Medigap Shopping: Closing the Book & Rate Increases

[teej1985]

Yes, that is common across many states. But a recent poster from Illinois I believe said they were required to stay with the same company so it was essentially useless.

That doesn't make any sense. What is the purpose of even having the rule? The option to go from G to N within the same insurer with no underwriting? If they closed the book, does that mean you stay in the closed book with the new letter or you would go into the new letter on whatever the current book is?

 

[audreyh1]

That doesn't make any sense. What is the purpose of even having the rule? The option to go from G to N within the same insurer with no underwriting? If they closed the book, does that mean you stay in the closed book with the new letter or you would go into the new letter on whatever the current book is?

When the poster explained it didn’t make any sense to me either and I don’t think they had any option to go to the new open book because that is officially a different company. The closed book company doesn’t have any open plans anymore.

 

[mf15]

Cigna not only closing the book,selling off all medicare business.
Just what I need, F-HD supplement. Live in Pa.
oldmike
https://www.cigna.com/static/www-cigna-com/docs/medicare/cigna-medicare-announcement.pdf

 

[Gotadimple]

Cigna not only closing the book,selling off all medicare business.
Just what I need, F-HD supplement.
oldmike
https://www.cigna.com/static/www-cigna-com/docs/medicare/cigna-medicare-announcement.pdf

Yeah this happens too but very infrequently. That can create a special exception and the customer may be able to avoid underwriting when moving to a new insurer/new plan. Or not even need the waiver of underwriting because . . .

Cigna is selling their entire book of Medicare products to HSCS, who owns BCBS plans in 5 states: Illinois, Montana, New Mexico Oklahoma, and Texas. In these states the new owners will likely try and convert them to their Medicare products.

 

[mf15]

This is the 3rd time in 15 years, had to use guaranteed issue twice,hope I don't have to do it again. Need to change the law in Pa, so you can switch without underwriting for supplements. Don't think any company selling F-HD now. If new company decides not to cover in Pa,going to be a real pain.
oldmike

 

[ERD50]

Yes, that is common across many states. But a recent poster from Illinois I believe said they were required to stay with the same company so it was essentially useless.

Not easy to sort out the info, so much is "Advantage Plan'-centric, but I found this:

https://www.healthinsurance.org/medicare/illinois/

In 2021, Illinois enacted legislation that created a new Medicare Supplement Annual Open Enrollment Period (effective as of 2022). The annual enrollment opportunity is fairly limited, but it does still go beyond federal rules. Under the new Illinois law, Medigap enrollees between the ages of 65 and 75 have an annual window during which they can switch to a different Medigap plan, offered by their current Medigap insurer, as long as the plan offers equal or lesser benefits (so a person could switch from Plan F to Plan G, but not from Plan A to Plan G, for example). The window starts on the beneficiary’s birthday, and lasts for 45 days.

Additional legislation is under consideration in 2023 that would slightly expand the current birthday rule, allowing people to pick a plan with equal or lesser benefits from the same insurer or “any affiliate authorized to transact business” in Illinois. That would still be quite limited, but would allow access to a plan offered by an affiliate the person’s current insurer, rather than just the current insurer.

-ERD50

 

[audreyh1]

Ok so clearly if the book is closed it does no good except that now the legislation under consideration will allow access to the new open book at an “affiliate”. Obviously someone wised up to the game. Still having to stay with the same company or affiliate is very restrictive.

 

[teej1985]

This is the 3rd time in 15 years, had to use guaranteed issue twice,hope I don't have to do it again. Need to change the law in Pa, so you can switch without underwriting for supplements. Don't think any company selling F-HD now. If new company decides not to cover in Pa,going to be a real pain.
oldmike

Get G HD instead? No real difference between the two? United American is in PA and is typically people's choice for F HD/G HD and offers both in PA. Globe Life (who owns United American) also has a G HD in PA.

 

[CRLLS]

Not easy to sort out the info, so much is "Advantage Plan'-centric, but I found this:

https://www.healthinsurance.org/medicare/illinois/



-ERD50

Exactly! Illinois has no real Birthday rule as we think of. But they are on the lists. If a list of states that lists Illinois doesn't qualify that fact, it makes me wonder what other states have their own "modified" birthday rule. Do your research before taking those lists as gospel.

 

[Buckeye]

Yes, just stay healthy all your life

Well, you're going to pay either way, whether you're healthy or not or whether you're paying the premium or paying the 20% Medicare co-pay. When I look at the EOB's, even including my husband's hip surgery, the 20% co-pay is a relatively small number compared to the amount of supplement premiums we've paid. In the 9.5 years he's had a supplement policy, we've paid at least $16,000 in premiums. The supplement policy has maybe paid out maybe paid out $3,000.

Medicare reimbursements are so incredibly low (for ex., MRI 20% copay is $43) which is why I even consider asking this question. I'm curious if anyone has gone without a supplement policy permanently or for a number of years and what the numbers looked like. I guess this is why folks use the HD policies but I'm not seeing that the HD plan premiums are much of a savings.

 

[sengsational]

I did, but it was still hard to read the tiny wording within the graphs.

Sorry about that. Those were screen captures.

Regarding being "stuck" when book is closed-
Reminder that's not everywhere -the following states allow you to change your plan annually without underwriting:

California, Connecticut, Idaho, Illinois, Maine, Massachusetts, Missouri, Nevada, New York, Oregon, Rhode Island and Washington

Some of those states require you to stay with the same company or otherwise restrict your options when changing per the annual rules. Be sure you understand them.

Yes. "Know your birthday rule." Can I get a diagnosis on a "free" Advantage plan and then jump to a Part-G?, I doubt it.

 

[audreyh1]

Well, you're going to pay either way, whether you're healthy or not or whether you're paying the premium or paying the 20% Medicare co-pay. When I look at the EOB's, even including my husband's hip surgery, the 20% co-pay is a relatively small number compared to the amount of supplement premiums we've paid. In the 9.5 years he's had a supplement policy, we've paid at least $16,000 in premiums. The supplement policy has maybe paid out maybe paid out $3,000.

Medicare reimbursements are so incredibly low (for ex., MRI 20% copay is $43) which is why I even consider asking this question. I'm curious if anyone has gone without a supplement policy permanently or for a number of years and what the numbers looked like. I guess this is why folks use the HD policies but I'm not seeing that the HD plan premiums are much of a savings.

Cancer treatments are what makes the copays go through the roof.

 

[CRLLS]

Cancer treatments are what makes the copays go through the roof.

When I first started working for a living my company's health insurance had a 20% copay. Pretty much the standard back in the day. Unlike today's Traditional Medicare, it also covered drugs and had a MOP. Traditional Medicare has neither of those. The company's HI did not cover anything related to childbirth unless there were "complications". My company was generous and gave us a gift of $750 when we had our 1st born. It covered all of the hospital and doctor's bills and we had some cash left over. A lot has changed since then.

For a moment, we considered not getting a Supplement when we signed up for Medicare. We quickly dismissed that thought and bought the best Supplement we could find from a reputable company. At first, we went with a F-HD plan with BCBS. When the Gov closed plans F, I saw the writing on the wall, effectively a closed book situation. We switched to full-coverage Plan G with AARP/UHC. We both had to go thru underwriting. Fortunately, we both made it.

 

[Svensk Anga]

Cancer treatments are what makes the copays go through the roof.

Maybe, but if you have G-HD, your part B costs are limited to $2800. Maybe your course of treatment spans 2 years, so double that. Compare that to paying higher premiums for a regular G plan for your whole life. I think most years one will not get close to the G-HD $2800 max OOP and one can bank most of the premium savings. I think G-HD self selects to a healthier pool and so tends to have smaller medical cost driven increases. The insurers have to justify their rate increases to the state regulators. There are limits as to how little of the premium dollars they can pay out in claims, I think 80%.

I am in Florida, which uses Issue Age pricing. I think that means I pay more in the early years but am better protected from price increases as I age. My G-HD is $52/month (at age 65 start) with United American. This plus the Part B premium is much cheaper than the retiree health insurance we had been buying through my wife's former employer - about 1/3 as much. And that retiree insurance still had a fairly substantial deductible and a hefty OOP maximum. I am looking forward to the cost savings next year when DW is Medicare eligible.

 

[audreyh1]

Right, if you have a Medigap supplement your costs are limited. However if you choose not to have a Medigap supplement at all there is no OOP limit and the chemotherapy treatment costs are enormous so 20% is still very high. That’s what I was talking about.

 

[Buckeye]

Maybe, but if you have G-HD, your part B costs are limited to $2800. Maybe your course of treatment spans 2 years, so double that. Compare that to paying higher premiums for a regular G plan for your whole life. I think most years one will not get close to the G-HD $2800 max OOP and one can bank most of the premium savings. I think G-HD self selects to a healthier pool and so tends to have smaller medical cost driven increases. The insurers have to justify their rate increases to the state regulators. There are limits as to how little of the premium dollars they can pay out in claims, I think 80%.

I am in Florida, which uses Issue Age pricing. I think that means I pay more in the early years but am better protected from price increases as I age. My G-HD is $52/month (at age 65 start) with United American. This plus the Part B premium is much cheaper than the retiree health insurance we had been buying through my wife's former employer - about 1/3 as much. And that retiree insurance still had a fairly substantial deductible and a hefty OOP maximum. I am looking forward to the cost savings next year when DW is Medicare eligible.

I think I'm going to take a look into this option. Are you in South, Central, or North Florida? I need insurance to pay for the big crashes, not the oil changes and general maintenance. Between my husband and I, we are up to $4,150 a year in supplement premiums (both Plan N's).

 

[teej1985]

Right, if you have a Medigap supplement your costs are limited. However if you choose not to have a Medigap supplement at all there is no OOP limit and the chemotherapy treatment costs are enormous so 20% is still very high. That’s what I was talking about.

What is Medicare's negotiated rate for chemotherapy treatment?

 

[audreyh1]

What is Medicare's negotiated rate for chemotherapy treatment?

I don’t know but back in 2006 there were no Medicare negotiated rates on Chemo drugs which were covered under Part B and relatives were looking at annual copays of $30,000 to $40,000 for one particular drug. I think the copay was something like $6000 per session.

 

[CRLLS]

What is Medicare's negotiated rate for chemotherapy treatment?

I don't think there is a number. I did check on a procedure that I had, the negotiated rate varied from hospital to hospital, even within the same "medical group". I think, based on that, that Medicare negotiates with each individual provider. It sure doesn't sound right though. I could be wrong.

 

[Yipper]

Looking at the medicare.gov website for my NJ zip code, it appears that AARP/UHC offers a 'community rated' medigap policy. Wouldn't that be better from a premium perspective over the longer term vs. an 'attained age' policy?

 

[audreyh1]

Looking at the medicare.gov website for my NJ zip code, it appears that AARP/UHC offers a 'community rated' medigap policy. Wouldn't that be better from a premium perspective over the longer term vs. an 'attained age' policy?

They give you a steep discount at first, gradually rising each year until age 75-86 (depending on state) no discount. This is probably the only way they can compete with the attained age pricing for the newbies signing up.

 

[Yipper]

They give you a steep discount at first, gradually rising each year until age 75-86 (depending on state) no discount. This is probably the only way they can compete with the attained age pricing for the newbies signing up.

That makes sense. But what about "closing the books" for AARP/UHC plans? Are they not doing that perhaps?

 

[audreyh1]

That makes sense. But what about "closing the books" for AARP/UHC plans? Are they not doing that perhaps?

No, they haven't closed the books and they also have a very large customer base in their plans.

 

[Midpack]

That makes sense. But what about "closing the books" for AARP/UHC plans? Are they not doing that perhaps?

No, they haven't closed the books and they also have a very large customer base in their plans.

If you look at the third chart in post #1, and/or watch the first video in post #23 - you will find that almost all providers (small-IAS and non IAS, large, local, mid-sized) use the practice of closing the books to stay competitive for new enrollees, they really don't have much choice. The chart in post #1 (from the video) clearly shows the bigs including Aetna, Cigna, MoO and Humana have regularly closed the book and opened new blocks. UHC/AARP has a block that has been open since 1992, but they have also increased their rates rapidly as well. The presenter in the video in #23 addresses UHC/AARP directly in the section on big companies - it's not a silver bullet or other insurers would follow (see the relative premiums I got below).

Like the OP said, you can find specific info on your plan through your states serff.com records, the video in post #23 shows how (a nightmare without some guidance).

FWIW, I was seriously considering switching from Mutual of Omaha to AARP/UHC due to the 'closing the book' discussions here in several threads over the past year. So I just looked at Plan G rates for Mutual of Omaha vs AARP/UHC for myself at medicare.gov - AARP/UHC was more than twice the cost in premiums. I assume it's because they haven't closed the book on the block since 1992? It all comes out in the wash over time, health care in the US is just not cheap?

 

[wdwwildbill]

If you look at the third chart in post #1, and/or watch the first video in post #23 - you will find that almost all providers (small-IAS and non IAS, large, local, mid-sized) use the practice of closing the books to stay competitive for new enrollees, they really don't have much choice. The chart in post #1 (from the video) clearly shows the bigs including Aetna, Cigna, MoO and Humana have regularly closed the book and opened new blocks. UHC/AARP has a block that has been open since 1992, but they have also increased their rates rapidly as well. The presenter in the video in #23 addresses UHC/AARP directly in the section on big companies - it's not a silver bullet or other insurers would follow.

Too bad we don't have access to serff.com without joining? Then you could know when/if the block you're in has closed?

FWIW, I was seriously considering switching from Mutual of Omaha to AARP/UHC due to the 'closing the book' discussions here in several threads over the past year. So I just looked at Plan G rates for Mutual of Omaha vs AARP/UHC for myself at medicare.gov - AARP/UHC was more than twice the cost in premiums. I assume it's because they haven't closed the book on the block I'd be in? It all comes out in the wash over time, health care in the US is not cheap?

So right Midpack. After tons of phone calls to several different agents it really comes down to, they don't know who is better and when they will close the books. Almost all do it ! and then you are stuck. UHC seems to be one that rarely does it but in my area they cost a lot more. So pay more now or pay more later for me. I'm getting a quote for Allstate right now that is very good but where will it end up I won't pass underwritng so really trying to make correct decision. But I don't think there is a correct one