Another Medigap question - which insurer

[MichaelB]

DW will be Medicare eligible before year end, so I'm getting ready to enroll her and am looking at two Medigap policies, G and Hi-deductible F. As it turns out, most of the policies available in our zip code are offered by life insurance companies, only 3 offerings (2 G and 1 hi-d F) are by health insurance companies.

Is this normal? If she signs up for a policy and the insurer leaves the market, she still has guaranteed issue rights, but not to a G policy, only one with less coverage. It seems to me that life insurers are more likely to leave the market while the large national health insurers (BCBS, Humana, Aetna) are more likely to stick around. Am I missing something and do others have this concern?

 

[REWahoo]

The majority of medigap policies available in my zip are from life insurance companies. I freely admit I am biased and didn't even consider them when purchasing our policies from BC/BS.

I'll also freely admit that I don't have a clue about what type of insurer is most likely to stick around for the long haul. On a positive note, I haven't seen a lot of instability in the medigap marketplace, which leads me to believe you may be OK no matter which company you choose.

 

[Bestwifeever]

Everyone I know has Mutual of Omaha G. I have to admit it never occurred to me that MofO is not a traditional health insurer, I guess, but it doesn't worry me.

 

[audreyh1]

I hadn't thought of it either even though I noticed Mutual of Omaha G was available in our area.

Some of the health insurance companies didn't offer a G plan.

 

[Huston55]

I will use Tricare for MediGap, when the time comes.

I'm hoping that Congress doesn't "exit" it via legislation.

 

[MichaelB]

I looked over the list of insurers and decided to check their financial statements, just to see how important the Medicare Supplemental business is to them.

- Sterling Investors Life Insurance Co. - is a private company and does not share their financial info.

- State Mutual Insurance Co is a mutual, owned by it's policyholders, but does not break out the details. It appears small, though.

- Colonial Penn Life Insurance, $3M.

- United American Insurance Co and Liberty National Life Insurance are both owned by the same holding group (Torchmark) and combined, have around $450M in total Medicare premiums across the US.

These choices are unexciting, none make my short list. The only health insurer on the list is Humana, and they're trying to sell themselves. I went back and did a different search on Medicare.gov, this time looked at options by insurer. All the big names are there, including MoO, USAA-UHC, Cigna, Aetna. It seems they all offer the "F" plan and most of the other Medigap options but not the hi-d F or the G.

F is not a good choice, as it is being phased out. Only F, hi-d F and G cover excess charges, and I want that coverage. So, it's Humana hi-d F @$132 vs BCBS G @$252. The cost difference is meaningful, but I'm still leaning toward G, as it would be easier to manage in the future when DW has to handle this stuff by herself or with help from the kids.

 

[misanman]

I thought if you had "F", you could keep "F". Is this incorrect?

 

[REWahoo]

I thought if you had "F", you could keep "F". Is this incorrect?

As I understand it, that is correct. Beginning in 2020 no new plan F policies will be sold, but you can keep what you have.

No word yet if the no new sales restriction will apply to the HD version of F.

 

[MichaelB]

I thought if you had "F", you could keep "F". Is this incorrect?

As I understand it, that is correct. Beginning in 2020 no new plan F policies will be sold, but you can keep what you have.

No word yet if the no new sales restriction will apply to the HD version of F.

Yes, according to the Medicare website section on guarenteed issue (here), if you have F you can buy F from another insurer.

Your Medigap insurance company goes bankrupt and you lose your coverage, or your Medigap policy coverage otherwise ends through no fault of your own.

You have the right to buy Medigap Plan A, B, C, F, K, or L that’s sold by any insurance company in your state.

The problem (for us) is we are interested in hi-d F and G, and neither are included.

 

[MichaelB]

I applied online. That is, I attempted to, but was rejected. So I called. After a 54 minute wait we had an entertaining 25 minute call. She scheduled a phone appointment for mid-Nov (earliest). I know this is too late to get the supplemental policy for 12/1 start date, so I think we'll go to a local office next week. Tuesday or Wednesday, first thing in the morning.

Now I understand why one should start this process 90 days before turning 65.

 

[REWahoo]

Now I understand why one should start this process 90 days before turning 65.

Yep.

There are so many of you d*mn old people it's a wonder anyone with a Medicare related business gets anything done!

 

[MBSC]

Yes, according to the Medicare website section on guarenteed issue (here), if you have F you can buy F from another insurer.
The problem (for us) is we are interested in hi-d F and G, and neither are included.

CMS references to Plan F refer to both versions except when noted otherwise. IOW, if your plan G (or plan N, etc.) goes away you cannot be turned down when you apply for HD-F.

Plan F also has an option called High Deductible Plan F (F*).

8. What does guaranteed issue mean relating to a Medicare Supplement policy?
If one of the following circumstances apply, an individual is guaranteed coverage under plans A, B, C, F, F*, K, and L: (snip)

9. Can my Medicare Supplement policy be cancelled by the insurance company?
All Medicare Supplement Policies sold in the State of Florida must be "Guaranteed Renewable." Florida law prohibits companies from canceling these policies except for nonpayment of premium or for material misrepresentation, such as incomplete or incorrect information on the original application.

Reference: http://www.floir.com/siteDocuments/MEDIGAPFAQs.pdf

Guaranteed Issue Right

You may have the right to buy a Medicare supplement policy outside of your open enrollment period if you lose certain types of health coverage. This is called guaranteed issue.

For people over age 65, the guaranteed issue right applies to Medicare supplement plans A, B, C, F (including Plan F with a high deductible), K, and L.

Reference: Medicare Supplement Insurance Handbook

 

[omni550]

These choices are unexciting, none make my short list. The only health insurer on the list is Humana, and they're trying to sell themselves. I went back and did a different search on Medicare.gov, this time looked at options by insurer. All the big names are there, including MoO, USAA-UHC, Cigna, Aetna. It seems they all offer the "F" plan and most of the other Medigap options but not the hi-d F or the G.

F is not a good choice, as it is being phased out. Only F, hi-d F and G cover excess charges, and I want that coverage. So, it's Humana hi-d F @$132 vs BCBS G @$252. The cost difference is meaningful, but I'm still leaning toward G, as it would be easier to manage in the future when DW has to handle this stuff by herself or with help from the kids.

MichaelB,

When I was shopping for Medigap policies last year (the year I first became eligible for Medicare), Chris Westfall at SeniorSavingsNetwork.org found me a Plan G thru American Continental Insurance which is owned by Aetna. This was the least expensive plan in my zip code at $113/mo. I live in Michigan. Perhaps something similar is available where you live?

omni

 

[MichaelB]

MichaelB,

When I was shopping for Medigap policies last year (the year I first became eligible for Medicare), Chris Westfall at SeniorSavingsNetwork.org found me a Plan G thru American Continental Insurance which is owned by Aetna. This was the least expensive plan in my zip code at $113/mo. I live in Michigan. Perhaps something similar is available where you live?

omni

Good tip, thanks for reminding me, especially since there's no cost to us to use an agent.

 

[ivinsfan]

So guaranteed renewable isn't worth the paper it's written on...just ask the 100K people who got dumped in mn by BCBS on January 1 2017.

 

[MichaelB]

So guaranteed renewable isn't worth the paper it's written on...just ask the 100K people who got dumped in mn by BCBS on January 1 2017.

Actually, guaranteed renewable is one aspect of Medicare that is worth a great deal. You're thinking of individual insurance, which still has issues to be worked out. Medicare is much more stable, mostly because it is much larger.

 

[ivinsfan]

Right, but if the insurer you choose simply leaves the market and doesn't sell Medicare supplements what recourse do you have? It might not happen, I agree,but that doesn't mean it cant happen...

I realize we can't forsee everything, I'm 100% sure all the BCBS customers who paid their bills didn't think they would be without insurance on Jan !.

 

[REWahoo]

Right, but if the insurer you choose simply leaves the market and doesn't sell Medicare supplements what recourse do you have?

Certainly there are no guarantees but there are currently more than 40 different insurers offering Medigap policies in my zip code. I'm relatively sure the guarantee issue (vs. guarantee renewable) provision of Medicare will allow me to get a policy from one of those other providers should my insurer leave the market.

 

[ivinsfan]

Certainly there are no guarantees but there are currently more than 40 different insurers offering Medigap policies in my zip code. I'm relatively sure the guarantee issue (vs. guarantee renewable) provision of Medicare will allow me to get a policy from one of those other providers should my insurer leave the market.

Yes overlap and competition is good, but I am really cynical about how fast things can change....our insurers in MN were allowed to place enrollment caps on total number of customers with little more then 30 days notices.

Once the insurance companies band together for their mutual financial benefit, bad stuff can happen

 

[mf15]

Two or three years ago Aetna left the medicare advantage market in my area, my wife had their policy.
They also sent a confirming letter to this effect.
I had no trouble getting the wife a supplement F HD policy, no underwriting was involved. But I did have to supply a copy of the letter with the application.
Old Mike

 

[Car-Guy]

"Realistically", I can't even consider a different medicare supplement from what I currently have. I'm not sure if there are better ones out there or not but if I drop/switch my current supplemental coverage (from my previous employer) they would not allow me to keep my DW on their regular insurance plan. The only way she can stay on their plan without me being on their supplement, is if I die. (Not an option ) Once she turns 65 and is on their supplement too, I may start looking for a better deal.

 

[Sue J]

DH and I are 61 and won't be starting Medicare until 2020 but I follow these topics to learn where we are headed.

Do you have to get a Medicare supplement? What is the gap that the Medigap covers?

Do you have to get drug plan? So far we take a few prescriptions but they are all cheap generics and for most we don't even use our insurance, we use GoodRx. I expect that may change as we age.

My Dad had a Medicare Advantage plan while I was managing his affairs. He liked it because it had no additional cost above his Medicare B deduction from his SS. To me it looked similar to an ACA Silver plan - limited network HMO with office visit co-pays and an reasonable out of pocket limit.

I read an article in Kiplingers about Advantage plans and one negative is that you may not be able to change your mind and go back to regular Medicare. Dad had his Advantage plan for many years and it worked well for him right up to the end.

Why does one choose to go the Medicare Supplement + Drug plan vs a Medicare Advantage plan?

 

[REWahoo]

Sue J, this answers most of your questions: Picking a Medigap Policy

 

[Sue J]

Maybe I need an example -

Let's say I have an office visit. Billed at $150, adjusted to $120 by my insurer. On a non Medicare HDHP plan I'd pay $120 as my deductible. On a non HDHP plan that would be a $30 co-pay.

If I have Medicare this would be part B, correct? Without a supplement, what would I pay? If I had a supplement and had not met the deductible, what would I pay? How about if I had already met the deductible?

If I have a medical test billed at $5000 my insurance adjusts it to $1500 and with a bronze plan I pay the $1500 as part of my deductible. How is this different with Medicare? How does a supplement cover this?

Being pre-Medicare we are used to seeing the billed amount reduced to an allowable amount determined by our insurers negotiated rate with the network providers. Does this still apply to Medicare?

 

[MBSC]

Being pre-Medicare we are used to seeing the billed amount reduced to an allowable amount determined by our insurers negotiated rate with the network providers. Does this still apply to Medicare?

The concept is basically the same with Medicare. The billed charges are reduced to the Medicare allowed amount. The allowed amount is applied toward your Part B deductible (currently $166 but varies each year). Once you meet your deductible, Part B pays 80% of the lower allowed amount and you have a 20% coinsurance on the lower allowed amount. There is an execption for non-participating providers who do not accept assignment. They can collect an additional excess charge of 15% on top of (Medicare allowable amount * 0.95).

The difference is there is no dollar limit to the 20% Part B coinsurance and it can add up quickly for intravenous chemotherapy in an office/clinic. Part D covers self-administered drugs and Part B covers intravenous drugs. A Medigap plan can limit this cost sharing exposure.

Part A has a "deductible" of $1288 but the term is misleading. It is not an annual deductible but resets once you have been discharged for 60 days. It only applies to the facility fees. You will also have Part B cost sharing associated with the professional charges from an inpatient admission. A Medigap plan may cover the Part A deductible and always gets you an additional 365 days of hospital coverage after Part A benefits are exhausted.