Medicare Supplement

What is Medicare?

Medicare is the Federal health insurance program for Americans age 65 and older and for certain disabled Americans. If you are eligible for Social Security or Railroad Retirement benefits and are age 65, you and your spouse automatically qualify for Medicare.

Medicare has three parts: hospital insurance, known as Part A, supplementary medical insurance, known as Part B, which provides payments for doctors and related services and supplies ordered by the doctor, and prescription drug coverage, known as Part D which covers both brand-name and generic prescription drugs at participating pharmacies in your area. If you are eligible for Medicare, Part A is free, but you must pay a premium for Part B and Part D.

Medicare will pay for many of your health care expenses, but not all of them. In particular, Medicare does not cover most nursing home care, long-term care services in the home, or prescription drugs. There are also special rules on when Medicare pays your bills that apply if you have employer group health insurance coverage through your own job or the employment of a spouse.

Medicare usually operates on a fee-for-service basis. HMOs and similar forms of prepaid health care plans are now available to Medicare enrollees in some locations.

The best source of information on the Medicare program is the Medicare Handbook . This booklet explains how the Medicare program works and what your benefits are. To order a free copy, go to: . You also can contact your local Social Security office for information.

Exceptions, Limitations and Exclusions

Most long term care insurance policies will not pay benefits for any confinement, care, treatment, or service(s):

  • That results from attempted suicide or intentionally self-inflicted injury
  • That results from voluntary participation in a felony, attempted felony, or illegal occupation
  • That results from a sickness or injury for which benefits are provided under any state or federal worker’s compensation law
  • Provided outside the United States or Canada
  • Provided in a government facility (unless otherwise required by law)
  • Provided for the treatment of alcoholism or drug addiction, or in facilities operated primarily for such treatment
  • Provided in facilities operated primarily for the treatment of mental or nervous disorders or disease, other than Alzheimer’s disease or dementia

Pre-Existing Conditions

You could be declined coverage if you already have the following condition(s):

  • Alzheimer’s Disease
  • Severe Arthritis with functional limitations
  • Diabetes which is not under control
  • Cancer within the past 6 months
  • Parkinson’s Disease
  • Stroke within the past 6 months
  • A Stroke at any time, which has caused functional limitations
  • Congestive Heart Failure within the past 6 months
  • Emphysema, if severe or still smoking
  • Chronic Obstructive Pulmonary Disease, if severe or still smoking
  • Any conditions which require the assistance of another human being for the basic activities of daily living: bathing, eating, toileting, or transferring in and out of a bed or chair