McClerkin Insurance Services, in Lodi, California began operation in 1973. Since then, our name has become synonymous with the Senior Markets. To serve the Medicare Supplement Insurance and Medicare Advantage needs of the fastest growing segment of the U.S. population, we are always working for you, our clients. Our goal at McClerkin Insurance Services is to provide insurance coverage to all ages, and to locate the best companies and rates for our clients.

In 1973 Charles McClerkin started McClerkin Insurance Services and in 1992, Charles formed a partnership with Rick Iverson. Over the years, they have become leaders in their field, serving thousands and keeping their clients up to date on the ever-changing Insurance markets. The business continues to grow by always updating our clients on whats new in the ever-changing Health Insurance/Medicare Supplement industry in California. We do our best to supply our clients with the information they need to make an educated decision on their Health Insurance needs.
We are based out of Lodi, CA and provide Insurance Services throughout the San Joaquin Valley with the majority of our client base in Stockon, CA and Lodi.

As being one of the top independent agencies for Life and Health Insurance in California, we provide our clients a local office and licensed agents to help our clients make the right decisions regarding their Medicare Supplements and Under 65 Individual Health Insurance. We would be more than happy to find you the perfect plan for you today! Please let us know how we can assist you!

Consumers Information Guide on Health Insurance:

Introduction to Health Insurance
Illness or non-work related injury can be financially devastating, especially when considering the rising cost of health care over the past 20 years. Health insurance can help protect you from large out-of-pocket health care expenses that can accumulate during an acute or chronic illness. If you have a job, your employer may provide group comprehensive major medical coverage. You can also purchase individual comprehensive major medical coverage privately or through an insurance agent or broker who is licensed by the State of California to sell health insurance products.

Types of Health Insurance and How Health Insurance Works
Health insurance pays for expenses incurred for diagnosis and treatment of covered medical conditions. There are many different types of health insurance plans available in California. If you have a choice, it is important to choose the plan that best fits your specific needs, budget, and lifestyle. Also, make sure that you are aware of the state or federal agency that regulates the type of health care plan you purchase in case you experience questions or problems. Each of the different ways of receiving health care services has advantages and disadvantages. It is in your best interest to become familiar with the different types of health insurance, so you know what may be available to you.

• Indemnity Policies (Traditional Fee-for-Service Insurance) Consumers Guide to Health Insurance
• Preferred Provider Organizations (PPOs)
• Health Maintenance Organizations (HMOs or Managed Care)
• Self-Insured Health Plans (Single Employer Self- Insured Plans)
• Multiple Employer Welfare Arrangements (MEWAs)

One Of the most popular Health Plan types is the PPO (Preferred Provider Organization):

Preferred Provider Organizations (PPOs). A Preferred Provider Organization (PPO) provides a list of contracted “preferred” providers from which to choose. You receive the highest monetary benefit when you limit your health care services to those providers on the list. Consumers Guide to Health Insurance If you go to a doctor or hospital that is not on the preferred provider list (referred to as going “out-of-network”), then the plan covers a smaller percentage of your health care expenses or may cover none of your health care expenses based on the contract wording of the plan. Always check with your PPO or consult your list of preferred providers before you seek health care services to make certain your physician or hospital is a contracting provider (part of the network). Make sure that your doctor refers you to health care providers within your PPO network, if applicable. PPOs in California may be regulated by either the CDI or the Department of Managed Health Care (DMHC) depending on whether the contract or policy was issued by a licensed insurance company or a managed care company. The California Department of Managed Health Care regulates HMOs and plans issued by Blue Cross of California and Blue Shield of California. The CDI regulates policies issued by insurance companies such as BC Life and Health Insurance Company and Blue Shield of California Life and Health Insurance Company. If you are confused about whom to call regarding a PPO problem or concern, then consult your plan documents for regulatory information.

Important Points to Remember About Preferred Provider Organizations:

• You receive the highest monetary benefit when staying within the PPO network.
• You may have the option to go outside the PPO network at a higher monetary cost to you.
• Check to make sure your doctor or any specialist referred to you is part of the PPO network before utilizing covered services. State of California Department of Insurance
• PPOs can be regulated by either the CDI or the DMHC depending on if the company that issued the contract is a licensed insurance company, or a managed care plan. PPOs can also be self-funded. If you need assistance and you are not sure which agency regulates your plan you can contact the CDI or the DMHC for clarification.

The other popular type of Health Insurance Plan in California is an HMO (Health Maintenance Organization):

Health Maintenance Organizations (HMOs or Managed Care). Membership in a Health Maintenance Organization (HMO) requires plan members to obtain their health care services from doctors and hospitals affiliated with the HMO. It is common practice in HMOs for the plan member to choose a primary care physician who treats and directs health care decisions and who coordinates referrals to specialties within the HMO network. The doctors and hospital personnel may be employees of the HMO or contracted providers. Since HMOs operate in restricted geographic regions, this may limit coverage for plan members if medical treatment is obtained outside the HMO network or coverage area. California HMOs are required to cover medically necessary emergency services even when outside of their coverage area. The intent of managed care products is to create less costly delivery of health care services while maintaining quality health care. HMOs offer access to a comprehensive package of covered health care services in return for a prepaid monthly amount (premium). Most HMOs charge a small co-payment depending upon the type of service provided. All HMOs in California are regulated by the Department of Managed Health Care (DMHC). If you have a complaint with an HMO, contact the member services department of your HMO. HMOs are required to have an internal complaint/grievance process in place. If you file a grievance and it has not been resolved within 30 days or there is some question as to the HMOs decision, then you may contact Consumers Guide to Health Insurance the DMHC for assistance. Please see contact information listed for the DMHC in the “Resources” section of this brochure.

Important Points to Remember About Health Maintenance Organizations:

• You must obtain health care services from HMO providers, except in certain emergency situations.
• Your choice of primary care physician is important because he/she directs your care. Also, your primary care physician often coordinates referrals to specialties within the HMO.
• Your options may be limited by the geographic restrictions of the HMO network.
• You may be charged a small co-payment each time you utilize an HMO covered service.
• You can seek assistance from the DMHC on all HMO and managed care questions

More Information on Health Insurance in California

Supplemental Health Insurance Policies
Most supplemental health insurance policies are designed to pay in addition to your comprehensive major medical coverage. These supplemental policies should not be used as a substitute or replacement for a traditional health insurance policy or a health plan. Supplemental health insurance can pay limited benefits such as a daily dollar amount if you are hospitalized (hospital income policy) or a lump sum dollar amount if you are diagnosed with a specified or named disease, such as cancer. This type of supplemental policy can also be structured to pay expenses incurred in the treatment of the specified disease. Sometimes this insurance provides payment over and above your medical expenses. It is important that you understand the limitations and exclusions of supplemental health insurance policies and how the policies coordinate benefits, so that you can make the best decision based on your needs and your budget.

How Do I Get Health Coverage?

Health insurance is generally available through groups and to individuals. Premiums—the regular fees that you pay for health insurance coverage—are generally lower for group coverage. When you receive group insurance at work, the premium usually is paid through your employer. Group insurance is typically offered through employers, although unions, professional associations, and other organizations also offer it. As an employee benefit, group health insurance has many advantages. Much—although not all—of the cost may be borne by the employer. Premium costs are frequently lower because economies of scale in large groups make administration less expensive. With group insurance, if you enroll when you first become eligible for coverage, you generally will not be asked for evidence that you are insurable. (Enrollment usually occurs when you first take a job, and/or during a specified period each year, which is called open enrollment.) Some employers offer employees a choice of fee-for-service and managed care plans. In addition, some group plans offer dental insurance as well as medical. Individual insurance is a good option if you work for a small company that does not offer health insurance or if you are self-employed. Buying individual insurance allows you to tailor a plan to fit your needs from the insurance company of your choice. It requires careful shopping, because coverage and costs vary from company to company. In evaluating policies, consider what medical services are covered, what benefits are paid, and how much you must pay in deductibles and coinsurance. You may keep premiums down by accepting a higher deductible.

How Is Health Insurance Marketed in California?

Health insurance coverage is sold to consumers through individual policies or group policies. Individual health insurance coverage should be pursued when your employer does not offer health insurance as a benefit of employment, when you cannot be named as the dependent on another person’s insurance policy, or when you are not a member of a professional or trade association that offers group coverage. Many consumers are self-employed, contract employees, or work for small employers and do not have access to a group policy secured by an employer. Individual coverage can be obtained by contacting a licensed health insurance agent or broker. You will need to complete an application that includes your medical history, which will be reviewed by a medical underwriter at the health insurance company. If you meet the underwriting qualifications and are issued a policy, the company may not cover preexisting conditions up to one year after the effective date of the policy. However, if you have been previously insured under an individual or group policy without a break in coverage of more than 62 days, your new insurance company must apply the prior creditable coverage (refer to the “Health Insurance Terms” on page 25) towards any waiting period for preexisting conditions. Individual health insurance companies may reject your application based on your medical history. Group health insurance offers certain advantages over individual health insurance policies. The waiting period for preexisting conditions is six months for policies covering 3 or more persons, not one year as with individual policies. Also, if you have been previously insured under a group policy without a break in coverage of more than 180 days, your new insurance company must apply the prior creditable coverage toward the six-month waiting period for preexisting conditions. It should be noted that, upon application for coverage, large employer groups (more than 50 employees) may be underwritten, as a group, by insurance companies. However, after coverage becomes effective, newly hired employees entering the group health plan must be afforded coverage without going through the medical underwriting process. Association group health insurance, like individual health insurance, is subject to medical underwriting. You can be denied coverage based on your medical history. Medical underwriting rules for small group health insurance (2-50 employees) differs from large group and individual health insurance policies. Regardless of any preexisting condition, you must be offered coverage under a small group policy on a guaranteed issue basis. However, the small group insurance company can utilize the six-month waiting period for preexisting conditions. Of course, if you have prior creditable coverage it must be applied to decrease or eliminate the waiting period.

Important Points to Remember About Individual and Group Health Insurance Coverage:

• Health insurance coverage is sold to consumers under either individual or group policies.
• Individual and Association group policies are subject to medical underwriting, on an individual basis.
• Qualifying creditable coverage must be applied towards the year waiting period for preexisting conditions in individual policies and towards the six-month waiting period for preexisting conditions in group policies.
• Small group policies require that coverage be offered on a guaranteed issue basis regardless of any preexisting condition.

Supplemental Health Insurance Policies

Most supplemental health insurance policies are designed to pay in addition to your comprehensive major medical coverage. These supplemental policies should not be used as a substitute or replacement for a traditional health insurance policy or a health plan. Supplemental health insurance can pay limited benefits such as a daily dollar amount if you are hospitalized (hospital income policy) or a lump sum dollar amount if you are diagnosed with a specified or named disease, such as cancer. This type of supplemental policy can also be structured to pay expenses incurred in the treatment of the specified disease. Sometimes this insurance provides payment over and above your medical expenses. It is important that you understand the limitations and exclusions of supplemental health insurance policies and how the policies coordinate benefits, so that you can make the best decision based on your needs and your budget.

Health Plan Checklist Form

Use this Interactive Checklist Form when comparing plans. Are things that are important to you covered? If covered, what are the limitations on the coverage? How much is paid for by the insurance and how much do I have to pay out-of-pocket?

List of Health and Life Insurance Providers in California that McClerkin Insurance Services Currently Offers

Choosing a Medigap. Plan Questions To Ask.

Before purchasing a Medigap policy, get as much information as you can. If you are considering a Medigap policy, here are some questions you should ask.

• Do you need a Medigap policy, or are you eligible for a program for people with low-incomes?
• Do you have a Medicare Advantage plan (such as an HMO, PPO, PFFS, or MSA)? If so, you can't use a Medigap policy while you are in a Medicare Advantage plan, and it would be illegal for an agent to sell you one unless you plan to leave the Medicare Advantage plan.
• Do you want to be able to see any doctor or specialist who accepts Medicare, or are you willing to be restricted to a ‘network' of doctors, hospitals and other providers in some Medicare Advantage plans or in a Medicare Select plan?
• How much can you afford to spend on monthly premiums for Medigap and how does that compare to premiums and co-payments you might have in an HMO, PPO, PFFS, MSA or Medicare Select plan?
• How might your costs change in the future?
• What is the premium? Remember, all policies with the same letter — for example all plan A or J policies — cover identical benefits, no matter which insurance company is offering them. This makes it easy for you to compare premiums for the same lettered policy, quickly and easily.
• What benefits do you need? Remember, if you can pay some predictable costs yourself — such as the Part B deductible — it may save you premium dollars to buy a plan that doesn't include that benefit
• Does the insurer file claims electronically? Insurers that accept electronic claims directly from Medicare make it easier for you and your doctors to receive payment. Doctors who do not accept assignment are not required to file your Medigap claims for you. Electronic claims will save you time and money
• Is there a waiting period to cover pre-existing conditions? If so, how long is it? And do you have any previous coverage that applies toward the waiting period?

Health Insurance Termss

Assignment of Benefits — Your signed authorization to your doctor or hospital (medical provider) assigning payment to be made directly to them for your medical treatment.

Actuary - a mathematician in the insurance field. Responsible for calculating premiums, developing plans and defining underwriting risk.

Agent - a licensed individual who represents several insurance companies and sells their products

Business Day — Every day an insurance company is open for business, which excludes Saturday, Sunday, and state and federal holidays.

Benefit - reimbursement for covered medical expenses as specified by the plan.

Brand-name drug - prescription drug which is marketed with a specific brand name by the company that manufactures it. May cost insured individuals a higher co-pay than generic drugs on some health plans. (see "generic.")

Broker - a licensed insurance professional who obtains multiple quotes and plan information in the interest of his client.

Carrier - insurance company or HMO insuring the health plan.

Certificate Booklet - the plan agreement. A printed description of the benefits and coverage provisions intended to explain the contractual arrangement between the carrier and the insured group or individual. May also be referred to as a policy booklet

Claim - a formal request made by an insured person for the benefits provided by a policy.

COBRA (Consolidated Omnibus Budget Reconciliation Act) - Federal legislation that requires group health plans to provide health plan members the opportunity to purchase continued coverage in the event their insurance is terminated. Applies only to employer groups with 20 or more employees. Learn more about COBRA at the Department of Labor's website. - Please note this may take a few minutes to appear.

Co-insurance - the percentage of covered expenses an insured individual shares with the carrier. (i.e., for an 80/20 plan, the health plan member's co-insurance is 20%.) If applicable, co-insurance applies after the insured pays the deductible and is only required up to the plan's stop loss amount. (see "stop loss.")

Co-pay/co-payment - the amount an insured individual must pay toward the cost of a particular benefit. For example, a plan might require a $10 co-pay for each doctor's office visit.

Credit for prior coverage - any pre-existing condition waiting period met under an employer's prior (qualifying) coverage will be credited to the current plan, if any interruption of coverage between the new and prior plans meets state guidelines.

Calendar Day — Every day of the calendar month, which includes Saturday, Sunday, and state and federal holidays. However, if any action tied to a time frame in an insurance policy or CDI regulation or code falls on a Saturday, Sunday, or state or federal holiday; then the action is postponed to the next calendar day that does not fall on a Saturday, Sunday, or state or federal holiday.

Certificate of Coverage — A document issued to a member of a group health insurance plan showing evidence of participation in the insurance.

Certificate of Creditable Coverage — A written statement from your prior insurance company or health plan documenting the length of time you were covered.

Creditable Coverage or Prior Qualifying Coverage — The number of months you had health insurance in place before your current or new policy became effective. Creditable coverage must be counted towards any preexisting condition exclusion in either an individual or group policy.

Claim — A notification to your insurance company that payment is due under the policy provisions. Consumers Guide to Health Insurance 25

Co-payment — The portion of charges you pay to your provider for covered health care services in addition to any deductible.

Coverage — The scope of protection provided by an insurance contract which includes any of the listed benefits in an insurance policy.

Denial — An insurance company decision to withhold a claim payment or preauthorization. A denial may be made because the medical service is not covered, not medically necessary, or experimental or investigational.

Deductible — A fixed amount which is deducted from eligible expenses before benefits from the insurance company are payable.

Dependents - usually the spouse and unmarried children (adopted, step or natural) of an employee.

Effective date - the date requested by an employer for insurance coverage to begin.

ERISA — Stands for the Employee Retirement Income Security Act (1974). Administered by the U.S. Department of Labor, Employee Benefits Security Administration. ERISA regulates employer sponsored pension and insurance plans (self-insured plans) for employees.

Exclusions and/or Limitations — Conditions or circumstances spelled out in an insurance policy which limit or exclude coverage benefits. It is important to read all exclusion, limitation, and reduction clauses in your health insurance policy or certificate of coverage to determine which expenses are not covered.

Experimental and/or Investigational Medical Services — A drug, device, procedure, treatment plan, or other therapy which is currently not within the accepted standards of medical care.

Grace Period — A specified period immediately following the premium due date during which a payment can be made to continue a policy in force without interruption. This applies only to Life and Health policies. Check your policy to be sure that a grace period is offered and how many days, if any, are allowed.

Guaranteed Issue — A health insurance policy that must be issued regardless of any preexisting medical condition. The present and past physical condition of a health insurance applicant is not considered as a part of underwriting. No physical examination is required. The insurance company cannot decline coverage to an applicant of a guaranteed issue policy based on medical history.

HIPAA - Health Insurance Portability and Accountability Act of 1996, P.L. 104-91. This law relates to underwriting, pre-existing limitations, guaranteed renewal, COBRA and certification requirements in the event someone terminates from the plan. The new law, commonly known as the "Kennedy-Kassebaum Bill," establishes new requirements for self-funded, fully-insured group plans (including church plans) and Individual Health policies. The purpose of the law is to:

• Improve portability and continuity of health insurance coverage in the group and individual markets
• To combat waste, fraud and abuse in health insurance and health care delivery
• To promote the use of medical savings accounts
• To improve access to long-term care services and coverage
• To simplify the administration of health insurance

Independent Medical Review — A process where expert medical professionals who have no relationship to your health insurance company or health plan review specific medical decisions made by the insurance company. California law provides for an Independent Medical Review Program, which is administered by the CDI and the DMHC depending upon what type of coverage you have (indemnity or HMO).

Medically Necessary — A drug, device, procedure, treatment plan, or other therapy that is covered under your health insurance policy and that your doctor, hospital, or provider has determined essential for your medical well-being, specific illness, or underlying condition.

Network - a group of doctors, hospitals and other providers contracted to provide services to insured individuals for less than their usual fees. Provider networks can cover large geographic markets and/or a wide range of health care services. If a health plan uses a preferred provider network, insured individuals typically pay less for using a network provider.

Out-of-network - describes a provider or health care facility which is not part of a health plan's network. Insured individuals usually pay more when using an out-of-network provider, if the plan uses a network.

Out-of-pocket maximum - the total of an insured individual's co-insurance payments and co-payments

Policy — The written contract between an individual or group policyholder and an insurance company. The policy outlines the duties, obligations, and responsibilities of both the policyholder and the insurance company. A policy may include any application, endorsement, certificate, or any other document that can describe, limit, or exclude coverage benefits under the policy.

Preexisting Condition — Any illness or health condition for which you have received medical advice or treatment during the six months prior to obtaining health insurance. Group healthcare policies of 3 or more persons cover preexisting conditions after you have been insured for 6 months, and individual policies cover preexisting conditions after you have been insured for 1 year. Creditable coverage must be counted towards any preexisting condition exclusion in either an individual or group policy.

Usual, Reasonable, and Customary — The amount that your insurance company determines is the normal payment range for a specific medical procedure performed within a given geographic area. If the charges you submit to your health insurance company are higher than what is considered normal for the covered health care services, then your health insurance company may not allow the full amount charged to you.

Information on Medicare Supplements Insurance in California

Do I Need Medicare Supplement Insurance?
Medicare Supplement policies help to pay the health care costs only if you have the Original Medicare Plan and have both Medicare Part A and Part B. Often people need medical services that Medicare does not cover. Some of these services may include medical emergencies incurred during foreign travel, custodial care in your home and even certain preventive care not covered by Medicare. Whether you need a Medicare Supplement policy is a decision only you can make.

You do not need to buy a Medicare Supplement policy if you are enrolled in a Medicare Advantage Plan. These plans include:

• Medicare Health Maintenance Organizations (HMOs)
• Private Fee-for-Service Plans
• Preferred Provider Organizations (PPO)
• Medicare Special Needs Plans

What Is Medicare?
Medicare is a federally funded insurance program for eligible participants 65 or over, for eligible participants of any age who have been qualified as disabled, and for persons with End-Stage Renal Disease (ESRD). There are two parts of Medicare: Part A (Hospital Insurance) and Part B (Medical Insurance). Under Medicare Part A, the Federal government will pay a portion of your expenses for inpatient hospitalization, skilled nursing facility care, hospice care services, home health care services, and for medically necessary blood transfusions. Medicare Part B covers your doctors’ services, outpatient hospital care, and other medical services. To better understand your Medicare benefits and how to use them, read the Medicare & You handbook, which is available from your local Social Security office or by calling Medicare at 800-633-4227. You may also refer to the Medicare Web site at www.medicare.gov.

Standard Medicare Supplement Benefits The basic benefits (also known as the “core benefits” or Plan A) are the minimum coverage you may buy. Plan A contains only the 3 core benefits listed below. Every other plan contains these three benefits as the “core” and then adds one or more additional benefits. Although Plan A is one of the least expensive policies, it may not be a good choice for low-income individuals who may not be able to afford the Medicare Part A hospital deductible when they are hospitalized.

(1) Hospitalization: Medicare Part A pays only a portion of the daily costs for hospitalizations. You must pay the coinsurance amounts for those days. This Medicare Supplement benefit pays the Part A coinsurance amount after the 60th day and an additional cost of 365 lifetime days.

(2) Blood: Medicare pays for all blood that is medically necessary except for the first three pints in each calendar year. This Medicare Supplement benefit pays for the first three pints of blood not paid for by Medicare, or equivalent quantities of packed red blood cells, as defined under federal regulations.

(3) Medical Expenses: Generally Medicare Part B pays for 80% of a predetermined amount (called the “Medicare approved” amount) for each procedure, supply, or service billed by your doctor or other provider that is not a hospital. This Medicare Supplement benefit pays the coinsurance (generally 20% of the “Medicare approved” amount) under Medicare Part B. There are eight additional benefits that are combined with the basic benefits in various ways to make up the eleven remaining Plans called Plan B through

2006 Guide to Medicare Supplement Insurance

1. The Part A Deductible: The Medicare Part A deductible is the expense for which you are obligated to pay when you are admitted to a hospital as an inpatient. Medicare pays eligible benefits above that amount. (The Medicare Part A deductible amount may change yearly, so check the current Medicare & You handbook.) This Medicare Supplement benefit reimburses you the deductible amount, no matter what the amount may be. This benefit is included in Plans B through L.

2. Skilled Nursing Coinsurance: Medicare Part A pays for the first 20 days of care in a skilled nursing facility following hospitalization, but requires you to pay a coinsurance beginning on the 21st day through the 100th day. This Medicare Supplement benefit pays the coinsurance amount beginning on the 21st day. This benefit is included in Plans C through L.

3. Part B Deductible: The Medicare Part B deductible is the amount you must pay each year for medical expenses (such as doctor fees) before Medicare begins paying. (The Part B deductible amount may change per year). This Medicare Supplement benefit reimburses you the deductible amount. This benefit is included in Plan C, Plan F, and Plan J.

4. Part B Excess Charges: Medicare Part B pays 80% of a predetermined amount (called the “Medicare approved” amount) for each procedure performed by your doctor or other medical care provider. If your doctor accepts Medicare “assignment,” the provider may only bill you for the difference between the amount paid by Medicare and the amount approved by Medicare. If your doctors do not accept Medicare assignment, they may bill you for the difference between the amount paid by Medicare and the amount they can legally charge you (called the “limiting charge.”) If you have a Medicare Supplement Policy with the following: Part B Excess Charges (100%) benefit, the policy will pay the full amount billed by your doctors or other providers who do not take Medicare assignment subject to the limiting charge. This benefit is included in Plan F, Plan I, and Plan J. The Part B Excess Charge (80%) benefit, the policy will pay 80% of the amount you are billed by your doctors or other providers. This benefit is only in Plan G. Theoretically, you should save money on premium costs if you select the 80% benefit rather than the 100% benefit. Remember that this coinsurance amount is paid by the Medical Expenses part of the Basic Benefits that are part of every Medicare Supplement insurance policy. Policies for A through J plans must pay 50% coinsurance for outpatient mental health treatment services. This percentage is different for Plans K and L.

5. Foreign Travel Emergency: The original Medicare plan does not pay for medical care outside of the United States, but some Medicare managed care plans, private fee-for-service plans, and some Medicare Supplement plans do. This Medicare Supplement benefit will pay 80% of your expenses for most emergency medical care in a foreign country during the first 60 days of a trip abroad after you pay a $250 deductible. There is a lifetime maximum benefit, so check your current handbook for the dollar amount. This benefit is in Plan C through Plan J. Check your insurance coverage before you travel.

6. At-Home Recovery: Under the home health care benefit, Medicare pays for intermittent visits by a nurse or other skilled care provider in your home during recovery from an acute illness. Medicare does not pay for custodial care in your home such as homemaker services, (i.e. help with bathing, dressing, laundry, or shopping). This Medicare Supplement benefit pays per home visit. Check your handbook for current benefits for medically necessary custodial care while you are recovering from an illness, injury, or surgery. An insurance company may limit the number of visits to equal the number of Medicare home health care visits. This benefit is in Plan D, Plan G, Plan I, and Plan J.

7. Basic Prescription Drug Benefit: Until January 1, 2006 this benefit had an annual limit of $1,250. The extended prescription drug benefit has an annual limit of $3,000. Medicare does not generally pay for outpatient prescription drugs. Each of these Medicare Supplement benefits pays 50% of the cost for outpatient prescription drugs to a maximum of $1,250 or $3,000 per year depending on the plan you purchased. The basic drug benefit is in Plan H and Plan I. The extended drug benefit is in Plan J only. Starting January 1, 2006 plans H, I, and J cannot be sold with the prescription drug benefit.

8. Preventive Care: Medicare pays for some testing for diagnostic purposes. This Medicare Supplement benefit pays up to $120 per year for certain tests done for screening purposes, routine physical exams, patient education, and other medically appropriate tests or preventive measures not covered by Medicare. This benefit is included in Plan E and Plan J. Plans K and L cover 100% of the coinsurance for Part B Preventative Services.

Open Enrollment for Purchasing a Medicare Supplement Policy If you are 65 years of age or older, you may buy any Medicare Supplement insurance policy, regardless of the condition of your health, during the “open enrollment” period. The open enrollment period lasts for six months after you first become eligible for Medicare Part B. Effective September 27, 2000, Medicare eligible disabled individuals under the age of 65 who do not have End-Stage Renal Disease have the right to a six month open enrollment period beginning with their entitlement to Medicare Part B to purchase selected standardized Plans A, B, C, F or Plan H, I, or J at the discretion of the insured and commencing January 1, 2007 plans K and L if currently available and at the discretion of the insurer. When a Medicare beneficiary under the age of 65 turns 65, they will have a second six month open enrollment period to purchase any of the standardized Plans A through L.

Once you have purchased a Medicare Supplement Policy, you will have an annual open enrollment commencing with your birthday and ending 30 days later. The policy must be of equal or lesser value in coverage to your existing plan. “Open Enrollment” means that no insurer may deny you the right to purchase any of the ten standard plans because of any preexisting medical condition, claims experience, or receipt of medical care. If you have a preexisting medical condition (a condition for which you received medical advice or treatment during the six months before your insurance begins), open enrollment is an important advantage to you.

NOTE: Although you are guaranteed the right to purchase any Medicare Supplement insurance product during open enrollment, insurers are permitted to impose a waiting period of up to six months before paying you benefits related to any preexisting condition, unless you have had prior creditable coverage. If an applicant has had a continuous period of creditable coverage of at least six months, the issuer cannot exclude benefits based on a preexisting condition. “Continuous period of creditable coverage” means the period during which an individual was covered by creditable coverage within the past 63 days from the end of their prior coverage. “Creditable coverage” means, with respect to an individual, that they were covered under any individual or group contract which provided medical, hospital and surgical coverage that was not designed to supplement other plans. If you have a preexisting medical condition, ask your agent to check the outline of coverage on the policy you are considering buying for the length of the waiting period as some policies have shorter waiting periods or no waiting period.


Prescription Drug Coverage (Medicare Part D) As of January 1, 2006 all Medicare beneficiaries are eligible to purchase prescription drug coverage regardless of age or pre-existing medical conditions under Medicare Part D. In the past, Medicare Supplement standardized Plans H, I, and J offered limited prescription drug benefits. However, H, I, and J Plans sold after December 31, 2005 can no longer offer this coverage. If you purchased one of these plans before January 1, 2006 you may keep it, however, if you decide to keep your existing plan you may be penalized if you decide to purchase a prescription drug plan under Medicare Part D after May 15, 2006. If you decide to purchase a Medicare Prescription Drug Plan, you cannot have a Medicare Supplement Policy with a prescription drug benefit. The Coverage under Part D for 2006 requires you to pay a $250 deductible before benefits begin. Once you have paid your $250 deductible Medicare will pay 75% of your drug cost and you will pay 25% until your total drug costs reach $2,250. From $2,250 through $5,100 there is no coverage and you are responsible for the cost of your drugs (this is referred to as a donut hole). Once your drug costs go beyond $5,100 Medicare will pay 95% of your drug cost and you are responsible for 5% of the cost. There is no annual limit. Under Medicare Part D you will have to purchase prescription drug coverage from an insurance company or other private company approved by Medicare to sell drug plans. It is important to make sure the prescription drug plan you are considering is approved by Medicare before you purchase it. You can do this by contacting Medicare at 1-800-633-4227 or by visiting their Web Site at: www.medicare.gov . Medicare drug plans cover generic and brand-name drugs. However, plans can have rules about what drugs are covered in different drug categories. If you are taking certain brand-name drugs and wish to continue taking the same brand, you will need to first check the formularies covered by the different plans. You can do this by contacting Medicare at 1-800-633-4227 or by visiting their Web Site at: www.medicare.gov .

You can find more information regarding Medicare Part D and Prescription Drug Plan in “Medicare & You” handbook obtained from Medicare.