Is there a wrong pick for a medicare [medigap] provider?

[MichaelB]

Thanks, in her zip code, all the Medicare Advantage plans seem to be HMOs but the network includes hospitals and medical groups which are well regarded.

They do continue to show all the Medigap options, including several Plan Fs.

Yes, all the websites show all the plans for a particular zip code, but there is no guarantee of enrollment.

One thing I understand is that Plan F includes Part B premiums? I think they were already deducting Part B premiums in her Social Security checks. Does that mean if she enrolled in Plan F, they'd stop deducting from her Social Security checks? That might offset the higher premiums of Plan F compared to the Medicare Advantage plans.

In each policy, both the Medicare Advantage and the MediGap F, she needs to pay Medicare B separately, and it is withheld from her monthly SS.

When you compare the Medicare Advantage with the Medicare B + MediGap F, don't forget to add the premiums and deductible for Plan D. The deductibles for D are usually pretty high. Medicare has a tool on it's website here that is very good. If you list the drugs it will tell you the cost for the plan, including premiums and cost sharing. It will also list all the plans available in your zip code.

 

[DatumPoint5]

Plan F is currently planned to be withdrawn in 2020 if you are not already on it. If you are looking for a good alternative to Plan F, then Plan G is still going to be available. For a good overview of this issue and why Plan F is being "dissolved" go to this website.
https://boomerbenefits.com/is-plan-f-going-away/

To read more about the "Plan G" option go to this link
https://boomerbenefits.com/medicare-supplement-g-two-ways-to-save/

 

[explanade]

Thanks.

So both the Medicare Advantage and the Medigap plans may reject her for whatever reason?

Will she know within the enrollment period so she has time to select another option?

 

[MichaelB]

Thanks.

So both the Medicare Advantage and the Medigap plans may reject her for whatever reason?

Will she know within the enrollment period so she has time to select another option?

MediGap - yes, she can be refused. Medicare Advantage, I'm not totally sure, I think a particular plan can close to all new entrants but not pick and choose one over another.

Good question on the response time. For Medicare Advantage, I'd call an agent. There's no additional cost, the premium is the same, the agent will know upfront if there are any acceptance issues.

 

[Gotadimple]

MediGap - yes, she can be refused. Medicare Advantage, I'm not totally sure, I think a particular plan can close to all new entrants but not pick and choose one over another.

Good question on the response time. For Medicare Advantage, I'd call an agent. There's no additional cost, the premium is the same, the agent will know upfront if there are any acceptance issues.

Medicare Advantage plans are not underwritten. That means there is no health questionnaire. There are a few exceptions that would keep a person from getting Medicare Advantage (like end stage renal disease - which is covered totally by Medicare). So if you decide that Medicare Advantage is the plan that meets your medical and prescription drug needs, then you just complete an application and they set you up for the new year.

Yes, a plan can close to new entrants. If that happens, I'd look for a different plan because over time, the premiums will increase more rapidly than in an open plan.

Medigap plans are not underwritten if you enroll when you are first eligible. And you can switch between them during the annual enrollment period, without underwriting. However, you could be subject to underwriting if you change from Medicare Advantage to traditional Medicare, or if you never enrolled in a Medigap plan when you were first eligible at age 65. See an insurance agent for an assessment of whether she would be rejected for health reasons by a Medigap carrier. Often an agent knows the underwriting rules of different carriers.

Your state insurance commissioner also has a program called Shiba where you can get advice on which Medigap carrier might be best or which Medicare Advantage Plan can meet your needs.

- Rita

 

[Bamaman]

We are fortunate in that my ex-megacorp handles our Medicare coverage except Part D (medicines.).

There is a large hospital to the north of me that refuses to accept Medicare Advantage Plans. In recent years they have purchased hundreds of physician groups and hospital affiliates in a number of states. Last I heard, the Advantage patients for 1700 physicians, CNRPs and PAs are having to find new doctors. And the hospitals they own and manage refuse to treat Advantage patients--sending patients to other hospitals--many in other cities/counties and sometimes states.

If You are considering one of the Advantage plans, check out that your preferred hospitals and physicians are signed with your insurer.

 

[audreyh1]

Medigap plans are not underwritten if you enroll when you are first eligible. And you can switch between them during the annual enrollment period, without underwriting. However, you could be subject to underwriting if you change from Medicare Advantage to traditional Medicare, or if you never enrolled in a Medigap plan when you were first eligible at age 65. See an insurance agent for an assessment of whether she would be rejected for health reasons by a Medigap carrier. Often an agent knows the underwriting rules of different carriers.
- Rita

I don't think it's true that you can switch between Medigap plans without underwriting once your initial enrollment period expires. AFAIK there is no such "annual enrollment period" for Medigap plans.

 

[kaneohe]

I don't it's true that you can switch between Medigap plans without underwriting once your initial enrollment period expires. AFAIK there is no such "annual enrollment period" for Medigap plans.

That's my understanding also. In some states (like CA) there is a birthday rule that you can switch w/o underwriting if you do it within ?? +/- 30 days ?? of birthday and to an equivalent or lower level plan.

 

[REWahoo]

I don't it's true that you can switch between Medigap plans without underwriting once your initial enrollment period expires. AFAIK there is no such "annual enrollment period" for Medigap plans.

Correct, although there are a few very limited exceptions.

Here is what the Medicare.gov website says about it:

In most cases, you won't have a right under Federal law to switch Medigap policies, unless one of these applies:

- You're eligible under a specific circumstance or guaranteed issue rights
- You're within your 6-month Medigap open enrollment period

 

[explanade]

When you say "when you are first eligible" are you talking about reaching 65 or the annual open enrollment period?

 

[Gotadimple]

When you say "when you are first eligible" are you talking about reaching 65 or the annual open enrollment period?

Age 65. Medicare expects you to enroll in the traditional Medicare program at age 65. There are 7 months to do this: 3 months before, the month of your birthday, and three months after your birthday.

- Rita
P.S. As others have said, you can change a medigap policy at any time, whereas with Medicare Advantage you can only enroll/disenroll/or change plans during the first open enrollment period after your initial enrollment. For example, you turn 65 in May and get enrolled in May and sign up with a Medicare Advantage plan. During open enrollment (10/15-12/7) you can change Medicare Advantage plans, or disenroll entirely and return to traditional Medicare.

 

[audreyh1]

When you say "when you are first eligible" are you talking about reaching 65 or the annual open enrollment period?

First eligible is a a few months around when you reach 65.

Annual enrollment period - there is not an annual enrollment period for Medigap plans. There may be exceptions in some states for some limited cases.

You can change Medigap plans, but in most circumstances you are subject to underwriting.

 

[audreyh1]

Age 65. Medicare expects you to enroll in the traditional Medicare program at age 65. There are 7 months to do this: 3 months before, the month of your birthday, and three months after your birthday.

- Rita
P.S. As others have said, you can change a medigap policy at any time, whereas with Medicare Advantage you can only enroll/disenroll/or change plans during the first open enrollment period after your initial enrollment. For example, you turn 65 in May and get enrolled in May and sign up with a Medicare Advantage plan. During open enrollment (10/15-12/7) you can change Medicare Advantage plans, or disenroll entirely and return to traditional Medicare.

But if you return to traditional Medicare after being on Medicare Advantage want to purchase a Medigap plan, in most cases you will be subject to underwriting if you are past the initial enrollment period.

 

[nhcycling]

Is there a wrong pick for a medicare provider?

Re: OP - this is a good question for Andrew Rubin who hosts a show on Sirius radio - Dr Radio - Healthcare Connect

 

[Gotadimple]

But if you return to traditional Medicare after being on Medicare Advantage want to purchase a Medigap plan, in most cases you will be subject to underwriting if you are past the initial enrollment period.

True. You get options, but they are never simple.

In this entire thread Steve asked about choosing a carrier. And then, being who we are we got into the details of choosing a plan.

OP, I would say choose a carrier based their reputation for stability in your community. Some carriers (Medigap or MedAdvantage) open and close offerings frequently. They only do that when claims experience in that plan has not been good (meaning they didn't price it properly and they are losing $$).

MedAdvantage and Part D plans also get measured by CMS for service, and a whole host of other things. The more stars the better the plan is. There is no star rating for Medigap plans.

So, I would choose a carrier based on open plans and history of stability in your community. Then if they are measured by CMS, choose a carrier with a high star rating (5 is the most), then, reputation for customer service. Price comes in there at some point, but by that point you have narrowed the field and can select on other more personal characteristics like physician network, drug coverage, etc.

- Rita

 

[audreyh1]

True. You get options, but they are never simple.

In this entire thread Steve asked about choosing a carrier. And then, being who we are we got into the details of choosing a plan.

Explanade asked later about his mother switching Medicare Advantage plans or her other options which is why were were talking about the switching rules.

 

[Steve s]

Picked my carrier

Surprised to see this tread still alive so though I would update on my decision on my carrier.
After much research I ended up going with Bankers Fidelity. Don't confuse it with Bankers Life. Not a lot of information on the company but the information I found was positive. When I called BF I was actually connected to an insurance broker. While talking to him about BF I mentioned I was also thinking of Atena, which he also sold but his opinion was in a few years I would probably be talking to him try to find a lower premium carrier and that BF was more constant on their prem.
I went with plan f High ded because I have money in retirement account that I cannot use for premium but can use it for the ded. I was really surprised in premium cost difference with the different carriers for the same plan f hi ded. BF was not the lowest but it was close. BCBS was one of the highest but if I would have gone with the regular plan F they would be one of the lowest.
Turning 65 and that supplement shopping can be a little overwhelming. Got it done now just need to stay healthy and enjoy.

 

[Cat-tirement]

That's my understanding also. In some states (like CA) there is a birthday rule that you can switch w/o underwriting if you do it within ?? +/- 30 days ?? of birthday and to an equivalent or lower level plan.

I helped MIL use the birthday rule to change her plan last year. She would never have passed underwriting.


Sent from my iPhone using Early Retirement Forum

 

[haha]

I helped MIL use the birthday rule to change her plan last year. She would never have passed underwriting.


Sent from my iPhone using Early Retirement Forum

This illustrates an important issue-rules around obtaining and changing Medigap plans are quite different from state to state. And they are subject to change. In some states, unless you are at one or more of a few privileged times, once you have a plan it can often be difficult to change to another one, except under certain conditions. Of course you can always drop a plan, but you cannot necessarily or even often get it back. You can move to Medicare Advantage, and if you talk to an agent he or she will usually be pushing to sell this.

I believe that Washington is the most favorable to consumers, or among the most favorable. Essentially in states where it is hard to switch without losing some protections, the insurers are free to play games with you. Most prominently closing a pool to new entrants, then opening another one with none of the old expensive patients in it, often in a different subsidiary. And Life and health companies are sellers of all the fancy annuity products that we have grown to know and hate.

There is also quite a bit of misinformation, so it is easy to become confused, pissed, or both.

Ha