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Individual Medicare Policy Options
If you are Medicare eligible, your Medicare options are changing... and expanding! How do you
know which policy to choose? Informed Choice can help find the right option for you!
How Can Informed Choice Help You?
Informed Choice is the only independent insurance agency in Northeastern Wisconsin licensed
to sell all individual Medicare policy options, including:
- Traditional Medicare supplements
- Medicare Select
- Medicare Advantage
Most agents/agencies sell only a few supplements – and most do not sell any Medicare
Advantage plans. Informed Choice can help you choose the policy option that’s best for you.
And, as your needs change, we can help you evaluate new, alternative plans. Schedule your
Private, personalized Medicare appointment. We’ll provide objective, unbiased information
on your options.
Your Medicare Policy Options:
Many insurance companies offer individual policies that supplement the benefits available
under Medicare. These policies are referred to as Medicare Supplement or Select policies.
Medicare Advantage Plans are also offered in Northeastern Wisconsin by private companies
that sign a contract with Medicare. Medicare pays a set amount of money to these private
health plans for your health care. They manage the Medicare coverage for their members.
Medigap Policies—Traditional Insurers
Individual Medicare supplement policies are designed to supplement the benefits available
under the original Medicare program. Medicare supplement policies pay the 20% of
Medicare-approved charges that Medicare does not pay. These Medicare supplement policies
do not restrict your ability to receive services from the doctor of your choice.
Individual Medicare supplement policies include a basic core of benefits. In addition to
the basic benefits, Medicare supplement insurers offer specified optional benefits. Each
of the options that an insurance company offers must be priced and sold separately from the
basic policy.
Medigap Policies—Medicare Select
Medicare select policies supplement the benefits available under the Medicare program
and are offered by insurance companies and health maintenance organizations (HMOs). Medicare
select policies are similar to standard Medicare supplement insurance. However, Medicare
select policies pay supplemental benefits only if covered services are obtained through
plan providers selected by the insurance company or HMO. Each insurance company that offers
a Medicare select policy contracts with its own network of plan providers to provide services.
If you buy a Medicare select policy, each time you receive covered services from a plan
provider, Medicare pays its share of the approved charges and the insurance company pays the
full supplemental benefits provided for in the policy. Medicare select insurers must pay
supplemental benefits for emergency health care furnished by providers outside the plan
provider network.
In general, Medicare select policies deny payment or pay less than the full benefit if you
go outside the network for non-emergency services. However, Medicare still pays its share of
approved charges if the services you receive outside the network are services covered by
Medicare. All Medicare select policies include a basic core of benefits.
Medicare Advantage Plans
Medicare Advantage is a special arrangement between the federal Centers for Medicare &
Medicaid Services (CMS) and certain insurance companies. Under this arrangement the
federal government pays the insurance company a set amount for each Medicare
beneficiary. The insurance company agrees to provide all Medicare benefits. The insurance
company may provide some additional benefits, but it may also require payment of an
additional premium. Beneficiaries under Medicare Advantage plans continue to pay the
Part B Medicare premium to CMS. Your Medicare Advantage plan can terminate at the
end of the contract year if either the plan or CMS decides to terminate their
agreement. Medicare Advantage plans are not regulated by the State of Wisconsin
Office of the Commissioner of Insurance. Therefore, these plans are NOT required to
cover Wisconsin mandated benefits, nor are the plans guaranteed renewable for life
like the Medicare supplement plans listed in this booklet.
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