Medicare Select

A Medicare Select policy is a Medicare Supplement policy (Plan A through N) that conditions the payment of benefits, in whole or in part, on the use of network providers. Network providers are providers of health care which have entered into a written agreement with an insurer to provide benefits under a Medicare Select policy.

A Medicare Select policy cannot restrict payment for covered services provided by non-network providers in an emergency or for an unforeseen illness, injury, or a condition where it is not reasonable to obtain such services through a network provider. A Medicare Select insurer must make full and fair disclosure in writing of the provisions, restrictions, and limitations of the Medicare Select policy to the applicant. This disclosure shall include at least all of the following:

  • An outline of coverage sufficient for the applicant to compare the coverage and premiums of the Medicare Select policy with other Medicare Supplement policies offered by the insurer or offered by other insurers

  • A description, including address, phone number, and hours of operation of the network providers, including primary care physicians, specialty physicians, hospitals, and other providers

  • A description of the restricted network provisions, including payments for co-insurance and deductibles, if providers other than network providers are utilized

  • A description of coverage for emergency and urgently needed care and other out-of-service area coverage

  • A description of limitations on referrals to restricted network providers and to other providers

  • A description of the policyholder's rights to purchase any other Medicare Supplement policy or certificate otherwise offered by the insurer

  • A description of the Medicare Select insurer's quality assurance program and grievance procedure

At your request, under a Medicare Select policy, the health insurer must make available to you the opportunity to purchase a Medicare Supplement policy offered by the insurer that has comparable or lesser benefits that does not contain a restricted network provision. The health insurer shall make the policy available and cannot require evidence of insurability after the Medicare Supplement policy or certificate has been in force for 6 months.