charge you for that insurance.
                                                         63
Medically Necessary: Services or supplies that:
  • are proper and needed for the diagnosis or treatment of your medical condition,
  • are provided for the diagnosis, direct care, and treatment of your medical condition,
  • meet the standards of good medical practice in the local area, and are not mainly for the convenience
  • of you or your doctor.
Medicare Advantage (called Medicare + Choice before 2004): A Medicare program that offers
beneficiaries additional health care options. Medicare Advantage plans are offered by private companies in
contract with the Medicare program. Medicare Advantage plans must offer the benefits offered by Original
Medicare, but may also offer additional benefits. Everyone who has Medicare Parts A and B is eligible, except
those who have End-Stage Renal Disease.
Medicare Advantage HMO: Plans that are offered by private companies in contract with Medicare. Medicare
agrees to terms annually with the HMOs.
Medicare + Choice: see Medicare Advantage.
Medicare-Approved Amount: The fee Medicare sets as reasonable for a covered medical service. This is
the amount a doctor or supplier is paid by you and Medicare for a service or supply. It may be less than the
actual amount charged by a doctor or supplier. The approved amount is sometimes called the "Approved
Charge." Ohio law prohibits medical practitioners and their employees from charging more than Medicare
approves.
Medicare Carrier: A private company that contracts with Medicare to pay Part B bills.
Medicare Advantage Private Fee-for-Service Plan: A private insurance plan that accepts people with
Medicare. You may go to any Medicare-approved doctor or hospital that accepts the plan's payment. The
insurance plan, rather than the Medicare program, decides how much it will pay and what you pay for the
services you get. You may pay more for Medicare-covered benefits. You may have extra benefits the Original
Medicare Plan doesn't cover.
Medicare Select: A type of MedSup policy that may require you to use hospitals and, in some cases, doctors
within its network to be eligible for full benefits.
MedSup Open Enrollment Period: A one-time-only six month period when you can buy any MedSup policy
you want that is sold in your state. It starts when you sign up for Medicare Part B and you are age 65 or older.
During this period, you cannot be denied coverage or charged more due to past or present health problems.
MedSup Policy: A Medicare supplement insurance policy sold by private insurance companies to fill "gaps"
in Original Medicare. There are ten standardized plans labeled Plan A through Plan J. MedSup policies only
work with the Original Medicare Plan.
Original Medicare Plan: A fee-for-service health plan that lets you go to any doctor, hospital, or other health
care provider who accepts Medicare. You must pay any applicable deductible. Medicare then pays its share of
the Medicare-Approved Amount, and you pay your share (coinsurance). The Original Medicare Plan has two
parts: Part A (Hospital Insurance) and Part B (Medical Insurance).
Pre-existing Condition: A health problem you had before the date a new insurance policy starts.
Premium: The periodic payment to Medicare, an insurance company, or a health care plan for health care
coverage.
Skilled Nursing Care*: A level of care given or supervised by Registered Nurses. All of your medical needs
are taken care of with this type of service. Examples of skilled care are: getting intravenous injections, tube
feeding, oxygen to help you breathe and changing sterile dressings on a wound. Any service that could be
safely done by an average non-medical person (or one’s self) without the supervision of a Registered Nurse is
not considered skilled care.
Skilled Nursing Facility: A nursing facility with the staff and equipment to give skilled nursing care and/or
skilled rehabilitation services and other related health services.

                    * These definitions in whole or in part were used with permission from
                    Walter Feldesman, Esq., 82 "Dictionary of Eldercare Terminology 2000."
                                                     64
      OHIO SENIOR HEALTH
INSURANCE INFORMATION PROGRAM
                   OSHIIP
   OSHIIP has more than 800 volunteer counselors serving most Ohio counties.
 These men and women have been trained by the Ohio Department of Insurance
  and are dedicated to helping fellow consumers. If you want assistance, call the
      number shown for your county on page 59. OSHIIP is a FREE service.



                   OUR COUNSELORS CAN HELP YOU:
                        Understand how various policies work

                        Make sense of that confusing pile of bills
                      from doctors and hospitals, and statements
                        from Medicare and insurance companies

                     Determine if you are getting the benefits you
                     are entitled to, and what to do if you are not

                         Better understand how to deal with
                         Medicare and insurance in the future




                  WANT TO BE AN OSHIIP COUNSELOR?
                    New volunteers are always needed & welcomed

                        OSHIIP has sites in most Ohio counties
                     (see page 59) – call us about training classes.

                Contact us if you want OSHIIP in your area . . . you may
                know of an organization that could serve as a sponsor




 Toll-Free Phone 1-800-686-1578                             Fax (614) 752-0740
    internet:
MEDICARE www.ohioinsurance.gov • email: oshiipmail@ins.state.oh.us
              MEDICAID MEDSUP LONG-TERM CARE INSURANCE
   RETIREMENT HEALTH PLANS OTHER HEALTH INSURANCE
   Other shopper’s guides available from the Ohio Department of Insurance:

              Annuities • Auto Insurance • Health Insurance
                   Homeowner’s Insurance • Life Insurance
                             Long-Term Care Insurance
                                     Managed Care




                           To request consumer publications
                         or ask questions about insurance, call
               1-800-686-1578 or 1-800-686-1526
       Fax: (614) 752-0740 TDD Phone (614) 644-3745
                                  Visit our website at
                            w w w. o h i o i n s u r a n c e . g o v


                The Ohio Department of Insurance is an Equal Opportunity Employer




The Ohio Department of Insurance
2100 Stella Ct.                                                                     Presorted Standard
                                                                                       U.S. Postage
Columbus, OH 43215-1067
                                                                                           PAID
                                                                                     Columbus, Ohio
                                                                                     Permit No. 4892

				
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