Frequently Asked Questions

View our list of frequently asked questions. If you still have questions, contact us at Service@AveraHealthPlans.com.

Am I eligible to apply for a Medicare Supplement Insurance plan?

In order to be eligible for Medicare Supplement Insurance,

  • You are 65 years or older and have Medicare Part A and Part B
  • You are under 65 years of age and disabled, and have Medicare Part A and Part B
  • You have ALS, and you have Medicare Part A and Part B

If you are on Medicaid, you might not need this insurance plan or any other Medicare Supplement Insurance.

Do I have to wait for any prior conditions to be covered?

No. If this is your first Medicare Supplement Insurance policy or you are replacing another Medicare Supplement Insurance policy, Avera Health Plans has no waiting periods for prior health conditions. When your application has been approved, your coverage will begin immediately on the effective date of your policy.

Is there an open enrollment period?

Yes. Open enrollment is a period of time when you cannot be denied coverage because of any prior health condition you may have. You will automatically be accepted for coverage if you are at least 65 years of age and apply for Avera Health Plans coverage within six months of your Medicare Part B effective date. The next open enrollment will take place from Oct. 1 through Jan. 1.

If you delay enrolling in Part B because you have group health coverage based on your current employment, your open enrollment period won’t start until you sign up for Part B.

What is the Medicare Supplement Insurance Policy guaranteed issue timeline?

You will automatically be issued an Avera Health Plans Medicare Supplement Insurance policy if you:

  1. Apply for an Medicare Supplement Insurance policy no later than 63 days after termination from a group health plan through your employer or union, and you provide evidence with a Certificate of Creditable Coverage.
  2. Apply for an Avera Health Plans Medicare Supplement Insurance no later than 63 days after dropping a Medicare Advantage Plan, a Medicare Supplement Plan or other Medicare Health Plan, as long as it is done within the first 12 months of enrolling in the plan, and it is the first time you have been in the plan.

NOTE: A Certificate of Creditible Coverage is a certificate which indicates effective date and termination date of your prior coverage.

Can I go to any physician?

Yes. You may see the physician of your choice. No referral slips are necessary. To receive full plan benefits when you need hospital services or outpatient surgery center, your physician must have admitting privileges at an in-network hospital or be willing to refer you to one who does.

Which hospitals are in-network for our Medicare Supplement Insurance Select plans?

Because we have great relations with Avera providers, we can offer the best rates when going with our Select plan for Medicare Supplement Insurance coverage. You can still see any doctor, but if you require hospital services or outpatient surgery center, you will be required to use an in-network hospitals.

Our Service Center can also confirm whether the treatment you require is available from a participating in-network hospital and, if not available, will assist you in locating a hospital that provides the necessary service. Contact us at 1-888-322-2115 or Service@AveraHealthPlans.com with any questions.

What happens in an emergency or while I'm traveling?

In an emergency, take care of yourself as you and your physician feel is appropriate. Avera Health Plans benefits will be paid at any Medicare-approved hospital or physician in an emergency.

When traveling outside of the service area, our benefits will be paid at any Medicare-approved hospital or clinic for up to 90 days.

NOTE: If you need treatment that is not available from an in-network hospital, you or your physician should contact our Service Center at 1-888-322-2115 or Service@AveraHealthPlans.com for admission procedures to a non-network hospital.

Can my policy be cancelled?

No. As long as you pay you premiums on time, your individual coverage cannot be canceled because of the size or number of claims you make.

Who can help me understand what benefits are covered by a Medicare Supplement Insurance Plan?

Benefits are the same for all Medicare Supplement Insurance Plans. For example, Plan F is the same Plan F benefits from all insurance carriers. There are different benefits between Plans A — L and there are also differences between Standard and Select plans.

We're here to help you. Simply contact us at 1-888-322-2115 or Service@AveraHealthPlans.com and we'll connect you to someone who can answer your questions. We're available Monday through Friday and can set up a time to meet with you.

If I become a policyholder, do I need another supplement insurance plan?

No. When you become an Avera Health Plans Medicare Supplement Insurance policyholder, you do not need another Medicare Supplement.

To avoid duplication of coverage and unneeded expense, our Medicare Supplement Insurance policy should replace any other Medicare Supplement Insurance you may have.

Who do I ask if I have more questions?

We're here to help you understand your options and answer any questions you have. Contact us at 1-888-322-2115 or Service@AveraHealthPlans.com and we'll be happy to talk with you about your coverage.