aarp® medicare supplement insurance plans, insured by … · greetings! like many on medicare, you...

Enrollment Kit

AARP® Medicare Supplement Insurance Plans, insured by UnitedHealthcare Insurance Company

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Enrollment is for January 1, 2020 – December 1, 2020 plan effective dates.Rates are for January 1, 2020 - December 1, 2020 plan effective dates.

Florida

Greetings!

Like many on Medicare, you may be looking for additional benefi ts to help pay for some of the out-of-pocket medical expenses not covered. That’s why you may want to consider an AARP® Medicare Supplement Insurance Plan, insured by UnitedHealthcare Insurance Company (UnitedHealthcare). You’ll have:

LA27089FL Important disclosures on back

Marie A. PeroLicensed AgentUnitedHealthcare Insurance Company

P.S. Did you know that UnitedHealthcare’s mission is to help people live healthier lives and make the health system work better for everyone? We’re proud to be endorsed by AARP, whose mission is to empower people to choose how they live as they age. Join AARP online, by phone, or use the enclosed form.

Choice. Freedom in the health system is important – that’s why Medicare supplement insurance may work for you. Like any Medicare supplement plan, you will have the ability to see any provider who accepts Medicare patients. In fact, 95% of our plan holders surveyed nationwide are satisfi ed with that ability.1

Stability. With more than 40 years of experience and an “A” rating by A.M. Best,2 UnitedHealthcare covers more people with Medicare supplement plans nationwide than any other individual insurance carrier.3

Service. UnitedHealthcare is committed to service that works, as our member satisfaction surveys illustrate. 96% of surveyed members nationwide are satisfi ed with their AARP Medicare Supplement Insurance Plan1 – and 9 out of 10 of those surveyed nationwide would recommend their plans to a friend or family member.1

With this enrollment kit, you may review benefi ts and rates for each available plan. You’ll also learn about discounts and our unique value-added services4 that may be available to you.

Your licensed insurance agent/producer will review the enclosed information with you, and answer your questions.

All of us at UnitedHealthcare would be honored to serve your health insurance needs – now, and for years to come.

Warm regards,

Meet the Medicare supplement insurance plans built to support you at every step.

Important Notice: You are entitled to receive a “Guide to Health Insurance for People with Medicare.” This guide is free and briefl y describes the Medicare program and the health insurance available to those on Medicare. If you are interested in receiving this free guide, please call 1-800-272-2146, toll-free, or fi nd it on the web at www.medsupeducation.com.

1 From a report prepared for UnitedHealthcare Insurance Company by GfK Custom Research NA, “Medicare Supplement Plan Satisfaction Posted Questionnaire,” March 2017 www.uhcmedsupstats.com or call 1-800-523-5800 to request a copy of the full report.

2 From A.M. Best Company, Inc. data retrieved in March 2019 from ambest.com. In 2019, UnitedHealthcare Insurance Company is rated “A” by A.M. Best, an independent organization that evaluates insurance company fi nancial performance. The rating only refers to the overall fi nancial status of the company and is not a recommendation of the specifi c policy provisions, rates or practices of the insurance company. www.ambest.com.

3 From a report prepared for UnitedHealthcare Insurance Company by Mark Farrah Associates “December 2017 Medigap Enrollment & Market Share,” May 2018, www.uhcmedsupstats.com or call 1-800-523-5800 to request a copy of the full report.

4 These are additional insured member services, apart from the AARP Medicare Supplement Plan benefi ts, are not insurance programs, are subject to geographic availability and may be discontinued at any time.

AARP endorses the AARP Medicare Supplement Insurance Plans, insured by UnitedHealthcare Insurance Company. UnitedHealthcare Insurance Company pays royalty fees to AARP for the use of its intellectual property. These fees are used for the general purposes of AARP. AARP and its affi liates are not insurers. AARP does not employ or endorse agents, brokers or producers.

You must be an AARP member to enroll in an AARP Medicare Supplement Plan.

Insured by UnitedHealthcare Insurance Company, Horsham, PA. Policy form No. GRP 79171 GPS-1 (G-36000-4).

Plans may be available to persons under age 65 who are eligible for Medicare by reason of disability or End-Stage Renal Disease. Not connected with or endorsed by the U.S. Government or the federal Medicare program.This is a solicitation of insurance. A licensed insurance agent/producer may contact you. See the enclosed materials for complete information including benefi ts, costs, eligibility requirements, exclusions and limitations.

Questions? Contact your licensed insurance agent/producer or call UnitedHealthcare toll-free: 1-866-387-7550 Monday – Friday, 7 a.m. to 11 p.m. and Saturday 9 a.m. to 5 p.m., Eastern Time.

Due to new Medicare rules, you may only apply for a plan that covers the Part B deductible for a 1/1/2020 or later plan effective date if:

IMPORTANT MESSAGE

For 1/1/2020 new plan effective dates and later

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OR

?

You will be age 65 PRIOR

to 1/1/2020

You will be age 65ON or AFTER

1/1/2020

AND

have a Medicare Part A Effective Date PRIOR to 1/1/2020

Questions?

Contact your licensed insurance agent/producer.

Please note, if you are age 50-64 and on Medicare due to disability, certain plans may be available to you in some states. Please talk to your licensed agent/producer for more information.

Exclusive Services & Discounts

Exclusive Services & D

iscounts

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Value-Added Services

AARP Member Benefi ts

Discounts

AARP Medicare Supplement Insurance Plans, insured by UnitedHealthcare Insurance Company

AARP endorses the AARP Medicare Supplement Insurance Plans, insured by UnitedHealthcare Insurance Company. UnitedHealthcare Insurance Company pays royalty fees to AARP for the use of its intellectual property. These fees are used for the general purposes of AARP. AARP and its affiliates are not insurers. AARP does not employ or endorse agents, brokers or producers. You must be an AARP member to enroll in an AARP Medicare Supplement Insurance Plan. Insured by UnitedHealthcare Insurance Company, Horsham, PA (UnitedHealthcare Insurance Company of New York, Islandia, NY for New York residents). Policy form No. GRP 79171 GPS-1 (G-36000-4). In some states, plans may be available to persons under age 65 who are eligible for Medicare by reason of disability or End-Stage Renal Disease.Not connected with or endorsed by the U.S. Government or the federal Medicare program.This is a solicitation of insurance. A licensed insurance agent/producer may contact you.See enclosed materials for complete information including benefits, costs, eligibility requirements, exclusions and limitations.SA25707ST

At Your Best by UnitedHealthcare™ — available at no additional cost to you starting January 1, 2020 — gives you more than you expected as an insured member of an AARP® Medicare Supplement Insurance Plan, insured by UnitedHealthcare Insurance Company (UnitedHealthcare). The offering includes health and wellness resources, discount programs and support services to help you live better.

With the newly expanded services, insured members will have access to an extensive network of participating gyms and fitness locations^ at no additional cost, a hearing program, 24/7 Nurse line, and more.

Call UnitedHealthcare now to request information about AARP Medicare Supplement Insurance Plans and to learn more about At Your Best by UnitedHealthcare.

atyourbestbyuhc.com

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^Availability of fitness program may vary by area. Fitness program network only includes participating facilities and locations.These are additional insured member services apart from the AARP Medicare Supplement Plan benefits, are not insurance programs, are subject to geographical availability, and may be discontinued at any time.

Renew Active™ by UnitedHealthcare AARP®

Staying Sharp

Access to an extensive network of participating gyms and fitness locations at no additional cost, and online brain health tools.

Online brain health program that helps support a healthy brain lifestyle. For insured members of the AARP Medicare Supplement Plan, AARP Staying Sharp includes: a brain health assessment, articles, brain exercises, activities, recipes, and brain games.

Hearing Care Program by HearUSA

A discount on hearing aids and access to screenings by certified HearUSA hearing care providers. The Hearing Care Program by HearUSA includes:• The AARP member rate plus an additional $100 discount on hearing devices in the top 5 tiers

of technology and features, ranging from standard to premium.• Extended warranties on many of HearUSA’s digital hearing aids.• Your very own hearing health support team.

AARP® Vision Discounts provided by EyeMed:

Save on eyewear purchases and routine eye exams. AARP Vision Discounts provided by EyeMed includes: • At LensCrafters, take an additional $50 off the AARP® Vision Discount provided by EyeMed or

best in-store offer on no-line progressive lenses with frame purchase**.• $50 eye exams at participant providers*.

24/7 Nurse line A registered nurse is available to discuss your concerns and answer questions over the phone anytime, day or night. Spanish is available, as well as translation assistance in 140+ languages.

• Nurses are also available to help guide you to community resources. These resources may help provide assistance on transportation services, understanding medication cost options, and availability of meal delivery services.

Wellness coaching

Trained wellness coaches are available over the phone to provide personalized programs and support that may help you reach your specific wellness goals.

IntroducingAt Your Best by UnitedHealthcare™

WELLNESS SUPPORTDISCOUNTS

None of these services should be used for emergency or urgent care needs. In an emergency, call 911 or go to the nearest emergency room. Note that certain services are provided by Affiliates of UnitedHealthcare Insurance Company or other third parties not affiliated with UnitedHealthcare.

Renew Active™ by UnitedHealthcare You can only receive the Renew Active special membership rate if you are an insured member covered under an AARP Medicare Supplement Insurance Plan, insured by UnitedHealthcare Insurance Company. Renew Active includes standard fitness membership. Participation in the Renew Active program is voluntary. Consult your doctor prior to beginning an exercise program or making changes to your lifestyle or health care routine. Equipment and classes may vary by location.

AARP® Staying Sharp AARP® will share only non-identifiable, aggregate information with UnitedHealthcare that is collected through the use of the AARP Staying Sharp Platform. This information may be used by UnitedHealthcare to potentially help develop future programs and services for its insured members. This program offering is not an insurance program, is only offered in certain jurisdictions and may be discontinued at any time. Links are made available so that you will have an opportunity to obtain information from the third party on its website. Links are provided solely as a convenience and not as an endorsement of the content of the third-party site or any products or services offered on that site. UnitedHealthcare Insurance Company is not responsible for the content on any linked site or any link contained in a linked site. UnitedHealthcare does not make any representations regarding the content or accuracy of the materials on such sites.Participation in the brain health assessment is voluntary. Access to this service is subject to your acceptance of Staying Sharp’s Terms of Use and AARP’s Privacy Policy. Existing Users who have already accepted AARP’s Terms of Use and Privacy Policy will not be required to create a new AARP® Online Account, but should refer to the additional Terms of Use regarding AARP Staying Sharp. Your health assessment responses will be kept confidential in accordance with applicable law and will only be used to provide health and wellness recommendations within the AARP Staying Sharp program.

Hearing program by HearUSA HearUSA makes available a network of hearing care providers through which AARP members may access AARP Hearing Program Discounts. All decisions about medications, medical care and hearing care are between you and your health care provider. Products or services that are reimbursable by federal programs including Medicare and Medicaid are not available on a discounted or complimentary basis. HearUSA pays a royalty fee to AARP for use of the AARP intellectual property. Amounts paid are used for the general purposes of AARP and its members. HearUSA is not affiliated with AARP or UnitedHealthcare. AARP and UnitedHealthcare do not endorse and are not responsible for the services, products or information provided by this program. You are strongly encouraged to evaluate your own needs. Hearing aid discount from HearUSA is $100 off already discounted AARP Member pricing for HearUSA hearing aids. Discount only applies to hearing aids in HearUSA pricing levels 1-5 (minimum purchase of $1300 hearing aid required to receive discount.) One complimentary hearing screening and other hearing discounts, services or offerings contingent upon purchase of qualifying hearing aids. Complimentary hearing screening only available from HearUSA Network providers.

AARP® Vision Discounts provided by EyeMed EyeMed Vision Care LLC (EyeMed) is the network administrator of AARP Vision provided by EyeMed. These discounts cannot be combined with any other discounts, promotions, coupons, or vision care plans unless noted herein. All decisions about medications and vision care are between you and your health care provider. Products or services that are reimbursable by federal programs including Medicare and Medicaid are not available on a discounted or complimentary basis. EyeMed pays a royalty fee to AARP for use of the AARP intellectual property. Amounts paid are used for the general purposes of AARP and its members.* Offer valid at participating providers. Eye exam discount applies

only to comprehensive eye exams and does not include contact lens exams or fitting. Contact lens purchase requires valid contact lens prescription.

** Present offer to receive a bonus $50 off your AARP Vision Discount or best in-store offer when you purchase a frame and progressive lenses. Complete pair required. Frame and lens purchase cannot be combined with any other offers, discounts, past purchases, readers or non-prescription sunglasses. Valid doctor’s prescription required and the cost of an eye exam is not included. Eyeglasses priced from $218.29 to $2,423.33. Discounts are off tag price. Select brands excluded including: Varilux lenses, and Cartier frames. Void where prohibited. See associate for details. Offer expires 12/31/2020. Code 755453.

24/7 Nurse line & Wellness coaching The information provided through these services is for informational purposes only. Your health information is kept confidential in accordance with applicable law. None of these programs are a substitute for your doctor’s care. Nurses, wellness coaches, and other representatives from these services cannot diagnose problems or recommend treatment. All decisions about medications, vision care, hearing care, health and wellness care or other care are between you and your health care provider. Consult your physician before beginning an exercise program or making major changes in your diet or health care regimen.

AARP Medicare Supplement Insurance PlansAARP endorses the AARP Medicare Supplement Insurance Plans, insured by UnitedHealthcare Insurance Company. UnitedHealthcare Insurance Company pays royalty fees to AARP for the use of its intellectual property. These fees are used for the general purposes of AARP. AARP and its affiliates are not insurers. AARP does not employ or endorse agents, brokers or producers.You must be an AARP member to enroll in an AARP Medicare Supplement Plan.AARP Medicare Supplement Insurance Plans insured by UnitedHealthcare Insurance Company, Horsham, PA. Policy Form No. GRP 79171 GPS-1 (G-36000-4).In some states, plans may be available to persons under age 65 who are eligible for Medicare by reason of disability or End-Stage Renal Disease.Not connected with or endorsed by the U.S. Government or the federal Medicare program.This is a solicitation of insurance. A licensed agent/producer may contact you.Please see the enclosed materials for complete information including benefits, costs, eligibility requirements, exclusions and limitations.

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Membership with AARP means being part of a community of nearly 38 million members*. It means benefiting from a nonprofit, nonpartisan social-welfare organization that has been advocating for the rights of people age 50 and over for over 50 years*. Members of AARP also enjoy exclusive discounts and offers such as the programs and examples listed below, plus much more!

Discover the Real Possibilities of AARP Membership

* 2016 AARP Annual Report (July 7, 2017). Retrieved November 21, 2017, from www.aarp.org/content/dam/aarp/about_aarp/about_us/2017/2016-annual-report-aarp.pdf

**The AARP benefits described are not a benefit of an insurance program.

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There’s always more to discover with your AARP membership.

Explore all your benefits by visitingaarp.org/benefits

Health & WellnessDiscounts on hearing exams, hearing aids and eyeglasses as well as health and wellness tools

Entertainment, Shopping & RestaurantsDiscounts on movie tickets and concessions as well as shopping and restaurants

Home & FamilyGet help with caregiving and other resources

Insurance** & FinancesAccess to insurance programs as well as other financial services such as free tax preparation for those who qualify

Travel & AutoSave on car rental, hotel, airline tickets and other travel bookings as well as car care & maintenance

Magazine, Advocacy & CommunityJoin AARP’s advocacy efforts or a local AARP chapter in your area

TAKE $24 OFF with Electronic Funds Transfer You’ll save $2.00 off your total monthly household premium, or $24 per year, when you use the convenient and easy payment option, Electronic Funds Transfer (EFT). Your monthly payments are automatically forwarded by your bank, which means no checks to write and no postage to pay. Simply complete the EFT form located in this booklet.

SAVE $24 per year with the Annual Payer Discount Take $24 off your total household premium when you pay your entire calendar year premium in January. Note: Electronic Funds Transfer (EFT) discount and Annual Payer discount cannot be combined

When you choose an AARP® Medicare Supplement Insurance Plan, insured by UnitedHealthcare Insurance Company, you may be able to take advantage of the discounts shown below.

AARP endorses the AARP Medicare Supplement Insurance Plans, insured by UnitedHealthcare Insurance Company. UnitedHealthcare Insurance Company pays royalty fees to AARP for the use of its intellectual property. These fees are used for the general purposes of AARP. AARP and its affiliates are not insurers. AARP does not employ or endorse agents, brokers or producers.You must be an AARP member to enroll in an AARP Medicare Supplement Plan. Insured by UnitedHealthcare Insurance Company, Horsham, PA. Policy Form No. GRP 79171 GPS-1 (G-36000-4). In some states, plans may be available to persons under age 65 who are eligible for Medicare by reason of disability or End-Stage Renal Disease.Not connected with or endorsed by the U.S. government or the federal Medicare program.This is a solicitation of insurance. A licensed insurance agent/producer may contact you.See the enclosed materials for complete information, including benefits, costs, eligibility requirements, exclusions, and limitations.SA25795S5

Questions? Contact your licensed insurance agent/producer.

Bright Ways To

Save

Plans, Rates, &

Benefi ts

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Plans, Rates,& Benefi ts

Overview of Plans

Rates

Rules & Disclosures

Plan Benefi t Tables

Your Guide

Hospital Directory -- Select Plans

ZIP Codes -- Select Plans

AARP endorses the AARP Medicare Supplement Insurance Plans, insured by UnitedHealthcare Insurance Company. UnitedHealthcare Insurance Company pays royalty fees to AARP for the use of its intellectual property. These fees are used for the general purposes of AARP. AARP and its affiliates are not insurers. AARP does not employ or endorse agents, brokers or producers. You must be an AARP member to enroll in an AARP Medicare Supplement Insurance Plan. Insured by UnitedHealthcare Insurance Company, Horsham, PA. Policy form No. GRP 79171 GPS-1 (G-36000-4). In some states, plans may be available to persons under age 65 who are eligible for Medicare by reason of disability or End-Stage Renal Disease.Not connected with or endorsed by the U.S. Government or the federal Medicare program.This is a solicitation of insurance. A licensed insurance agent/producer may contact you.See enclosed materials for complete information including benefits, costs, eligibility requirements, exclusions and limitations.

UnitedHealthcare Insurance Company OUTLINE OF COVERAGE

Benefit Plans A, B, C, F, G, K, L, N, Select G, Select N Benefit Chart of Medicare Supplement Plans Sold on or after January 1, 2020

NOTICE TO BUYER: This policy may not cover all of the costs associated with medical care incurred by the buyer during the period of coverage. The buyer is advised to review carefully all policy limitations.

Benefits

Plans Available to All Applicants Medicare first eligible before 2020

only+ A B D G 1 ♦ K L M N ♦

C F 1

Medicare Part A coinsurance and hospital coverage (up to an additional 365 days after Medicare benefits are used up)

✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔

✔ ✔

Medicare Part B coinsurance or Copayment ✔ ✔ ✔ ✔

50%

75% ✔

✔ copays apply3

✔ ✔

Blood (first three pints) ✔ ✔ ✔ ✔ 50% 75% ✔ ✔ ✔ ✔

Part A hospice care coinsurance or copayment

✔ ✔ ✔ ✔ 50% 75% ✔ ✔ ✔ ✔

Skilled nursing facility coinsurance

✔ ✔ 50% 75%

✔ ✔ ✔ ✔

Medicare Part A deductible ✔ ✔ ✔ 50% 75% 50% ✔ ✔ ✔

Medicare Part B deductible ✔ ✔

Medicare Part B excess charges

✔

✔

Foreign travel emergency (up to plan limits)

✔ ✔

✔ ✔ ✔ ✔

Out-of-pocket limit in 20202 $58802 $29402 Note: A ✔ means 100% of this benefit is paid. +Only applicants first eligible for Medicare before January 1, 2020 may purchase Plans C, F, and high deductible F. This chart shows the benefits included in each of the standard Medicare supplement plans. Some plans may not be available. Every company must make Plan “A” available. 1 - Plans F and G also have a high deductible option which require first paying a plan deductible of $2340 before the plan begins to pay. Once the plan deductible is met, the plan pays 100% of covered services for the rest of the calendar year. High deductible Plans F and G do not cover the separate Foreign travel emergency deductible. High deductible Plan G does not cover the Medicare Part B deductible. However, high deductible Plans F and G count your payment of the Medicare Part B deductible toward meeting the plan deductible. 2 - Plans K and L pay 100% of covered services for the rest of the calendar year once you meet the out-of- pocket yearly limit. 3 - Plan N pays 100% of the Part B coinsurance, except for a co-payment of up to $20 for some office visits and up to a $50 co-payment for emergency room visits that do not result in an inpatient admission. ♦ Medicare Select Plans G and N contain the same benefits as standardized Medicare Supplement Plans G and N, except for restrictions on your use of hospitals. OOCFL6 POV57 S 1/20

BASIC BENEFITS Hospitalization – Part A coinsurance plus coverage for 365 additional days after Medicare benefits end. Medical Expenses – Part B coinsurance (generally 20% of Medicare-approved expenses) or copayments for outpatient services. Plans K, L and N require insureds to pay a portion of Part B coinsurance or co-payments. Blood – First three pints of blood each year. Hospice – Part A coinsurance. PREMIUM INFORMATION We, UnitedHealthcare Insurance Company, can only raise your premium if we raise the premium for all plans like yours in the state of Florida READ YOUR POLICY VERY CAREFULLY This is only an outline describing your certificate’s most important features. The certificate is your insurance contract. You must read the certificate itself to understand all of the rights and duties of both you and your insurance company. RIGHT TO RETURN THE CERTIFICATE If you find that you are not satisfied with your coverage, you may return the certificate to:

UnitedHealthcare PO BOX 30607 Salt Lake City, UT 84130-0607

If you send the certificate back to us within 30 days after you receive it, we will treat the certificate as if it had never been issued and return all of your premium payments. NOTICE Neither UnitedHealthcare Insurance Company, nor its agents are connected with Medicare. This outline of coverage does not give all the details of Medicare coverage. Contact your local Social Security Office or consult Medicare and You for more details. Use this outline to compare benefits and premiums among policies. POLICY REPLACEMENT If you are replacing another health insurance policy, do NOT cancel it until you have actually received your new certificate and are sure you want to keep it. COMPLETE ANSWERS ARE VERY IMPORTANT When you fill out the application for the new certificate and it is NOT an “Open Enrollment or Guaranteed Issue status application,” be sure to answer truthfully and completely all questions about your medical and health history. The certificate is issued on the basis that the answers to all questions and all information shown in the application are correct and complete. The company may cancel your certificate and refuse to pay any claims if you make misstatements, you leave out or falsify important information. Review the application carefully before you sign it. Be certain that all information has been properly recorded. To review “Open Enrollment” timeframes please go to the following link on the Medicare.gov website: https://www.medicare.gov/supplement-other-insurance/when-can-i-buy-medigap/when-can-i-buy-medigap.html OOCFL6 RD74 S

Grievance Procedure Complaint and Grievance Procedure - UnitedHealthcare has established a formal procedure to respond to customer complaints and grievances. UnitedHealthcare desires to provide a fair, accessible and responsive method of evaluating and resolving complaints and grievances. If UnitedHealthcare determines that any prior action that it has taken was incorrect, corrective action will be taken. You may, at any time, submit a written complaint to the Department of Insurance in your state. Complaints - If you have a complaint, you may call us at 1-800-523-5880 or write to us at UnitedHealthcare, PO BOX 740807, Atlanta, GA 30374-0807. We will acknowledge all complaints within 15 days and will respond to all complaints within a reasonable period of time. Grievances - If you are dissatisfied with our handling of a complaint or a claim denial, or are dissatisfied for any other reason, you may submit a formal grievance. Grievances must be in writing and contain the words "this is a grievance" to ensure that we understand the purpose of the communication. You must clearly state the nature of the grievance and send it to: UnitedHealthcare, PO BOX 740807, Atlanta, GA 30374-0807. We will acknowledge in writing all grievances within 15 days and respond to all grievances within a reasonable period of time. All grievances must be filed within 60 days or as soon as reasonably possible from the date of denial of benefits or other action giving rise to the grievance. OOCFL6 RD74 S

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79$2

94.6

6$3

56.9

3$3

55.5

0$3

28.8

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30.0

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48.3

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91.8

6$2

69.9

6$4

13.7

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16.2

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22.1

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90.1

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88.6

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59.4

8$1

42.1

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71.4

4$3

19.0

4$2

95.1

1$4

52.2

6$4

54.9

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Plan

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.76

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.75

$883

.08

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16.6

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,223

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65$2

21.7

6$2

68.6

2$2

67.5

4$2

47.4

8$9

7.88

$186

.87

$219

.64

$203

.17

$311

.36

$313

.22

66$2

29.1

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77.5

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76.4

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55.7

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93.1

2$2

26.9

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09.9

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21.7

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23.6

967

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.22

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.56

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.40

$265

.85

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.16

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.75

$235

.96

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.26

$334

.48

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47.0

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99.2

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98.0

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75.6

6$1

09.0

3$2

08.1

5$2

44.6

5$2

26.3

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46.8

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48.8

869

$256

.06

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.17

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.93

$285

.76

$113

.03

$215

.78

$253

.62

$234

.59

$359

.53

$361

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64.5

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20.4

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19.1

9$2

95.2

6$1

16.7

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22.9

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62.0

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42.3

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71.4

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73.7

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$273

.07

$330

.78

$329

.46

$304

.76

$120

.54

$230

.13

$270

.47

$250

.19

$383

.42

$385

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81.3

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40.7

5$3

39.3

9$3

13.9

5$1

24.1

7$2

37.0

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78.6

3$2

57.7

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94.9

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97.3

473

$289

.81

$351

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$349

.66

$323

.44

$127

.94

$244

.23

$287

.05

$265

.52

$406

.93

$409

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74$2

97.5

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60.3

7$3

58.9

3$3

32.0

2$1

31.3

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50.7

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94.6

6$2

72.5

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17.7

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20.2

275

$305

.74

$370

.34

$368

.87

$341

.20

$134

.95

$257

.65

$302

.83

$280

.11

$429

.27

$431

.84

76$3

13.1

4$3

79.3

2$3

77.8

0$3

49.4

8$1

38.2

3$2

63.9

0$3

10.1

6$2

86.9

0$4

39.6

8$4

42.3

177

$321

.11

$388

.96

$387

.40

$358

.35

$141

.74

$270

.60

$318

.05

$294

.19

$450

.85

$453

.55

78$3

24.1

2$3

92.6

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91.0

5$3

61.7

3$1

43.0

7$2

73.1

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21.0

4$2

96.9

5$4

55.0

9$4

57.8

279

$324

.12

$392

.62

$391

.05

$361

.73

$143

.07

$273

.15

$321

.04

$296

.95

$455

.09

$457

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$354

.32

$429

.18

$427

.48

$395

.42

$156

.40

$298

.58

$350

.94

$324

.62

$497

.48

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Cov

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93.7

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$991

.64

$414

.30

$690

.63

$835

.74

$773

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51.3

8$1

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65$2

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54.2

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53.2

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34.2

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2.64

$176

.86

$207

.87

$192

.28

$294

.67

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66$2

16.8

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62.7

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61.6

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42.0

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5.74

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.82

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25.4

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9.52

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.31

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83.1

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82.0

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97.0

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31.5

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.45

$106

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$204

.22

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.02

$340

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50.3

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03.3

0$3

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79.4

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10.5

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11.0

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48.0

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29.4

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51.5

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53.6

671

$258

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$313

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$311

.80

$288

.42

$114

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$217

.79

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66.2

3$3

22.4

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0$2

97.1

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17.5

2$2

24.3

6$2

63.7

0$2

43.9

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73.8

1$3

76.0

473

$274

.28

$332

.24

$330

.92

$306

.10

$121

.08

$231

.14

$271

.67

$251

.29

$385

.11

$387

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74$2

81.5

6$3

41.0

5$3

39.6

9$3

14.2

2$1

24.2

9$2

37.2

7$2

78.8

7$2

57.9

6$3

95.3

2$3

97.6

975

$289

.35

$350

.49

$349

.09

$322

.92

$127

.73

$243

.84

$286

.59

$265

.09

$406

.26

$408

.70

76$2

96.3

6$3

58.9

9$3

57.5

5$3

30.7

4$1

30.8

2$2

49.7

5$2

93.5

4$2

71.5

2$4

16.1

1$4

18.6

077

$303

.89

$368

.11

$366

.64

$339

.15

$134

.15

$256

.10

$301

.00

$278

.42

$426

.69

$429

.24

78$3

06.7

5$3

71.5

7$3

70.0

9$3

42.3

4$1

35.4

1$2

58.5

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03.8

3$2

81.0

4$4

30.7

0$4

33.2

879

$306

.75

$371

.57

$370

.09

$342

.34

$135

.41

$258

.50

$303

.83

$281

.04

$430

.70

$433

.28

80+

$335

.32

$406

.18

$404

.56

$374

.22

$148

.02

$282

.58

$332

.13

$307

.22

$470

.81

$473

.63

Cov

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The

rate

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A 1-

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Plan

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50-6

4$9

28.2

9$1

,093

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79.2

4$1

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$455

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$759

.69

$919

.31

$850

.36

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66.5

1$1

,273

.88

65$2

30.8

5$2

79.6

4$2

78.5

2$2

57.6

4$1

01.9

0$1

94.5

4$2

28.6

5$2

11.5

0$3

24.1

3$3

26.0

766

$238

.56

$288

.98

$287

.82

$266

.24

$105

.31

$201

.04

$236

.30

$218

.57

$334

.97

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67$2

47.9

9$3

00.3

9$2

99.2

0$2

76.7

7$1

09.4

7$2

08.9

8$2

45.6

4$2

27.2

1$3

48.2

0$3

50.2

868

$257

.13

$311

.47

$310

.23

$286

.96

$113

.50

$216

.70

$254

.69

$235

.58

$361

.04

$363

.19

69$2

66.5

7$3

22.8

9$3

21.6

0$2

97.4

9$1

17.6

6$2

24.6

4$2

64.0

3$2

44.2

2$3

74.2

8$3

76.5

170

$275

.42

$333

.63

$332

.29

$307

.38

$121

.58

$232

.10

$272

.80

$252

.34

$386

.71

$389

.02

71$2

84.2

8$3

44.3

5$3

42.9

8$3

17.2

6$1

25.4

8$2

39.5

6$2

81.5

7$2

60.4

5$3

99.1

5$4

01.5

472

$292

.85

$354

.73

$353

.32

$326

.83

$129

.27

$246

.79

$290

.07

$268

.31

$411

.19

$413

.64

73$3

01.7

0$3

65.4

6$3

64.0

1$3

36.7

1$1

33.1

8$2

54.2

5$2

98.8

3$2

76.4

1$4

23.6

2$4

26.1

674

$309

.71

$375

.15

$373

.65

$345

.64

$136

.71

$260

.99

$306

.75

$283

.75

$434

.85

$437

.45

75$3

18.2

8$3

85.5

3$3

83.9

9$3

55.2

1$1

40.5

0$2

68.2

2$3

15.2

4$2

91.5

9$4

46.8

8$4

49.5

776

$325

.99

$394

.88

$393

.30

$363

.81

$143

.90

$274

.72

$322

.89

$298

.67

$457

.72

$460

.46

77$3

34.2

7$4

04.9

2$4

03.3

0$3

73.0

6$1

47.5

6$2

81.7

1$3

31.1

0$3

06.2

6$4

69.3

5$4

72.1

678

$337

.42

$408

.72

$407

.09

$376

.57

$148

.95

$284

.35

$334

.21

$309

.14

$473

.77

$476

.60

79$3

37.4

2$4

08.7

2$4

07.0

9$3

76.5

7$1

48.9

5$2

84.3

5$3

34.2

1$3

09.1

4$4

73.7

7$4

76.6

080

+$3

68.8

5$4

46.7

9$4

45.0

1$4

11.6

4$1

62.8

2$3

10.8

3$3

65.3

4$3

37.9

4$5

17.8

9$5

20.9

9

1 You

r age

as of

your

plan

effec

tive d

ate. Y

our r

ate w

ill alw

ays b

e bas

ed on

your

age o

n you

r effe

ctive

date.

2 IMP

ORTA

NT: O

nly a

pplic

ants

firs

t elig

ible

for M

edica

re b

efor

e Jan

uary

1, 20

20 m

ay p

urch

ase P

lans C

and

F.

App

lican

ts firs

t elig

ible f

or M

edica

re be

fore 1

/1/20

20 ha

ve (a

) a 65

th bir

thday

prior

to 1/

1/202

0 or (

b) a

Medic

are P

art A

effec

tive d

ate pr

ior to

1/1/2

020.

3 You

mus

t use

a ne

twor

k hos

pital

with

Selec

t Plan

s G an

d N.

OO

CFL

6

MR

P019

6 FL

A 1-

20

FLORIDA Area 1 ZIP CodesThe ZIP Codes Below Apply to Rates Included on the Page Headed “Cover Page – Rates”

SA5074 FA (07-19) Page 1 of 1

330023300433008330093301033011330123301333014330153301633017330183301933020330213302233023330243302533026330273302833029330303303133032330333303433035330393305433055330563306033061330623306333064330653306633067

330683306933071330723307333074330753307633077330813308233083330843309033092330933309733101331023310633109331113311233114331163311933122331243312533126331273312833129331303313133132331333313433135331363313733138

331393314033141331423314333144331453314633147331493315033151331523315333154331553315633157331583316033161331623316333164331653316633167331683316933170331723317333174331753317633177331783317933180331813318233183

331843318533186331873318833189331903319133192331933319433195331963319733198331993320633222332313323333234332383323933242332433324533247332553325633257332613326533266332693328033283332963329933301333023330333304

333053330633307333083330933310333113331233313333143331533316333173331833319333203332133322333233332433325333263332733328333293333033331333323333433335333363333733338333393334033345333463334833349333513335533359

333883339433401334023340333404334053340633407334083340933410334113341233413334143341533416334173341833419334203342133422334243342533426334273342833429334303343133432334333343433435334363343733438334413344233443

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Cov

er P

age

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lans

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nce

Com

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The

rate

s ab

ove

are

for p

lan

effe

ctiv

e da

tes

from

Jan

uary

- D

ecem

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020

and

may

cha

nge.

OO

CFL

6

MR

P019

6 FL

B 1-

20

Plan

s Ava

ilabl

e to A

ll App

lican

tsMe

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re fi

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ligib

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befo

re 20

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nly2

Fem

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Non

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Sta

ndar

d R

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Age1

Plan

APl

an B

Plan

GSe

lect G

3Pl

an K

Plan

LPl

an N

Selec

t N3

Plan

C2

Plan

F2

50-6

4$5

70.6

9$6

72.0

5$7

24.9

8$6

70.6

0$2

80.1

7$4

67.0

4$5

65.1

7$5

22.7

9$7

78.6

3$7

83.1

665

$141

.93

$171

.92

$171

.23

$158

.39

$62.

65$1

19.6

0$1

40.5

7$1

30.0

3$1

99.2

7$2

00.4

666

$146

.67

$177

.66

$176

.95

$163

.68

$64.

74$1

23.6

0$1

45.2

7$1

34.3

7$2

05.9

3$2

07.1

667

$152

.46

$184

.68

$183

.94

$170

.15

$67.

30$1

28.4

8$1

51.0

1$1

39.6

8$2

14.0

7$2

15.3

568

$158

.08

$191

.49

$190

.73

$176

.42

$69.

78$1

33.2

2$1

56.5

8$1

44.8

3$2

21.9

6$2

23.2

969

$163

.88

$198

.51

$197

.72

$182

.89

$72.

34$1

38.1

0$1

62.3

2$1

50.1

4$2

30.1

0$2

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42.6

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.77

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.70

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.86

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15$1

47.2

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$230

.64

$229

.72

$212

.49

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6$1

88.5

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475

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.67

$237

.02

$236

.08

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.37

$86.

38$1

64.9

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93.8

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7$2

74.7

4$2

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876

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.42

$242

.77

$241

.80

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.67

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47$1

68.8

9$1

98.5

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83.6

2$2

81.4

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83.0

877

$205

.51

$248

.94

$247

.94

$229

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72$1

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9$2

03.5

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878

$207

.44

$251

.28

$250

.27

$231

.51

$91.

57$1

74.8

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05.4

7$1

90.0

5$2

91.2

6$2

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179

$207

.44

$251

.28

$250

.27

$231

.51

$91.

57$1

74.8

1$2

05.4

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90.0

5$2

91.2

6$2

93.0

180

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74.6

8$2

73.5

9$2

53.0

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91.1

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24.6

0$2

07.7

6$3

18.3

9$3

20.3

0

Cov

er P

age

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mal

e To

bacc

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onth

ly P

lan

Rat

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r Flo

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Com

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rate

s ab

ove

are

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lan

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tes

from

Jan

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ber 2

020

and

may

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nge.

OO

CFL

6

MR

P019

6 FL

B 1-

20

Plan

s Ava

ilabl

e to A

ll App

lican

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27.7

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39.2

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97.4

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37.6

6$3

08.1

8$5

13.7

4$6

21.6

8$5

75.0

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61.4

765

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.12

$189

.11

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.35

$174

.22

$68.

91$1

31.5

6$1

54.6

2$1

43.0

3$2

19.1

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20.5

066

$161

.33

$195

.42

$194

.64

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21$1

35.9

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59.7

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26.5

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27.8

767

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.70

$203

.14

$202

.33

$187

.16

$74.

03$1

41.3

2$1

66.1

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53.6

4$2

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868

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$210

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75$1

46.5

4$1

72.2

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59.3

1$2

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45.6

169

$180

.26

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.36

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.49

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57$1

51.9

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78.5

5$1

65.1

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54.6

270

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.26

$225

.62

$224

.71

$207

.86

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22$1

56.9

5$1

84.4

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70.6

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61.5

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63.0

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.24

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.87

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.94

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.55

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86$1

62.0

0$1

90.4

2$1

76.1

3$2

69.9

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71.5

472

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.89

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42$1

66.8

9$1

96.1

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81.4

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373

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874

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.44

$253

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$252

.69

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.73

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45$1

76.5

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07.4

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8$2

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375

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.23

$260

.72

$259

.68

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$95.

01$1

81.3

9$2

13.1

9$1

97.1

9$3

02.2

1$3

04.0

176

$220

.46

$267

.04

$265

.98

$246

.03

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31$1

85.7

7$2

18.3

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01.9

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11.3

877

$226

.06

$273

.83

$272

.73

$252

.28

$99.

79$1

90.5

0$2

23.9

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07.1

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17.4

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19.3

078

$228

.18

$276

.40

$275

.29

$254

.66

$100

.72

$192

.29

$226

.01

$209

.05

$320

.38

$322

.31

79$2

28.1

8$2

76.4

0$2

75.2

9$2

54.6

6$1

00.7

2$1

92.2

9$2

26.0

1$2

09.0

5$3

20.3

8$3

22.3

180

+$2

49.4

3$3

02.1

4$3

00.9

4$2

78.3

7$1

10.1

1$2

10.2

1$2

47.0

6$2

28.5

3$3

50.2

2$3

52.3

3

Cov

er P

age

- Rat

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Non

-Tob

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Mon

thly

Pla

n R

ates

for F

lorid

a - A

rea

2A

AR

P® M

edic

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The

rate

s ab

ove

are

for p

lan

effe

ctiv

e da

tes

from

Jan

uary

- D

ecem

ber 2

020

and

may

cha

nge.

OO

CFL

6

MR

P019

6 FL

B 1-

20

Plan

s Ava

ilabl

e to A

ll App

lican

tsMe

dica

re fi

rst e

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befo

re 20

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e N

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co S

tand

ard

Rat

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Age1

Plan

APl

an B

Plan

GSe

lect G

3Pl

an K

Plan

LPl

an N

Selec

t N3

Plan

C2

Plan

F2

50-6

4$5

94.1

0$6

99.6

2$7

54.7

2$6

98.1

2$2

91.6

7$4

86.2

0$5

88.3

6$5

44.2

4$8

10.5

7$8

15.2

965

$147

.75

$178

.97

$178

.25

$164

.89

$65.

22$1

24.5

1$1

46.3

4$1

35.3

6$2

07.4

5$2

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966

$152

.68

$184

.95

$184

.21

$170

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$67.

40$1

28.6

7$1

51.2

3$1

39.8

9$2

14.3

8$2

15.6

667

$158

.72

$192

.26

$191

.49

$177

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$70.

06$1

33.7

5$1

57.2

1$1

45.4

1$2

22.8

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968

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$199

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$198

.55

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.66

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65$1

38.6

9$1

63.0

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31.0

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32.4

569

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$206

.66

$205

.83

$190

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$75.

31$1

43.7

7$1

68.9

8$1

56.3

0$2

39.5

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40.9

770

$176

.27

$213

.52

$212

.67

$196

.72

$77.

81$1

48.5

5$1

74.5

9$1

61.5

0$2

47.5

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48.9

871

$181

.94

$220

.39

$219

.51

$203

.05

$80.

31$1

53.3

2$1

80.2

1$1

66.6

9$2

55.4

6$2

56.9

972

$187

.43

$227

.03

$226

.13

$209

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$82.

74$1

57.9

5$1

85.6

4$1

71.7

2$2

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6$2

64.7

373

$193

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$233

.90

$232

.97

$215

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$85.

24$1

62.7

2$1

91.2

6$1

76.9

1$2

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474

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.22

$240

.10

$239

.14

$221

.21

$87.

50$1

67.0

4$1

96.3

3$1

81.6

0$2

78.3

1$2

79.9

775

$203

.70

$246

.75

$245

.76

$227

.33

$89.

92$1

71.6

6$2

01.7

6$1

86.6

3$2

86.0

1$2

87.7

276

$208

.64

$252

.73

$251

.72

$232

.84

$92.

10$1

75.8

2$2

06.6

5$1

91.1

5$2

92.9

4$2

94.6

977

$213

.94

$259

.15

$258

.12

$238

.76

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44$1

80.2

9$2

11.9

0$1

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878

$215

.95

$261

.59

$260

.54

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33$1

81.9

9$2

13.9

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5$3

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1$3

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379

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.95

$261

.59

$260

.54

$241

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33$1

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9$2

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0$1

97.8

5$3

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1$3

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380

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36.0

7$2

85.9

5$2

84.8

1$2

63.4

5$1

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1$1

98.9

4$2

33.8

2$2

16.2

8$3

31.4

5$3

33.4

4

Cov

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Mon

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The

rate

s ab

ove

are

for p

lan

effe

ctiv

e da

tes

from

Jan

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- D

ecem

ber 2

020

and

may

cha

nge.

OO

CFL

6

MR

P019

6 FL

B 1-

20

Plan

s Ava

ilabl

e to A

ll App

lican

tsMe

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re 20

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Mal

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Age1

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50-6

4$6

53.5

1$7

69.5

8$8

30.1

9$7

67.9

3$3

20.8

3$5

34.8

2$6

47.1

9$5

98.6

6$8

91.6

2$8

96.8

165

$162

.52

$196

.86

$196

.07

$181

.37

$71.

74$1

36.9

6$1

60.9

7$1

48.8

9$2

28.1

9$2

29.5

566

$167

.94

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.44

$202

.63

$187

.44

$74.

14$1

41.5

3$1

66.3

5$1

53.8

7$2

35.8

1$2

37.2

267

$174

.59

$211

.48

$210

.63

$194

.84

$77.

06$1

47.1

2$1

72.9

3$1

59.9

5$2

45.1

3$2

46.6

068

$181

.02

$219

.28

$218

.40

$202

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$79.

91$1

52.5

5$1

79.3

0$1

65.8

5$2

54.1

7$2

55.6

969

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.66

$227

.32

$226

.41

$209

.44

$82.

84$1

58.1

4$1

85.8

7$1

71.9

3$2

63.4

9$2

65.0

670

$193

.89

$234

.87

$233

.93

$216

.39

$85.

59$1

63.4

0$1

92.0

4$1

77.6

5$2

72.2

5$2

73.8

771

$200

.13

$242

.42

$241

.46

$223

.35

$88.

34$1

68.6

5$1

98.2

3$1

83.3

5$2

81.0

0$2

82.6

872

$206

.17

$249

.73

$248

.74

$230

.08

$91.

01$1

73.7

4$2

04.2

0$1

88.8

9$2

89.4

7$2

91.2

073

$212

.41

$257

.29

$256

.26

$237

.05

$93.

76$1

78.9

9$2

10.3

8$1

94.6

0$2

98.2

3$3

00.0

174

$218

.04

$264

.11

$263

.05

$243

.33

$96.

25$1

83.7

4$2

15.9

6$1

99.7

6$3

06.1

4$3

07.9

675

$224

.07

$271

.42

$270

.33

$250

.06

$98.

91$1

88.8

2$2

21.9

3$2

05.2

9$3

14.6

1$3

16.4

976

$229

.50

$278

.00

$276

.89

$256

.12

$101

.31

$193

.40

$227

.31

$210

.26

$322

.23

$324

.15

77$2

35.3

3$2

85.0

6$2

83.9

3$2

62.6

3$1

03.8

8$1

98.3

1$2

33.0

9$2

15.6

1$3

30.4

2$3

32.3

978

$237

.54

$287

.74

$286

.59

$265

.11

$104

.86

$200

.18

$235

.29

$217

.63

$333

.53

$335

.53

79$2

37.5

4$2

87.7

4$2

86.5

9$2

65.1

1$1

04.8

6$2

00.1

8$2

35.2

9$2

17.6

3$3

33.5

3$3

35.5

380

+$2

59.6

7$3

14.5

4$3

13.2

9$2

89.7

9$1

14.6

3$2

18.8

3$2

57.2

0$2

37.9

0$3

64.5

9$3

66.7

8

1 You

r age

as of

your

plan

effec

tive d

ate. Y

our r

ate w

ill alw

ays b

e bas

ed on

your

age o

n you

r effe

ctive

date.

2 IMP

ORTA

NT: O

nly a

pplic

ants

firs

t elig

ible

for M

edica

re b

efor

e Jan

uary

1, 20

20 m

ay p

urch

ase P

lans C

and

F.

App

lican

ts firs

t elig

ible f

or M

edica

re be

fore 1

/1/20

20 ha

ve (a

) a 65

th bir

thday

prior

to 1/

1/202

0 or (

b) a

Medic

are P

art A

effec

tive d

ate pr

ior to

1/1/2

020.

3 You

mus

t use

a ne

twor

k hos

pital

with

Selec

t Plan

s G an

d N.

OO

CFL

6

MR

P019

6 FL

B 1-

20


SA5074 FB (07-19) Page 1 of 2

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The following ZIP code has been added by the U.S. Post Office: 34249

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347883478934797

Plan A MEDICARE (PART A) – HOSPITAL SERVICES – PER BENEFIT PERIOD

*A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row.

Services Medicare Pays Plan Pays You Pay HOSPITALIZATION* Semiprivate room and board, general nursing and miscellaneous services and supplies

First 60 days All but $1,408 $0 $1,408 (Part A Deductible)

61st thru 90th day All but $352 a day $352 a day $0 91st day and after: – While using 60 lifetime reserve days

All but $704 a day $704 a day $0

– Once lifetime reserve days are used:

Additional 365 days

$0

100% of Medicare eligible expenses

$0**

Beyond the additional 365 days

$0 $0 All costs

SKILLED NURSING FACILITY CARE* You must meet Medicare’s requirements, including having been in a hospital for at least 3 days and entered a Medicare Approved facility within 30 days after leaving the hospital

First 20 days

All approved amounts

$0

$0

21st thru 100th day All but $176.00 a day $0 Up to $176.00 a day 101st day and after $0 $0 All costs

BLOOD First 3 pints

$0

3 pints

$0

Additional amounts 100% $0 $0 HOSPICE CARE You must meet Medicare’s requirements, including a doctor’s certification of terminal illness.

All but very limited copayment/ coinsurance for outpatient drugs and inpatient respite care.

Medicare copayment/ coinsurance

$0

**NOTICE: When your Medicare Part A hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy’s “Core Benefits.” During this time the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid.

OOCFL6 BT178 1/20

Plan A MEDICARE (PART B) – MEDICAL SERVICES – PER CALENDAR YEAR

* Once you have been billed $198 of Medicare Approved amounts for covered services (which are noted

with an asterisk), your Part B Deductible will have been met for the calendar year.

Services Medicare Pays Plan Pays You Pay MEDICAL EXPENSES - IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT, such as Physician’s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment First $198 of Medicare Approved

amounts*

$0

$0

$198 (Part B Deductible)

Remainder of Medicare Approved amounts

Generally 80% Generally 20% $0

PART B EXCESS CHARGES (Above Medicare Approved

amounts)

$0

$0

All costs

BLOOD First 3 pints

$0

All costs

$0

Next $198 of Medicare Approved amounts*

$0 $0 $198 (Part B Deductible)


80% 20% $0

CLINICAL LABORATORY SERVICES – Tests For Diagnostic Services

100%

$0

$0

PARTS A & B HOME HEALTH CARE MEDICARE APPROVED SERVICES – Medically necessary skilled care services and medical supplies

100%

$0

$0

– Durable medical equipment: First $198 of Medicare

Approved amounts* $0

$0 $198 (Part B Deductible)


80% 20% $0

OOCFL6 BT178 1/20

Plan B MEDICARE (PART A) – HOSPITAL SERVICES – PER BENEFIT PERIOD

* A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row.


First 60 days

All but $1,408

$1,408 (Part A Deductible)

$0

61st thru 90th day All but $352 a day $352 a day $0 91st day and after:

– While using 60 lifetime reserve days



Additional 365 days

$0


$0**


$0 $0 All costs


First 20 days


$0

$0

21st thru 100th day All but $176.00 a day $0 Up to $176.00 a day

101st day and after $0 $0 All costs BLOOD First 3 pints

$0

3 pints

$0


All but very limited copayment/coinsurance for outpatient drugs and inpatient respite care.


$0

** NOTICE: When your Medicare Part A hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy’s “Core Benefits.” During this time the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid.

OOCFL6 BT179 1/20

Plan B MEDICARE (PART B) – MEDICAL SERVICES – PER CALENDAR YEAR

* Once you have been billed $198 of Medicare Approved amounts for covered services (which are noted with an asterisk), your Part B Deductible will have been met for the calendar year.


amounts*

$0

$0




PART B EXCESS CHARGES (Above Medicare-approved amounts)

$0

$0

All costs

BLOOD First 3 pints

$0

All costs

$0




80% 20% $0


100%

$0

$0


100%

$0

$0

– Durable medical equipment: First $198 of Medicare Approved amounts*

$0



80% 20% $0

OOCFL6 BT179 1/20

Plan C+ MEDICARE (PART A) – HOSPITAL SERVICES – PER BENEFIT PERIOD



First 60 days

All but $1,408


$0




Additional 365 days

$0


$0**


$0 $0 All costs


First 20 days


$0

$0

21st thru 100th day All but $176.00 a day Up to $176.00 a day $0 101st day and after $0 $0 All costs

BLOOD First 3 pints

$0

3 pints

$0




$0


+Only applicants first eligible for Medicare before January 1, 2020 may purchase Plans C, F, and high deductible F.

OOCFL6 BT180 1/20

Plan C+ MEDICARE (PART B) – MEDICAL SERVICES – PER CALENDAR YEAR



amounts*

$0


$0




$0

$0

All costs

BLOOD First 3 pints

$0

All costs

$0



$0


80% 20% $0

CLINICAL LABORATORY SERVICES– Tests For Diagnostic Services

100%

$0

$0


100%

$0

$0


$0

$198 (Part B Deductible) $0


80% 20% $0


OOCFL6 BT180 1/20

Plan C+

OTHER BENEFITS – NOT COVERED BY MEDICARE FOREIGN TRAVEL – NOT COVERED BY MEDICARE Medically necessary emergency care services beginning during the first 60

days of each trip outside the USA First $250 each calendar year

$0

$0

$250

Remainder of Charges

$0

80% to a lifetime maximum benefit of $50,000

20% and amounts over the $50,000 lifetime maximum


OOCFL6 BT180 1/20

Plan F+ MEDICARE (PART A) – HOSPITAL SERVICES – PER BENEFIT PERIOD


Services Medicare Pays Plan Pays You Pay

HOSPITALIZATION* Semiprivate room and board, general nursing and miscellaneous services and supplies

First 60 days

All but $1,408


$0




Additional 365 days

$0


$0**


$0 $0 All costs


First 20 days


$0

$0


BLOOD First 3 pints

$0

3 pints

$0




$0



OOCFL6 BT181 1/20

Plan F+ MEDICARE (PART B) – MEDICAL SERVICES – PER CALENDAR YEAR


Services Medicare Pays Plan Pays You Pay MEDICAL EXPENSES – IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT, such as Physician’s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment First $198 of Medicare Approved

amounts*

$0

$198 (Part B

Deductible)

$0




$0

100%

$0

BLOOD First 3 pints

$0

All costs

$0



$0


80% 20% $0


100%

$0

$0


100%

$0

$0


$0


$0


80% 20% $0


OOCFL6 BT181 1/20

Plan F+

OTHER BENEFITS – NOT COVERED BY MEDICARE FOREIGN TRAVEL – NOT COVERED BY MEDICARE Medically necessary emergency care services beginning during the first 60 days of each trip outside the USA

First $250 each calendar year

$0

$0

$250

Remainder of Charges

$0

80% to a lifetime maximum benefit of $50,000



OOCFL6 BT181 1/20

Plan G MEDICARE (PART A) – HOSPITAL SERVICES – PER BENEFIT PERIOD




First 60 days

All but $1,408


$0




Additional 365 days

$0


$0**


$0 $0 All costs


First 20 days


$0

$0


BLOOD First 3 pints

$0

3 pints

$0




$0

**NOTICE: When your Medicare Part A hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy’s “Core Benefits.” During this time the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid. OOCFL6 BT182 1/20

Plan G MEDICARE (PART B) – MEDICAL SERVICES – PER CALENDAR YEAR



amounts*

$0

$0

$198 (Unless Part B Deductible has been met)




$0

100%

$0

BLOOD First 3 pints

$0

All costs

$0


$0 $0 $198 (Unless Part B Deductible has been met)


80% 20% $0


100%

$0

$0


100%

$0

$0


$0

$0 $198 (Unless Part B Deductible has been met)


80% 20% $0

OOCFL6

BT182 1/20

Plan G

OTHER BENEFITS – NOT COVERED BY MEDICARE

FOREIGN TRAVEL – NOT COVERED BY MEDICARE Medically necessary emergency care services beginning during the first 60 days of each trip outside the USA


$0

$0

$250

Remainder of Charges $0 80% to a lifetime maximum benefit of $50,000


OOCFL6 BT182 1/20

Plan K * You will pay half of the cost-sharing of some covered services until you reach the annual out-of-pocket limit of $5880 each calendar year. The amounts that count toward your annual limit are noted with diamonds (♦) in the chart below. Once you reach the annual limit, the plan pays 100% of the Medicare copayment and coinsurance for the rest of the calendar year. However, this limit does NOT include charges from your provider that exceed Medicare-approved amounts (these are called “Excess Charges”) and you will be responsible for paying this difference in the amount charged by your provider and the amount paid by Medicare for the item or service.

MEDICARE (PART A) – HOSPITAL SERVICES – PER BENEFIT PERIOD ** A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row.

Services Medicare Pays Plan Pays You Pay* HOSPITALIZATION** Semiprivate room and board, general nursing and miscellaneous services and supplies

First 60 days

All but $1,408

$704 (50% of Part A

Deductible)

$704 (50% of Part A Deductible)♦




Additional 365 days (lifetime)

$0

100% of Medicare Eligible Expenses

$0***


$0 $0 All costs

SKILLED NURSING FACILITY CARE** You must meet Medicare’s requirements, including having been in a hospital for at least 3 days and entered a Medicare Approved facility within 30 days after leaving the hospital

First 20 days


$0

$0

21st thru 100th day All but $176.00 a day Up to $88.00 a day $88.00 a day♦ 101st day and after $0 $0 All costs

BLOOD – First 3 Pints

$0

50%

50%♦



50% of copayment/ coinsurance

50% of copayment/ coinsurance♦

*** NOTICE: When your Medicare Part A hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy’s “Core Benefits.” During this time the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid. OOCFL6 BT183 1/20

Plan K MEDICARE (PART B) – MEDICAL SERVICES – PER CALENDAR YEAR

Services Medicare Pays Plan Pays You Pay* MEDICAL EXPENSES – IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT, such as Physician’s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment First $198 of Medicare

Approved Amounts****

$0

$0

$198 (Part B

Deductible)****♦ Preventive Benefits for

Medicare Covered Services Generally 80% or more of Medicare Approved amounts


All costs above Medicare Approved amounts

Remainder of Medicare Approved Amounts

Generally 80% Generally 10% Generally 10%♦


Amounts)

$0

$0

All costs (and they do not count toward annual out-of-pocket limit of $5880)*

BLOOD First 3 Pints $0 50% 50%♦ Next $198 of Medicare

Approved Amounts**** $0 $0 $198 (Part B

Deductible)****♦ Remainder of Medicare

Approved Amounts Generally 80% Generally 10% Generally 10%♦


100%

$0

$0

* This plan limits your annual out-of-pocket payments for Medicare-approved amounts to $5880 per year. However, this limit does NOT include charges from your provider that exceed Medicare Approved amounts (these are called “Excess Charges”) and you will be responsible for paying

this difference in the amount charged by your provider and the amount paid by Medicare for the item or service. PARTS A & B

HOME HEALTH CARE MEDICARE APPROVED SERVICES - Medically necessary skilled care services and medical supplies

100%

$0

$0

- Durable medical equipment: First $198 of Medicare

Approved Amounts***** $0

$0 $198 (Part B Deductible)♦


80% 10% 10%♦

***** Medicare benefits are subject to change. Please consult the latest Guide to Health Insurance for People with Medicare. OOCFL6 BT183 1/20

**** Once you have been billed $198 of Medicare Approved amounts for covered services (which are noted with asterisks), your Part B Deductible will have been met for the calendar year.

Plan L * You will pay one-fourth of the cost-sharing of some covered services until you reach the annual out-of-pocket limit of $2940 each calendar year. The amounts that count toward your annual limit are noted with diamonds (♦) in the chart below. Once you reach the annual limit, the plan pays 100% of your Medicare copayment and coinsurance for the rest of the calendar year. However, this limit does NOT include charges from your provider that exceed Medicare-approved amounts (these are called “Excess Charges”) and you will be responsible for paying this difference in the amount charged by your provider and the amount paid by Medicare for the item or service.

MEDICARE (PART A) – HOSPITAL SERVICES – PER BENEFIT PERIOD ** A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row.

Services Medicare Pays Plan Pays You Pay* HOSPITALIZATION** Semiprivate room and board, general nursing and miscellaneous services and supplies

First 60 days

All but $1,408

$1,056 (75% of Part A

Deductible)

$352 (25% of Part A

Deductible)♦ 61st thru 90th day All but $352 a day $352 a day $0 91st day and after: – While using 60 lifetime reserve days



Additional 365 days (lifetime)

$0

100% of Medicare Eligible Expenses

$0***


$0 $0 All costs

SKILLED NURSING FACILITY CARE** You must meet Medicare’s requirements, including having been in a hospital for at least 3 days and entered a Medicare Approved facility within 30 days after leaving the hospital

First 20 days


$0

$0

21st thru 100th day All but $176.00 a day Up to $132.00 a day $44.00 a day♦ 101st day and after $0 $0 All costs

BLOOD – First 3 Pints

$0

75%

25%♦



75% of copayment/ coinsurance

25% of copayment/ coinsurance♦

*** NOTICE: When your Medicare Part A hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy’s “Core Benefits.” During this time the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid. OOCFL6 BT184 1/20

Plan L MEDICARE (PART B) – MEDICAL SERVICES – PER CALENDAR YEAR

Services Medicare Pays Plan Pays You Pay* MEDICAL EXPENSES – IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT, such as Physician’s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment First $198 of Medicare

Approved Amounts****

$0

$0

$198 (Part B Deductible)****♦

Preventive Benefits for Medicare Covered Services

Generally 80% or more of Medicare Approved amounts


All costs above Medicare Approved amounts


Generally 80% Generally 15% Generally 5%♦


Amounts)

$0

$0

All costs (and they do not count toward annual out-of-pocket limit of $2940)*

BLOOD First 3 Pints $0 75% 25%♦ Next $198 of Medicare

Approved Amounts**** $0 $0 $198 (Part B

Deductible)****♦ Remainder of Medicare

Approved Amounts Generally 80% Generally 15% Generally 5%♦


100%

$0

$0

* This plan limits your annual out-of-pocket payments for Medicare-approved amounts to $2940 per year. However, this limit does NOT include charges from your provider that exceed Medicare Approved amounts (these are called “Excess Charges”) and you will be responsible for paying this difference in the amount charged by your provider and the amount paid by Medicare for the item or service.

PARTS A & B HOME HEALTH CARE MEDICARE APPROVED SERVICES - Medically necessary skilled care services and medical supplies

100%

$0

$0

- Durable medical equipment: First $198 of Medicare

Approved Amounts***** $0

$0 $198 (Part B Deductible)♦


80% 15% 5%♦

***** Medicare benefits are subject to change. Please consult the latest Guide to Health Insurance for People with Medicare. OOCFL6 BT184 1/20

**** Once you have been billed $198 of Medicare Approved amounts for covered services (which are noted with asterisks), your Part B Deductible will have been met for the calendar year.

Plan N MEDICARE (PART A) – HOSPITAL SERVICES – PER BENEFIT PERIOD




First 60 days

All but $1,408


$0




Additional 365 days

$0


$0**


$0 $0 All costs


First 20 days


$0

$0


BLOOD First 3 pints

$0

3 pints

$0




$0

**NOTICE: When your Medicare Part A hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy’s “Core Benefits.” During this time the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid. OOCFL6 BT185 1/20

Plan N MEDICARE (PART B) – MEDICAL SERVICES – PER CALENDAR YEAR



amounts*

$0

$0

$198 (Part B

Deductible) Remainder of Medicare Approved

amounts Generally 80% Balance other than up to

$20 per office visit and up to $50 per emergency room visit. The co-payment of up to $50 is waived if the insured is admitted to any hospital and the emergency visit is covered as a Medicare Part A expense.

Up to $20 per office visit and up to $50 per emergency room visit. The co-payment of up to $50 is waived if the insured is admitted to any hospital and the emergency visit is covered as a Medicare Part A expense.


$0

$0

All Costs

BLOOD First 3 pints

$0

All costs

$0




80% 20% $0


100%

$0

$0


100%

$0

$0


$0



80% 20% $0

OTHER BENEFITS – NOT COVERED BY MEDICARE FOREIGN TRAVEL – NOT COVERED BY MEDICARE Medically necessary emergency care services beginning during the first 60 days of each trip outside the USA


$0

$0

$250



OOCFL6 BT185 1/20

Medicare Select - Plan G

MEDICARE (PART A) – HOSPITAL SERVICES – PER BENEFIT PERIOD * A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you

have been out of the hospital and have not received skilled care in any other facility for 60 days in a row. ** Provider restrictions apply.

Services Medicare Pays Medicare Select Plan G Pays

You Pay

HOSPITALIZATION* in a Participating Hospital** Semiprivate room and board, general nursing and miscellaneous services and supplies

First 60 days

All but $1,408


$0




Additional 365 days

$0


$0***


$0 $0 All costs

SKILLED NURSING FACILITY CARE* You must meet Medicare’s requirements, including having been in a hospital for atleast 3 days and entered a Medicare Approved facility within 30 days after leaving the hospital

First 20 days


$0

$0


BLOOD First 3 pints

$0

3 pints

$0




$0

***NOTICE: When your Medicare Part A hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy’s “Core Benefits.” During this time the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid. OOCFL6 BT186 1/20

Medicare Select - Plan G MEDICARE (PART B) – MEDICAL SERVICES – PER CALENDAR YEAR

* Once you have been billed $198 of Medicare Approved amounts for covered services (which are noted with an Asterisk), your Part B Deductible will have been met for the calendar year.

Services Medicare Pays Medicare Select Plan G Pays

You Pay

MEDICAL EXPENSES – IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT, such as Physician’s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment First $198 of Medicare

Approved amounts*

$0

$0

$198 (Unless Part B Deductible has been met)




amounts)

$0

100%

$0

BLOOD First 3 pints

$0

All costs

$0


$0 $0 $198 (Unless Part B Deductible has been met)


80% 20% $0


100%

$0

$0

PARTS A & B HOME HEALTH CARE - MEDICARE APPROVED SERVICES – Medically necessary skilled care services and medical supplies

100%

$0

$0

– Durable medical equipment:

First $198 of Medicare Approved amounts*

$0

$0 $198 (Unless Part B Deductible has been met)


80% 20% $0

OOCFL6 BT186 1/20

Medicare Select - Plan G MEDICARE (PART B) – MEDICAL SERVICES – PER CALENDAR YEAR

OTHER BENEFITS – NOT COVERED BY MEDICARE

Services

Medicare Pays Medicare Select Plan G Pays

You Pay

FOREIGN TRAVEL – NOT COVERED BY MEDICARE Medically necessary emergency care services beginning during the first 60 days of each trip outside the USA. First $250 each calendar year

$0

$0

$250



OOCFL6 BT186 1/20

Medicare Select - Plan N MEDICARE (PART A) – HOSPITAL SERVICES – PER BENEFIT PERIOD


** Provider restrictions apply. Services Medicare Pays Medicare Select

Plan N Pays You Pay

HOSPITALIZATION* in a Participating Hospital** Semiprivate room and board, general nursing and miscellaneous services and supplies

First 60 days

All but $1,408


$0




Additional 365 days

$0


$0***


$0 $0 All costs

SKILLED NURSING FACILITY CARE* You must meet Medicare’s requirements, including having been in a hospital for at least 3 days and entered a Medicare Approved facility within 30 days after leaving the hospital.

First 20 days


$0

$0


BLOOD First 3 pints

$0

3 pints

$0




$0

***NOTICE: When your Medicare Part A hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy’s “Core Benefits.” During this time the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid.

OOCFL6 BT187 1/20

Medicare Select - Plan N MEDICARE (PART B) – MEDICAL SERVICES – PER CALENDAR YEAR


Services Medicare Pays Medicare Select

Plan N Pays You Pay

MEDICAL EXPENSES – IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT, such as Physician’s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment. First $198 of Medicare Approved

amounts*

$0

$0


Remainder of Medicare-approved amounts

Generally 80% Balance other than up to $20 per office visit and up to $50 per emergency room visit. The co-payment of up to $50 is waived if the insured is admitted to any hospital and the emergency visit is covered as a Medicare Part A expense.

Up to $20 per office visit and up to $50 per emergency room visit. The co-payment of up to $50 is waived if the insured is admitted to any hospital and the emergency visit is covered as a Medicare Part A expense.


$0

$0

All costs

BLOOD First 3 pints

$0

All costs

$0



Remainder of Medicare-approved amounts

80% 20% $0


100%

$0

$0

OOCFL6 BT187 1/20

Medicare Select - Plan N MEDICARE (PART B) – MEDICAL SERVICES – PER CALENDAR YEAR


PARTS A & B

Services Medicare Pays Medicare Select Plan N Pays

You Pay

HOME HEALTH CARE - MEDICARE APPROVED SERVICES – Medically necessary skilled care services and medical supplies

100%

$0

$0

– Durable medical equipment: First $198 of Medicare

Approved amounts* $0



80% 20% $0

OTHER BENEFITS – NOT COVERED BY MEDICARE FOREIGN TRAVEL – NOT COVERED BY MEDICARE Medically necessary emergency care services beginning during the first 60 days of each trip outside the USA. First $250 each calendar year

$0

$0

$250



OOCFL6 BT187 1/20

Your Guide To AARP Medicare Select and Medicare Supplement Insurance Plans

To help you choose the AARP Medicare Select or AARP Medicare Supplement Insurance Plan, insured by UnitedHealthcare Insurance Company, to best meet your needs and budget, be sure to look at the information shown in this Guide and the other documents that show the expenses that Medicare pays, the benefits each Plan pays and the costs you will have to pay yourself. Also, be sure to review the Monthly Premium information. Please use the documents that show the specific benefits and rates of each plan which allow you to compare the AARP Medicare Select and AARP Medicare Supplement Plans with other Medicare supplement plans. Benefits and cost vary depending upon the Plan selected.

Eligibility to Apply ______________________________________________________To be eligible to apply, you must be an AARP member or spouse of a member, age 50 or older, enrolled in both Part A and Part B of Medicare, and not duplicating any Medicare supplement coverage.

Guaranteed Acceptance __________________________________________________n Your acceptance in any plan for which you’re eligible to enroll is guaranteed during your Medicare Supplement Open Enrollment

Period which lasts for 6 months beginning with the first day of the month in which you are both age 65 or older and enrolled in Medicare Part B. Also, there is a 2-month open enrollment period after the loss of group health insurance coverage*.

n If you are age 50-64 and are eligible for Medicare due to disability or End-Stage Renal Disease, your acceptance in any plan is guaranteed during your Medicare supplement open enrollment period which is the first 6 months you are enrolled in Medicare Part B, unless you are entitled to one of the following Guaranteed Issue situations.

n Also, you may be eligible for Guaranteed Issue of a Medicare supplement plan if you lost or terminated other health coverage under one of the following circumstances. You must provide a copy of the termination notice or letter you received from your prior plan or employer and your Application Form must be received no more than 63 days after the termination date of your prior coverage.

GU25097FL (01-20)Continued…

Plans Available Without Underwriting For Applicants Entitled to Guaranteed Issue

Guaranteed Issue Situations:

For Applicants Age 50-64 who are eligible for Medicare by reason of disability or End-Stage Renal Disease with: Notice, letter or other documentation

from prior insurer must include items below.

Also, please answer the questions on the Application Form in the “Is your acceptance guaranteed” and “Your past and current coverage” sections.

• A Medicare Part A Effective Date PRIOR to 1/1/2020.

• A Medicare Part A Effective Date on or AFTER 1/1/2020.

For Applicants Age 65 and over with:• A 65th birthday PRIOR to

1/1/2020. OR

• A Medicare Part A Effective Date PRIOR to 1/1/2020.

• A 65th birthday AND Medicare Part A Effective Date on or AFTER 1/1/2020.

1. Applicant loses, learns they have lost, or drops employer coverage, or the employer plan no longer provides benefits at least equal to those of Medicare Supplement Plan A*.

A, B, C, F, K, L, N or, if available in your area, Medicare Select N

A, B, G, K, L, N or, if available in your area, Medicare Select G or Medicare Select N

• Applicant’s name.• Plan Type – confirmation that it’s

employer coverage being lost.• Coverage termination date.

2. Applicant is enrolled in a Medicare Advantage (MA), other Medicare managed care, Program of All-Inclusive Care for the Elderly (PACE) or Medicare Select plan and:• The plan stops coverage in the

area, or• The plan sends notice it will

stop coverage, or• Applicant moves out of the

service area



• Applicant’s name.• Plan Type – confirmation that it’s a

Medicare Advantage, other Medicare managed care, Program of All-Inclusive Care for the Elderly (PACE) or Medicare Select plan being lost.

• Coverage termination date and one of the termination reasons shown in the first column.

Marie A. Pero, Licensed AgentAgent License ID #W128591

3. Applicant is enrolled in an MA, other Medicare managed care, PACE or Medicare supplement (including Select) and the plan:• Violates the insurance contract

(for example, by failing to provide necessary medical care), or

• Was misrepresented in marketing to the individual



• Applicant’s name.• Plan Type – confirmation that it’s a

Medicare Advantage, other Medicare managed care, Program of All-Inclusive Care for the Elderly (PACE) or Medicare Supplement (including Select) being replaced.

• Coverage termination date.• Termination reason.

4. Applicant is enrolled in a Medicare supplement plan (including Select) that is involuntarily terminated (for example, company bankruptcy).



• Applicant’s name. • Plan Type – confirmation that it’s a

Medicare supplement plan being lost.• Insurer name.• Reason for involuntary termination.• If available, documentation of

bankruptcy of insurer.• Coverage termination date.

5. Applicant dropped Medicare supplement coverage to enroll for the first time in an MA, other Medicare managed care, PACE, or Select plan, and dropped that plan within two years.

- If the previous plan you had was an AARP Medicare Supplement Plan, then you may apply for Plans A, B, C, F, K, L, N or, if available in your area, Medicare Select N. Also, you can apply for Plan G or, if available in your area, Medicare Select G without having to answer health questions only if Plan G or Medicare Select G was the Plan you previously had.- If the previous Medicare Supplement Plan** you had was with another insurer, then you can only apply for Plans A, B, C, F, K, L, N or, if available in your area, Medicare Select N.


• See information at the top of this chart.

6. On first enrolling in Medicare Part A at age 65***, applicant enrolled in an MA or PACE plan at the same time, and dropped that plan within two years.***NOTE: The MA or PACE plan effective date must be equal to the Medicare Part A effective date for this qualifying event to apply.

A, B, C, F, G, K, L, N or, if available in your area, Medicare Select G or Medicare Select N


• See information at the top of this chart.

*Also, there is a 2-month open enrollment period after the loss of group health insurance coverage. Applicants with a 65th birthday or a Medicare Part A Effective Date prior to 1/1/2020 may apply for Plans A, B, C, F, G, K, L, N or, if available in your area, Medicare Select G or Medicare Select N. Applicants with a 65th birthday and a Medicare Part A Effective Date on or after 1/1/2020 may apply for Plans A, B, G, K, L, N or, if available in your area, Medicare Select G or Medicare Select N. Proof of loss of the group health insurance coverage must be submitted with the Application Form.**Prior Plan can also be a Medicare Select or High Deductible version of the Plan being applied for.

If you have any questions on your guaranteed right to insurance, you may wish to contact the administrator of your prior health insurance plan or your local state department on aging.

Additional InformationExclusions ____________________________________________________________n Benefits provided under Medicare.

n Care not meeting Medicare’s standards.

n Injury or sickness payable by Workers’ Compensation or similar laws.

n Stays or treatment provided by a government-owned or -operated hospital or facility unless payment of charges is required by law.

n Stays, care, or visits for which no charge would be made to you in the absence of insurance.

n Care or services provided by a non-participating hospital, except in the event of a medical emergency, or if the services are not available from any participating hospital in the service area.

n Any stay which begins, or medical expenses you incur, during the first 3 months after your effective date will not be considered if due to a pre-existing condition. A pre-existing condition is a condition for which medical advice was given or treatment was recommended by or received from a physician within 3 months prior to your plan’s effective date.

The following individuals are entitled to a waiver of this pre-existing condition exclusion:

1. Individuals who are replacing prior creditable coverage within 63 days after termination; or2. Individuals who are turning age 65 and whose application form is received within six (6) months after they turn 65 AND are

enrolled in Medicare Part B; or3. Individuals who are entitled to Guaranteed Issue; or4. Individuals who have been covered under other health insurance coverage within the last 63 days and have enrolled in Medicare

Part B within the last 6 months.Other exclusions may apply; however, in no event will your plan contain coverage limitations or exclusions for the Medicare Eligible Expenses that are more restrictive than those of Medicare. Benefits and exclusions paid by your plan will automatically change when Medicare’s requirements change.

Medicare Select Disclosure StatementPlease read this information carefully. The following information is provided in order to make a full and fair disclosure to you of the provisions, restrictions, and limitations of the AARP Medicare Select Plan.

Medicare Select Provider Restrictions ______________________________________In order for benefits to be payable under this insurance plan, you must use one of the select hospitals located throughout the United States, unless:

(1) there is a Medical Emergency; (2) covered services are not available from any select hospital in the Service Area; or (3) covered services are received from a Medicare-approved non-select hospital more than 100 miles from your Primary Residence.

In the case of (3) above, the following benefits may be payable subject to the terms and conditions of this plan:

- 75% of the Part A Medicare Inpatient Hospital Deductible amount per Benefit Period;

- 75% of the Part A Medicare Eligible Expenses not paid by Medicare; and

- 75% of the Part B Medicare Eligible Expenses for outpatient hospital services not paid by Medicare.

Only certain hospitals are network providers under this policy. Check with your physician to determine if he or she has admitting privileges at the Network Hospital. If he or she does not, you may be required to use another physician at the time of hospitalization or you will be required to pay for all expenses.

Right to Replace Your Medicare Select Plan _________________________________You have the right to replace your AARP Medicare Select Plan with any other AARP Medicare Supplement Plan, insured by UnitedHealthcare Insurance Company, that has the same or lesser benefits as your current insurance and which does not require the use of participating providers, without providing evidence of insurability.

Quality Assurance ______________________________________________________Participating providers are required to maintain a quality assurance program conforming with nationally recognized quality of care standards.

For Your Protection, Please Be Aware of the Following:You Cannot Be Singled Out for Cancellation _________________________________Your AARP Medicare Select or Medicare Supplement Plan cannot be canceled because of your age, your health, or the number of claims you make. Your AARP Medicare Select or Medicare Supplement Plan may be canceled due to nonpayment of premium or material misrepresentation. If your group policy terminates and is not replaced by another group policy providing the same type of coverage, you may convert your AARP Medicare Select Plan or AARP Medicare Supplement Plan to an individual Medicare supplement

policy issued by UnitedHealthcare Insurance Company. Of course, you may cancel your AARP Medicare Select Plan or AARP Medicare Supplement Plan any time you wish. Any premium for days after the date of cancellation or death will be refunded.

The AARP Insurance Trust _______________________________________________AARP established the AARP Insurance Plan, a trust, to hold the master group insurance policies. The AARP Medicare Select and AARP Medicare Supplement Plans are insured by UnitedHealthcare Insurance Company, not by AARP or its affiliates. Please contact UnitedHealthcare Insurance Company if you have questions about your policy, including any limitations and exclusions.

Premiums are collected from you by the Trust. These premiums are paid to the insurance company for your insurance coverage, a percentage is used to pay expenses, benefitting the insureds, and incurred by the Trust in connection with the insurance programs. At the direction of UnitedHealthcare Insurance Company, a portion of the premium is paid as a royalty to AARP and used for the general purposes of AARP. Income earned from the investment of premiums while on deposit with the Trust is paid to AARP and used for the general purposes of AARP.

Participants are issued certificates of insurance by UnitedHealthcare Insurance Company under the master group insurance policy. The benefits of participating in an insurance program carrying the AARP name are solely the right to receive the insurance coverage and ancillary services provided by the program.

General Information By enrolling, you are agreeing to the release of Medicare claim information to UnitedHealthcare Insurance Company so your AARP Medicare Select or Medicare Supplement Plan claims may be processed automatically.

AARP and its affiliates are not insurers. AARP does not employ or endorse agents, brokers or producers.

You must be an AARP member to enroll in an AARP Medicare Select or Medicare Supplement Plan.

The Policy Form No. GRP79171 GPS-1 (G-36000-4) is issued in the District of Columbia to the Trustees of the AARP Insurance Plan.

AARP Medicare Select and Medicare Supplement Plans have been developed in line with federal standards. However, these plans are not connected with, or endorsed by, the U.S. Government or the federal Medicare program.

This is a solicitation of insurance. An agent may contact you.

These materials describe the AARP Medicare Select and AARP Medicare Supplement Plans available in your state, but is not a contract, policy, or insurance certificate. Please read your Certificate of Insurance, upon receipt, for plan benefits, definitions, exclusions, and limitations.

(1 of 6)HD1000FLG

Alachua CountyUF Health Shands Hospital* 1600 SW Archer Road Gainesville, FL 32608 (352) 265-5491

UF Health Shands Rehab Hospital* 4101 NW 89th Boulevard Gainesville, FL 32606 (352) 265-8938

Bay CountyBay Medical Center 615 North Bonita Avenue Panama City, FL 32401 (850) 769-1511

Encompass Health Rehabilitation Hospital of Panama City*1847 Florida AvenuePanama City, FL 32405(850) 914-8600

Bradford CountyShands Starke Regional Medical Center* 922 East Call Street Starke, FL 32091 (904) 368-2300

Brevard CountyMelbourne Regional Medical Center* 250 N Wickham Road Melbourne, FL 32935 (321) 752-1200

Brevard County (Continued)Rockledge Regional Medical Center* 110 Longwood Avenue Rockledge, FL 32955 (321) 636-2211

Sea Pines Rehabilitation Hospital* 101 East Florida Avenue Melbourne, FL 32901 (321) 984-4600

Broward CountyBroward Health Coral Springs 3000 Coral Hills Drive Coral Springs, FL 33065 (954) 344-3000

Broward Health Imperial Point 6401 North Federal Highway Ft. Lauderdale, FL 33308 (954) 776-8500

Broward Health Medical Center 1600 South Andrews Avenue Ft. Lauderdale, FL 33316 (954) 355-4400

Broward Health North 201 East Sample Road Deerfield Beach, FL 33064 (954) 941-8300

Cleveland Clinic Florida – Weston 2950 Cleveland Clinic Boulevard Weston, FL 33331 (954) 659-5000

Broward County (Continued)Encompass Health Rehabilitation Hospital of Sunrise* 4399 North Nob Hill Road Sunrise, FL 33351 (954) 749-0300

North Shore Medical Center – FMC Campus 5000 West Oakland Park Boulevard Lauderdale Lakes, FL 33313 (954) 735-6000

Calhoun CountyCalhoun Liberty Hospital 20370 NE Burns Avenue Blountstown, FL 32424 (850) 674-5411

Charlotte CountyBayfront Health Port Charlotte** 2500 Harbor Boulevard Port Charlotte, FL 33952 (941) 766-4122

Bayfront Health Punta Gorda** 809 East Marion Avenue Punta Gorda, FL 33950 (941) 639-3131

Fawcett Memorial Hospital 21298 Olean Boulevard Port Charlotte, FL 33952 (941) 629-1181

Florida

Participating Hospitals - Effective April 2020For AARP® Medicare Select Plans

Florida Resident Directory

* This hospital was contracted by USA Managed Care Organization and leased by UnitedHealthcare for inclusion in the AARP Medicare Select Network.

** This hospital was contracted by AmeriPlus and leased by UnitedHealthcare for inclusion in the AARP Medicare Select Network.

(2 of 6)

Citrus CountyBayfront Health Seven Rivers** 6201 North Suncoast Boulevard Crystal River, FL 34428 (352) 795-6560

Citrus Memorial Hospital 502 West Highland Boulevard Inverness, FL 34452 (352) 726-1551

Collier CountyNCH Downtown Naples Hospital 350 Seventh Street North Naples, FL 34102 (239) 624-5000

NCH North Naples Hospital 11190 Health Park Boulevard Naples, FL 34110 (239) 552-7000

Physicians Regional Collier** 8300 Collier Boulevard Naples, FL 34114 (239) 354-6000

Physicians Regional Pine Ridge** 6101 Pine Ridge Road Naples, FL 34119 (239) 348-4000

Willough at Naples* 9001 Tamiami Trail East Naples, FL 34113 (239) 775-4500

Columbia CountyShands Lake Shore Regional Medical Center* 368 NE Franklin Street Lake City, FL 32055 (386) 292-8000

Duval CountyUF Health Jacksonville* 655 West Eighth Street Jacksonville, FL 32209 (904) 244-0411

Franklin CountyGeorge E. Weems Memorial Hospital 135 Avenue G Apalachicola, FL 32320 (850) 653-8853

Hernando CountyBayfront Health Brooksville* 17240 Cortez Boulevard Brooksville, FL 34601 (352) 796-5111

Bayfront Health Spring Hill* 10461 Quality Drive Spring Hill, FL 34609 (352) 688-8200

Encompass Health Rehabilitation Hospital of Spring Hill* 12440 Cortez Boulevard Brooksville, FL 34613 (352) 592-4250

Oak Hill Hospital 11375 Cortez Boulevard Brooksville, FL 34613 (352) 596-6632

Springbrook Hospital* 7007 Grove Road Brooksville, FL 34609 (352) 600-3288

Hillsborough CountyBrandon Regional Hospital 119 Oakfield Drive Brandon, FL 33511 (813) 681-5551

H. Lee Moffitt Cancer Center** 12902 USF Magnolia Drive Tampa, FL 33612 (813) 972-4673

Hillsborough County (Continued)Memorial Hospital of Tampa 2901 Swann Avenue Tampa, FL 33609 (813) 873-6400

South Bay Hospital 4016 Sun City Center Boulevard Sun City Center, FL 33573 (813) 634-3301

South Florida Baptist Hospital** 301 North Alexander Street Plant City, FL 33563 (813) 757-1200

St. Joseph’s Hospital** 3001 West Dr. Martin Luther King Jr. Boulevard Tampa, FL 33607 (813) 870-4000

St. Joseph’s Hospital South** 6901 Simmons Loop Riverview, FL 33578 (813) 302-8000

Tampa Community Hospital 6001 Webb Road Tampa, FL 33615 (813) 888-7060

Holmes CountyDoctors Memorial Hospital – Holmes County 2600 Hospital Drive Bonifay, FL 32425 (850) 547-8000

Indian River CountyEncompass Health Rehabilitation Hospital of Treasure Coast* 1600 37th Street Vero Beach, FL 32960 (772) 778-2100

Florida (Continued)



(3 of 6)

Indian River County (Continued)Indian River Medical Center** 1000 36th Street Vero Beach, FL 32960 (772) 567-4311

Lee CountyLehigh Regional Medical Center** 1500 Lee Boulevard Lehigh Acres, FL 33936 (941) 369-2101

Leon CountyApalachee Center, Inc.* 2634 Capital Circle NE Tallahassee, FL 32308 (850) 523-3333

Encompass Health Rehabilitation Hospital of Tallahassee* 1675 Riggins Road Tallahassee, FL 32308 (850) 656-4800

Tallahassee Memorial Healthcare 1300 Miccosukee Road Tallahassee, FL 32308 (850) 431-1155

Manatee CountyBlake Medical Center 2020 59th Street West Bradenton, FL 34209 (941) 792-6611

Lakewood Ranch Medical Center 8330 Lakewood Ranch Boulevard Lakewood Ranch, FL 34202 (941) 782-2100

Manatee Memorial Hospital 206 Second Street East Bradenton, FL 34208 (941) 746-5111

Miami-Dade CountyCoral Gables Hospital 3100 Douglas Road Coral Gables, FL 33134 (305) 445-8461

Encompass Health Rehabilitation Hospital of Miami* 20601 Old Cutler Road Miami, FL 33189 (305) 251-3800

Hialeah Hospital 651 East 25th Street Hialeah, FL 33013 (305) 693-6100

Jackson Memorial Hospital* 1611 NW 12th Avenue Miami, FL 33136 (305) 585-1111

Jackson North Medical Center* 160 NW 170th Street North Miami Beach, FL 33169 (305) 651-1100

Jackson South Community Hospital* 9333 SW 152nd Street Miami, FL 33157 (305) 251-2500

Miami Jewish Home and Hospital* 5200 NE 2nd Avenue Miami, FL 33137 (305) 751-8626

North Shore Medical Center 1100 NW 95th Street Miami, FL 33150 (305) 835-6000

Palmetto General Hospital 2001 West 68th Street Hialeah, FL 33016 (305) 823-5000

Miami-Dade County (Continued)Westchester General Hospital* 2500 SW 75th Avenue Miami, FL 33155 (305) 264-5252

Okaloosa CountyNorth Okaloosa Medical Center* 151 E Redstone Avenue Crestview, FL 32539 (580) 689-8100

Orange CountyHealth Central Hospital** 10000 West Colonial Drive Ocoee, FL 34761 (407) 296-1000

University Behavioral Center* 2500 Discovery Drive Orlando, FL 32826 (407) 281-7000

Osceola CountyThe Blackberry Center* 91 Beehive Circle Saint Cloud, FL 34769 (321) 805-5090

Palm Beach CountyBethesda Hospital 2815 S Seacrest Boulevard Boynton Beach, FL 33435 (561) 737-7733

Delray Medical Center 5352 Linton Boulevard Delray Beach, FL 33484 (561) 498-4440

Good Samaritan Medical Center 1309 North Flagler Drive West Palm Beach, FL 33401 (561) 655-5511

Jupiter Medical Center 1210 South Old Dixie Highway Jupiter, FL 33458 (561) 263-2234

Florida (Continued)



(4 of 6)

Palm Beach County (Continued)Lakeside Medical Center* 39200 Hooker Highway Belle Glade, FL 33430 (561) 996-6571

Palm Beach Gardens Medical Center 3360 Burns Road Palm Beach Gardens, FL 33410 (561) 622-1411

Pinecrest Rehabilitation Hospital 5360 Linton Boulevard Delray Beach, FL 33484 (561) 495-0400

Saint Mary’s Medical Center 901 45th Street West Palm Beach, FL 33407 (561) 844-6300

Wellington Regional Medical Center 10101 Forest Hill Boulevard Wellington, FL 33414 (561) 798-8500

West Boca Medical Center 21644 State Road 7 Boca Raton, FL 33428 (561) 488-8000

Pasco CountyBayfront Health Dade City* 13100 Fort King Road Dade City, FL 33525 (352) 521-1100

Florida Hospital Zephyrhills INC* 7050 Gall Boulevard Zephyrhills, FL 33541 (813) 788-0411

Medical Center of Trinity 9330 State Road 54 Trinity, FL 34655 (727) 834-4000

Pasco County (Continued)Medical Center of Trinity – West Pasco Campus 5637 Marine Parkway New Port Richey, FL 34652 (727) 845-9180

Morton Plant North Bay Hospital* 6600 Madison Street New Port Richey, FL 34625 (727) 842-8468

Regional Medical Center – Bayonet Point 14000 Fivay Road Hudson, FL 34667 (727) 819-2929

Pinellas CountyBayfront Health Saint Petersburg** 701 6th Street South St. Petersburg, FL 33701 (727) 823-1234

Encompass Health Rehabilitation Hospital of Largo*901 Clearwater Largo Road NorthLargo, FL 33770(727) 586-2999

Florida Hospital North Pinellas** 1395 South Pinellas Avenue Tarpon Springs, FL 34689 (727) 942-5000

Largo Medical Center 201 14th Street SW Largo, FL 33770 (727) 588-5200

Largo Medical Center Indian Rocks Campus 2025 Indian Rocks Road Largo, FL 33774 (727) 588-5200

Mease Countryside Hospital** 3231 McMullen Booth Road Safety Harbor, FL 34695 (727) 725-6111

Pinellas County (Continued)Mease Dunedin Hospital** 601 Main Street Dunedin, FL 34698 (727) 733-1111

Morton Plant Hospital** 300 Pinellas Street Clearwater, FL 33756 (727) 462-7000

Northside Hospital and Heart Institute 6000 49th Street North St. Petersburg, FL 33709 (727) 521-4411

Palms of Pasadena Hospital 1501 Pasadena Avenue South St. Petersburg, FL 33707 (727) 381-1000

St. Anthony Hospital** 1200 7th Avenue North St. Petersburg, FL 33705 (727) 825-1100

St. Petersburg General Hospital 6500 38th Avenue North St. Petersburg, FL 33710 (727) 384-1414

Polk CountyAdventHealth Heart of Florida** 40100 U.S. Highway 27 Davenport, FL 33837 (863) 422-4971

Saint Lucie CountyPort Saint Lucie Hospital* 2550 SE Walton Road Port Saint Lucie, FL 34952 (772) 335-0400

Santa Rosa CountySanta Rosa Medical Center* 6002 Berryhill Road Milton, FL 32570 (850) 626-7762

Florida (Continued)



(5 of 6)

Sarasota CountyDoctors Hospital of Sarasota 5731 Bee Ridge Road Sarasota, FL 34233 (941) 342-1100

Encompass Health Rehabilitation Hospital of Sarasota*6400 Edgelake DriveSarasota, FL 34240(941) 921-8600

Englewood Community Hospital 700 Medical Boulevard Englewood, FL 34223 (941) 475-6571

Venice Regional Medical Center** 540 The Rialto Venice, FL 34285 (941) 485-7711

Suwannee CountyShands Live Oak Regional Medical Center* 1100 SW 11th Street Live Oak, FL 32064 (386) 362-0800

Taylor CountyDoctors Memorial Hospital – Taylor County 333 North Byron Butler Parkway Perry, FL 32347 (850) 584-0800

Volusia CountyHalifax Medical Center of Daytona Beach 303 North Clyde Morris Boulevard Daytona Beach, FL 32114 (386) 254-4000

Volusia County (Continued)Halifax Medical Center of Port Orange 1041 Dunlawton Avenue Port Orange, FL 32127 (386) 322-4700

Walton CountyHealthmark Regional Medical Center** 4413 U.S. Highway 331 South Defuniak Springs, FL 32435 (850) 951-4500

Washington CountyNorthwest Florida Community Hospital** 1360 Brickyard Road Chipley, FL 32428 (850) 638-1610

Florida (Continued)



Coffee CountyMedical Center Enterprise** 400 North Edwards Street Enterprise, AL 36330 (334) 347-0584

Conecuh CountyEvergreen Medical Center 101 Crestview Avenue Evergreen, AL 36401 (251) 578-2480

Covington CountyAndalusia Regional Hospital* 849 South Three Notch Street Andalusia, AL 36420 (334) 222-8466

Covington County (Continued)Mizell Memorial Hospital* 702 N Main Street Opp, AL 36467 (334) 493-3541

Dale CountyDale Medical Center* 126 Hospital Avenue Ozark, AL 36360 (334) 774-2601

Houston CountyEncompass Health Rehabilitation Hospital of Dothan*1736 East Main StreetDothan, AL 36301(334) 712-6333

Houston County (Continued)Flowers Hospital 4370 West Main Street Dothan, AL 36305 (334) 793-5000

Southeast Health Medical Center 1108 Ross Clark Circle Dothan, AL 36301 (334) 793-8111

Monroe CountyMonroe County Hospital 2016 South Alabama Avenue Monroeville, AL 36460 (251) 575-3111

Alabama

(6 of 6)

Participating Hospitals listed in this directory are subject to change. For health systems with multiple hospitals, all locations may not participate. Check with your doctor to make sure he or she has admitting privileges at a network hospital. Prior to scheduling any inpatient or outpatient hospital service it is recommended you contact Customer Service at 1-800-523-5800 (any weekday between 7 a.m. and 11 p.m., and on Saturdays between 9 a.m. and 5 p.m., Eastern Time) for a current listing of participating hospitals in your area. You may also call this number to obtain a directory of participating hospitals for other areas when you will be traveling.

All participating hospitals are open 24 hours a day, 7 days a week.

Your Medicare Select policy will only pay full supplemental benefits if covered services are obtained through specified participating hospitals. Medicare Select policies deny payment or pay less than the full benefit if you use a non-participating hospital for non-emergency services.

Brooks CountyBrooks County Hospital 903 North Court Street Quitman, GA 31643 (229) 263-4171

Decatur CountyMemorial Hospital and Manor 1500 East Shotwell Street Bainbridge, GA 39819 (229) 246-3500

Grady CountyGrady General Hospital 1155 Fifth Street SE Cairo, GA 39828 (229) 377-1150

Mitchell CountyMitchell County Hospital 90 East Stephens Street Camilla, GA 31730 (229) 336-5284

Thomas CountyJohn D. Archbold Memorial Hospital 915 Gordon Avenue Thomasville, GA 31792 (229) 228-2000

Georgia

UnitedHealthcare Insurance Company (UnitedHealthcare)

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CONTINUED ON REVERSE

For AARP® Medicare Select Plans OnlyFlorida - Effective April 2020

Medicare Select Plans are available to individuals in the following zip code areas:

(1 of 4)SA25194FL (04-20)

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(4 of 4)

CONTINUED

SA25710ST

Forms

Forms

Enrollment Checklist

Application for Insurance

AARP Membership

Electronic Funds Transfer (2)

Replacement Notice (2)


AARP endorses the AARP Medicare Supplement Insurance Plans, insured by UnitedHealthcare Insurance Company. UnitedHealthcare Insurance Company pays royalty fees to AARP for the use of its intellectual property. These fees are used for the general purposes of AARP. AARP and its affiliates are not insurers. AARP does not employ or endorse agents, brokers or producers. You must be an AARP member to enroll in an AARP Medicare Supplement Insurance Plan. Insured by UnitedHealthcare Insurance Company, Horsham, PA (UnitedHealthcare Insurance Company of New York, Islandia, NY for New York residents). Policy form No. GRP 79171 GPS-1 (G-36000-4). In some states, plans may be available to persons under age 65 who are eligible for Medicare by reason of disability or End-Stage Renal Disease.Not connected with or endorsed by the U.S. Government or the federal Medicare program.This is a solicitation of insurance. A licensed insurance agent/producer may contact you.See enclosed materials for complete information including benefits, costs, eligibility requirements, exclusions and limitations.SA25710ST

Enrollment Checklist

In the following section, you will find the forms you need to complete when applying for coverage. Please be sure to complete and submit all the necessary forms to ensure your enrollment is processed quickly and accurately.

Here is an overview of the different forms and some helpful tips:

Application Form • Be sure to review and complete each applicable section. • Please only write comments where indicated on the application. • Be sure to sign and date the application in all the places indicated.

AARP Membership FormAARP membership is required to enroll in an AARP Medicare Supplement Plan, insured by UnitedHealthcare Insurance Company. If you are not currently an AARP member or are unsure, you may enroll, renew or verify in one of three ways:

• Log on to AGNTU.aarpenrollment.com;• Call toll-free 1-866-331-1964; or• Complete the membership form and submit it with the plan application, along with a separate check for $16.00 payable to AARP. Note: One membership covers both the member and another individual living in the same household. Therefore, only one membership application is required if two individuals of a household are applying for AARP membership.

Electronic Funds Transfer (EFT) Authorization FormAutomatic payments are available by submitting the completed form (signed and dated). If requesting automatic payments, you may deduct $2 from the first month’s household premium check.

Notice to Applicants Regarding Replacement of CoverageIf you are replacing or losing current coverage as indicated on the form, complete both copies of the form, submit one copy with the enrollment application, and keep the other copy for your records. The licensed insurance agent must also sign and date both copies of the form.

If Reply Envelope Is MissingPlease mail completed application to: UnitedHealthcare Insurance Company P.O. Box 105331 Atlanta, GA 30348-5331

(Over Please)

4

4

4

4

4

SA25510ST 5-19

AARP endorses the AARP Medicare Supplement Insurance Plans, insured by UnitedHealthcare Insurance Company. UnitedHealthcare Insurance Company pays royalty fees to AARP for the use of its intellectual property. These fees are used for the general purposes of AARP. AARP and its affiliates are not insurers. AARP does not employ or endorse agents, brokers or producers.

Insured by UnitedHealthcare Insurance Company, Horsham, PA. Policy form No. GRP 79171 GPS-1 (G-36000-4).

In some states plans may be available to persons under age 65 who are eligible for Medicare by reason of disability or End-Stage Renal Disease.

Not connected with or endorsed by the U.S. Government or the federal Medicare program.

This is a solicitation of insurance. A licensed insurance agent/producer may contact you.

See the following materials for complete information including benefits, costs, eligibility requirements, exclusions and limitations.

Application FormAARP® Medicare Supplement Insurance PlansInsured by UnitedHealthcare Insurance Company (UnitedHealthcare), Horsham, PA 19044

Note: Plans and rates are only good for residents of the state of Florida. The information you provide on this Application Form will be used to determine your acceptance and rate.

Instructions1. Fill in all requested information on this Application Form and sign in all places a signature is needed.2. Print clearly, using CAPITAL letters AND black or blue ink - not pencil. Example: X Yes No Not Sure 3. Initial any changes or corrections you make while completing this Application Form.

2460720307 _AGT

S33E49MNAGFL03 01E Page 1 of 9

1 Provide additional information about yourself and your Medicare Insurance.

( ) -___________________________ _________________________________________________________1A. Phone Number 1B. Email address (optional). Include periods (.) and symbols (@).By providing your address, phone number and/or email address, you are agreeing to receive information and be contacted by UnitedHealthcare Insurance Company.

1C. Birthdate ________________________ 1D. Gender £ Male £ Female Month Day Year

1E. Medicare Number _____________________________ (From your Medicare card.)

1F. Medicare Start: Hospital (Part A) ____________________ Medical (Part B) ___________________ Month Year Month Year

1G. Will your Medicare Part A and Part B be active on your AARP Medicare Supplement Plan start date? £ Yes £ No

/ 01 / / 01 /

AARP Membership Number (If you are already a member) ___________________________________________

_______________________________________________________________________________________Applicant First Name MI Last Name

_______________________________________________________________________________________Permanent Home Address Line 1 (P.O. Box/PMB is not allowed)

_______________________________________________________________________________________Permanent Home Address Line 2 City State Zip

_______________________________________________________________________________________Mailing Address Line 1 (if different from permanent address)

_______________________________________________________________________________________Mailing Address Line 2 City State Zip

/ /


First Name Last Name

2 Choose your Plan and start date.

3 Is your acceptance guaranteed?

Plan Choice2A. You are eligible to apply if all of these are true:• you are an AARP member, • you are age 50 or older, • you are enrolled in Medicare Parts A and B,• you are not enrolled in more than one Medicare supplement plan at the same time,• if you are age 65 or older and are entitled to guaranteed acceptance, please look at “Your Guide” to determine which Plans you are eligible for guaranteed acceptance in without having to answer health questions.• if you are age 50-64 and eligible for Medicare by reason of disability or End-Stage Renal Disease (ESRD), you are eligible only if you enrolled in Medicare Part B within the last 6 months, unless you are entitled to guaranteed acceptance in certain Plans as shown in “Your Guide.”Please choose 1 Plan from the right-hand column. Important: Plans C and F are only available to eligible Applicants with a 65th birthday prior to 1/1/2020 or who will be age 50 or older on or after 1/1/2020 with a Medicare Part A Effective Date prior to 1/1/2020. Please call if you have questions.

Plan A Plan B Plan C Plan F Plan G Plan K Plan L Plan N Medicare Select Plan G Medicare Select Plan N

Plan Start Date2B. Your Plan will start on the first day of the month following receipt and approval of this Application Form and receipt of your first month’s payment. If you would like your Plan to start on a later date (the first day of a future month), please indicate the date:

____________________ Month Day Year

3A. Will your AARP Medicare Supplement Plan start date be within 6 months after you turn age 65 or enroll in Medicare Part B?

Yes No

• If YES, your acceptance is guaranteed. Go directly to Section 7. You do not have to answer the questions in Sections 4, 5 and 6.• If NO, you must answer Question 3B.

3B. Do you have guaranteed issue rights, as listed in the Guaranteed Acceptance section of “Your Guide”? If YES, see Your Guide for the documentation you will need to provide from your prior insurer or employer.

Yes No

• If YES, and you are applying for a Plan that is eligible for guaranteed acceptance as defined in the Guaranteed Acceptance Section in “Your Guide”, skip directly to Section 7.If YES and you are applying for a Plan that is NOT eligible for guaranteed acceptance as defined in the Guaranteed Acceptance Section in “Your Guide”, continue to Section 4. Note: Applicants age 50-64 who answer YES and are eligible for Medicare by reason of disability or ESRD may only apply for the Plans shown in the Guaranteed Acceptance Section in “Your Guide”.• If you answered NO to both questions in Section 3 and you are: - age 65 or over, continue to Section 4. - age 50-64 and eligible for Medicare by reason of disability or ESRD, you are NOT eligible to apply for

these Plans.

/ 01 /



4 Answer this health question only if your acceptance is not guaranteed as defi nedin Section 3.

4A. Within the past 2 years, did a licensed medical professional provide treatment or advice to you for any problems with your kidneys? Yes No Not Sure

If you answered YES or NOT SURE to question 4A, we may follow up for additional information.

5 Answer these eligibility health questions only if your acceptance is not guaranteed as defi ned in Section 3.

5A. Within the past 90 days, were you hospitalized as an inpatient (not including overnight outpatient observation)? Yes No Not Sure

5B. Are you currently being treated or living in any type of nursing facility other than an assisted living facility? Yes No Not Sure

5C. Within the past 2 years, did a licensed medical professional tell you that you may need any of the following treatments for a medical condition that has NOT been completed? • hospital admittance as an inpatient • joint replacement • organ transplant • surgery for cancer • back or spine surgery • heart or vascular surgery

Yes No Not Sure

5D. Within the past 2 years, did you have (as determined by a licensed medical professional) a Heart Attack, Stroke, Transient Ischemic Attack (TIA) or mini-stroke? Yes No Not Sure

5E. Within the past 2 years, did you have (as determined by a licensed medical professional) or were you diagnosed, treated, given medical advice or prescribed medication/refi lls for any of the following conditions? • Atrial Fibrillation or Flutter • Artery or Vein Blockage • Peripheral Vascular Disease (PVD) • Cardiomyopathy • Congestive Heart Failure (CHF) • Coronary Artery Disease (CAD) • Chronic Obstructive Pulmonary Disease (COPD) or Emphysema • End Stage Renal (Kidney) Disease or Require Dialysis • Chronic Kidney Disease • Diabetes, but only if you have circulation problems or Retinopathy

Yes No Not Sure Yes No Not Sure Yes No Not Sure Yes No Not Sure Yes No Not Sure Yes No Not Sure Yes No Not Sure Yes No Not Sure Yes No Not Sure Yes No Not Sure



6 Tell us about your medical providers.

Provide the following information for all physicians that you have seen within the past two years. We may follow up with your physicians for additional information. If needed, please use an additional sheet of paper and check this box to indicate you are attaching it. £

_______________________________________________________________________________________Primary Physician Phone #

_______________________________________________________________________________________Address

_______________________________________________________________________________________City State ZIP Code

_______________________________________________________________________________________Specialist Name Specialty

_______________________________________________________________________________________Diagnosis/Condition

_______________________________________________________________________________________Specialist Name Specialty

_______________________________________________________________________________________Diagnosis/Condition

( ) -

• Cancer including Melanoma (but not other skin cancers), Leukemia and Lymphoma • Cirrhosis of the Liver • Macular Degeneration, but only if you have the wet form • Multiple Sclerosis • Rheumatoid Arthritis • Systemic Lupus Erythematosus (SLE)

Yes No Not Sure Yes No Not Sure Yes No Not Sure Yes No Not Sure Yes No Not Sure Yes No Not Sure

Answering YES to any question in Section 5 will result in a denial of coverage. If your health status changes in the future, allowing you to answer NO to all of the questions in this section, please submit a new application at that time.If you answered NOT SURE to any question in Section 5, we may follow up for additional information.

5 Answer these eligibility health questions only if your acceptance is not guaranteed as defi ned in Section 3. (continued)



7 Tell us about your tobacco usage.

7A. At any time within the past 12 months, have you smoked tobacco cigarettes or used any other tobacco product?

Yes No

If you answered YES to Question 7A, your rate will be the tobacco rate. See “Cover Page - Rates.”

8 Your past and current coverage

Review the statements.• You do not need more than one Medicare supplement policy.• If you purchase this policy, you may want to evaluate your existing health coverage and decide if you need multiple coverages.• You may be eligible for benefits under Medicaid and may not need a Medicare supplement policy.• If, after purchasing this policy, you become eligible for Medicaid, the benefits and premiums under your Medicare supplement policy can be suspended, if requested, during your entitlement to benefits under Medicaid for 24 months. You must request this suspension within 90 days of becoming eligible for Medicaid. If you are no longer entitled to Medicaid, your suspended Medicare supplement policy (or, if that is no longer available, a substantially equivalent policy) will be reinstituted if requested within 90 days of losing Medicaid eligibility. • If you are eligible for, and have enrolled in a Medicare supplement policy by reason of disability and you later become covered by an employer or union-based group health plan, the benefits and premiums under your Medicare supplement policy can be suspended, if requested, while you are covered under the employer or union-based group health plan. If you suspend your Medicare supplement policy under these circumstances, and later lose your employer or union-based group health plan, your suspended Medicare supplement policy (or, if that is no longer available, a substantially equivalent policy) will be reinstituted if requested within 90 days of losing your employer or union-based group health plan.• Counseling services may be available in your state to provide advice concerning your purchase of Medicare supplement insurance and concerning medical assistance through the state Medicaid program, including benefits as a Qualified Medicare Beneficiary (QMB) and a Specified Low-Income Medicare Beneficiary (SLMB).

If you lost or are losing other health insurance coverage and received a notice from your prior insurer saying you were eligible for guaranteed issue of a Medicare supplement insurance policy, or that you had certain rights to buy such a policy, you may be guaranteed acceptance in one or more of our Medicare supplement plans. Please include a copy of the notice from your prior insurer with your Enrollment Form.

PLEASE ANSWER ALL QUESTIONS.To the best of your knowledge,8A. Did you turn age 65 in the last 6 months? Yes No

8B. Did you enroll in Medicare Part B within the last 6 months? Yes No

8C. If YES, what is the effective date? ____________________ Month Day Year

/ /



8 Your past and current coverage (continued)

Questions about Medicaid 8D. Are you covered for medical assistance through the state Medicaid program?(Medicaid is a state-run health care program that helps with medical costs for people with low or limited income. It is not the federal Medicare program.) Note to applicant: If you are participating in a “Spend-down Program” and have not met your “Share of Cost”, answer NO to this question. If YES, you must answer Questions 8E and 8F.

Yes No

8E. Will Medicaid pay your premiums for this Medicare supplement policy? Yes No

8F. Do you receive any benefits from Medicaid OTHER THAN payments toward your Medicare Part B premium?

Yes No

Questions about Medicare Advantage plans (sometimes called Medicare Part C)8G. Have you had coverage from any Medicare plan other than original Medicare within the past 63 days (for example, a Medicare Advantage plan, a Medicare HMO, or PPO)?If YES, you must answer Questions 8H through 8K.

Yes No

8H. Provide the start and end dates of your Medicare plan other than original Medicare. If you are still covered under this plan, leave the end date blank.

Start Date____________________ Month Day Year

End Date____________________ Month Day Year

8I. If you are still covered under the Medicare plan other than original Medicare, do you intend to replace your current coverage with this new Medicare supplement policy?(When you receive confirmation that this Medicare Supplement plan has been issued, you will need to cancel your Medicare Advantage Plan. Please contact your Medicare Advantage insurer for instructions on how to cancel, using the customer service number on the back of your ID card.)If YES, please enclose a copy of the Replacement Notice.

Yes No

8J. Was this your first time in this type of Medicare plan? Yes No

8K. Did you drop a Medicare supplement policy to enroll in the Medicare plan? Yes No

Questions about Medicare supplement plans8L. Do you have another Medicare supplement policy in force?If so, what insurance company and what plan do you have?Insurance Company: _________________________________________________Policy: ___________________________________________________________If YES, you must answer Question 8M.

Yes No

8M. Do you intend to replace your current Medicare supplement policy with this policy?If YES, please enclose a copy of the Replacement Notice.

Yes No

Questions about any other type of health insurance coverage8N. Have you had coverage under any other health insurance within the past 63 days (for example, an employer, union, or individual plan)?If YES, you must answer Questions 8O through 8Q.

Yes No

/ /

/ /



7 ______________________________________________________________ __________________ Your Signature (required) Today’s Date (required) Month Day Year

/ /

8O. If so, with what insurance company and what kind of policy?Insurance Company:_______________________________________________

Policy: HMO/PPO Major Medical Employer Plan Union Plan Other_______________

8P. What are your dates of coverage under the other policy? Leave the end date blank if you are still covered under the policy.

Start Date____________________ Month Day Year

End Date____________________ Month Day Year

8Q. Are you replacing this health insurance? Yes No

/ /

/ /

8 Your past and current coverage (continued)

Read carefully, and sign and date in the signature box. • I declare the answers on this Application Form are complete and true to the best of my knowledge and belief and are the basis for issuing coverage. I understand that this Application Form becomes a part of the insurance contract and that if the answers are incomplete, incorrect or untrue, UnitedHealthcare Insurance Company may have the right to rescind my coverage, adjust my premium, or reduce my benefits.• Any person who, knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing any false, incomplete, or misleading information is guilty of a felony of the third degree.• I understand coverage, if provided, will not take effect until issued by UnitedHealthcare Insurance Company, the actual premium is not determined until coverage is issued and that this Application Form and payment of the initial premium does not guarantee coverage will be provided.• I acknowledge receipt of the Guide to Health Insurance for People with Medicare and the Outline of Coverage.• If you are enrolling in a Medicare Select Plan: I acknowledge that I have received an Outline of Coverage, Grievance Procedure, Provider Directory and a Medicare Select Disclosure Statement covering Provider Restrictions, Right to Replace Your Medicare Supplement Plan and Quality Assurance Program. I affirm that I understand the benefits, restrictions, limitations and other provisions of the Medicare Select Plan for which I am applying.If the Application Form is being completed through an Agent or Broker:• I understand the Florida-licensed Insurance agent or broker discussing Plan options with me is appointed by UnitedHealthcare Insurance Company, and may be compensated based on my enrollment in a Plan.• I understand that an agent or broker cannot change or waive any terms or requirements related to this Application Form and its contents, underwriting, premium or coverage and cannot grant approval.

9 Authorization and Verification of Application Information



My signature indicates I have read and understand all contents of this Application Form and have answered all questions to the best of my ability.

7 ______________________________________________________________ __________________ Your Signature (required) Today’s Date (required) Month Day YearNote: If you are signing as the legal representative (e.g., POA, Guardian, Conservator, etc.) for the applicant, please send a complete copy of the appropriate legal documentation and check this box. £

My signature indicates I have read and understand all contents of this Application Form and have answered all questions to the best of my ability.

7 ______________________________________________________________ __________________ Your Signature (required) Today’s Date (required) Month Day YearNote: If you are signing as the legal representative (e.g., POA, Guardian, Conservator, etc.) for the applicant, please send a complete copy of the appropriate legal documentation and check this box. £

/ /

/ /

Authorization for the Release of Medical InformationI authorize UnitedHealthcare Insurance Company and its affiliates (“The Company”) to obtain from any health care provider, licensed physician, medical practitioner, hospital, pharmacy, clinic or other medical facility, health care clearinghouse, pharmacy benefit manager, insurance company, or other organization, institution or person, or The Company’s own information, any data or records about me or my mental or physical health. I understand the purpose of this disclosure and use of my information is to allow The Company to determine my eligibility for coverage and rate. I understand this authorization is voluntary and I may refuse to sign the authorization. My refusal may, however, affect my eligibility to enroll in the health plan. I understand the information I authorize The Company to obtain and use may be re-disclosed to a third party only as permitted under applicable law, and once re-disclosed, the information may no longer be protected by Federal privacy laws. I understand I may end this authorization if I notify The Company, in writing, except to the extent that The Company has already acted on my authorization. If not revoked, this authorization is valid for 24 months from the date of my signature.Please see “Your Guide” to determine if the following pre-existing condition waiting period applies to you.I understand the plan will not pay benefits for stays beginning or medical expenses incurred during the first 3 months of coverage if they are due to conditions for which medical advice was given or treatment recommended by or received from a physician within 3 months prior to the insurance effective date.

Read carefully, and sign and date in the signature box below.I authorize any health care provider, licensed physician, medical practitioner, hospital, pharmacy, clinic or other medical facility, health care clearinghouse, pharmacy benefit manager, insurance company, or other organization, institution, or person to give UnitedHealthcare Insurance Company and its affiliates (“The Company”) any data or records about me or my mental or physical health. I understand the purpose of this disclosure and use of my information is to allow The Company to determine the eligibility of and/or amount payable for my claims and for analytic studies. I understand this authorization is voluntary and I may refuse to sign the authorization. My refusal may, however, affect my eligibility to enroll in the health plan. I understand the information I authorize The Company to obtain and use may be re-disclosed to a third party only as permitted under applicable law, and once re-disclosed, the information may no longer be protected by Federal privacy laws. I understand I may end this authorization if I notify The Company, in writing, except to the extent that The Company has already acted on my authorization. If not revoked, this authorization is valid for 24 months from the date of my signature.

9 Authorization and Verification of Application Information (continued)

10 Authorization for Verification of Information



Agent/Broker must complete the following information and include the notice of replacement coverage, if appropriate, with this Application Form. All information must be complete or the Application Form will be returned.1. List any other health insurance policies issued to the applicant:

_____________________________________________________________________________________

_____________________________________________________________________________________2. List policies issued which are still in force:

_____________________________________________________________________________________

_____________________________________________________________________________________3. List policies issued in the past 5 years which are no longer in force:

_____________________________________________________________________________________

_____________________________________________________________________________________

/ /

Agent Name (PLEASE PRINT) _______________________ ___ _____________________________________ First Name MI Last Name

7 ______________________________________ ________________________ ___________________ Agent Signature (required) Agent ID (required) Today’s Date (required) Month Day Year

___________________________________________________ _______________________________ Agent Email Address Agent Phone Number

7 ______________________________________ ____________________________________________ Broker Name Broker ID

11 For Agent/Broker Use Only

( ) -

MEDICARE SUPPLEMENT INSURANCEAGENT CERTIFICATION FORM

I, the undersigned insurance agent certify:

THAT, I have taken an application for Policy Form No. G-36000-4 offered by the UnitedHealthcare Insurance Company to __________________________________________________ (Applicant).

THAT, I have explained the provisions of the policy being applied for, including specifically, all the different benefits, exceptions and limitations of the plan.

THAT, I am a licensed agent of this insurance company and have given a company receipt for an initial premium in the amount of $____________ (Insert zero if no premium received) which has been paid to me by ( ) Check ( ) Cash ( ) Money Order (Check appropriate method of payment).

THAT, I have clearly explained any benefits of this plan are a supplement to any benefits that the applicant may be entitled to receive from the Medicare Program of the Federal Government.

THAT, I have not made any representation to the applicant that there is any endorsement whatsoever by the Social Security Administration or the Centers for Medicare & Medicaid Services of the Federal Government in connection with this insurance policy being applied for.

Date

I, the undersigned applicant, have received a copy of this form

Applicant’s signature

Signature of Agent

Name of Agency

Address of Agent or Agency

Phone No.

SA25383FL DEC16

YES, I want to join AARP or renew by mail!

With AARP automatic renewal, you will be charged $12 for your first year. For anysubsequent year you remain enrolled, you will be charged the full annual rate (currently $16)on the first day of the month in which your membership expires. You may cancel at any timeby calling 1-800-516-1993.

1 year/$16 3 years/$43 5 years/$63

Your Name (please print)________________________________________________________

Address___________________________________________________Apt._______________

City ________________________________________ State _________ Zip ______________

Date of Birth __________________ / _____________________ / ______________________Month Day Year

For FREE Spouse/Partner MembershipSpouse’s/Partner’s Name_________________________________________________________

Date of Birth __________________ / _____________________ / ______________________Month Day Year

VCGFDAUH

HEALTHCARE PRODUCTS & SERVICES access to health and dentalinsurance products, as well asvision and prescription discounts

AARP BENEFITS are worth far more than the cost of membership.

Check or money order enclosed, payable to AARP.(Send no cash, please.)

Join or renew and save 25% when yousign up for Automatic Renewal!

$

Yes, I want to join or renewwith Automatic Renewal and

Why sign up for Automatic Renewal?Saves time with fewer mailings. It’s safe, secure and you can cancel at any time.

ORSAVE25%

Visit agntu.aarpenrollment.com

AWARD-WINNING PUBLICATIONSincluding AARP The Magazine,the AARP Bulletin, and freeguides on financial planning and health

FINANCIAL SERVICES access to life, autoand homeowners insurance, AARP-endorsedcredit card, plus investment program options

PROTECTION OF YOUR RIGHTSin Washington and your state government

to strengthen Medicare and Social Security, confront agediscrimination and protect pension benefits

TRAVEL DISCOUNTSon hundreds of hotels, resorts,car rentals, tours, cruises andplane fares worldwide

COMMUNITY INVOLVEMENTLocal chapters with volunteer opportunities,social activities, Driver Safety Courses, andAARP Foundation Tax-Aide program

MEMBERSHIP ACTIVATION FORM

Save 25% off AARP standard yearly pricefor your first year when you select

Automatic Renewal.Visit agntu.aarpenrollment.com

Your AARP membership is separate from your relationship with UnitedHealthcare Insurance Company and could be coming up for renewal or could even have expired.

BA25444ST AGT

AA25002ST AGT2020

1-866-331-1964

Here are some featured health related benefits ofAARP that you’ll have access to as a member:

$

Please allow 3-4 weeks for delivery of your Membership Kit. Dues are not deductible for income tax purposes. One membership also includes spouse/partner.Some AARP member benefits are provided by third parties, not by AARP or its affiliates. Providers pay a royalty fee to AARP for the use of its intellectualproperty. These fees are used for general purposes of AARP. Some provider offers are subject to change and may have restrictions. Please contact the providerdirectly for details. Annual dues include $4.03 for a subscription to AARP The Magazine and $3.09 for the AARP Bulletin. Dues outside U.S. domestic maillimits: $17/one year for Canada and Mexico, $28/one year for all other countries. When you join, AARP shares your membership information with thecompanies we have selected to provide AARP member benefits, companies that support AARP operations, and select non-profit organizations. If you do notwant us to share your information with providers of AARP member benefits or non-profit organizations, please let us know by calling 1-800-516-1993 or e-mailing us at [email protected]. We may steward your resources by converting your check into an electronic deposit.

4 Supplemental Health Insurance

4 Dental Coverage

4 Hearing Care Program

4 Vision Care Discounts

4 AARP Prescription Discounts

4 AARP Brain Health Center

agntu.aarpenrollment.com

Act now and make the most of membership.

SAVE25%

Join or renew with Automatic Renewal and save 25% your first year!

Return this form in theenclosed envelope.

4 Health Tools

4 Online Recipe Database

4 Hearing Center

4 Family Caregiving Resources

4 Housing and Mobility Resources

4 Local Assistance Directory

1-866-331-1964

Save $24 a year with the Electronic Funds Transfer (EFT) service

The Easiest Way to PayMore than 2.5 million AARP® members nationwide enjoy the convenience of the EFT option. With EFT,your monthly payment will automatically be deducted from your checking or savings account. Also,you’ll save $2.00 off the total monthly premium for your household.

In addition to saving up to $24 a year:• You’ll save on the cost of checks and rising postal rates.• You don’t have to take time to write a check each month.• You don’t have to worry about mailing a payment if you travel or become ill, because your payment is always deducted on or about the fifth day of each month.

Signing Up is Easy Complete the Automatic Payment Authorization Form on the reverse side. Return it with the application and be sure to keep a copy for your records. Please be sure the information is clear, as it is required for processing your request for EFT. You do not need to include a voided check.

Your EFT Effective DateIf you are submitting this EFT form with your enrollment application, your automatic payment start date will be the same as your plan effective date. A letter will be sent to confirm this and will include theamount of your withdrawal. Please note that if your coverage is effective in the future or your account is paid in advance, EFT withdrawals will begin for the next payment due. If your account is effective in the pastor is past due, a letter will be sent that explains how to make the payment that is due.

Complete Form on Reverse

This side for your information only, return not required.

�

BA25300ST Nov 13

IMPORTANTPlease refer to the diagram below to obtain your bank routing information.

We look forward to continuing to serve you.

VOID

AUTOMATIC PAYMENT AUTHORIZATION FORM

I allow UnitedHealthcare Insurance Company (UnitedHealthcare Insurance Company of NewYork for New York residents), hereafter named UnitedHealthcare, to take monthly withdrawals

for the then-current monthly rate from the account named on this form. I also allow the named banking facility (BANK) to charge such withdrawals to this account.

Monthly withdrawal amounts will be for the total household payment due each month. This will includepremiums for a spouse or other member(s) of the household on the same membership account. Thisauthority is active until UnitedHealthcare and the BANK receive notice from me to end withdrawals inenough time to give UnitedHealthcare and the BANK a reasonable opportunity to act on it. I have theright to stop payment of a withdrawal by giving notice to the BANK in such time as to give the BANK areasonable opportunity to act upon it. I understand such action may make the health care insurancecoverage past due and subject to cancellation.

Member Name ________________________________ AARP Member Number___________________

Member Address _____________________________________________________________________Street Addresss

Member Address _____________________________________________________________________City State Zip Code

Bank Name _____________________________

Bank Routing No. ________________________

(9 digit number)

Bank Account No. ________________________

Bank Account Holder’s Name if other than Member ________________________________________________

Bank Account Holder’s Signature _______________________________________________________________

Account Type: Checking Savings (statement savings only)

Save $24 a year with the Electronic Funds Transfer (EFT) service

The Easiest Way to PayMore than 2.5 million AARP® members nationwide enjoy the convenience of the EFT option. With EFT,your monthly payment will automatically be deducted from your checking or savings account. Also,you’ll save $2.00 off the total monthly premium for your household.

In addition to saving up to $24 a year:• You’ll save on the cost of checks and rising postal rates.• You don’t have to take time to write a check each month.• You don’t have to worry about mailing a payment if you travel or become ill, because your payment is always deducted on or about the fifth day of each month.

Signing Up is Easy Complete the Automatic Payment Authorization Form on the reverse side. Return it with the application and be sure to keep a copy for your records. Please be sure the information is clear, as it is required for processing your request for EFT. You do not need to include a voided check.

Your EFT Effective DateIf you are submitting this EFT form with your enrollment application, your automatic payment start date will be the same as your plan effective date. A letter will be sent to confirm this and will include theamount of your withdrawal. Please note that if your coverage is effective in the future or your account is paid in advance, EFT withdrawals will begin for the next payment due. If your account is effective in the pastor is past due, a letter will be sent that explains how to make the payment that is due.

Complete Form on Reverse

This side for your information only, return not required.

�

BA25300ST Nov 13

IMPORTANTPlease refer to the diagram below to obtain your bank routing information.

We look forward to continuing to serve you.

VOID

AUTOMATIC PAYMENT AUTHORIZATION FORM

I allow UnitedHealthcare Insurance Company (UnitedHealthcare Insurance Company of NewYork for New York residents), hereafter named UnitedHealthcare, to take monthly withdrawals

for the then-current monthly rate from the account named on this form. I also allow the named banking facility (BANK) to charge such withdrawals to this account.

Monthly withdrawal amounts will be for the total household payment due each month. This will includepremiums for a spouse or other member(s) of the household on the same membership account. Thisauthority is active until UnitedHealthcare and the BANK receive notice from me to end withdrawals inenough time to give UnitedHealthcare and the BANK a reasonable opportunity to act on it. I have theright to stop payment of a withdrawal by giving notice to the BANK in such time as to give the BANK areasonable opportunity to act upon it. I understand such action may make the health care insurancecoverage past due and subject to cancellation.

Member Name ________________________________ AARP Member Number___________________

Member Address _____________________________________________________________________Street Addresss

Member Address _____________________________________________________________________City State Zip Code

Bank Name _____________________________

Bank Routing No. ________________________

(9 digit number)

Bank Account No. ________________________

Bank Account Holder’s Name if other than Member ________________________________________________

Bank Account Holder’s Signature _______________________________________________________________

Account Type: Checking Savings (statement savings only)

NOTICE TO APPLICANT REGARDING REPLACEMENT OF MEDICARE SUPPLEMENT INSURANCE OR MEDICARE ADVANTAGE

UNITEDHEALTHCARE INSURANCE COMPANYHorsham, Pennsylvania

Save this notice! It may be important to you in the futureAccording to the information you furnished, you intend to terminate existing Medicare supplement or Medicare Advantage insurance and replace it with a policy to be issued by UnitedHealthcare Insurance Company. Your new policy will provide thirty (30) days within which you may decide without cost whether you desire to keep the policy. You should review this new coverage carefully. Compare it with all accident and sickness coverage you now have. If,after due consideration, you find that purchase of this Medicare supplement coverage is a wise decision, you should terminate your present Medicare supplement or Medicare Advantage coverage. You should evaluate the need for otheraccident and sickness coverage you have that may duplicate this policy.

Statement To Applicant By Issuer, Agent, Broker Or Other Representative:I have reviewed your current medical or health insurance coverage. To the best of my knowledge, this Medicare supplement policy will not duplicate your existing Medicare supplement or, if applicable, Medicare Advantage coveragebecause you intend to terminate your existing Medicare supplement policy or leave your Medicare Advantage plan. The replacement policy is being purchased for one of the following reasons (check one):

Additional benefits.No change in benefits, but lower premiums.Fewer benefits and lower premiumsMy plan has outpatient prescription drug coverage and I am enrolling in Part D.

Disenrollment from a Medicare Advantage plan. Please explain reason for Disenrollment.Other (Please Specify)

1. Health conditions which you may presently have (Pre-existing conditions) may not be immediately or fully covered under the new policy. This could result in denial or delay of a claim for benefits under the new policy, whereas a similar claim might have been payable under your present policy.

2. State law provides that your replacement policy or certificate may not contain new pre-existing conditions, waiting periods, elimination periods, or probationary periods. The insurer will waive any time periods applicable to pre-existing conditions, waiting periods, elimination periods, or probationary periods in the new policy (or coverage) for similar benefits to

the extent such time was spent (depleted) under the original policy.

3. If you still wish to terminate your present policy and replace it with new coverage, be certain to truthfully and completely answer all questions on the application concerning your medical and health history. Failure to include all material medical information on an application may provide a basis for the company to deny any future claims and to refund your premium as though your policy had never been in force. After the application has been completed and before you sign it, review it carefully to be certainthat all information has been properly recorded.

Do not cancel your present policy until you have received your new policy and are sure that you want to keep it.

RN033 7/09

(Signature of Agent, Broker or Other Representative) (Date)

(Applicant’s Printed Name & Address)

(Date) (Applicant’s Signature)

Complete and submit this copy with the application

NOTICE TO APPLICANT REGARDING REPLACEMENT OF MEDICARE SUPPLEMENT INSURANCE OR MEDICARE ADVANTAGE

UNITEDHEALTHCARE INSURANCE COMPANYHorsham, Pennsylvania

Save this notice! It may be important to you in the futureAccording to the information you furnished, you intend to terminate existing Medicare supplement or Medicare Advantage insurance and replace it with a policy to be issued by UnitedHealthcare Insurance Company. Your new policy will provide thirty (30) days within which you may decide without cost whether you desire to keep the policy. You should review this new coverage carefully. Compare it with all accident and sickness coverage you now have. If,after due consideration, you find that purchase of this Medicare supplement coverage is a wise decision, you should terminate your present Medicare supplement or Medicare Advantage coverage. You should evaluate the need for otheraccident and sickness coverage you have that may duplicate this policy.

Statement To Applicant By Issuer, Agent, Broker Or Other Representative:I have reviewed your current medical or health insurance coverage. To the best of my knowledge, this Medicare supplement policy will not duplicate your existing Medicare supplement or, if applicable, Medicare Advantage coveragebecause you intend to terminate your existing Medicare supplement policy or leave your Medicare Advantage plan. The replacement policy is being purchased for one of the following reasons (check one):

Additional benefits.No change in benefits, but lower premiums.Fewer benefits and lower premiumsMy plan has outpatient prescription drug coverage and I am enrolling in Part D.

Disenrollment from a Medicare Advantage plan. Please explain reason for Disenrollment.Other (Please Specify)

1. Health conditions which you may presently have (Pre-existing conditions) may not be immediately or fully covered under the new policy. This could result in denial or delay of a claim for benefits under the new policy, whereas a similar claim might have been payable under your present policy.

2. State law provides that your replacement policy or certificate may not contain new pre-existing conditions, waiting periods, elimination periods, or probationary periods. The insurer will waive any time periods applicable to pre-existing conditions, waiting periods, elimination periods, or probationary periods in the new policy (or coverage) for similar benefits to

the extent such time was spent (depleted) under the original policy.

3. If you still wish to terminate your present policy and replace it with new coverage, be certain to truthfully and completely answer all questions on the application concerning your medical and health history. Failure to include all material medical information on an application may provide a basis for the company to deny any future claims and to refund your premium as though your policy had never been in force. After the application has been completed and before you sign it, review it carefully to becertain that all information has been properly recorded.

Do not cancel your present policy until you have received your new policy and are sure that you want to keep it.

RN034 7/09

(Signature of Agent, Broker or Other Representative) (Date)

(Applicant’s Printed Name & Address)

(Date) (Applicant’s Signature)

Complete and keep this copy for your records

注意事項：日本語を話される場合、無料の言語支援サービスをご利用いただけます。にお電話ください。

1-800-523-5800

: . 1-800-523-5800 .

2020Choosing a Medigap Policy:

A Guide to Health Insurance for People with Medicare

C E N T E R S F O R M E D I C A R E & M E D I C A I D S E R V I C E S

This o�cial government guide has important information about:

• Medicare Supplement Insurance(Medigap) policies

• What Medigap policies cover

• Your rights to buy a Medigap policy

• How to buy a Medigap policy

Developed jointly by the Centers for Medicare & Medicaid Services (CMS) and the National Association of Insurance Commissioners (NAIC)

Who should read this guide? This guide can help if you’re thinking about buying a Medicare Supplement Insurance (Medigap) policy or already have one. It’ll help you understand how Medigap policies work.

Important information about this guideThe information in this guide describes the Medicare Program at the time this guide was printed. Changes may occur after printing. Visit Medicare.gov, or call 1‑800‑MEDICARE (1‑800‑633‑4227) to get the most current information. TTY users can call 1‑877‑486‑2048.The “2020 Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare” isn’t a legal document. Official Medicare Program legal guidance is contained in the relevant statutes, regulations, and rulings.

Paid for by the Department of Health & Human Services.

3Table of Contents

Medicare Basics 5A brief look at Medicare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5What’s Medicare? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6The different parts of Medicare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Your Medicare coverage choices at a glance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Medicare and the Health Insurance Marketplace . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Medigap Basics 9

What’s a Medigap policy?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9What Medigap policies cover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10What Medigap policies don’t cover. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Types of coverage that are NOT Medigap policies . . . . . . . . . . . . . . . . . . . . . . . . . 12What types of Medigap policies can insurance companies sell? . . . . . . . . . . . . . . 12What do I need to know if I want to buy a Medigap policy?. . . . . . . . . . . . . . . . . 13When’s the best time to buy a Medigap policy? . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Why is it important to buy a Medigap policy when I’m first eligible? . . . . . . . . . 16How do insurance companies set prices for Medigap policies? . . . . . . . . . . . . . . 17Comparing Medigap costs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19What’s Medicare SELECT? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20How does Medigap help pay my Medicare Part B bills? . . . . . . . . . . . . . . . . . . . . 20

Your Right to Buy a Medigap Policy 21

What are guaranteed issue rights? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21When do I have guaranteed issue rights?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Can I buy a Medigap policy if I lose my health care coverage? . . . . . . . . . . . . . . 24

Steps to Buying a Medigap Policy 25

Step‑by‑step guide to buying a Medigap policy . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

If You Already Have a Medigap Policy 31

Switching Medigap policies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32Losing Medigap coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36Medigap policies and Medicare prescription drug coverage . . . . . . . . . . . . . . . . 36

Section 1:

Section 2:

Section 3:

Section 4:

Section 5:

4 Table of Contents

Medigap Policies for People with a Disability or ESRD 39

Information for people under 65 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

Medigap Coverage in Massachusetts, Minnesota, and Wisconsin 41

Massachusetts benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42Minnesota benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

Wisconsin benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

For More Information 45

Where to get more information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45How to get help with Medicare and Medigap questions . . . . . . . . . . . . . . . . . . . . 46State Health Insurance Assistance Program and State Insurance Department. . 47

Definitions 49

Where words in BLUE are defined . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

Section 6:

Section 7:

Section 8:

Section 9:

15

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Medicare Basics

A brief look at MedicareA Medicare Supplement Insurance (Medigap) policy is health insurance that can help pay some of the health care costs that Original Medicare doesn’t cover, like coinsurance, copayments, or deductibles. Private insurance companies sell Medigap policies. Some Medigap policies also cover certain bene�ts Original Medicare doesn’t cover, like emergency foreign travel expenses. Medigap policies don’t cover your share of the costs under other types of health coverage, including Medicare Advantage Plans (like HMOs or PPOs), stand-alone Medicare Prescription Drug Plans, employer/union group health coverage, Medicaid, or TRICARE. Insurance companies generally can’t sell you a Medigap policy if you have coverage through Medicaid or a Medicare Advantage Plan.

�e next few pages provide a brief look at Medicare. If you already know the basics about Medicare and only want to learn about Medigap, skip to page 9.

Words in blue are de�ned on pages 49–50.

6 Section 1: Medicare Basics

What’s Medicare? Medicare is health insurance for people 65 or older, certain people under 65 with disabilities, and people of any age with End‑Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant).

The different parts of Medicare The different parts of Medicare help cover specific services.

Part A (Hospital Insurance)Helps cover:• Inpatient care in hospitals• Skilled nursing facility care• Hospice care• Home health care

Part B (Medical Insurance)Helps cover:• Services from doctors and other health care providers• Outpatient care• Home health care• Durable medical equipment (like wheelchairs, walkers,

hospital beds, and other equipment)• Many preventive services (like screenings, shots or vaccines,

and yearly “Wellness” visits)

Part D (Prescription drug coverage)Helps cover:• Cost of prescription drugs (including many recommended

shots or vaccines)Part D plans are run by private insurance companies that follow rules set by Medicare.

7Section 1: Medicare Basics

Your Medicare options When you �rst enroll in Medicare and during certain times of the year, you can choose how you get your Medicare coverage. �ere are 2 main ways to get Medicare.

Original Medicare• Original Medicare includes Medicare

Part A (Hospital Insurance) and Part B(Medical Insurance).

• If you want drug coverage, you can join aseparate Part D plan.

• To help pay your out-of-pocket costsin Original Medicare (like your 20%coinsurance), you can also shop for andbuy supplemental coverage.

• Can use any doctor or hospital that takesMedicare, anywhere in the U.S.

Part A

Part B

You can add:

Part D

You can also add:

Supplemental coverage

(Some examples includecoverage from a MedicareSupplement Insurance(Medigap) policy, or coveragefrom a former employer orunion.)

Medicare Advantage(also known as Part C)

• Medicare Advantage is an “all in one” alternative to Original Medicare. These“bundled” plans include Part A, Part B,and usually Part D.

• Plans may have lower out-of-pocket coststhan Original Medicare.

• In most cases, you’ll need to use doctorswho are in the plan’s network.

• Most plans o�er extra bene�ts thatOriginal Medicare doesn’t cover— likevision, hearing, dental, and more.

Part A

Part B

Most plans include:

Part D

Extra bene�ts

Some plans also include:

Lower out-of-pocket-costs

8 Section 1: Medicare Basics

Medicare and the Health Insurance MarketplaceIf you have coverage through an individual Marketplace plan (not through an employer), you may want to end your Marketplace coverage and enroll in Medicare during your Initial Enrollment Period to avoid the risk of a delay in future Medicare coverage and the possibility of a Medicare late enrollment penalty. For most people, their Initial Enrollment period is the 7‑month period that starts 3 months before the month they turn 65, includes the month they turn 65, and ends 3 months after the month they turn 65. You can keep your Marketplace plan without penalty until your Medicare coverage starts. Once you’re considered eligible for premium‑free Part A, you won’t qualify for help paying your Marketplace plan premiums or other medical costs. If you continue to get help paying your Marketplace plan premium after you have Medicare, you may have to pay back some or all of the help you got when you file your taxes. Visit HealthCare.gov to connect to the Marketplace in your state, or find out how to terminate your Marketplace financial help or plan to avoid a gap in coverage. You can also call the Marketplace Call Center at 1‑800‑318‑2596. TTY users can call 1‑855‑889‑4325. Note: Medicare isn’t part of the Marketplace. The Marketplace doesn’t offer Medicare Supplement Insurance (Medigap) policies, Medicare Advantage Plans, or Medicare prescription drug coverage (Part D).

For more information Remember, this guide is about Medigap policies. To learn more about Medicare, visit Medicare.gov, look at your “Medicare & You” handbook, or call 1‑800‑MEDICARE (1‑800‑633‑4227). TTY users can call 1‑877‑486‑2048.

29

SECTION

Medigap Basics

What’s a Medigap policy? A Medigap policy is an insurance policy that helps supplement Original Medicare and is sold by private companies. A Medigiap policy can help pay some of the remaining health care costs that Original Medicare doesn't pay for covered services and supplies, like copayments, coinsurance, and deductibles. Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. �ese are “gaps” in Medicare coverage. If you have Original Medicare and a Medigap policy, Medicare will pay its share of the Medicare-approved amounts for covered health care costs. �en your Medigap policy pays its share. A Medigap policy is di�erent from a Medicare Advantage Plan (like an HMO or PPO) because those plans are ways to get Medicare bene�ts, while a Medigap policy only supplements the costs of your Original Medicare bene�ts. Note: Medicare doesn’t pay any of your costs for a Medigap policy.All Medigap policies must follow federal and state laws designed to protect you, and policies must be clearly identi�ed as “Medicare Supplement Insurance.” Each standardized Medigap policy must o�er the same basic bene�ts, no matter which insurance company sells it.

Cost is usually the only di�erence between Medigap policies with the same letter sold by di�erent insurance companies.

10 Section 2: Medigap Basics

What Medigap policies cover

�e chart on page 11 gives you a quick look at the standardized Medigap Plans available. You’ll need more details than this chart provides to compare and choose a policy. Call your State Health Insurance Assistance Program (SHIP) for help. See pages 47–48 for your state’s phone number.

• Insurance companies selling Medigap policies are required to make Plan Aavailable. If they o�er any other Medigap policy, they must also o�er eitherPlan C or Plan F to individuals who are not new to Medicare and either Plan D orPlan G to individuals who are new to Medicare. Not all types of Medigap policiesmay be available in your state.

• Plans D and G with coverage starting on or a�er June 1, 2010, have di�erentbene�ts than Plans D or G bought before June 1, 2010.

• Plans E, H, I, and J are no longer sold, but, if you already have one, you cangenerally keep it.

• Starting January 1, 2020, Medigap plans sold to people new to Medicare won’t beallowed to cover the Part B deductible. Because of this, Plans C and F will nolonger be available to people who are new to Medicare on or a�er January 1,2020.

– If you already have either of these two plans (or the high deductible versionof Plan F) or are covered by one of these plans prior to January 1, 2020, you'llbe able to keep your plan. If you were eligible for Medicare before January 1,2020 but not yet enrolled, you may be able to buy one of these plans.

– People new to Medicare are those who turn 65 on or a�er January 1, 2020,and those who get Medicare Part A (Hospital Insurance) on or a�erJanuary 1, 2020.

In Massachusetts, Minnesota, and Wisconsin, Medigap policies are standardized in a di�erent way. (See pages 42–44.) In some states, you may be able to buy another type of Medigap policy called Medicare SELECT. Medicare SELECT plans are standardized plans that may require you to see certain providers and may cost less than other plans. (See page 20.)

11Section 2: Medigap Basics

Medicare Supplement Insurance (Medigap) Plans

Benefits A B C D F* G* K L M NMedicare Part A coinsurance and hospital costs (up to an additional 365 days after Medicare benefits are used)

100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

Medicare Part B coinsurance or copayment

100% 100% 100% 100% 100% 100% 50% 75% 100% 100% ***

Blood (first 3 pints) 100% 100% 100% 100% 100% 100% 50% 75% 100% 100%Part A hospice care coinsurance or copayment

100% 100% 100% 100% 100% 100% 50% 75% 100% 100%

Skilled nursing facility care coinsurance

100% 100% 100% 100% 50% 75% 100% 100%

Part A deductible 100% 100% 100% 100% 100% 50% 75% 50% 100%Part B deductible 100% 100%Part B excess charges 100% 100%Foreign travel emergency (up to plan limits)

80% 80% 80% 80% 80% 80%

Out‑of‑pocket limit

in 2020**$5,880 $2,940

* Plans F and G also offer a high‑deductible plan in some states. With this option, you must pay forMedicare‑covered costs (coinsurance, copayments, and deductibles) up to the deductible amount of$2,340 in 2020 before your policy pays anything. (Plans C and F won’t be available to people who arenewly eligible for Medicare on or after January 1, 2020.)**For Plans K and L, after you meet your out‑of‑pocket yearly limit and your yearly Part B deductible ($198 in 2020), the Medigap plan pays 100% of covered services for the rest of the calendar year.*** Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don’t result in an inpatient admission.

This chart shows basic information about the different benefits that Medigap policies cover. If a percentage appears, the Medigap plan covers that percentage of the benefit, and you must pay the rest.


What Medigap policies don’t coverGenerally, Medigap policies don’t cover long‑term care (like non‑skilled care you get in a nursing home), vision or dental care, hearing aids, eyeglasses, or private‑duty nursing.

Types of coverage that are NOT Medigap policies• Medicare Advantage Plans (also known as Part C), like an HMO or PPO• Medicare Prescription Drug Plans (Part D)• Medicaid• Employer or union plans, including the Federal Employees Health

Benefits Program (FEHBP)• TRICARE• Veterans’ benefits• Long‑term care insurance policies• Indian Health Service, Tribal, and Urban Indian Health plans• Qualified Health Plans sold in the Health Insurance Marketplace

What types of Medigap policies can insurance companies sell?In most cases, Medigap insurance companies can sell you only a “standardized” Medigap policy. All Medigap policies must have specific benefits, so you can compare them easily. If you live in Massachusetts, Minnesota, or Wisconsin, see pages 42– 44.Insurance companies that sell Medigap policies don’t have to offer every Medigap plan. However, they must offer Plan A if they offer any Medigap policy. If they offer any plan in addition to Plan A, they must also offer Plan C or Plan F. Each insurance company decides which Medigap plan it wants to sell, although state laws might affect which ones they offer.In some cases, an insurance company must sell you a Medigap policy if you want one, even if you have health problems. Here are certain times that you’re guaranteed the right to buy a Medigap policy: • When you’re in your Medigap Open Enrollment Period. (See pages 14 –15.)• If you have a guaranteed issue right. (See pages 21–23.)

You may be able to buy a Medigap policy at other times, but the insurance company can deny you a Medigap policy based on your health. Also, in some cases it may be illegal for the insurance company to sell you a Medigap policy (like if you already have Medicaid or a Medicare Advantage Plan).

Words in blue are defined on pages 49–50.


What do I need to know if I want to buy a Medigap policy?• You must have Medicare Part A (Hospital Insurance) and Medicare Part B

(Medical Insurance).

• If you have a Medicare Advantage Plan (like an HMO or PPO) but are planningto return to Original Medicare, you can apply for a Medigap policy before yourcoverage ends. The Medigap insurer can sell it to you as long as you’re leaving thePlan. Ask that the new Medigap policy start when your Medicare Advantage Planenrollment ends, so you’ll have continuous coverage.

• You pay the private insurance company a premium for your Medigap policy inaddition to the monthly Part B premium you pay to Medicare.

• A Medigap policy only covers one person. If you and your spouse both wantMedigap coverage, you each will have to buy separate Medigap policies.

• When you have your Medigap Open Enrollment Period, you can buy a Medigappolicy from any insurance company that’s licensed in your state.

• Any standardized Medigap policy is guaranteed renewable even if you havehealth problems. This means the insurance company can’t cancel your Medigappolicy as long as you stay enrolled and pay the premium.

• Different insurance companies may charge different premiums for the sameexact policy. As you shop for a policy, be sure you’re comparing the same policy(for example, compare Plan A from one company with Plan A from anothercompany).

• Some states may have laws that may give you additional protections.

• Although some Medigap policies sold in the past covered prescription drugs,Medigap policies sold after January 1, 2006, aren’t allowed to include prescriptiondrug coverage. If you want prescription drug coverage, you can join a MedicarePrescription Drug Plan (Part D) offered by private companies approved byMedicare. (See pages 6–7.) To learn about Medicare prescription drug coverage,visit Medicare.gov, or call 1‑800‑MEDICARE (1‑800‑633‑4227). TTY users can call1‑877‑486‑2048.


When’s the best time to buy a Medigap policy? The best time to buy a Medigap policy is during your Medigap Open Enrollment Period. This period lasts for 6 months and begins on the first day of the month in which you’re both 65 or older and enrolled in Medicare Part B. Some states have additional Open Enrollment Periods including those for people under 65. During this period, an insurance company can’t use medical underwriting to decide whether to accept your application. This means the insurance company can’t do any of these because of your health problems:• Refuse to sell you any Medigap policy it offers• Charge you more for a Medigap policy than they charge someone with no

health problems• Make you wait for coverage to start (except as explained below)While the insurance company can’t make you wait for your coverage to start, it may be able to make you wait for coverage related to a pre‑existing condition. A pre‑existing condition is a health problem you have before the date a new insurance policy starts. In some cases, the Medigap insurance company can refuse to cover your out‑of‑pocket costs for these pre‑existing health problems for up to 6 months. This is called a “pre‑existing condition waiting period.” After 6 months, the Medigap policy will cover the pre‑existing condition. Coverage for a pre‑existing condition can only be excluded if the condition was treated or diagnosed within 6 months before the coverage starts under the Medigap policy. This is called the “look‑back period.” Remember, for Medicare‑covered services, Original Medicare will still cover the condition, even if the Medigap policy won’t, but you’re responsible for the Medicare coinsurance or copayment.



When's the best time to buy a Medigap policy? (continued) Creditable coverageIt’s possible to avoid or shorten your waiting period for a pre‑existing condition if:• You buy a Medigap policy during your Medicare Open Enrollment Period.

• You’re replacing certain kinds of health coverage that counts as “creditablecoverage”.

Prior creditable coverage is generally any other health coverage you recently had before applying for a Medigap policy. If you’ve had at least 6 months of continuous prior creditable coverage, the Medigap insurance company can’t make you wait before it covers your pre‑existing conditions.There are many types of health care coverage that may count as creditable coverage for Medigap policies, but they’ll only count if you didn’t have a break in coverage for more than 63 days.Your Medigap insurance company can tell you if your previous coverage will count as creditable coverage for this purpose. You can also call your State Health Insurance Assistance Program. (See pages 47– 48.)If you buy a Medigap policy when you have a guaranteed issue right (also called “Medigap protection”), the insurance company can’t use a pre‑existing condition waiting period. See pages 21–23 for more information about guaranteed issue rights.Note: If you’re under 65 and have Medicare because of a disability or End‑Stage Renal Disease (ESRD), you might not be able to buy the Medigap policy you want, or any Medigap policy, until you turn 65. Federal law generally doesn’t require insurance companies to sell Medigap policies to people under 65. However, some states require Medigap insurance companies to sell you a Medigap policy, even if you’re under 65. See page 39 for more information.


Why is it important to buy a Medigap policy when I’m first eligible? When you’re first eligible, you have the right to buy any Medigap policy offered in your state. In addition, you generally will get better prices and more choices among policies. It’s very important to understand your Medigap Open Enrollment Period. Outside of Medigap Open Enrollment, Medigap insurance companies are generally allowed to use medical underwriting to decide whether to accept your application and how much to charge you for the Medigap policy. However, if you apply during your Medigap Open Enrollment Period, you can buy any Medigap policy the company sells, even if you have health problems, for the same price as people with good health. If you apply for Medigap coverage after your Open Enrollment Period, there’s no guarantee that an insurance company will sell you a Medigap policy if you don’t meet the medical underwriting requirements, unless you’re eligible for guaranteed issue rights (Medigap protections) because of one of the limited situations listed on pages 22–23.It’s also important to understand that your Medigap rights may depend on when you choose to enroll in Medicare Part B. If you’re 65 or older, your Medigap Open Enrollment Period begins when you enroll in Part B, and it can’t be changed or repeated. After your Medigap Open Enrollment Period ends, you may be denied a Medigap policy or charged more for a Medigap policy due to past or present health problems. In most cases, it makes sense to enroll in Part B and buy a Medigap policy when you’re first eligible for Medicare, because you might otherwise have to pay a Part B late enrollment penalty and might miss your 6‑month Medigap Open Enrollment Period. However, there are exceptions if you have employer coverage.

Employer coverageIf you have group health coverage through an employer or union, because either you or your spouse is currently working, you may want to wait to enroll in Part B. Benefits based on current employment often provide coverage similar to PartB, so you wouldn’t want to pay for Part B before you need it, and your MedigapOpen Enrollment Period might expire before a Medigap policy would beuseful. When the employer coverage ends, you’ll get a chance to enroll in Part Bwithout a late enrollment penalty which means your Medigap Open EnrollmentPeriod will start when you’re ready to take advantage of it. If you or your spouseis still working and you have coverage through an employer, contact youremployer or union benefits administrator to find out how your insurance workswith Medicare. See page 24 for more information.



How do insurance companies set prices for Medigap policies? Each insurance company decides how it’ll set the price, or premium, for its Medigap policies. The way they set the price affects how much you pay now and in the future. Medigap policies can be priced or “rated” in 3 ways: 1. Community‑rated (also called “no‑age‑rated”)

2. Issue‑age‑rated (also called “entry‑age‑rated”)

3. Attained‑age‑rated

Each of these ways of pricing Medigap policies is described in the chart on the next page. The examples show how your age affects your premiums, and why it’s important to look at how much the Medigap policy will cost you now and in the future. The amounts in the examples aren’t actual costs. Other factors like where you live, medical underwriting, and discounts can also affect the amount of your premium.


How do insurance companies set prices for Medigap policies? (continued)

Type of pricing

Community-rated (also called “no-age-rated”)

How it’s priced

What this pricing may mean for you

Examples

Generally the same premium is charged to everyone who has the Medigap policy, regardless of age or gender.

The premium is based on the age you are when you buy (are “issued”) the Medigap policy.

The premium is based on your current age (the age you’ve “attained”), so your premium goes up as you get older.

Your premium isn’t based on your age. Premiums may go up because of inflation and other factors but not because of your age.

Premiums are lower for people who buy at a younger age and won’t change as you get older. Premiums may go up because of inflation and other factors but not because of your age.

Premiums are low for younger buyers but go up as you get older. They may be the least expensive at first, but they can eventually become the most expensive. Premiums may also go up because of inflation and other factors.

Mr. Smith is 65. He buys a Medigap policy and pays a $165 monthly premium.

Mrs. Perez is 72. She buys the same Medigap policy as Mr. Smith. She also pays a $165 monthly premium.

Mr. Han is 65. He buys a Medigap policy and pays a $145 monthly premium.

Mrs. Wright is 72. She buys the same Medigap policy as Mr. Han. Since she is older when she buys it, her monthly premium is $175.

Mrs. Anderson is 65. She buys a Medigap policy and pays a $120 monthly premium. Her premium will go up each year: • At 66, her premium goes up to $126.• At 67, her premium goes up to $132.

Mr. Dodd is 72. He buys the same Medigap policy as Mrs. Anderson. He pays a $165 monthly premium. His premium is higher than Mrs. Anderson’s because it’s based on his current age. Mr. Dodd’s premium will go up each year:• At 73, his premium goes up to $171.• At 74, his premium goes up to $177.

Issue-age-rated (also called “entry age-rated”)

Attained-age-rated


Comparing Medigap costs As discussed on the previous pages, the cost of Medigap policies can vary widely. There can be big differences in the premiums that different insurance companies charge for exactly the same coverage. As you shop for a Medigap policy, be sure to compare the same type of Medigap policy, and consider the type of pricing used. (See pages 17–18.) For example, compare a Plan G plan from one insurance company with a Plan G plan from another insurance company. Although this guide can’t give actual costs of Medigap policies, you can get this information by calling insurance companies or your State Health Insurance Assistance Program. (See pages 47– 48.)You can also find out which insurance companies sell Medigap policies in your area by visiting Medicare.gov.The cost of your Medigap policy may also depend on whether the insurance company:

• Offers discounts (like discounts for women, non‑smokers, or peoplewho are married; discounts for paying yearly; discounts for paying yourpremiums using electronic funds transfer; or discounts for multiplepolicies).

• Uses medical underwriting, or applies a different premium when you don’thave a guaranteed issue right or aren’t in a Medigap Open EnrollmentPeriod.

• Sells Medicare SELECT policies that may require you to use certainproviders. If you buy this type of Medigap policy, your premium may beless. (See page 20.)

• Offers a “high‑deductible option” for Plans F or G. If you buy Plans F or Gwith a high‑deductible option, you must pay the first $2,340 of deductibles,copayments, and coinsurance (in 2020) for covered services not paid byMedicare before the Medigap policy pays anything. You must also pay aseparate deductible ($250 per year) for foreign travel emergency services.

If you bought Medigap Plan J before January 1, 2006, and it still covers prescription drugs, you would also pay a separate deductible ($250 per year) for prescription drugs covered by the Medigap policy. And, if you have a Plan J with a high deductible option, you must also pay a $2,340 deductible (in 2020) before the policy pays anything for medical benefits.


What’s Medicare SELECT? Medicare SELECT is a type of Medigap policy sold in some states that requires you to use hospitals and, in some cases, doctors within its network to be eligible for full insurance benefits (except in an emergency). Medicare SELECT can be any of the standardized Medigap plans. (See page 11.) These policies generally cost less than other Medigap policies. However, if you don’t use a Medicare SELECT hospital or doctor for non‑emergency services, you’ll have to pay some or all of what Medicare doesn’t pay. Medicare will pay its share of approved charges no matter which hospital or doctor you choose.

How does Medigap help pay my Medicare Part B bills? In most Medigap policies, when you sign the Medigap insurance contract you agree to have the Medigap insurance company get your Medicare Part B claim information directly from Medicare, and then they pay the doctor directly whatever amount is owed under your policy. Some Medigap insurance companies also provide this service for Medicare Part A claims.If your Medigap insurance company doesn’t provide this service, ask your doctors if they participate in Medicare. Participating providers have signed an arrangement to accept assignment for all Medicare‑covered services. If your doctor participates, the Medigap insurance company is required to pay the doctor directly if you request. If your doctor doesn’t participate but still accepts Medicare, you may be asked to pay the coinsurance amount at the time of service. In these cases, your Medigap insurance company may pay you directly according to policy limits. Check with your Medigap plan for more details.If you have any questions about Medigap claim filing, call 1‑800‑MEDICARE (1‑800‑633‑4227). TTY users can call 1‑877‑486‑2048.

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Your Right to Buy a Medigap Policy

What are guaranteed issue rights? Guaranteed issue rights are rights you have in certain situations when insurance companies must o�er you certain Medigap policies when you aren’t in your Medigap Open Enrollment Period. In these situations, an insurance company must: • Sell you a Medigap policy• Cover all your pre-existing health conditions• Can’t charge you more for a Medigap policy regardless of past or present

health problemsIf you live in Massachusetts, Minnesota, or Wisconsin, you have guaranteed issue rights to buy a Medigap policy, but the Medigap policies are di�erent. See pages 42– 44 for your Medigap policy choices.

When do I have guaranteed issue rights? In most cases, you have a guaranteed issue right when you have certain types of other health care coverage that changes in some way, like when you lose the other health care coverage. In other cases, you have a “trial right” to try a Medicare Advantage Plan and still buy a Medigap policy if you change your mind. For information on trial rights, see page 23.

22 Section 3: Your Right to Buy a Medigap Policy

Medigap guaranteed issue right situations

The chart on this page and the next page describes the most common situations, under federal law, that give you a right to buy a policy, the kind of policy you can buy, and when you can or must apply for it. States may offer additional Medigap guaranteed issue rights.

You have a guaranteed issue right if...

You’re in a Medicare Advantage Plan (like an HMO or PPO), and your plan is leaving Medicare or stops giving care in your area, or you move out of the plan’s service area.

You have Original Medicare and an employer group health plan (including retiree or COBRA coverage) or union coverage that pays after Medicare pays and that plan is ending.

Note: In this situation, you may have additional rights under state law.

You have Original Medicare and a Medicare SELECT policy. You move out of the Medicare SELECT policy’s service area.

Call the Medicare SELECT insurer for more information about your options.

You have the right to buy...

Medigap Plan A, B, C*, D*, F*, G*, K, or L that’s sold in your state by any insurance company.

You only have this right if you switch to Original Medicare rather than join another Medicare Advantage Plan.


If you have COBRA coverage, you can either buy a Medigap policy right away or wait until the COBRA coverage ends.

Medigap Plan A, B, C*, D*, F*, G*, K, or L that’s sold by any insurance company in your state or the state you’re moving to.

You can/must apply for a Medigap policy...

As early as 60 calendar days before the date your health care coverage will end, but no later than 63 calendar days after your health care coverage ends. Medigap coverage can’t start until your Medicare Advantage Plan coverage ends.

No later than 63 calendar days after the latest of these 3 dates:

1. Date the coverage ends.

2. Date on the notice you gettelling you that coverage isending (if you get one).

3. Date on a claim denial, if thisis the only way you know thatyour coverage ended.

As early as 60 calendar days before the date your Medicare SELECT coverage will end, but no later than 63 calendar days after your Medicare SELECT coverage ends.

*Note: Plans C and F will no longer be available to people who are new to Medicare on or after January 1, 2020.However, if you were eligible for Medicare before January 1, 2020 but not yet enrolled, you may be able to buyPlan C or Plan F. People eligible for Medicare on or after January 1, 2020 have the right to buy Plans D and Ginstead of Plans C and F.

23Section 3: Your Right to Buy a Medigap Policy

You have a guaranteed issue right if...

(Trial right) You joined a Medicare Advantage Plan (like an HMO or PPO) or Programs of All‑inclusive Care for the Elderly (PACE) when you were first eligible for Medicare Part A at 65, and within the first year of joining, you decide you want to switch to Original Medicare.

(Trial right) You dropped a Medigap policy to join a Medicare Advantage Plan (or to switch to a Medicare SELECT policy) for the first time, you’ve been in the plan less than a year, and you want to switch back.

Your Medigap insurance company goes bankrupt and you lose your coverage, or your Medigap policy coverage otherwise ends through no fault of your own.

You leave a Medicare Advantage Plan or drop a Medigap policy because the company hasn’t followed the rules, or it misled you.

You have the right to buy...

Any Medigap policy that’s sold in your state by any insurance company.*

The Medigap policy you had before you joined the Medicare Advantage Plan or Medicare SELECT policy, if the same insurance company you had before still sells it. If your former Medigap policy isn’t available, you can buy Medigap Plan A, B, C*, D*, F*, G*, K, or L that’s sold in your state by any insurance company.



You can/must apply for a Medigap policy...

As early as 60 calendar days before the date your coverage will end, but no later than 63 calendar days after your coverage ends.

Note: Your rights may last for an extra 12 months under certain circumstances.

As early as 60 calendar days before the date your coverage will end, but no later than 63 calendar days after your coverage ends. Note: Your rights may last for an extra 12 months under certain circumstances.

No later than 63 calendar days from the date your coverage ends.

No later than 63 calendar days from the date your coverage ends.

Medigap guaranteed issue right situations (continued)

*Note: Plans C and F will no longer be available to people who are new to Medicare on or after January 1, 2020.However, if you were eligible for Medicare before January 1, 2020 but not yet enrolled, you may be able to buyPlan C or Plan F. People eligible for Medicare on or after January 1, 2020 have the right to buy Plans D and Ginstead of Plans C and F.

24

Can I buy a Medigap policy if I lose my health care coverage? Yes, you may be able to buy a Medigap policy. Because you may have a guaranteed issue right to buy a Medigap policy, make sure you keep these: • A copy of any letters, notices, emails, and/or claim denials that have your name on

them as proof of your coverage being terminated.

• The postmarked envelope these papers come in as proof of when it was mailed.You may need to send a copy of some or all of these papers with your Medigap application to prove you have a guaranteed issue right. If you have a Medicare Advantage Plan (like an HMO or PPO) but you’re planning to return to Original Medicare, you can apply for a Medigap policy before your plan coverage ends. The Medigap insurer can sell it to you as long as you’re leaving the Medicare Advantage Plan. Ask that the new policy take effect when your Medicare Advantage enrollment ends, so you’ll have continuous health coverage.

For more information about Medigap rights If you have any questions or want to learn about any additional Medigap rights in your state, you can: • Call your State Health Insurance Assistance Program to make sure that you qualify

for these guaranteed issue rights. (See pages 47– 48.)• Call your State Insurance Department if you’re denied Medigap coverage in any of

these situations. (See pages 47– 48.)

Important: The guaranteed issue rights in this section are from federal law. These rights are for both Medigap and Medicare SELECT policies. Many states provide additional Medigap rights.

There may be times when more than one of the situations in the chart on pages 22–23 applies to you. When this happens, you can choose the guaranteed issue right that gives you the best choice. Some of the situations listed include loss of coverage under Programs of All‑inclusive Care for the Elderly (PACE). PACE combines medical, social, and long‑term care services, and prescription drug coverage for frail people. To be eligible for PACE, you must meet certain conditions. PACE may be available in states that have chosen it as an optional Medicaid benefit. If you have Medicaid, an insurance company can sell you a Medigap policy only in certain situations. For more information about PACE, visit Medicare.gov, or call 1‑800‑MEDICARE (1‑800‑633‑4227). TTY users can call 1‑877‑486‑2048.

Section 3: Your Right to Buy a Medigap Policy

425

SECTION

Steps to Buying a Medigap Policy

Step-by-step guide to buying a Medigap policyBuying a Medigap policy is an important decision. Only you can decide if a Medigap policy is the way for you to supplement Original Medicare coverage and which Medigap policy to choose. Shop carefully. Compare available Medigap policies to see which one meets your needs. As you shop for a Medigap policy, keep in mind that di�erent insurance companies may charge di�erent amounts for exactly the same Medigap policy, and not all insurance companies o�er all of the Medigap policies. Below is a step-by-step guide to help you buy a Medigap policy. If you live in Massachusetts, Minnesota, or Wisconsin, see pages 42– 44.

STEP 1: Decide which bene�ts you want, then decide which of the standardized Medigap policies meet your needs.

STEP 2: Find out which insurance companies sell Medigap policies in your state.

STEP 3: Call the insurance companies that sell the Medigap policies you’re interested in and compare costs.

STEP 4: Buy the Medigap policy.

26

STEP 1: Decide which benefits you want, then decide which Medigap policy meets your needs.

Think about your current and future health care needs when deciding which benefits you want because you might not be able to switch Medigap policies later. Decide which benefits you need, and select the Medigap policy that will work best for you. The chart on page 11 provides an overview of Medigap benefits.

STEP 2: Find out which insurance companies sell Medigap policies in your state.

To find out which insurance companies sell Medigap policies in your state: • Call your State Health Insurance Assistance Program. (See pages 47– 48.)

Ask if they have a “Medigap rate comparison shopping guide” for yourstate. This guide usually lists companies that sell Medigap policies in yourstate and their costs.

• Call your State Insurance Department. (See pages 47– 48.)• Visit Medicare.gov/medigap‑supplemental‑insurance‑plans:

This website will help you find information on your health planoptions, including the Medigap policies in your area. You can also get information on: 4 How to contact the insurance companies that sell Medigap policies in

your state.4 What each Medigap policy covers.4 How insurance companies decide what to charge you for a Medigap policy premium.

If you don’t have a computer, your local library or senior center may be able to help you look at this information. You can also call 1‑800‑MEDICARE (1‑800‑633‑4227). A customer service representative will help you get information on all your health plan options including the Medigap policies in your area. TTY users can call 1‑877‑486‑2048.

Section 4: Steps to Buying a Medigap Policy


27Section 4: Steps to Buying a Medigap Policy

STEP 2: (continued)

Since costs can vary between companies, plan to call more than one insurance company that sells Medigap policies in your state. Before you call, check the companies to be sure they’re honest and reliable by: • Calling your State Insurance Department. Ask if they keep a record of

complaints against insurance companies that can be shared with you.When deciding which Medigap policy is right for you, consider thesecomplaints, if any.

• Calling your State Health Insurance Assistance Program. These programscan give you help at no cost to you with choosing a Medigap policy.

• Going to your local public library for help with:– Getting information on an insurance company’s financial strength

from independent rating services like weissratings.com, A.M. Best,and Standard & Poor’s.

– Looking at information about the insurance company online.• Talking to someone you trust, like a family member, your insurance

agent, or a friend who has a Medigap policy from the same Medigapinsurance company.

28 Section 4: Steps to Buying a Medigap Policy

Before you call any insurance companies, figure out if you’re in your Medigap Open Enrollment Period or if you have a guaranteed issue right. Read pages 14 –15 and 22–23 carefully. If you have questions, call your State Health Insurance Assistance Program. (See pages 47– 48.) This chart can help you keep track of the information you get.

STEP 3: Call the insurance companies that sell the Medigap policies you’re interested in and compare costs.

Community Issue‑age Attained‑age

Community Issue‑age Attained‑age

Ask each insurance company…

“Are you licensed in ___?” (Say the name of your state.) Note: If the answer is NO, STOP here, and try another company. “Do you sell Medigap Plan ___?” (Say the letter of the Medigap Plan you’re interested in.) Note: Insurance companies usually offer some, but not all, Medigap policies. Make sure the company sells the plan you want. Also, if you’re interested in a Medicare SELECT or high‑deductible Medigap policy, tell them.

“Do you use medical underwriting for this Medigap policy?” Note: If the answer is NO, go to step 4 on page 30. If the answer is YES, but you know you’re in your Medigap Open Enrollment Period or have a guaranteed issue right to buy that Medigap policy, go to step 4. Otherwise, you can ask, “Can you tell me if I’m likely to qualify for the Medigap policy?”

“Do you have a waiting period for pre‑existing conditions?” Note: If the answer is YES, ask how long the waiting period is and write it in the box.

“Do you price this Medigap policy by using community‑rating, issue‑age‑rating, or attained‑age‑rating?” (See page 18.) Note: Circle the one that applies for that insurance company.

“I’m ___ years old. What would my premium be under this Medigap policy?” Note: If it’s attained‑age, ask, “How frequently does the premium increase due to my age?”

“Has the premium for this Medigap policy increased in the last 3 years due to inflation or other reasons?” Note: If the answer is YES, ask how much it has increased, and write it in the box.

“Do you offer any discounts or additional benefits?” (See page 19.)

Company 2 Company 1

29Section 4: Steps to Buying a Medigap Policy

STEP 3: (continued)

Watch out for illegal practices. It’s illegal for anyone to:

• Pressure you into buying a Medigap policy, or lie to or mislead you to switchfrom one company or policy to another.

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

• Sell you a Medigap policy if they know you have Medicaid, except in certainsituations.

• Sell you a Medigap policy if they know you’re in a Medicare Advantage Plan(like an HMO or PPO) unless your coverage under the Medicare AdvantagePlan will end before the effective date of the Medigap policy.

• Claim that a Medigap policy is a part of Medicare or any other federal program.Medigap is private health insurance.

• Claim that a Medicare Advantage Plan is a Medigap policy.• Sell you a Medigap policy that can’t legally be sold in your state. Check with

your State Insurance Department (see pages 47– 48) to make sure that theMedigap policy you’re interested in can be sold in your state.

• Misuse the names, letters, or symbols of the U.S. Department of Health &Human Services (HHS), Social Security Administration (SSA), Centers forMedicare & Medicaid Services (CMS), or any of their various programs likeMedicare. (For example, they can’t suggest the Medigap policy has beenapproved or recommended by the federal government.)

• Claim to be a Medicare representative if they work for a Medigap insurancecompany.

• Sell you a Medicare Advantage Plan when you say you want to stay in OriginalMedicare and buy a Medigap policy. A Medicare Advantage Plan isn’t the sameas Original Medicare. (See page 5.) If you enroll in a Medicare Advantage Plan,you can’t use a Medigap policy.

If you believe that a federal law has been broken, call the Inspector General’s hotline at 1‑800‑HHS‑TIPS (1‑800‑447‑8477). TTY users can call 1‑800‑377‑4950. Your State Insurance Department can help you with otherinsurance‑related problems.

30

STEP 4: Buy the Medigap policy. Once you decide on the insurance company and the Medigap policy you want, apply. The insurance company must give you a clearly worded summary of your Medigap policy. Read it carefully. If you don’t understand it, ask questions. Remember these when you buy your Medigap policy: • Filling out your application. Fill out the application carefully and completely,

including medical questions. The answers you give will determine youreligibility for an Open Enrollment Period or guaranteed issue rights. If theinsurance agent fills out the application, make sure it’s correct. If you buy aMedigap policy during your Medigap Open Enrollment Period or provideevidence that you’re entitled to a guaranteed issue right, the insurancecompany can’t use any medical answers you give to deny you a Medigap policyor change the price. The insurance company can’t ask you any questions aboutyour family history or require you to take a genetic test.

• Paying for your Medigap policy. Your insurance company will let you knowyour payment options for your particular policy. You may be able to pay foryour Medigap policy by check, money order, or bank draft. Make it payableto the insurance company, not the agent. If buying from an agent, get areceipt with the insurance company’s name, address, and phone number foryour records. Some companies may offer electronic funds transfer, whichlets you set up a repeating payment to debit automatically from a checkingaccount or credit card.

• Starting your Medigap policy. Ask for your Medigap policy to becomeeffective when you want coverage to start. Generally, Medigap policiesbegin the first of the month after you apply. If, for any reason, the insurancecompany won’t give you the effective date for the month you want, call yourState Insurance Department. (See pages 47– 48.)Note: If you already have a Medigap policy, ask for your new Medigap policyto become effective when your old Medigap policy coverage ends.

• Getting your Medigap policy. If you don’t get your Medigap policy in 30days, call your insurance company. If you don’t get your Medigap policy in60 days, call your State Insurance Department.

Section 4: Steps to Buying a Medigap Policy

531

SECTION

If You Already Have a Medigap Policy

Read this section if any of these situations apply to you:

• You’re thinking about switching to a different Medigap policy.(See pages 32–35.)

• You’re losing your Medigap coverage. (See page 36.)

• You have a Medigap policy with Medicare prescription drugcoverage. (See pages 36–38.)

If you just want a refresher about Medigap insurance, turn to page 11.

32

Switching Medigap policies If you’re thinking about switching to a new Medigap policy, see below and pages 33–35 to answer some common questions.

Can I switch to a different Medigap policy?

In most cases, you won’t have a right under federal law to switch Medigap policies, unless you’re within your 6‑month Medigap Open Enrollment Period or are eligible under a specific circumstance for guaranteed issue rights. But, if your state has more generous requirements, or the insurance company is willing to sell you a Medigap policy, make sure you compare benefits and premiums before switching. If you bought your Medigap policy before 2010, it may offer coverage that isn’t available in a newer Medigap policy. On the other hand, Medigap policies bought before 1992 might not be guaranteed renewable and might have bigger premium increases than newer, standardized Medigap policies currently being sold.If you decide to switch, don’t cancel your first Medigap policy until you’ve decided to keep the second Medigap policy. On the application for the new Medigap policy, you’ll have to promise that you’ll cancel your first Medigap policy. You have 30 days to decide if you want to keep the new Medigap policy. This is called your “free look period.” The 30‑day free look period starts when you get your new Medigap policy. You’ll need to pay both premiums for one month.

Section 5: If You Already Have a Medigap Policy


33Section 5: If You Already Have a Medigap Policy

Switching Medigap policies (continued)

Do I have to switch Medigap policies if I have a Medigap policy that’s no longer sold?

No. But you can’t have more than one Medigap policy, so if you buy a new Medigap policy, you have to give up your old policy (except for your 30‑day “free look period,” described on page 32). Once you cancel the old policy, you can’t get it back.

Do I have to wait a certain length of time after I buy my first Medigap policy before I can switch to a different Medigap policy?

No. If you’ve had your old Medigap policy for less than 6 months, the Medigap insurance company may be able to make you wait up to 6 months for coverage of a pre‑existing condition. However, if your old Medigap policy had the same benefits, and you had it for 6 months or more, the new insurance company can’t exclude your pre‑existing condition. If you’ve had your Medigap policy less than 6 months, the number of months you’ve had your current Medigap policy must be subtracted from the time you must wait before your new Medigap policy covers your pre‑existing condition.If the new Medigap policy has a benefit that isn’t in your current Medigap policy, you may still have to wait up to 6 months before that benefit will be covered, regardless of how long you’ve had your current Medigap policy.If you’ve had your current Medigap policy longer than 6 months and want to replace it with a new one with the same benefits and the insurance company agrees to issue the new policy, they can’t write pre‑existing conditions, waiting periods, elimination periods, or probationary periods into the replacement policy.

34

Switching Medigap policies (continued)Why would I want to switch to a different Medigap policy?

Some reasons for switching may include: • You’re paying for benefits you don’t need.• You need more benefits than you needed before.• Your current Medigap policy has the right benefits, but you want to

change your insurance company.• Your current Medigap policy has the right benefits, but you want to find a

policy that’s less expensive.

It’s important to compare the benefits in your current Medigap policy to the benefits listed on page 11. If you live in Massachusetts, Minnesota, or Wisconsin, see pages 42– 44. To help you compare benefits and decide which Medigap policy you want, follow the “Steps to Buying a Medigap Policy” in Section 4. If you decide to change insurance companies, you can call the new insurance company and apply for your new Medigap policy. If your application is accepted, call your current insurance company, and ask to have your coverage end. The insurance company can tell you how to submit a request to end your coverage.As explained on page 32, make sure your old Medigap policy coverage ends after you have the new Medigap policy for 30 days. Remember, this is your 30‑day free look period. You’ll need to pay both premiums for one month.



Switching Medigap policies (continued)

Can I keep my current Medigap policy (or Medicare SELECT policy) or switch to a different Medigap policy if I move out-of-state?

In general, you can keep your current Medigap policy regardless of where you live as long as you still have Original Medicare. If you want to switch to a different Medigap policy, you’ll have to check with your current or the new insurance company to see if they’ll offer you a different Medigap policy.You may have to pay more for your new Medigap policy and answer some medical questions if you’re buying a Medigap policy outside of your Medigap Open Enrollment Period. (See pages 14–16.)If you have a Medicare SELECT policy and you move out of the policy’s area, you can:• Buy a standardized Medigap policy from your current Medigap policy

insurance company that offers the same or fewer benefits than your currentMedicare SELECT policy. If you’ve had your Medicare SELECT policy for morethan 6 months, you won’t have to answer any medical questions.

• Use your guaranteed issue right to buy any Plan A, B, C, F, K, or L that’s sold inmost states by any insurance company.

Note: Plans C and F will no longer be available to people who are new to Medicare on or after January 1, 2020. However, if you were eligible for Medicare before January 1, 2020 but not yet enrolled, you may be able to buy Plan C or Plan F.Your state may provide additional Medigap rights. Call your State Health Insurance Assistance Program or State Department of Insurance for more information. See pages 47–78 for their phone numbers.

What happens to my Medigap policy if I join a Medicare Advantage Plan?

Medigap policies can’t work with Medicare Advantage Plans. If you decide to keep your Medigap policy, you’ll have to pay your Medigap policy premium, but the Medigap policy can’t pay any deductibles, copayments, coinsurance, or premiums under a Medicare Advantage Plan. So, if you join a Medicare Advantage Plan, you may want to drop your Medigap policy. Contact your Medigap insurance company to find out how to disenroll. However, if you leave the Medicare Advantage Plan you might not be able to get the same Medigap policy back, or in some cases, any Medigap policy unless you have a “trial right.” (See page 23.) Your rights to buy a Medigap policy may vary by state. You always have a legal right to keep the Medigap policy after you join a Medicare Advantage Plan. However, because you have a Medicare Advantage Plan, the Medigap policy would no longer provide benefits that supplement Medicare.


36

Losing Medigap coverage Can my Medigap insurance company drop me?

If you bought your Medigap policy a�er 1992, in most cases the Medigap insurance company can’t drop you because the Medigap policy is guaranteed renewable. �is means your insurance company can’t drop you unless one of these happens: • You stop paying your premium.• You weren’t truthful on the Medigap policy application.• �e insurance company becomes bankrupt or insolvent.

If you bought your Medigap policy before 1992, it might not be guaranteed renewable. �is means the Medigap insurance company can refuse to renew the Medigap policy, as long as it gets the state’s approval to cancel your Medigap policy. However, if this does happen, you have the right to buy another Medigap policy. See the guaranteed issue right on page 23.

Medigap policies and Medicare prescription drug coverage If you bought a Medigap policy before January 1, 2006, and it has coverage for prescription drugs, see below and page 37.

Medicare o�ers prescription drug coverage (Part D) for everyone with Medicare. If you have a Medigap policy with prescription drug coverage, that means you chose not to join a Medicare Prescription Drug Plan when you were �rst eligible. However, you can still join a Medicare drug plan. Your situation may have changed in ways that make a Medicare Prescription Drug Plan �t your needs better than the prescription drug coverage in your Medigap policy. It’s a good idea to review your coverage each fall, because you can join a Medicare Prescription Drug Plan between October 15–December 7. Your new coverage will begin on January 1.



Medigap policies and Medicare prescription drug coverage (continued)

What if I change my mind and join a Medicare Prescription Drug Plan?

If your Medigap premium or your prescription drug needs were very low when you had your first chance to join a Medicare Prescription Drug Plan, your Medigap prescription drug coverage may have met your needs. However, if your Medigap premium or the amount of prescription drugs you use has increased recently, a Medicare Prescription Drug Plan might now be a better choice for you.In a Medicare Prescription Drug Plan, you may have to pay a monthly premium. There’s no yearly maximum coverage amounts as with Medigap prescription drug benefits in old Plans H, I, and J (these plans are no longer sold). However, a Medicare Prescription Drug Plan might only cover certain prescription drugs (on its “formulary” or “drug list”). It’s important that you check whether your current prescription drugs are on the Medicare Prescription Drug Plan’s list of covered prescription drugs before you join.

Will I have to pay a late enrollment penalty if I join a Medicare Prescription Drug Plan now?

If you qualify for Extra Help, you won’t pay a late enrollment penalty. If you don’t qualify for Extra Help, it will depend on whether your Medigap policy includes “creditable prescription drug coverage.” This means that the Medigap policy’s drug coverage pays, on average, at least as much as Medicare’s standard prescription drug coverage. If your Medigap policy’s drug coverage isn’t creditable coverage, and you join a Medicare Prescription Drug Plan now, you’ll probably pay a higher premium (a penalty added to your monthly premium) than if you had joined when you were first eligible. Each month that you wait to join a Medicare Prescription Drug Plan will make your late enrollment penalty higher. Your Medigap carrier must send you a notice each year telling you if the prescription drug coverage in your Medigap policy is creditable. Keep these notices in case you decide later to join a Medicare Prescription Drug Plan. Also consider that your prescription drug needs could increase as you get older.

38

Will I have to pay a late enrollment penalty if I join a Medicare Prescription Drug Plan now? (continued)

If your Medigap policy includes creditable prescription drug coverage and you decide to join a Medicare Prescription Drug Plan, you won’t have to pay a late enrollment penalty as long as you don’t go 63 or more days in a row without creditable prescription drug coverage. So, don’t drop your Medigap policy before you join the Medicare Prescription Drug Plan and the coverage starts. In general, you can only join a Medicare drug plan between October 15 –December 7. However, if you lose your Medigap policy (for example, if it isn’t guaranteed renewable, and your company cancels it), you may be able to join a Medicare drug plan at the time you lose your Medigap policy.

Can I join a Medicare Prescription Drug Plan and have a Medigap policy with prescription drug coverage?

No. If your Medigap policy covers prescription drugs, you must tell your Medigap insurance company if you join a Medicare Prescription Drug Plan so it can remove the prescription drug coverage from your Medigap policy and adjust your premium. Once the drug coverage is removed, you can’t get that coverage back even though you didn’t change Medigap policies.

What if I decide to drop my entire Medigap policy (not just the Medigap prescription drug coverage) and join a Medicare Advantage Plan that offers prescription drug coverage?

In general, you can only join a Medicare Prescription Drug Plan or Medicare Advantage Plan (like an HMO or PPO) during the Medicare Open Enrollment Period between October 15 –December 7. If you join during Medicare Open Enrollment Period, your coverage will begin on January 1. In most cases, if you drop your Medigap policy to join a Medicare Advantage Plan, you won’t be able to get it back so pay careful attention to the timing.


639

SECTION

Medigap Policies for People with a Disability or ESRD

Information for people under 65Medigap policies for people under 65 and eligible for Medicare because of a disability or End-Stage Renal Disease (ESRD) You may have Medicare before turning 65 due to a disability or ESRD (permanent kidney failure requiring dialysis or a kidney transplant).If you’re under 65 and have Medicare because of a disability or ESRD, you might not be able to buy the Medigap policy you want, or any Medigap policy, until you turn 65. Federal law generally doesn’t require insurance companies to sell Medigap policies to people under 65. However, some states require Medigap insurance companies to sell you a Medigap policy, even if you’re under 65. �ese states are listed on the next page.

Important: �is section provides information on the minimum federal standards. For your state requirements, call your State Health Insurance Assistance Program. (See pages 47– 48.)

40

Medigap policies for people under 65 and eligible for Medicare because of a disability or End-Stage Renal Disease (ESRD) (continued)At the time of printing this guide, these states required insurance companies to offer at least one kind of Medigap policy to people with Medicare under 65:

Section 6: Medigap Policies for People with a Disability or ESRD

• Arkansas• California• Colorado• Connecticut• Delaware• Florida• Georgia• Hawaii• Illinois• Idaho• Kansas

• Kentucky• Louisiana• Maine• Maryland• Massachusetts• Michigan• Minnesota• Mississippi• Missouri• Montana• New Hampshire

• New Jersey• New York• North Carolina• Oklahoma• Oregon• Pennsylvania• South Dakota• Tennessee• Texas• Vermont• Wisconsin

Note: Some states provide these rights to all people with Medicare under 65, while others only extend them to people eligible for Medicare because of disability or only to people with ESRD. Check with your State Insurance Department about what rights you might have under state law.

Even if your state isn’t on the list above, some insurance companies may voluntarily sell Medigap policies to people under 65, although they’ll probably cost you more than Medigap policies sold to people over 65, and they can probably use medical underwriting. Also, some of the federal guaranteed rights are available to people with Medicare under 65. (See pages 21–24.) Check with your State Insurance Department about what additional rights you might have under state law.Remember, if you’re already enrolled in Medicare Part B, you’ll get a Medigap Open Enrollment Period when you turn 65. You’ll probably have a wider choice of Medigap policies and be able to get a lower premium at that time. During the Medigap Open Enrollment Period, insurance companies can’t refuse to sell you any Medigap policy due to a disability or other health problem, or charge you a higher premium (based on health status) than they charge other people who are 65.Because Medicare (Part A and/or Part B) is creditable coverage, if you had Medicare for more than 6 months before you turned 65, you may not have a pre‑existing condition waiting period imposed for coverage bought during the Medigap Open Enrollment Period. For more information about the Medigap Open Enrollment Period and pre‑existing conditions, see pages 16 –17. If you have questions, call your State Health Insurance Assistance Program. (See pages 47–48.)


741

SECTION

Medigap Coverage in Massachusetts, Minnesota,

and Wisconsin

Massachusetts benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Minnesota benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

Wisconsin benefits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

42 Section 7: Medigap Coverage Charts

Massachusetts benefits • Inpatient hospital care: covers the Medicare Part A coinsurance plus coverage for 365

additional days after Medicare coverage ends• Medical costs: covers the Medicare Part B coinsurance (generally 20% of the

Medicare‑approved amount)• Blood: covers the first 3 pints of blood each year• Part A hospice coinsurance or copaymentNote: Supplement 1 Plan (which includes coverage of the Part B deductible) will no longer be available to people who are new to Medicare on or after January 1, 2020. These people can buy Supplement 1A Plan.However, if you were eligible for Medicare before January 1, 2020 but not yet enrolled, you may be able to buy Supplement Plan 1.The check marks in this chart mean the benefit is covered.

Massachusetts—Chart of standardized Medigap policies

For more information on these Medigap policies, visit Medicare.gov/find‑a‑plan, or call your State Insurance Department. (See pages 47– 48.)

Medigap benefits Core plan Supplement 1 Plan Supplement 1A Plan

Basic benefits 3 3 3

Part A inpatient hospital deductible

3 3

Part A skilled nursing facility (SNF) coinsurance

3 3

Part B deductible 3

Foreign travel emergency

3 3

Inpatient days in mental health hospitals

60 days per calendar year

120 days per benefit year

120 days per benefit year

State‑mandated benefits (annual Pap tests and mammograms—check your plan for other state‑mandated benefits)

3 3 3

43Section 7: Medigap Coverage Charts

Minnesota benefits • Inpatient hospital care: covers the Part A coinsurance• Medical costs: covers the Part B coinsurance (generally 20% of the Medicare‑approved amount)• Blood: covers the first 3 pints of blood each year• Part A hospice and respite cost sharing• Parts A and B home health services and supplies cost sharingThe check marks in this chart mean the benefit is covered.

Minnesota—Chart of standardized Medigap policies

Basic benefits

Part A inpatient hospital deductible


Part B deductible**

Foreign travel emergency

Outpatient mental health

Usual and customary fees

Medicare‑covered preventive care

Physical therapy

Coverage while in a foreign country

State‑mandated benefits (diabetic equipment and supplies, routine cancer screening, reconstructive surgery, and immunizations)

Medigap benefits Basic plan Extended

20% 20%

3 3

3 3

80%*

3

3(Provides 120 days of

SNF care)

3

3(Provides 100 days of

SNF care)

80%

80%*

20% 20%

80%*

basic plan

3 3

Mandatory riders

Insurance companies can offer 4 additional riders that can be added to a basic plan. You may choose any one or all of these riders to design a Medigap policy that meets your needs:

1. Part A inpatienthospital deductible

2. Part B deductible**3. Usual and

customary fees4. Non‑Medicare

preventive care

* Pays 100% after you spend $1,000 in out-of-pocket costs for a calendar year.**Note: Coverage of the Part B deductible will no longer be available to people who are new to Medicare on or after January 1, 2020. However, if you were eligible for Medi care before January 1, 2020 but not yet enrolled, you may be able to get this benefit Minnesota versions of Medigap Plans K, L, M and N are available. Minnesota versions of high-deductible F are available to people who had or were eligible for Medicare before January 1, 2020. (See page 10 for details on eligibility.)

Important: The basic and extended basic benefits are available when you enroll in Part B, regardless of age or health problems. If you are under 65, return to work and drop Part B to elect your employer’s health plan, you’ll get a 6‑month Medigap Open Enrollment Period after you turn 65 and retire from that employer when you can join Part B again.

44 Section 7: Medigap Coverage Charts

Basic benefits


Inpatient mental health coverage

Home health care

State‑mandated benefits

Wisconsin benefits • Inpatient hospital care: covers the Part A coinsurance• Medical costs: covers the Part B coinsurance (generally 20% of the Medicare‑approved

amount)• Blood: covers the first 3 pints of blood each year• Part A hospice coinsurance or copayment

The check marks in this chart mean the benefit is covered.

For more information on these Medigap policies, visit Medicare.gov/find‑a‑plan or call your State Insurance Department. (See pages 47– 48.)

Plans known as “50% and 25% cost‑sharing plans” are available. These plans are similar to standardized Plans K (50%) and L (25%). A high‑deductible plan ($2,340 deductible for 2020) is also available.

175 days per lifetime in addition to Medicare’s benefit

3

3

3

40 visits per year in addition to those paid by Medicare

Wisconsin — Chart of standardized Medigap policies

Medigap benefits Basic plan Optional riders

Insurance companies are allowed to offer these 7 additional riders to a Medigap policy:1. Part A deductible2. Additional home health

care (365 visits includingthose paid by Medicare)

3. Part B deductible*4. Part B excess charges5. Foreign travel emergency6. 50% Part A deductible7. Part B copayment or coinsurance*Note: Coverage of the Part Bdeductible will no longer be availableto people who are new to Medicare onor after January 1, 2020. However, ifyou were eligible for Medicare beforeJanuary 1, 2020 but not yet enrolled,you may be able to get this benefit.

845

SECTION

For More Information

Where to get more information On pages 47– 48, you’ll �nd phone numbers for your State Health Insurance Assistance Program (SHIP) and State Insurance Department.

• Call your SHIP for help with:

– Buying a Medigap policy or long-term care insurance.

– Dealing with payment denials or appeals.

– Medicare rights and protections.

– Choosing a Medicare plan.

– Deciding whether to suspend your Medigap policy.

– Questions about Medicare bills.

• Call your State Insurance Department if you have questions aboutthe Medigap policies sold in your area or any insurance-relatedproblems.

46

How to get help with Medicare and Medigap questions If you have questions about Medicare, Medigap, or need updated phone numbers for the contacts listed on pages 47– 48:

Visit Medicare.gov: • For Medigap policies in your area, visit

Medicare.gov/medigap‑supplemental‑insurance‑plans.• For updated phone numbers, visit Medicare.gov/contacts.

Call 1-800-MEDICARE (1-800-633-4227): Customer service representatives are available 24 hours a day, 7 days a week. TTY users can call 1‑877‑486‑2048. If you need help in a language other than English or Spanish, let the customer service representative know the language.

Section 8: For More Information

47Section 8: For More Information

State Insurance Department

State State Health Insurance Assistance Program

Alabama 1‑800‑243‑5463 1‑800‑433‑3966Alaska 1‑800‑478‑6065 1‑800‑467‑8725American Samoa Not available 1‑684‑633‑4116Arizona 1‑800‑432‑4040 1‑800‑325‑2548Arkansas 1‑800‑224‑6330 1‑800‑224‑6330California 1‑800‑434‑0222 1‑800‑927‑4357Colorado 1‑888‑696‑7213 1‑800‑930‑3745Connecticut 1‑800‑994‑9422 1‑800‑203‑3447Delaware 1‑800‑336‑9500 1‑800‑282‑8611Florida 1‑800‑963‑5337 1‑877‑693‑5236Georgia 1‑866‑552‑4464 1‑800‑656‑2298Guam 1‑671‑735‑7415 1‑671‑635‑1835Hawaii 1‑888‑875‑9229 1‑808‑586‑2790Idaho 1‑800‑247‑4422 1‑800‑721‑3272Illinois 1‑800‑252‑8966 1‑888‑473‑4858Indiana 1‑800‑452‑4800 1‑800‑622‑4461Iowa 1‑800‑351‑4664 1‑877‑955‑1212Kansas 1‑800‑860‑5260 1‑800‑432‑2484Kentucky 1‑877‑293‑7447 1‑800‑595‑6053Louisiana 1‑800‑259‑5300 1‑800‑259‑5301Maine 1‑800‑262‑2232 1‑800‑300‑5000Maryland 1‑800‑243‑3425 1‑800‑735‑2258Massachusetts 1‑800‑243‑4636 1‑877‑563‑4467Michigan 1‑800‑803‑7174 1‑877‑999‑6442Minnesota 1‑800‑333‑2433 1‑800‑657‑3602Mississippi 1‑844‑822‑4622 1‑800‑562‑2957Missouri 1‑800‑390‑3330 1‑800‑726‑7390Montana 1‑800‑551‑3191 1‑800‑332‑6148Nebraska 1‑800‑234‑7119 1‑800‑234‑7119

State Health Insurance Assistance Program and State Insurance Department

48 Section 8: For More Information

Nevada 1‑800‑307‑4444 1‑800‑992‑0900New Hampshire 1‑866‑634‑9412 1‑800‑852‑3416New Jersey 1‑800‑792‑8820 1‑800‑446‑7467New Mexico 1‑800‑432‑2080 1‑888‑727‑5772New York 1‑800‑701‑0501 1‑800‑342‑3736North Carolina 1‑855‑408‑1212 1‑800‑546‑5664North Dakota 1‑888‑575‑6611 1‑800‑247‑0560Northern Mariana Not available 1‑670‑664‑3064Islands Ohio 1‑800‑686‑1578 1‑800‑686‑1526Oklahoma 1‑800‑763‑2828 1‑800‑522‑0071Oregon 1‑800‑722‑4134 1‑888‑877‑4894Pennsylvania 1‑800‑783‑7067 1‑877‑881‑6388Puerto Rico 1‑877‑725‑4300 1‑888‑722‑8686Rhode Island 1‑888‑884‑8721 1‑401‑462‑9500South Carolina 1‑800‑868‑9095 1‑803‑737‑6160South Dakota 1‑800‑536‑8197 1‑605‑773‑3563Tennessee 1‑877‑801‑0044 1‑800‑342‑4029Texas 1‑800‑252‑9240 1‑800‑252‑3439Utah 1‑800‑541‑7735 1‑800‑439‑3805Vermont 1‑800‑642‑5119 1‑800‑964‑1784Virgin Islands 1‑340‑772‑7368 (St. Croix) 1‑340‑774‑7166

1‑340‑714‑4354 (St. Thomas)Virginia 1‑800‑552‑3402 1‑877‑310‑6560Washington 1‑800‑562‑6900 1‑800‑562‑6900Washington D.C. 1‑202‑727‑8370 1‑202‑727‑8000West Virginia 1‑877‑987‑4463 1‑888‑879‑9842Wisconsin 1‑800‑242‑1060 1‑800‑236‑8517Wyoming 1‑800‑856‑4398 1‑800‑438‑5768

State Insurance Department

State State Health Insurance Assistance Program

949

SECTION

De�nitions

Assignment—An agreement by your doctor, provider, or supplier to be paid directly by Medicare, to accept the payment amount Medicare approves for the service, and not to bill you for any more than the Medicare deductible and coinsurance.

Coinsurance—An amount you may be required to pay as your share of the cost for services a�er you pay any deductibles. Coinsurance is usually a percentage (for example, 20%).

Copayment—An amount you may be required to pay as your share of the cost for a medical service or supply, like a doctor’s visit, hospital outpatient visit, or a prescription drug. A copayment is usually a set amount, rather than a percentage. For example, you might pay $10 or $20 for a doctor’s visit or prescription drug.

Deductible—�e amount you must pay for health care or prescriptions before Original Medicare, your prescription drug plan, or your other insurance begins to pay.

Excess charge—If you have Original Medicare, and the amount a doctor or other health care provider is legally permitted to charge is higher than the Medicare-approved amount, the di�erence is called the excess charge.

Guaranteed issue rights (also called “Medigap protections”) —Rights you have in certain situations when insurance companies are required by law to sell or o�er you a Medigap policy. In these situations, an insurance company can’t deny you a Medigap policy, or place conditions on a Medigap policy, like exclusions for pre-existing conditions, and can’t charge you more for a Medigap policy because of a past or present health problem.

Where words in BLUE are de�ned

50 Section 9: Definitions

Guaranteed renewable policy—An insurance policy that can’t be terminated by the insurance company unless you make untrue statements to the insurance company, commit fraud, or don’t pay your premiums. All Medigap policies issued since 1992 are guaranteed renewable.

Medicaid—A joint federal and state program that helps with medical costs for some people with limited income and 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, based on your medical history, whether to take your application for insurance, whether to add a waiting period for pre‑existing conditions (if your state law allows it), and how much to charge you for that insurance.

Medicare Advantage Plan (Part C)—A type of Medicare health plan offered by a private company that contracts with Medicare. Medicare Advantage Plans provide all of your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee‑for‑Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you’re enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan and aren’t paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage.

Medicare-approved amount—In Original Medicare, this is the amount a doctor or supplier that accepts assignment can be paid. It may be less than the actual amount a doctor or supplier charges. Medicare pays part of this amount and you're responsible for the difference.

Medicare prescription drug plan (Part D)— Part D adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private‑Fee‑for‑Service Plans, and Medicare Medical Savings Account Plans. These plans are offered by insurance companies and other private companies approved by Medicare. Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans.

Medicare SELECT—A type of Medigap policy that may require you to use hospitals and, in some cases, doctors within its network to be eligible for full benefits.

Medigap Open Enrollment Period—A one‑time‑only, 6‑month period when federal law allows you to buy any Medigap policy you want that’s sold in your state. It starts in the first month that you’re covered under Medicare Part B, and you’re 65 or older. During this period, you can’t be denied a Medigap policy or charged more due to past or present health problems. Some states may have additional Open Enrollment rights under state law.

Premium—The periodic payment to Medicare, an insurance company, or a health care plan for health care or prescription drug coverage.

State Health Insurance Assistance Program (SHIP)—A state program that gets money from the federal government to give free local health insurance counseling to people with Medicare.

State Insurance Department—A state agency that regulates insurance and can provide information about Medigap policies and other private health insurance.

CMS Accessible CommunicationsTo help ensure people with disabilities have an equal opportunity to participate in our services, activities, programs, and other benefits, we provide communications in accessible formats. The Centers for Medicare & Medicaid Services (CMS) provides free auxiliary aids and services, including information in accessible formats like Braille, large print, data/audio files, relay services and TTY communications. If you request information in an accessible format from CMS, you won’t be disadvantaged by any additional time necessary to provide it. This means you’ll get extra time to take any action if there’s a delay in fulfilling your request. To request Medicare or Marketplace information in an accessible format you can:1. Call us:

For Medicare: 1‑800‑MEDICARE (1‑800‑633‑4227)TTY: 1‑877‑486‑2048

2. Email us: [email protected]. Send us a fax: 1‑844‑530‑36764. Send us a letter:

Centers for Medicare & Medicaid Services Offices of Hearings and Inquiries (OHI)7500 Security Boulevard, Mail Stop S1‑13‑25Baltimore, MD 21244‑1850Attn: Customer Accessibility Resource Staff

Your request should include your name, phone number, type of information you need (if known), and the mailing address where we should send the materials. We may contact you for additional information.Note: If you’re enrolled in a Medicare Advantage Plan or Medicare Prescription Drug Plan, contact your plan to request its information in an accessible format. For Medicaid, contact your State or local Medicaid office.

Nondiscrimination NoticeThe Centers for Medicare & Medicaid Services (CMS) doesn’t exclude, deny benefits to, or otherwise discriminate against any person on the basis of race, color, national origin, disability, sex, or age in admission to, participation in, or receipt of the services and benefits under any of its programs and activities, whether carried out by CMS directly or through a contractor or any other entity with which CMS arranges to carry out its programs and activities.You can contact CMS in any of the ways included in this notice if you have any concerns about getting information in a format that you can use. You may also file a complaint if you think you’ve been subjected to discrimination in a CMS program or activity, including experiencing issues with getting information in an accessible format from any Medicare Advantage Plan, Medicare Prescription Drug Plan, State or local Medicaid office, or Marketplace Qualified Health Plans. There are three ways to file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights:

1. Online:hhs.gov/civil‑rights/filing‑a‑complaint/complaint‑process/index.html.

2. By phone:Call 1‑800‑368‑1019. TDD user can call 1‑800‑537‑7697.

3. In writing: Send information about your complaint to:Office for Civil RightsU.S. Department of Health and Human Services200 Independence Avenue, SWRoom 509F, HHH BuildingWashington, D.C. 20201

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services 7500 Security Boulevard Baltimore, Maryland 21244‑1850

Official Business Penalty for Private Use, $300

CMS Product No. 02110 Revised February 2020

To get this publication in Braille, Spanish, or large print (English), visit Medicare.gov, or call 1‑800‑MEDICARE (1‑800‑633‑4227). TTY users can call 1‑877‑486‑2048.

¿Necesita una copia en español? Visite Medicare.gov en el sitio Web. Para saber si esta publicación esta impresa y disponible (en español), llame GRATIS al 1‑800‑MEDICARE (1‑800‑633‑4227). Los usuarios de TTY deben llamar al 1‑877‑486‑2048.

GU25114ST

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BA25479ST

Thank You for Applying for an AARP® Medicare Supplement Insurance Plan Insured by UnitedHealthcare Insurance Company

For Your Records:You selected Plan with a requested effective date (1st day of a future month) of / / .

Based on the information you provided, your monthly premium for the plan you selected may be $ . Please note that your final monthly premium will be determined once your application is approved.

You will be notified when review of your application has been completed.

What’s Next:Once your application is approved, you can expect your insured Member Identification (ID) Card to arrive. Using the information on the Member ID Card, you can register for a secure online account at www.myaarpmedicare.com to gain access to tools and resources to help you manage both your plan and your health.

In addition to your insured Member ID Card and website access, you’ll also receive:

Your Welcome Kit. The Welcome Kit will include your Certificate of Insurance and coverage details.

Educational Materials. UnitedHealthcare’s educational materials can help you make the most of your plan benefits.

Dedicated Customer Service.You’ll receive a friendly call from one of our courteous and caring UnitedHealthcare Customer Service Advocates, who will review your new member materials, and help answer questions you may have.

Exclusive AARP Member Benefits. A full listing of the benefits you receive with your AARP membership — including healthcare-related discounts, access to financial programs, driver safety courses, social activities, and more — can be found when you log into www.myaarpmedicare.com.

AARP endorses the AARP Medicare Supplement Insurance Plans, insured by UnitedHealthcare Insurance Company. UnitedHealthcare Insurance Company pays royalty fees to AARP for the use of its intellectual property. These fees are used for the general purposes of AARP. AARP and its affiliates are not insurers. AARP does not employ or endorse agents, brokers or producers. You must be an AARP member to enroll in an AARP Medicare Supplement Insurance Plan. Insured by UnitedHealthcare Insurance Company, Horsham, PA (UnitedHealthcare Insurance Company of New York, Islandia, NY for New York residents). Policy form No. GRP 79171 GPS-1 (G-36000-4). In some states, plans may be available to persons under age 65 who are eligible for Medicare by reason of disability or End-Stage Renal Disease.Not connected with or endorsed by the U.S. Government or the federal Medicare program.This is a solicitation of insurance. A licensed insurance agent/producer may contact you.See enclosed materials for complete information including benefits, costs, eligibility requirements, exclusions and limitations.BA25479ST

Let’s talk about your needsYour licensed insurance agent/producer contracted with UnitedHealthcare Insurance Company is here to help.

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