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2017 MEDICARE SUPPLEMENT COMPARISON GUIDE

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State and Federal

State and Federal Regulation Guarantees Medigap to Medicare Beneficiaries A change in federal and state regulation guarantees acceptance into Medicare Supplement insurance (Medigap), in addition to the regular open enrollment period, if a Medicare beneficiary qualifies in one of six categories. In each case, the Medicare beneficiary has 63 days from the date of loss of coverage to take advantage of this guaranteed access to Medicare Supplement insurance. In addition, no insurer may impose a preexisting waiting period. CATEGORY 1: If a Medicare beneficiary is enrolled in an employer-sponsored plan, whether primary or secondary to Medicare, and the plan terminates or ceases to provide benefits, or the beneficiary voluntarily leaves the plan, then the Medicare beneficiary is entitled to Medigap plans A, B, C, F, K or L with any company selling these plans. CATEGORY 2: If a Medicare beneficiary is enrolled in a Medicare Health Plan (e.g., a Medicare HMO, PPO or PFFS) and • the plans certification is terminated, or • the plan ceases to provide all services, or • the enrollee moves out of the service area, or • the plan violates the contract, misrepresents during marketing, or • there are other circumstances as determined by the HHS Secretary, CATEGORY 3: If a Medicare beneficiary is enrolled in a Medicare Health Plan (e.g., a Medicare HMO, PPO or PFFS), Demonstration, HCPP, or select plan, and • the plan’s certification is terminated, or • the plan ceases to provide all services, or • the enrollee moves out of the service area, or • the plan violates the contract, misrepresents during marketing, or • there are other circumstances as determined by the HHS Secretary, then the Medicare beneficiary is entitled to Medigap plans A, B, C, F, K or L with any company selling these plans. CATEGORY 4: If a Medicare beneficiary is enrolled in a Medigap policy and any of the following occur: • the insurer becomes insolvent or bankrupt, or • there is involuntary termination of coverage or enrollment, or • there is material violation of the policy, or • material misrepresentation during marketing, then the Medicare beneficiary is entitled to Medigap plans A, B, C, F, K or L with any company selling these plans. then the Medicare beneficiary is entitled to Medigap plans A, B, C, F, K, or L with any company selling these plans. 18

CATEGORY 5: If a Medicare beneficiary is enrolled in a Medigap policy and terminates it and enrolls for the first time in a Medicare Health Plan (e.g., a Medicare HMO), Demonstration, HCPP, or Select plan, and disenrolls from the chosen coverage within the first 12 months as permitted under federal law, then the Medicare beneficiary is entitled to his/her prior Medigap plan if it is still available or, if it is not available, Medigap plans A, B, C, F, K or L with any company selling these plans. CATEGORY 6: If an individual is eligible for Medicare Part A and enrolled in Medicare Part B for the first time, and • enrolls in a Medicare Health Plan (e.g., a Medicare HMO), and • disenrolls within the first 12 months after enrollment as permitted by federal law, then the Medicare beneficiary is entitled to any Medigap plan sold by any insurer. The Louisiana Department of Insurance is committed to seeing that your rights are upheld in all circumstances pertaining to guaranteed acceptance into Medicare Health Plans, Medicare Supplement or Medicare Select insurance. If you believe you fall into one of these categories and have been denied a policy, contact SHIIP at 1-800- 259-3500 or CMS Consumer Affairs at 1-800-MEDICARE. 19

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