FREQUENTLY ASKED QUESTIONS

Does Medicare cover Home Care or Long Term Care?

Many people mistakenly believe that Medicare provides coverage for long-term home care. It doesn't.

Medicare covers only limited periods of skilled nursing care and therapy at home, and only if certain strict conditions are met. Still, Medicare's home care coverage can be vital if the person you're caring for has suffered a serious medical event that suddenly changes his or her condition. Medicare can pay for costly short-term, intensive home care, which can give you a chance to arrange for longer-term care if it's needed.

If a patient needs only nonmedical home care and assistance, such as help with eating, dressing, walking, meal preparation, and housekeeping, Medicare does not cover it.

Medicare or Medicaid?

One of the reasons many people mistakenly believe that Medicare covers long-term home care is that they confuse Medicare with Medicaid, which is a completely separate program only available to people who have very low income and few assets other than their home. Unlike Medicare, Medicaid can cover long-term home care, the amount and frequency depending on the patient's needs.

For more information, please visit: www.medicare.gov

What is a Medicare Supplement Insurance?

A Medicare Supplement Insurance (Medigap) policy, sold by private companies, can help pay some of the health care costs that Original Medicare doesn't cover, like copayments, coinsurance, and deductibles.

Some Medigap policies also offer coverage for services that Original Medicare doesn't cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Then your Medigap policy pays its share.

A Medigap policy is different from a Medicare Advantage Plan. Those plans are ways to get Medicare benefits, while a Medigap policy only supplements your Original Medicare benefits.

8 things to know about Medigap policies

1. You must have Medicare Part A and Part B.

2. If you have a Medicare Advantage Plan, you can apply for a Medigap policy, but make sure you can leave the Medicare Advantage Plan before your Medigap policy begins.

3. You pay the private insurance company a monthly premium for your Medigap policy in addition to the monthly Part B premium that you pay to Medicare.

4. A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you'll each have to buy separate policies.

5. You can buy a Medigap policy from any insurance company that's licensed in your state to sell one.

6. Any standardized Medigap policy is guaranteed renewable even if you have health problems. This means the insurance company can't cancel your Medigap policy as long as you pay the premium.

7. Some Medigap policies sold in the past cover prescription drugs, but Medigap policies sold after January 1, 2006 aren't allowed to include prescription drug coverage. If you want prescription drug coverage, you can join a Medicare Prescription Drug Plan (Part D).

8. It's illegal for anyone to sell you a Medigap policy if you have a Medicare Medical Savings Account (MSA) Plan.

For more information, please visit: www.medicare.gov


Medicare Supplement Birthday Rule
Currently, Oregon, California, Nevada & Idaho only have the Birthday Rule.

Medicare beneficiaries have a yearly opportunity to compare Medicare supplement prices
and switch companies. The change is guaranteed, regardless of your health. You must keep the same
plan type or choose one with lesser benefits. Example, a Plan F enrollee can switch to any Medicare
Supplement Plan A through N, except for an Innovative Plan F.

Some insurance companies allow you to enroll in a Medicare Supplement plan under the Birthday rule as
early as 60 days prior to your Birthday. However, the plan would not go into effect until your Birthday, and
would have to go into effect no later than 30 days after your Birthday.

For more information, please visit: www.medicare.gov

When can I apply for a Medicare Supplement plan?

There is no "season"; you can apply for a Medigap supplement policy at any time. However, insurance
companies generally may increase your starting premium because of your medical history (underwrite)
and refuse to issue a policy. You have "guaranteed issue" (they may neither deny nor underwrite) during
your six-month Medigap open enrollment period. This period begins the day your Part B starts and lasts
for six months. This is the best time to purchase this insurance if you want to try it.
 
Other situations, such as employer coverage ending, may open a 63-day guaranteed issue opportunity. The SHIBA publication, Oregon Guide to Medigap, Medicare Advantage & Prescription Drug Plans, has information on Medigap carriers, premium comparisons, and a list of guaranteed issue situations.

For more information see our Resource Page