Medicare Choices

[Another Reader]

My understanding is that you can switch across insurers in the same plan or drop to a lower level plan, but you can't upgrade under the California regulation. Not sure how that would apply to Plan F-HD.

 

[REWahoo]

My understanding is that you can switch across insurers in the same plan or drop to a lower level plan, but you can't upgrade under the California regulation. Not sure how that would apply to Plan F-HD.

Good point. Don't recall where I saw the strategy I mentioned above and, like so many things you read on the Intewebs, it might be totally wrong.

Edit: A little research reveals that California, Oregon and Missouri allow you to change plans once a year without underwriting, but the rules differ for each state.

 

[MBSC]

I read a Medicare strategy blog a while back where, even before the 2020 closure of F was passed, California Medigap purchasers without major health issues were encouraged to purchase plan F-HD initially, then switch to a non-HD plan in later years when they started using more medical services.

The CA Birthday Rule allows changes to plans of equal or lessor benefits without underwriting. HD-F is considered to have the lowest level of benefits so a person can only lateral to another insurer's HD-F under the rule. The person has to pass underwriting to upgrade to a non-HD plan unless the carrier has an internal exception or if Guaranteed Issue rules apply due to loss of coverage.

I have seen suggestions to start with regular F and downgrade to G then D, if needed. (I didn't say I agree.)

NY, CT, and WA allow upgrades without underwriting.

Because of the California Birthday Rule I recommend anyone new to Medicare start on a plan F. This way, you have the option to change to a plan G or N in the future regardless of your health.
Source: https://sandiegomedicareplans.com/medicare-supplement-plans/

Edit: A little research reveals that California, Oregon and Missouri allow you to change plans once a year without underwriting, but the rules differ for each state. Oregon does allow an insured to change from F-HD to F, but not to any other plan.

Check your link again, please. Oregon F-HD can only lateral to another "high F".

The following site also includes the rules for NY, CT, WA and Maine. https://gmiainc.com/medigap-birthday-rule-applies/

 

[REWahoo]

Check your link again, please. Oregon F-HD can only lateral to another "high F".

Oops, you are correct, no upgrade without underwriting in Oregon.

 

[Another Reader]

When the ACA was implemented, I could not understand why the law was written and implemented with so many bizarre rules and "gotchas." From what I have learned about Medicare in the last year, Medicare is also a minefield.

As a pre-Medicare retiree, my insurance choices required me to live in the Bay Area. If what I read is correct, it looks like Medicare and the Medigap policies might get me out of that prison!

 

[REWahoo]

As a pre-Medicare retiree, my insurance choices required me to live in the Bay Area. If what I read is correct, it looks like Medicare and the Medigap policies might get me out of that prison!

Yes, one of the nice things about going the Medicare/Medigap route is the ability to use the healthcare provider of your choice anywhere in the US.

 

[Corporateburnout]

In MA there are only two Medigap plans, supplement one and core. DW has been on BC/BS supplement one plan since she became eligible last year and it pays for everything. She had a couple of procedures with an overnight stay in the hospital and the plan covered 100% of what Medicare did not cover.

Later this year I will be on Medicare and plan to sign up for the BC/BS core plan which does not pay for part A and B deductibles and does not cover skilled nursing beyond the 20 days covered by Medicare. They both cover International emergencies up to 50K.

State law allows participants to switch between the two plans as many times as they need to with the only stipulation that coverage starts the first of the month.

 

[Ian S]

My inclination is to sign up for Plan F now. If, when F closes, the premiums skyrocket, I will use the California regulation that allows me to switch across or down in benefits to move to Plan G.

I found that the total annual premiums for Plan F were more than the total annual premiums for Plan G plus the annual deductible. So why would I ever sign up for Plan F?

 

[REWahoo]

I found that the total annual premiums for Plan F were more than the total annual premiums for Plan G plus the annual deductible. So why would I ever sign up for Plan F?

Good question - those of us who bother to figure that out wouldn't, but many either lack the skills to run the numbers or don't think to do so.

I have heard that some insurers in some locations actually have Plan F priced so that the annual cost is less than paying for Plan G and the deductible. Haven't looked to see if that's the case in my location since I'm not going to purchase either F or G.

 

[Another Reader]

If someone else is paying, as may be the case for those of us whose employers contribute, that's a choice for convenience over cost. Also a choice of the highest level of benefits, in case things change down the road. I won't decide until I see all the numbers and what the employer will pay.

 

[meierlde]

I found that the total annual premiums for Plan F were more than the total annual premiums for Plan G plus the annual deductible. So why would I ever sign up for Plan F?

If the community rated insurer that does not charge by age does not offer G?

 

[imoldernu]

A long read, but worth it.
https://medicare.gov/Pubs/pdf/02110-Medicare-Medigap.guide.pdf

A good review for me... We have been on medigap since it began, around the year 2006 I think, and on medicare since 2001, when we became eligible.

While there is no easy way to compare supplement policies one of the most important things to consider and this can be very important. Here is a current list of co-pays by drug tier for one plan.

Copays are listed by tiers. Tiers are groups of drugs with the same copay.
·Tier 1 drugs have the lowest copay. They are generic drugs. The copay is from $1.25 to
$3.35, depending on your income.
·Tier 2 drugs have a higher copay. They are brand name drugs. The copay is from $3.70
to $8.35, depending on your income.
·Tier 3 drugs have a $0 copay. They are OTCs/Non-Part D drugs.

Now, while this doesn't seem too important now,especially for those who don't take many medicines, it can become VERY important later. In many plans, some of the latest drugs are not covered in any tier. An example... The drug Xarelto costs (retail) about $521.00 for a 30 day supply, and even in the GOODRX plan $424.

The other part of this, is that the Medigap plans hold no guarantees. This year, one of my own drugs was dropped from the "approved" tier, costing me an additional $600/yr., and 2 more were changed from tier 1 to tier 2. No recourse.

Checking this out is the equivalent of taking a full year college course, though there are apparently some government websites that offer a drug cost calculator. I couldn't find them.

Would be interested in the "average" costs of medicare/medigap at different age levels.

Good luck. Not your imagination that this is a tough decision to make.

 

[meierlde]

A long read, but worth it.
https://medicare.gov/Pubs/pdf/02110-Medicare-Medigap.guide.pdf

A good review for me... We have been on medigap since it began, around the year 2006 I think, and on medicare since 2001, when we became eligible.

While there is no easy way to compare supplement policies one of the most important things to consider and this can be very important. Here is a current list of co-pays by drug tier for one plan.


Now, while this doesn't seem too important now,especially for those who don't take many medicines, it can become VERY important later. In many plans, some of the latest drugs are not covered in any tier. An example... The drug Xarelto costs (retail) about $521.00 for a 30 day supply, and even in the GOODRX plan $424.

The other part of this, is that the Medigap plans hold no guarantees. This year, one of my own drugs was dropped from the "approved" tier, costing me an additional $600/yr., and 2 more were changed from tier 1 to tier 2. No recourse.

Checking this out is the equivalent of taking a full year college course, though there are apparently some government websites that offer a drug cost calculator. I couldn't find them.

Would be interested in the "average" costs of medicare/medigap at different age levels.

Good luck. Not your imagination that this is a tough decision to make.

Actually this is mostly part D not medigap which does not cover drugs (other than drugs covered by part B which are administered at the physicians office). You can change part D plans once a year. Some plans have 5 tiers and some have a $400 deductable before anything is paid.

Medigap is really about closing holes in part B coverage. The drug plans were put in place during the second Bush Admin.




BTW the patent on Xeralto expires in 2024.

 

[MichaelB]

Actually this is mostly part D not medigap which does not cover drugs (other than drugs covered by part B which are administered at the physicians office). You can change part D plans once a year. Some plans have 5 tiers and some have a $400 deductable before anything is paid.

Medigap is really about closing holes in part B coverage. The drug plans were put in place during the second Bush Admin.

Right. This is how that sentence should read

A good review for me... We have been on [-]medigap[/-] Medicare Plan D since it began, around the year 2006 I think, and on medicare since 2001, when we became eligible.

Medicare is not easy to understand.

 

[wmc1000]

I just ran the xarelto scenario on medicare.gov and it shows a silverscript part D plan costing $23.40 per mo where a prescription for zarelto costs you $41.00 per mo. for the 1st 8 mos. then $64.35 in mo. 9 and approx. $148 per mo for the last 3 mos. of the year. Not cheap but way better than $24 per mo.

 

[aja8888]

DW has been on Medicare with supplemental full plan F since 2011. She has failing health and has had several major surgeries, including a heart valve replacement without breaking through her sternum for cavity entry (very special procedure). Without this coverage, we would have spent a ton on deductibles and coinsurance costs.

Her Part D covers 13 drugs, some of which are quite expensive. I am an expert in choosing a Part D plan for her, which we do annually. I just wish the donut hole would completely close up!

 

[REWahoo]

I just wish the donut hole would completely close up!

According to this, your wish comes true next year:

Under Friday’s budget deal, the doughnut hole will now close next year. Beginning in 2019, Part D enrollees will pay 25 percent of the cost of all their prescription drugs from the time they enter the gap until they reach catastrophic coverage.

https://www.aarp.org/health/medicare-insurance/info-2018/part-d-donut-hole-closes-fd.html

 

[aja8888]

According to this, your wish comes true next year:



https://www.aarp.org/health/medicare-insurance/info-2018/part-d-donut-hole-closes-fd.html

Nice, we hit it in May this year! It will be like getting a raise!

Looks like it won't close up completely but will still require a 25% cost of the drugs vs. a 5 % cost normally. So the "hole" just shuts off at 25%?

 

[meierlde]

Nice, we hit it in May this year! It will be like getting a raise!

Looks like it won't close up completely but will still require a 25% cost of the drugs vs. a 5 % cost normally. So the "hole" just shuts off at 25%?

The aarp article states that gap is 3750 to 5000 with the reduction in the

amount the donut hole costs about $312 in 2019. (25 percent of the total gap).

 

[REWahoo]

Here's a graphic on what the new donut hole will look like next year. It says 2020 but the budget deal earlier this year moved it up to 2019.

 

[aja8888]

Here's a graphic on what the new donut hole will look like next year. It says 2020 but the budget deal earlier this year moved it up to 2019.

I was hoping rather than just dropping to a cost of 25%, it would have gone to the 5% catastrophic fee sooner. We get to the 5% (for some drugs) every year.

Our Part D OOP for DW's drugs is pretty high and dropped quite a bit once she was taken off Forteo, which was costing near $1000 per month (our cost) with the daily needle package.

 

[MBSC]

I wish the sites that provide options would say what date their information is valid on. I find lots of sites that are getting long in the tooth with their information, i.e. several years old.

The state's Department of Insurance website is the best place to start. If your state does not make Medigap rates public, the SHIP counselor at your local Council on Aging office usually has the rates and may be willing to email them to you without meeting in person.

https://www.shiptacenter.org/

Otherwise, if you don't want to deal with an agent you can pay $10 for one month/one state access to the quote engine used by agents.

https://www.csgactuarial.com/software/market-advisor/pricing/

This provides current rates for ALL Medigap plans available in your area. Brokers filter these results to only show companies they are contracted with. Remember to cancel when finished or they'll charge you for another month. If you go this route, you want an insurer with competitive rates at age 65 and in the future so input multiple ages (65, 80).

 

[audreyh1]

The state's Department of Insurance website is the best place to start. If your state does not make Medigap rates public, the SHIP counselor at your local Council on Aging office usually has the rates and may be willing to email them to you without meeting in person.

https://www.shiptacenter.org/

Otherwise, if you don't want to deal with an agent you can pay $10 for one month/one state access to the quote engine used by agents.

https://www.csgactuarial.com/software/market-advisor/pricing/

This provides current rates for ALL Medigap plans available in your area. Brokers filter these results to only show companies they are contracted with. Remember to cancel when finished or they'll charge you for another month. If you go this route, you want an insurer with competitive rates at age 65 and in the future so input multiple ages (65, 80).

Great. Thanks for that gem!

I see certain Medigap insurers that seem to have broad national coverage such as United Healthcare, Humana, Blue Cross family, Cigna maybe. There must be other well known companies - I see a lot of “regular” insurance companies listed like Mutual of Omaha. I never see any comparative discussions about these Medigap companies and which are easier to deal with. An important part of making a choice I would think.

We are likely buying a plan in one place, but could very well move to another state later, and certainly would like to have the full flexibility to do so.