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Q. How long do I have to decide whether or not I
want to keep my Medicare supplement policy?
A. You have a 30 day "free look" period from the
date the policy is delivered to you. During this time the company will fully
refund all premiums paid, if cancellation is requested in writing by the
insured.
Q. I am 65 years old and retired from my job. I
kept my company insurance plan, and I am also covered as a dependent under my
wife's plan where she works. In addition, I have Medicare benefits, and a
Medicare supplement policy. If I have a claim, who pays first? Second? Third?
A. As long as the wife is working, her plan
would be primary; then Medicare; then your group. The Medicare supplement would
pay in addition to other plans. If your wife retires, the Medicare supplement
would pay in addition to other plans.
Q. A producer wants to sell me a nursing home
policy. I was under the impression my Medicare supplement policy provided
nursing home coverage.
A. A Medicare supplement policy provides very
limited nursing home coverage. It supplements payments made by Medicare toward
skilled nursing care only. The major percentage of patients in nursing homes
receive either intermediate or custodial care, which is not covered under the
Medicare supplement policy.
Q. This producer just sold me a Medicare
supplement policy, and I do not want it. How do I get my money back?
A. If the policy has been issued, you need to
send it back and request a refund within the 30 day "free look" period. If the
policy has not been issued, write the company a letter advising them that you
wish to cancel your contract. If you encounter problems, contact the Alabama
Department of Insurance.
Q. I have a Medicare supplement policy that has
always paid 100% of the charges Medicare did not pay. Now the company is only
paying 100% of the charges approved by Medicare. Can they do this?
A. You need to read your policy very carefully
to determine if benefits are paid on the basis of actual charges, or the amount
of charges approved by Medicare. If it pays based on the amount approved by
Medicare, then Medicare would pay 80% of the amount approved, and your
supplemental policy would pay 20% of the amount approved. For example, if the
doctor's bill is $1,000, and Medicare approves $800, Medicare will pay 80% of
$800 ($640). Your supplemental policy will pay the remaining 20% of $800
($160). You will be responsible for the $200 difference between the doctor's
bill and the amount approved, unless your physician accepts Medicare
assignments (the amount that Medicare approves).
Q. Why can't your Department help me resolve the
many problems I am having with my Medicare claim?
A. Medicare is a Federal program over which this
Department has no jurisdiction. Specific problems concerning this program
should be directed to:
MEDICARE CLAIMS INFORMATION
(800)633-4227