Almost 65 and pondering medicare supplement/advantage policies

[Nova]

Oh no...not another Medicare thread. First, let me say that I've done a lot of homework and I did a search on this board...Medicare, Advantage, Medigap, Supplement. Comments on this board have given me a lot of "oh, that's what it means" moments. I have always considered myself to be fairly intelligent, but this stuff is confusing.

For those of you looking only for my question, see the sentence in bold below.

When I first started getting Medicare information, I had a positive attitude and was anxious to read everything I could about my choices. I figured I could read through the information and make an informed decision. The more I read, the less I am sure of what I should do. I live in an area where there is a large senior population and the Advantage option is a popular choice. Problem I see is that the 4.5 quality star rating (guidance from Medicare) facilities are HMOs...low monthly premiums, co-pays, significant potential out of pocket expenses should you have real health problems. The Medigap/Supplemental policies (looking at F, possibly F* high deductible) have significantly larger premiums, but cover basically all medical costs.

DH (who will be eligible two months after I am) and I are in good health (no meds). Even if I had significant health issues, any medicare option I choose must accept me without medical qualification. Sales pitches vary from...you are in good health and don't need to pay for the higher premiums of a medigap policy...to...the choice you make now is one that will have long term consequences so if you want to protect yourself from large out of pocket expenses you might have when you are older (sick and feeble?) you should choose a supplement so you won't have to worry about huge medical bills in the future. From what I understand, if one is in good health and initially opts for an Advantage plan (low premiums, etc.), and at a later date develops...say cancer or some other significant illness...one must medically qualify for a supplement policy. Probably not possible to qualify. So, one is "stuck" with the original decision. Of course, if one's health remains good, it is possible to switch to another plan during open season.

BTW, I am sort of thinking out loud and if I have a misconception, please speak up and let me know.

I am aware that there is a limited period during which a 65 year old can request a "do-over" decision, and Advantage plans and Medigap plans must accept that person without medical qualification. Whew! If I make the wrong decision, at least I can correct it. Now if I could only determine which decision is right, and if I could tell that I made the wrong decision in time to correct it.

I looked on line to see what companies offer supplements in Arizona. USAA was listed, so I called. They were very straightforward. She said all plans are standardized per Medicare, so one is only shopping for price and stability of the insurer. They only offer plans A, C and F, no F* high deductible. They use the issue-age rate, so at least they don't increase the premium every year just because you are a year older, but they do have annual increases...usually about 7%. I did a spreadsheet on that...out to 100 years of age...times two. Sort of took my breath away. I digress. Does anyone have any experience with USAA's suplement F policy. Everything else I have with USAA has been top notch.

I would love to hear from those of you who have ventured through this decision process recently and might have some advice to offer. Has anyone done a "do-over" and would care to say why you decided to do so.

 

[REWahoo]

Nova, I go on Medicare next month and am going through the same decision process you describe. I agree - determining the best option for an individual it is much more complex than it should be.

I am not selecting to go the Medicare Advantage route due to some of the same concerns you mention. In addition, my doctor does not participate in any of the Advantage programs but does take basic Medicare.

I'm going with the high deductible version of supplement F and the Part D (drug) coverage with the lowest premium I can find. This is because I currently take no (prescription) drugs but want to avoid being hit with a penalty in the future. I know I will not be drug-free forever and if I don't purchase a drug plan during the first couple of months after going on Medicare, I'll have to pay premium penalty when I do decide to purchase Part D coverage.

Since we have a 6 month window (beginning the month we turn 65) to choose a Medigap policy, I haven't done a great deal of research on what insurer I should choose. My current individual policy is with BC/BS, and they have done a good job with my claims for the past five years so I may go with them for my Medicap policy. I do plan to talk to USAA as well and can't imagine you would go wrong choosing them.

 

[JOHNNIE36]

I am in a Medicare Advantage plan in Florida and I am happy with it. Only time will tell if I made the right decision. The thing I always look at is what doctors and hospitals participate in the plan and what is the maximum out-of-pocket expenses in a year. Currently that is $4750 with Blue Cross/Blue Shield (excludes drug costs). My sister and BIL swear by Medicare and a supplemental F plan. He had a heart valve repaired at the Cleveland clinic this year and no out-of-pocket costs. However, they pay up front premiums. He shops every year for the lowest cost supplemental plan. Told me Mutual of Omaha was good at about $105/mo each. Hard to say what plan is best. I just don't like to pay up front for something I may never use or at least not very often. I prefer the pay as you go method.

 

[MichaelB]

Nova, I go on Medicare next month and am going through the same decision process you describe. I agree - determining the best option for an individual it is much more complex than it should be.

I am not selecting to go the Medicare Advantage route due to some of the same concerns you mention. In addition, my doctor does not participate in any of the Advantage programs but does take basic Medicare.

I'm going with the high deductible version of supplement F and the Part D (drug) coverage with the lowest premium I can find. This is because I currently take no (prescription) drugs but want to avoid being hit with a penalty in the future. I know I will not be drug-free forever and if I don't purchase a drug plan during the first couple of months after going on Medicare, I'll have to pay premium penalty when I do decide to purchase Part D coverage.

Since we have a 6 month window (beginning the month we turn 65) to choose a Medigap policy, I haven't done a great deal of research on what insurer I should choose. My current individual policy is with BC/BS, and they have done a good job with my claims for the past five years so I may go with them for my Medicap policy. I do plan to talk to USAA as well and can't imagine you would go wrong choosing them.

Is a Medigap policy, such as USAA "F", open in that it covers any physician, provider or facility anywhere in the US that accepts Medicare?

 

[REWahoo]

Is a Medigap policy, such as USAA "F", open in that it covers any physician, provider or facility anywhere in the US that accepts Medicare?

Yes, it has no restriction as to your choice of providers.

A Medigap policy supplements basic Medicare and, depending on which of the policies you choose, covers the out-of-pocket cost of Medicare deductibles, co-pays, and other charges in excess of what Medicare pays.

All about Medigap insurance coverage

 

[MichaelB]

Yes, it has no restriction as to your choice of providers.

A Medigap policy supplements basic Medicare and, depending on which of the policies you choose, covers the out-of-pocket cost of Medicare deductibles, co-pays, and other charges in excess of what Medicare pays.

All about Medigap insurance coverage

Thanks. I knew the benefits and coverage were defined but I did not know if they were subject to network limitations.

 

[kaneohe]

Nova......sounds like you've done your homework as you've sworn to.
I went thru the same process that you did a few months ago, not bc of my youth, but bc Megacorp decided they'd rather outsource this job to the private sector rather than have their own inhouse plan for retirees.

I found the Medigap plans to be more than the Advantage plans but not
"outrageously" more......of course, that term might mean different things to different folks. In the end, I decided on the "Cadillac" F Medigap plan because it has emergency foreign coverage (not that I would use that a lot).
Mostly, I rationalized, it bought me another yr (or more) of reflection time to gather by random means additional info. My belief (correct me if wrong) is that I can always move later (at open enrollment) to an Advantage plan if
I was wrong but I can't go the other way easily under all circumstances.

I ended up w/ the AARP Medigap F plan which seemed to be the cheapest of a number supplements in our area tho I'm sure I didn't see all of them.
I know people who have had serious medical issues and are happy with their Advantage plan. I could probably see my same doctors in an Advantage plan for less but there is no guarantee they will always be in the plan network......ever. I think it is as you have assessed.......you get more freedom w/ Medigap but you will pay for it. Only you can decide it's value. Good luck w/ your decision....good that you are starting early.

 

[Moemg]

I went through this months ago for my SO . It truly was confusing but after a lot of reading we went with a Medicare Advantage plan . He takes no meds and has no health issues except arthritis in his knees . The month after he went on the plan he had to go to the ER for a kidney stone . The total bill for the experience including a cat scan and several prescriptions was $50 . The plan is a HMO but it has all the physicians we would use in it . I like that the Advantage plans include medication and some even include a gym membership .My insurance is through the federal government so when it's my turn I will just pick a lesser government plan as my secondary and Medicare as my primary .

 

[Sue J]

I'm reading this with great interest as we are being advised to change my Dad from Anthem Senior Advantage Basic (HMO) to Traditional Medicare. So far he's been very pleased with his Advantage plan but this last week his circumstances have changed and he's currently in rehab at a nursing home.

When we got to the nursing home yesterday and I was doing the admission paperwork they gave me a quick education on Traditional Medicare vs Supplemental Plan vs Advantage Plan. They would rather deal with Traditional Medicare instead of the Advantage Plan. I'm not certain that it's better for my Dad or just easier for them.

My head is spinning.

My new acronym for the day is - SNF = Skilled Nursing Facility

 

[rescueme]

I don't qualify for Traditional Medicare until Jan 1, 2013 but I did go through the initial analysis, and annual review for my adult (disabled) son, over the last six years.

In his case, he was on Traditional Medicare for the first two years, followed by a Medicare Advantage program the following three (now it will be four) years.

The Advantage plan (and they are all different - we already had two different ones) was vastly superior to Traditional Medicare in services supplied (for example, vision coverage which is not covered by Traditional Medicare).

And his PCP? He accepted both Medicare and his Advantage Plan, without any problem.

Just my (our) $.02.

 

[haha]

. The more I read, the less I am sure of what I should do. I live in an area where there is a large senior population and the Advantage option is a popular choice. Problem I see is that the 4.5 quality star rating (guidance from Medicare) facilities are HMOs...low monthly premiums, co-pays, significant potential out of pocket expenses should you have real health problems. The Medigap/Supplemental policies (looking at F, possibly F* high deductible) have significantly larger premiums, but cover basically all medical costs.

DH (who will be eligible two months after I am) and I are in good health (no meds). Even if I had significant health issues, any medicare option I choose must accept me without medical qualification. Sales pitches vary from...you are in good health and don't need to pay for the higher premiums of a medigap policy...to...the choice you make now is one that will have long term consequences so if you want to protect yourself from large out of pocket expenses you might have when you are older (sick and feeble?) you should choose a supplement so you won't have to worry about huge medical bills in the future. From what I understand, if one is in good health and initially opts for an Advantage plan (low premiums, etc.), and at a later date develops...say cancer or some other significant illness...one must medically qualify for a supplement policy. Probably not possible to qualify. So, one is "stuck" with the original decision. Of course, if one's health remains good, it is possible to switch to another plan during open season.

BTW, I am sort of thinking out loud and if I have a misconception, please speak up and let me know.

I am aware that there is a limited period during which a 65 year old can request a "do-over" decision, and Advantage plans and Medigap plans must accept that person without medical qualification. Whew! If I make the wrong decision, at least I can correct it. Now if I could only determine which decision is right, and if I could tell that I made the wrong decision in time to correct it.
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I would love to hear from those of you who have ventured through this decision process recently and might have some advice to offer. Has anyone done a "do-over" and would care to say why you decided to do so.

Check your own state to be sure, but in WA one can always move from Classic Medicare to a Medicare Advantage Plan, during the open enrollment period which is in late fall. There is no medical qualification for this. Also, you can switch from one Medicare Advantage Plan to another yearly, during the fall open enrollment period. Additionally, the premium for brand new enrollees is the same as it would be for a 90 year old with 14 chronic diseases. The competition to get new-to-Medicare enrollees, without which the plan would quickly be in trouble keeps the premiums reasonable.
The reverse movement is not guaranteed. You can drop your MA plan and return to Classic Medicare during a certain period after the beginning of the year, but except under certain limited circumstances you cannot force a Medigap insurer to insure you.

For this reason, I choose Classic Medicare and a Medigap Plan F when I turned 65. I was told and read that my premium would always be the same as new plan entrants. However, this has turned out not to be true. Several years ago Medicare reorganized the Medigap plan menu, and many companies somehow were able to use this to hive off their existing members into a separate pool from their new entrants. In 2011, for example, my premium was ca. $80/mo higher than new entrants, and of course it will get higher yet, each and every year, as those in my pool age and are not replenished by new participants. Additionally, the healthiest participants will leave, either to Medicare Advantage or try to qualify medically for a different, new Medigap plan and pool.
This business is directly in conflict with what I was told at issuance, both by the company I choose and by the State Insurance Office, and also in conflict with the principle of insurance being non-cancellable once it is in place.

I was recently told that the WA Insurance Commissioner ruled against this practice, but later learned that this only applied to policies originally issued during or after 2010.
So, as usual, these insurance companies are lying thieves, and our federal government is collaborating with them.

In my state, many doctors, clinics, and hospitals are demanding membership in certain MA plans, rather than original Medicare, because these chosen plans pay better, and the billing procedures are more streamlined and payment is faster. I am not sure how I will proceed currently, but I am tempted by the good MA plans, because it appears that worst case, if I got every disease known to man and was in and out of the hospital weekly it would only cost me marginally more than a Plan F Medigap, and if my health continues good I will save money.

It is my opinion that federal government wants to hobble Plan F, as it violates the principle in place in almost all employer plans that there must be meaningful co-pays.

One note about the star rating. They are not outcomes oriented, they are process oriented. To a large extent they depend on getting lots of paper filled out, which is easy in an HMO as you just require it of the staff, who are in fact your employees. But not so easy with a PPO, the providers of which have power equal to or greater than the insurers'.

One large and well regarded HMO in Puget Sound has a 5 star rating which I think is reasonable, from what I know by talking with plan members and a few people I know who work there. My girlfriend has this HMO through her work (an employer plan, not the MA plan) and she seems to get very good and attentive care from them, but her primary care Doc is in charge of who she gets to see, other than few things, like I think dermatology and ob/gyn. I think Medicare people get similar or equal care, and they pay very much less due to the government subsidy. All this may change as the medical system gets tinkered with, and I don’t think it will be possible to guarantee oneself that very appealing choices will always be available. But MA plans must stay large and successful or they close up shop, as they fail to attract new participants, their costs get out of whack, and plan participants bolt out the door. In WA anyway, if your MA plan stops, you do have guaranteed issue of a Medigap policy during a certain period.

An equally large and well regarded PPO plan has only a 3.5 rating. As best I can tell, it is only becasue they cannot get all the documentaion that Medicare wants to see. It may also be that Medicare would like to see an end to PPO plans.

It is all ridiculously complicated and frustrating. Good luck with your choice, as you will need it if my experience is typical.

Ha

 

[SteveL]

Because the coverage is set by the Federal Government, there is no difference between F supplements except the price. Supplement carriers are connected electronically with Medicare, and their service is transparent to you. This means that they pay what they pay to the providers, and then notify you of what they have done. If Medicare accepts a claim, they pay the Medicare deductibles and co-pays. If Medicare does not accept, they pay nothing.

You need to provide evidence of current coverage when you apply for a supplement otherwise there is a 61 day waiting period on pre-existing conditions. I believe that during the annual open enrollment, you can choose a different supplement provider every year.
So, in my opinion, the only consideration is price. In WA the Dept of Ins has a comparison of prices for the top ten carriers in the state. I just go there and choose the cheapest one.

 

[SteveL]

Just a short F/U to my last post. The waiting period is 63 days. After visiting the USAA website, I don't think they offer Medicare Supplements. They have a Plan D drug plan, however this is Humana and not USAA. For the most part, USAA itself does not offer any health insurance.

 

[haha]

You need to provide evidence of current coverage when you apply for a supplement otherwise there is a 61 day waiting period on pre-existing conditions. I believe that during the annual open enrollment, you can choose a different supplement provider every year.
So, in my opinion, the only consideration is price.

I would like to see documentation of this. It is my understanding, after considerable looking, that there is no annual open period for Medigap other than the period when one first become Medicare eligible, and there is no guaranteed issue except during this period, or after a limited number of special events. Later, if you want a different plan, you must apply, and if the company requires it fill out the health form. I believe that in Washington, every company offering Medigap plans does require an applicant to fill out the health form.

You make definitive statements, that if true would help me. And from your post, it sounds as if you habitually change Medigap plans yourself, in WA, without underwriting. So please, if you can, document this with the relevant links as I would like to do it too.

Ha

 

[REWahoo]

It is my understanding, after considerable looking, that there is no annual open period for Medigap other than the period when one first become Medicare eligible, and there is no guaranteed issue except during this period, or after a limited number of special events.

The following info from a California based Medicare site indicates this is correct:

If you are in a Medicare Advantage (MA) plan, you have guaranteed-issue rights to buy a Medigap policy in certain situations. These rights require private insurers to sell you a policy without a health screening. You cannot be denied a policy or charged a higher premium due to your current health or history.
You have guaranteed-issue rights to a Medigap policy when:

• Your Medicare Advantage (MA) plan terminates coverage. In this case, you can return to Original fee-for-service Medicare with Medigap, but you must apply within 123 days of the end of your MA plan benefits.
• You move outside your MA plan service area. You must apply within 63 days of moving.
• You joined an MA plan when you first became eligible for Medicare and want to switch to a Medigap policy during your first 12 months in the MA plan. This is your Medicare Trial Period #1.
• You switch from a Medigap policy to an MA plan for the first time since becoming eligible for Medicare, and you disenroll from the MA plan within the first 12 months. This is your Medicare Trial Period #2.

If you are switching from an MA plan to a Medigap policy and do not fall into one of the categories above, Medigap companies are not required to sell you a policy.

Switching From a Medicare Advantage Plan to a Medigap Policy | California Health Advocates

 

[SteveL]

Ha Ha,
You are correct and I am in error. Changing supplements does involve underwriting. A possible way out of this is to opt for a Medicare advantage plan instead of a supplement. No underwriting. The following year, I think you can opt back out to a supplement again with no underwriting. Sorry for the confusion.

 

[Nova]

Is a Medigap policy, such as USAA "F", open in that it covers any physician, provider or facility anywhere in the US that accepts Medicare?

USAA offers the F policy in all states, and said policy is accepted by all doctors/hospitals, etc. IF they take Medicare patients.

I tried to call USAA to get a few answers...closed-holiday. I know that the address you give SS/Medicare determines where you can secure Medicare services, advantage/medigap insurance. I know that USAA can issue a policy in any state you move to, but I don't know whether their policy is portable to any other state without the issuance of a new policy in the new state. If USAA has to issue a new policy in the new state, I don't know how that would change the premium (issue-age rate). I'll call USAA Monday to get those answers.

 

[rescueme]

Sorry, but my question is simple.

Why must it be with USAA?

There are many insurance companies offering Medicare plans...

 

[MichaelB]

I'm reading this with great interest as we are being advised to change my Dad from Anthem Senior Advantage Basic (HMO) to Traditional Medicare. So far he's been very pleased with his Advantage plan but this last week his circumstances have changed and he's currently in rehab at a nursing home.

When we got to the nursing home yesterday and I was doing the admission paperwork they gave me a quick education on Traditional Medicare vs Supplemental Plan vs Advantage Plan. They would rather deal with Traditional Medicare instead of the Advantage Plan. I'm not certain that it's better for my Dad or just easier for them.

My head is spinning.

My new acronym for the day is - SNF = Skilled Nursing Facility

Does your father need and can he get a supplemental plan? If he is in a SNF it sounds like he may need additional coverage. I would not make any change until I was certain his coverage needs were met by a new policy that has been priced.

 

[Nova]

Just a short F/U to my last post. The waiting period is 63 days. After visiting the USAA website, I don't think they offer Medicare Supplements. They have a Plan D drug plan, however this is Humana and not USAA. For the most part, USAA itself does not offer any health insurance.

Mmmm...yes USAA does offer Medicare insurance policies. USAA's F plan is through USAA. Their Advantage plan in AZ is through Humana. They were up front with their AZ Advantage plan...it's offered through Humana and they do not have a large presence in my area...didn't recommend it for me. They do offer Part D (meds) plan(s?) for as low as $15/month. I didn't pursue part D because I would probably go with the $15/month plan offered through Walmart...in order to prevent the penalty for not having signed up for part D when initially offered. A quick call to USAA can confirm this information. You can find the information on their website, but you do have to wade through the links...I just called.

 

[JOHNNIE36]

Ha Ha,
You are correct and I am in error. Changing supplements does involve underwriting. A possible way out of this is to opt for a Medicare advantage plan instead of a supplement. No underwriting. The following year, I think you can opt back out to a supplement again with no underwriting. Sorry for the confusion.

I think this is incorrect. Once you are in a Medicare Advantage plan, you cannot just decide you want to go back to original Medicare with a supplemental plan. The supplemental plan insuer would have to agree to insure you a policy. You can go back to Medicare but you can't force any company to sell you a supplemental plan. As mentioned in a previous post, there are two or three exceptions, ie. if your Advantage plan goes belly up which forces you out of the Advantage system.

 

[Nova]

Sorry, but my question is simple.

Why must it be with USAA?

There are many insurance companies offering Medicare plans...

Well, it doesn't have to be USAA. Their F plan is cheaper than some plans I have been offered and higher than others. I mainly called to check their rates and was favorably impressed with their lack of a sales job and straightforward analysis of options. They also do a great job of explaining options and pros and cons of each. They have been in the Medicare supplement business for 25 years, so I think they will weather ObamaCare as well as any insurance provider. My original post was to see whether or not anyone has the USAA F plan and what their experience has been...and to see if anyone had any suggestions to add to my understanding of my options and insight on the decision process.

BTW, I don't work for USAA...I am just one happy camper with all of the other services I have through USAA...thus my slant toward USAA.

 

[Nova]

I'm reading this with great interest as we are being advised to change my Dad from Anthem Senior Advantage Basic (HMO) to Traditional Medicare. So far he's been very pleased with his Advantage plan but this last week his circumstances have changed and he's currently in rehab at a nursing home.

When we got to the nursing home yesterday and I was doing the admission paperwork they gave me a quick education on Traditional Medicare vs Supplemental Plan vs Advantage Plan. They would rather deal with Traditional Medicare instead of the Advantage Plan. I'm not certain that it's better for my Dad or just easier for them.

My head is spinning.

My new acronym for the day is - SNF = Skilled Nursing Facility

Pure speculation, but if your father were covered by the F supplement, all of their bills would be paid in full. As it is, they have to deal with his Advantage plan and possibly look to your father for his co-pay(s) and the max out of pocket set by his current plan. Just thinking...

 

[kaneohe]

Ha Ha,
You are correct and I am in error. Changing supplements does involve underwriting. A possible way out of this is to opt for a Medicare advantage plan instead of a supplement. No underwriting. The following year, I think you can opt back out to a supplement again with no underwriting. Sorry for the confusion.

I highly doubt this also but like Ha, I can be convinced w/ some reference link. My conclusion following a rushed transition this yr is that we are like old
salmon........we can swim easily downstream from Supplement to Advantage but we are likely to get beat up quite a bit if we try to navigate the other way.

 

[HpRyder]

Because the MA HMO I'm in doesn't cover the surgeon I want, but uses a less experienced surgeon, I'll have to switch to the only MA PPO listed in So. Ca. which this surgeon accepts. The only way I'll get to the F supplement coverage is if the MA PPO terminates. I've talked with a couple of other internists and surgeons & they are not accepting new Medicare patients even with F coverage. It doesn't pay enough. This correlates with a friend who has original Medicare + F. Every time he becomes sick he has a very tough time finding a doctor who will accept Medicare + F payment schedule. So at least here in Ca, Medicare insurance acceptance is a doctors last resort.

An up coming yearly congressional debate to void reducing doctor payments by 25% has additionally thrown the whole insurance schedule acceptance into turmoil.