What is a Medicare SELECT policy?
Medicare SELECT is a type of Medigap policy (Medicare supplement plan) that requires its members to get their primary care from a contracted provider.
Prior to the advent of Medicare Advantage, Medicare supplement insuranceMedicare Supplements are additional insurance policies that Medicare beneficiaries can purchase to cover the gaps in their Original Medicare (Medicare Part A and Medicare Part B) health insurance coverage. companies contracted with local hospitals and doctors to get favorable rates for their policyholders. These unique Medigap plans became known as Medicare SELECT policies.
Although Medicare SELECT policies are not available everywhere, where available they offer significant savings. In trade for the savings, you agree to use the local providers specified by the policy, just like you would with a Medicare Advantage planMedicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B).. The contracted providers charge less for the services they provide, but you are not limited to providers in the network. You can choose to use an out-of-network provider, but you will be responsible for copaymentsA copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service. and deductiblesA deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share. covered by the policy.
Be aware that:
- Not all of the hospitals and healthcare facilities in your local area will be in the network.
- A Medicare SELECT policy will not cover treatment by providers not in the network unless it is an emergency.
- Medicare SELECT policies require their members to get referrals from their primary care doctor when they want to see a specialist or get treatment at a network hospital.
Other than the restrictions stated above, SELECT policies work exactly the same way as other standardized Medigap plans, letters A – N.
Medicare SELECT plans are a good alternative in rural areas with few or no Medicare Advantage plan options. If you can’t afford a standard Medigap plan, and you can live with the network restrictions, a SELECT plan is an option to consider.
How to Enroll in Medicare SELECT
Enrollment in a Medicare SELECT policy works the same way as any other Medicare supplement. If you find a plan you like, and your doctors and hospital are part of the network, ask your insurance agent to work up a quote.
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Be aware that you have the freedom to choose any Medicare Supplement you want, including SELECT plans, with guaranteed acceptance, so long as you live in the plan’s service area. However, guaranteed acceptance is available during your individual open enrollment periodDuring the Medicare Open Enrollment Period, Medicare Advantage and Part D plan members can change, switch, or drop a plan they chose during the Annual Election Period. OEP starts on January 1 and ends on March 31.. This is a 6 month period that begins when you first enroll in Medicare Part BMedicare Part B is medical coverage for people with Original Medicare benefits. It covers doctor visits, preventative care, tests, durable medical equipment, and supplies. Medicare Part B pays 80 percent of most medically necessary healthcare services.. If you miss this window, you will lose your guaranteed issue right.
When your guaranteed issue rightsGuaranteed-issue is a right granted to Medicare beneficiaries and applies to Medicare Supplement insurance (aka, Medigap plans). All states and the federal government enforce this essential right, which protects Medicare beneficiaries from medical underwriting. expire, you may still qualify for the plan you want, but you will need to go through medical underwriting first. This is why getting enrolled when you first qualify is so important. With guaranteed issue rights you cannot be turned down for any pre-existing health conditions or be charged a higher premiumA premium is an amount that an insurance policyholder must pay for coverage. Premiums are typically paid on a monthly basis. In the federal Medicare program, there are four different types of premiums. .
Before you make your decision, remember this. Choosing a Medicare SELECT plan may limit your access to the healthcare providers you prefer. Think carefully before choosing.