Perspective
Insurance Companies Provide Misinformation at Least Half of the Time about Buying Medicare Supplemental InsuranceA new study conducted by the Medicare Rights Center (MRC) found that customer service representatives at insurance companies that sell Medigap -- insurance policies that supplement Medicare coverage -- provided wrong information at least half of the time, jeopardizing the ability of older adults who have been dropped by their Medicare HMOs to buy supplemental insurance.
MRC's "Medicare Rights and Realities: Problems with Medigap Guaranteed Issue Laws" finds that when asked what to do to get Medigap supplemental coverage by people whose HMOs were leaving Medicare, insurance representatives gave out wrong information 56 percent of the time. In fact, people with Medicare dropped by their HMOs must remain enrolled in their HMOs until December 31 in order to be guaranteed the right to buy Medigap supplemental coverage under federal law. Half of the time, the insurance company representatives wrongly stated that someone with cancer could not get a Medigap policy that would cover her pre-existing medical conditions.
MRC's "Medicare Rights and Realities: Problems with Medigap Guaranteed Issue Laws" finds that when asked what to do to get Medigap supplemental coverage by people whose HMOs were leaving Medicare, insurance representatives gave out wrong information 56 percent of the time. In fact, people with Medicare dropped by their HMOs must remain enrolled in their HMOs until December 31 in order to be guaranteed the right to buy Medigap supplemental coverage under federal law. Half of the time, the insurance company representatives wrongly stated that someone with cancer could not get a Medigap policy that would cover her pre-existing medical conditions.
If the customer service representatives do not know the rules, then older adults and people with disabilities can lose their ability to buy a Medigap policy. For example, if you are at least age 65 and your Medicare HMO is ending its coverage, you have the right to buy certain Medigap policies, even when prior medical conditions exist. However, under federal law, older adults must remain in their Medicare HMOs until their coverage ends on December 31, and they must buy a Medigap policy no later than 63 days from the end of the year. People who disenroll from their Medicare HMOs before December 31 do not have the right to buy a Medigap policy under federal law.
About 327,000 of the 6 million people enrolled in Medicare HMOs were notified in October that their Medicare HMO coverage would end on the last day of 1999. About 79,000 people who are losing their Medicare HMO coverage have no other Medicare HMO option in their area. People who do not sign up for Medicare HMOs are automatically enrolled in Original Medicare, and they often buy one of ten Medigap policies to supplement their coverage, if they do not have retiree coverage from a former employer that fills gaps in Original Medicare.
MRC's survey also found that in states where people with disabilities have the right to buy Medigap, the insurance representatives answered callers' questions correctly only 70 percent of the time. The federal law does not protect under-65 people with disabilities who are dropped by their Medicare HMO. But, people with disabilities do have the right to buy Medigap if they live in one of the 18 states that allow them to buy Medigap insurance to supplement their Original Medicare coverage. The full text of the report, "Problems with Medigap Guaranteed Issue Laws," can be found on Medicare Rights Center's Website, www.medicarerights.org.
To learn more about your rights in Medicare, call your State Health Insurance and Assistance Program, or SHIP. The number is listed in the back of Medicare & You, the government booklet which was sent to everyone on Medicare. You can also get a copy by calling 1-800-MEDICARE. Or call your Senator or Congressperson. They should have staff who can help you.
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