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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
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