Medicare Enrollment Question

[nwsteve]

Hoping the broader experience here can help me better understand the peculiarities regarding a Sept Medicare activation.
I have been issued my card for a Sept startup date and am now trying to sort out Supplemental Plans. The best choice for me looks like a Premera Blue Cross Plan F at 166/month. Premera also offers a High Ded Plan F for 68/mon. Since we currently have a 2500 deductible policy, carrying a 2070 looks pretty good since I am good health and will have my regular physical in a couple of days to confirm
Questions needing confirmation:

• Medicare is on a calendar year, so current rates are only good to end of year.
• Open enrollment starts in Oct, 2012 and I would be free to change to the Standard Plan F, starting next Jan 1 assuming the rate structure remains comparable. Correct?
• Any downsides (besides the deductible) for going with High Ded Plan F I am not appreciating?

Thanks in advance for sharing yoru experience.
Nwsteve

 

[kaneohe]

I don't know if your state is the other one mentioned in this article or not.
If not, you can read between the lines for the CA article re: changing outside the birthday window. It sounds like you will need to undergo underwriting and the insurance company can reject you for the higher level plan F or perhaps charge you more? Sounds like it wouldn't be problem now but later? You'll have to weigh that against the 1K+/- savings for high D policy.
The Medicare Birthday Rule In California – How It Helps You | Exemptions tax

Another link http://www.medicare.gov/Publications/Pubs/pdf/11219.pdf
My impression is that for supplement plans, you have one open enrollment period , period (unless your company goes out of biz,etc)....not annual
but once in a lifetime. Interesting question you pose: if you enroll in supplement,
is the open enrollment window still open for the rest of the 6 mos remaining so you can switch at will w/o underwriting? I guess I'm not sure.....seems like it would be simpler to pick the one you really want; if in doubt, since it's easier to downgrade than to upgrade, I would pick the high level straight plan F to start with.

You might want to ask the insurance co about the other questions. My company raised their rates at mid-yr and claim they only do it once a yr.

another useful link http://www.medicare.gov/Publications/Pubs/pdf/02110.pdf

 

[JOHNNIE36]

My BIL researches the supplemental plans religiously and tells me that all plan F's must be the same for benefits so he only shops for the best price. Does this sound right? I think he said he got Mutual of Omaha this year because it was the lowest price. Might be some other company next year. I'm in a Medicare Advantage plan so supplemental plans don't interest me.

 

[easysurfer]

My BIL researches the supplemental plans religiously and tells me that all plan F's must be the same for benefits so he only shops for the best price. Does this sound right? I think he said he got Mutual of Omaha this year because it was the lowest price. Might be some other company next year. I'm in a Medicare Advantage plan so supplemental plans don't interest me.

Yes, I believe by law all plan F's must be the same for benefits. I had a friend (passed away last Dec) who had Plan F. She had many ailments and having Plan F offered great security as during the past few years she had several hospital stays and ambulance trips. It was very helpful knowing that the plan covered what medicare did not. Otherwise, she would have been responsible for a large amount.

 

[73ss454]

My BIL researches the supplemental plans religiously and tells me that all plan F's must be the same for benefits so he only shops for the best price. Does this sound right? I think he said he got Mutual of Omaha this year because it was the lowest price. Might be some other company next year. I'm in a Medicare Advantage plan so supplemental plans don't interest me.

Johnnie, can you explain what a Medicare Advantage Plan is and why you wouldn't need a supplemental plan. I'm still a little over a 1 1/2 away from Medicare but I'm closing fast.

 

[kaneohe]

...... all plan F's must be the same for benefits so he only shops for the best price. Does this sound right? I think he said he got Mutual of Omaha this year because it was the lowest price. Might be some other company next year.

The first sentence is basically correct. Unless you live in CA or 1 other
state, switching annually w/o underwriting is not guaranteed. You might get away w/ that strategy if your health is good and you are a profitable customer
but if your health deteriorates, I suspect the other company will either deny you coverage or raise your rates.

 

[JOHNNIE36]

Johnnie, can you explain what a Medicare Advantage Plan is and why you wouldn't need a supplemental plan. I'm still a little over a 1 1/2 away from Medicare but I'm closing fast.

I would prefer to leave this to a site that will do a terrific job of describing Medicare Advantage plans. Just Google "Medicare Advantage Plans" and you will see a site titled medicare.gov. Just remember that every state is different in the benefits provided by the different insurance companies. Also, remember that once you choose an advantage plan, it replaces both Medicare. You can always go back to Medicare but you can't just go back to a supplemental plan. The insurance company would have to accept you. We have been really happy with our Blue Cross Blue Shield Advantage plan. That's in Florida. Your state may be different.

 

[Moemg]

A medicare Advantage plan is basically a combination of Medicare & a supplement for a lower price . They also cover basic drugs and other drugs with co-pays . A gym membership is also included to select gyms . You have a choice of several plans ranging from HMO's to PPO's . Depending on the plan you pick your cost may be only your $100 Medicare payment . My So has Universal Medicare Advantage which is a physician run Florida plan and so far we have been very happy .He went on medicare last year and I read all the literature at least three times . It was very confusing . The literature that Medicare sends was the best for explaining it . Good luck !

 

[73ss454]

Thanks Johnnie and Moemg, I'm also in Florida so I'll be facing the same decisions in the near future.

We have a plan from DW's old job and from what I've heard it will continue after we turn 65. We pay 10% of the cost and once we turn 65 the premium will go down from the 2K a year we are paying now. They said about 1100 a year after we both hit 65.
They also said that we will have to buy part B and they would reimburse us every 3 months. I think they also provide drugs but not really sure. I just don't know much about how Medicare works so I'll have to do some reading. I guess part B is the one we will have to choose but not sure.

 

[Moemg]

Thanks Johnnie and Moemg, I'm also in Florida so I'll be facing the same decisions in the near future.

. I just don't know much about how Medicare works so I'll have to do some reading. I guess part B is the one we will have to choose but not sure.

Medicare sends out a booklet that explains everything . I think it arrives a few months before your birthday but if you want to see it earlier it is online at the Medicare site. Since your wife has coverage that will be secondary to Medicare and pays whatever Medicare does not cover.

 

[JOHNNIE36]

Just to clear things up about Medicare and Medicare Advantage. When you sign up for a Medicare Advantage plan you no longer are covered by Medicare itself. The best way I can describe this is that to make it easier for Medicare to manage it's business, they sublet the insurring of people like myself to various insurance companies (Blue Cross Blue Shield in my case). To aid the insurance companies in this endevour, Medicare pays those companies about $9000/year per enrolee to take care of us. So, the insurance companies have a lot of funds available for them to sweeten the pot to get people to sign with them. Those insurance companies must have at least as good of coverage as Medicare according to law. Hence, some dental, vision and good prescription drug coverage that those companies can easily afford to offer. Big competition here in Florida to sign with one of those plans. I pay nothing in the way of premiums except for the Medicare premium of what, $105/month? Medicare still takes that $105 out of my Social Security check and pays it to Blue Cross Blue Shield. Some of these insurance companies even offer part of that $105 back to you as rebates. At one time Universal returned the entire $105 Medicare premium.

The more you read about it the more you will learn. Blue Cross Blue Shield, United Health Care and Humana have huge networks of doctors, hospitals, and related health service groups under their umbrella.

 

[73ss454]

Thanks guys!

 

[Dancer373]

I have 3 years until Medicare so I really appreciate all this information. I also am in Florida and currently have BCBS.

 

[imoldernu]

Small point. Supplements are residence state specific. Changing legal residence may require change in plans.

 

[pasttense]

Right now Medicare Advantage plans get a significant subsidy over regular Medicare. With Obamacare this subsidy is being removed. Thus Medicare Advantage policies will become less attractive. OP, one point has been mentioned--what if your health turns bad. You probably won't be able to switch from the High Deductible to regular F. Another point has not. The health business is notorious for billing errors, incomprehensible bills etc. So it is worth something not to have to deal with this aggravation.

 

[nwsteve]

OP, one point has been mentioned--what if your health turns bad. You probably won't be able to switch from the High Deductible to regular F. Another point has not. The health business is notorious for billing errors, incomprehensible bills etc. So it is worth something not to have to deal with this aggravation.

Got some more education today from my insurance broker. I am using the BC provider for coverage and their app has a set of questions that determines if you have to go through underwriting to change plans--basically if you are coming from an existing plan that has comparable coverage and there is no gap in coverage, no underwriting is required. You just have to submit a letter of coverage from your current carrier. Pretty much the situation now when you change plans for individual coverage.
Nwsteve

 

[kaneohe]

"I am using the BC provider for coverage and their app has a set of questions that determines if you have to go through underwriting to change plans--basically if you are coming from an existing plan that has comparable coverage and there is no gap in coverage, no underwriting is required. You just have to submit a letter of coverage from your current carrier. Pretty much the situation now when you change plans for individual coverage."

Might very well be true going TO BC but is it guaranteed going FROM BC to
another provider?

 

[imoldernu]

Just a short word here re: paperwork, billing problems...
Something that may seem unbelievable...
IN the 11 years since we signed on to medicare... through literally "Hundreds" of medical care issues... tests, operations, checkups, treatments etc... and thousands and thousands of pieces of paper... Not just Government, but BCBS too, we have NEVER had a single problem.

The trick to this, is IMHO... not to question, but to wait. It may take three months or more, but the issues resolve themselves... most having to do with the deductible.

I believe that the eventual common health database, will eliminate all of the paper, and be a boost to single payer health care... might be another 10 years, but hope springs eternal.

So... been there, done that... not bad at all.

 

[Brat]

One of the ways both Medicare and health insurers could save a bundle of cash is to send statements of payments monthly. My recent treatment for breast cancer has resulted in about an inch of paper.

 

[misanman]

I hope this question is related enough to the original post. Please move elsewhere if it's the right thing to do.

I have been paying for Medicare part B for the last year or so as I wasn't drawing SS. Now I've applied for a SS benefit under my wife's account, while still letting mine accumulate.

So last year I had a Medicare account that was based on my SSN. Today, I received a new card that is based on my wife's SSN. I was really surprised - should I have expected this? Is there any downside? I wonder if I need to inform the company where I have my supplemental insurance?

 

[nwsteve]

"
Might very well be true going TO BC but is it guaranteed going FROM BC to
another provider?

Fair question and someone who is more of an authority then myself needs to weigh in for a definitive answer. The broker gave me impression these rules are pretty much standardized per the Feds. And when the Feds do not have a rule, each state has them.
Nwsteve

 

[haha]

Got some more education today from my insurance broker. I am using the BC provider for coverage and their app has a set of questions that determines if you have to go through underwriting to change plans--basically if you are coming from an existing plan that has comparable coverage and there is no gap in coverage, no underwriting is required. You just have to submit a letter of coverage from your current carrier. Pretty much the situation now when you change plans for individual coverage.
Nwsteve

This is exactly correct in WA, but it may not be true elswhere. I think the WA law allowing this is only 1.5-2 years old. Several years ago I wanted to switch plans, but a medical evaluation was required. Then last Dec (2011) I was allowed to switch without one. Type F -> Type F.

Ha

 

[haha]

Right now Medicare Advantage plans get a significant subsidy over regular Medicare. With Obamacare this subsidy is being removed.

Could you direct me to something where I can copy this to show to others?

 

[M Paquette]

Could you direct me to something where I can copy this to show to others?

Wikipedia: http://en.wikipedia.org/wiki/Medicare_Advantage#Effects_of_the_Health_Reform

From the government site covering PPACA changes: http://www.healthreform.gov/reports/medicare/medicare.pdf

Note that the Medicare Advantage subsidy was intended to kickstart the program, and was never intended to be permanent. The FY 2009 budget proposals already included phaseout of the subsidy. This wad rolled into PPACA as part of the congressional sausage making process.

 

[haha]

Wikipedia: Medicare Advantage - Wikipedia, the free encyclopedia

From the government site covering PPACA changes: http://www.healthreform.gov/reports/medicare/medicare.pdf

Note that the Medicare Advantage subsidy was intended to kickstart the program, and was never intended to be permanent. The FY 2009 budget proposals already included phaseout of the subsidy. This wad rolled into PPACA as part of the congressional sausage making process.

Thanks. I have avoided Medicare Advantage, because there is a one way door leading only into it. If you coime back to Regular Medicare, you have no guaranteed right to a Supplement- except under certain circumstances.

I read that Sen Kerry introduced a bill that wouldd address this, but I haven't heard much about it and imagine that in an election year, it is likely just massaging his base.


Ha