Frequently Asked Questions
Q. I have VA benefits or TRICARE. Should I consider a Medicare Supplement plan?
A. TRICARE for Life will work as your supplement to Medicare. VA benefits are different from TRICARE benefits. If you have good VA facilities nearby, you may feel comfortable that you’re protected from major medical expenses and have good and easy access to medical services. However, there are many former service people who live a pretty good distance from a VA facility and/or hospital. If you live a long distance from a VA hospital and have a medical emergency, you will be covered at a local hospital; however, they will want to transport you to a VA hospital as soon as you’re stable. Quality of care and availability varies with each VA facility. If you are a VA recipient, you might consider purchasing a Medicare Supplement plan to provide convenient choices for your health care options.
Q. I have a Medicare Advantage Plan. Should I consider a Medicare Supplement plan?
A. If you currently have a Medicare Advantage Plan, you should not buy a Medicare Supplement plan. A Medicare Supplement plan is intended to cover the gaps in Original Medicare. Medicare Advantage Plans replace Original Medicare and all your benefits are received through a private insurance company. So, if you have a Medicare Supplement plan and are on a Medicare Advantage Plan, you’re paying for coverage that you can’t use. It is actually illegal for an insurance agent to sell you a Medicare Supplement if you are currently on a Medicare Advantage Plan (and insurance companies go through great effort to prevent this from happening) - unless you are in the process of switching from a Medicare Advantage Plan to Original Medicare in a special enrollment period or annual enrollment period (October 15-December 7 of each year).
Q. I am a NC State Health Plan Medicare Primary Member. Should I consider a Medicare Supplement plan?
A. Maybe. The NC State Health Insurance Plan provides health care coverage to teachers, state employees, retirees, current and former lawmakers, state university and community college personnel, state hospital staff and their dependents.
The State Health Plan’s Board of Trustees announced new coverage options for Medicare Primary retirees for 2017. There are over 200,000 retirees and dependents. The 80/20 Plan is not being offered to Medicare Primary retirees. State Health Plan Primary retirees eligible for Medicare will automatically be enrolled in a Medicare Advantage Base Plan, unless you take action to enroll in the Traditional 70/30 Plan. The Traditional 70/30 Plan is your ONLY option if you want to be enrolled in Original Medicare. The 70/30 Plan option is offered to Medicare Primary retirees at no premium cost for the primary retiree. It will include the traditional State Health Plan pharmacy coverage. Remember, If you enroll in a Medicare Advantage Plan, you will NOT be enrolled in Original Medicare.
Original Medicare covers many healthcare services, but it won’t cover everything. Consequently, Medicare Supplement insurance plans have played a significant role alongside Original Medicare. Medicare Supplement Plans help pay for many of those extra expenses not covered by Original Medicare. They are simple to understand, affordable, offer nationwide coverage and allow policyholders to keep their healthcare providers.
Important: If you are turning 65 and in your open enrollment period, this will be the ONLY time during your lifetime that you will be eligible to buy a Medicare Supplement Plan without answering any health question to qualify. So, review your options carefully.
Many NC State Health Plan Medicare Primary Retirees see the value in purchasing a Medicare Supplement policy to cover the gaps in Original Medicare. You need to evaluate your options. Be sure you watch the two videos on Medicare Advantage Plans and see why so many State Health Plan choose the Traditional 70/30 Plan in order to remain on Original Medicare and select a Medicare Supplement Plan.
- With Original Medicare, you have the right to choose:*
- Any doctor or specialist that accepts Medicare in the United States
- Any hospital that accepts Medicare in the United States
- No doctor list or network to worry about
- No need for a referral to worry about
- No prior approval to worry about
Original Medicare and Plan F cover almost every medical expense:*
- You pay $0 when you go to a primary care physician or to a specialist
- You pay $0 when you go to the hospital and need inpatient services
- You pay $0 when you go to the hospital and need outpatient services
- You pay $0 for preventive care services
- You pay $0 when you go to a skilled nursing facility
- You pay $0 for Medicare deductibles and copayments
- You pay $0 for Medicare eligible excess charges
- You pay $0 for any additional Medicare-eligible medical services
Original Medicare and Plan F cover 100% of Medicare Part A and Part B deductibles, co-payments and coinsurance. Plan G pays the exact same benefits as Plan F except that Plan G doesn’t cover the Medicare Part B calendar-year deductible
The best time to purchase a Medicare Supplement policy is when you are turning 65 or during your Open Enrollment period. You won’t answer any health questions and your Medicare Supplement insurance policy will be guaranteed issue during your Medicare open enrollment period or if you’re losing your group retiree health coverage.
The NC State Health Plan provides credible prescription drug coverage so NC state health plan retirees do not need to purchase a Medicare Part D Drug Plan.