Medicare Supplement Plans/Extend Health

[westcoast]

Medicare Advantage plans are slated to be cut because they cost the government significantly more (I've seen numbers ranging from 11-18%) than traditional Medicare. This would be fine except that apparently only about 85% of the additional dollars go to paying for healthcare. The rest stays in the pockets of the insurance companies.

 

[kaneohe]

kanehoe, you can find all the answers here: http://www.medicare.gov/Publications/Pubs/pdf/10050.pdf

Take a look at page 68.

Thanks again, REW. Looks pretty much like a corporate open enrollment period in the last quarter of yr. I greatly appreciate not only the link but the driving directions.......better than Google Maps.

I'm tentatively concluding:
1) Advantage/Supplement--->Advantage: easy, no underwriting, annual open enrollment
2) Advantage/Supplement------>Supplement: possible underwriting issues

If I'm wrong, pls correct me.

 

[wolf]

You are correct. A Medicare Advantage Plan may offer both HMO and PPO coverages. Like most, I prefer the PPO. We are with Secure Horizons by United Health Care. They have the AARP credential affixed but United is just paying AARP to use their name. There is no affiliation. Again, the plan depends on what's available in your area and this information is available on the Medicare.gov website. All of our doctors and surgeons belong to the Secure Horizons plan, all the hospitals and labs in my area are in the plan. It has a mail order prescription drug plan and basic dental like cleanings and exams. We continue to pay the Medicare premium and that is all. Sure, there are deductible and copays and the maximum OOP is still $4500/yr. Copay is $1 for an office visit to primary care physician (you have to pick one), $30 for specialists. I just hate paying premiums for something you may never use. Others feel the opposite. They would pay up front and not have to worry about the nickle and dime stuff.

Just curious. Which Advantage plan had no premiums? Was it HMO or PPO?
Were you able to go to your own dentist? Or was the it a
"network" dentist?

 

[JakeBrake]

The Megacorp I retired from furnishes retiree Medigap insurance which is in addition to Medicare Parts A&B. This Medigap policy covers dental, vision, medicine, and whatever Medicare Parts A&B does not cover. The cost for DW & me is around $60 per month (the number is blurred for the sake of anonymity).

 

[tjscott0]

It is important to determine the pricing method as well as the quoted premium.

METHODS:
Issue-Age-Rated--The premium is based on the age you are when you buy (are "issued") the Medigap policy.

Attained-Age-Rated Policies--The premium is based on your current age (the age you have "attained") so your premium goes up as you get older.

Community-rated --The same monthly premium is charged to everyone who has the Medigap policy, regardless of age.
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Its obvious that one would wish to avoid an Attained-Age-Rated-Policies.

An Issue-Age-Ratedd policy could be a problem if your insurer goes bankrupt. Then you have to find a policy at an advanced age. I don't know if it would be difficult to obtain a Community-rated policy at an advanced age.

 

[REWahoo]

It is important to determine the pricing method as well as the quoted premium.

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Its obvious that one would wish to avoid an Attained-Age-Rated-Policies.

I'm finding [-]very few[/-] no medigap policies that aren't Attained-Age-Rated.

 

[Moemg]

Medicare Advantage plans are slated to be cut because they cost the government significantly more (I've seen numbers ranging from 11-18%) than traditional Medicare. This would be fine except that apparently only about 85% of the additional dollars go to paying for healthcare. The rest stays in the pockets of the insurance companies.

This is true but even with the insurance companies skimming off some money they are doing a better job at health care than the government . Imagine the waste in that program. Plus most of our area Physicians will accept those plans Medicare without supplements not so much.

 

[JOHNNIE36]

Editing my post to read "$10 copay for office visit to primary care physician".

 

[TN_INVEST]

Just curious. Which Advantage plan had no premiums? Was it HMO or PPO?
Were you able to go to your own dentist? Or was the it a
"network" dentist?

Rest assured, if there are no premiums, you won't get much coverage. Seems most of the $0 plans are HMOs and really seem to lack good coverage on the hospital side and the prescription drug side.

I'm tentatively concluding:
1) Advantage/Supplement--->Advantage: easy, no underwriting, annual open enrollment
2) Advantage/Supplement------>Supplement: possible underwriting issues

If I'm wrong, pls correct me.

That's my understanding too. Although I think you can also switch back from an Advantage plan to original medicare with no underwriting (and get a supplement) so long as you do it within the first year (i.e. before age 66). I also think some insurance companies have no underwriting for some of the new plans (M&N).

One thing that really seems seems to be a drawback of the Advantage plans is the doctor network. Like I said earlier, there was a big scuttle-butt a couple years back with a contract and the United Healthcare Advantage plans at one local hospital and one large physician group.

My dad had an Advantage plan and had to deal with some issues when he wanted to go to Houston for some cancer treatment (he didn't live in Texas so the network stuff became a problem).

 

[Moemg]

.

My dad had an Advantage plan and had to deal with some issues when he wanted to go to Houston for some cancer treatment (he didn't live in Texas so the network stuff became a problem).

Most health care plans have networks . I have Federal Blue Cross & Blue Shield and when I go out of network the cost skyrockets . If you pick a network with a large amount of Doctors realistically how many times in your life are you going to need to go out of network ?These plans do have provisions for emergency care when you travel.The good thing about the plan is if you do not like it you can switch .

 

[tjscott0]

I'm finding very few no medigap policies that aren't Attained-Age-Rated.

I just tried at medicare website & in my zip have 1 community rated-AARP, 4 issue age-transamerican Life Insurance, National States Insurance Co, Combined Inaurance Co of America, Bankers Fidelity Life for Plan F.

AARP my only alternative for a community-rated policy. They write a limited number of plans. To determine what is available in your zip code go to:
https://www.aarpmedicareplans.com/health-plans/medicare-supplement-plans?type=MSP&sourcecode=810107

Hover your mouse over plans section & go to either medigap policies or advantage plans & enter your zip to see what is offered in your area.

While I don't have any love for AARP. They do a good medigap policy that is community rated.

 

[REWahoo]

AARP my only alternative for a community-rated policy. They write a limited number of plans. To determine what is available in your zip code go to:
https://www.aarpmedicareplans.com/health-plans/medicare-supplement-plans?type=MSP&sourcecode=810107

Here's the message that popped up when I put in my zip:

Materials for the AARP Medicare Supplement Insurance Plans in TX are not yet available online. Please call for complete plan information. We appreciate your patience.

This makes me uncomfortable for a couple of reasons. Not only am I not a fan of AARP, there are too many reasons to want to 'reach out and touch someone' rather than allow an online comparison.

 

[westcoast]

Most health care plans have networks . I have Federal Blue Cross & Blue Shield and when I go out of network the cost skyrockets . .

True of plans for the employed, but not traditional Medicare. Unless you give away your freedom of choice, you can go to any doctor or hospital who accepts Medicare assignment (their fee schedule). If you get a Medicare F supplement, you can (I believe) go to any doctor or hospital, even if they don't accept assignment.

 

[JOHNNIE36]

Just curious. Which Advantage plan had no premiums? Was it HMO or PPO?
Were you able to go to your own dentist? Or was the it a
"network" dentist?

Network dentist is answer to last question. The dental benefit is not that great but better than nothing. As to the first question, there are a number of Medicare Advantage plans with no "additional" premium. You continue to pay the regular medicare premium of $115/mo. Medicare sends that amount plus a subsidy to the company offering the Advantage plan. Once you sign up for the Advantage plan, you no longer have any ties to Medicare. The Advantage plan takes care of everything. You can reverse that or go to a different Advantage plan every year. I think a post just before "wolf" was asking about an Advantage plan with a supplement. Never heard of anything like that. Why would you want to. Generally speaking, if you have Medicare alone, you would be responsible for deductibles and copays because Medicare does not cover you 100%. Hence, the supplements from some company. When I was first retired, megacorp provided the supplement through Blue Cross/Blue Shield for a premium they took out of my pension check. There are many companies out there offering supplements.

Like I said, Medicare trenafers your $115/mo premium along with a subsidy to whatever insurance company advantage plan you choose. That subsidy allows the insurance company to offer many "advantages" over just plain Medicare. The competition between those insurance companies is fierce and they are banking huge profits. That is why there is a move afoot in this administration to reduce or eliminate those subsidies.

I mentioned earlier that you should go to www.medicare.gov where you can review all the plans and make comparisons. Select two or three plans and then get into the details of those.

I disagree with TN__INVEST about not getting much coverage for zero premium. All Advantage plans must provide as much coverage as Medicare. They can't short change you there. You have to understand that the subsidy is everything to the company offering the
advantage plan. Under my Advantage plan, I get as much if not better coverage then I got with Medicare and a supplement and it's cheaper.

 

[TN_INVEST]

Most health care plans have networks . I have Federal Blue Cross & Blue Shield and when I go out of network the cost skyrockets . If you pick a network with a large amount of Doctors realistically how many times in your life are you going to need to go out of network ?These plans do have provisions for emergency care when you travel.The good thing about the plan is if you do not like it you can switch .

I agree about the odds being slim that you won't be able to find a good doctor in the local network, but with traditional medicare and a traditional supplement (I like the F plan), the network issue is pretty much non existent.

This isn't some scare tactic, but my dad wrestled with things when he wanted to see an out of state cancer specialist (he lived near the state border and Houston was actually a bit closer, plus Houston has a great reputation for cancer treatment). Same with one of the local hospitals in my town. It was the talk of the town for a few months as a lot of folks learned the hard way that at 65 they actually opted off of traditional medicare and went with an HMO/PPO type plan and their network of doctors and hospitals could/did change.

The advantage plans aren't terrible, but it's hard to beat complete, full coverage of an F plan supplement. Odds are, you/we will spend the last months/years of our life dealing with health issues (ain't like folks get healthier as they get older) and that could easily chew up any of the advantages of an advantage plan.

I disagree with TN__INVEST about not getting much coverage for zero premium. All Advantage plans must provide as much coverage as Medicare. They can't short change you there. You have to understand that the subsidy is everything to the company offering the
advantage plan. Under my Advantage plan, I get as much if not better coverage then I got with Medicare and a supplement and it's cheaper.

Local $0 plan has $35 in network co-pays for doctor visits, plus $75 co-pays for a bunch of their lab work (like x-rays and MRIs). Their prescription drug list is puny and that too has high deductibles and co-pays (it's been a while, but the $0 plan might not even have a drug plan). Heaven forbid you go to the hospital, then you have co-pays of about $250 a day for the first 100+ days (plus all the nickels and dimes of any work the doctors might do for you while you are in the hospital).

While they do pay for some care and they must meet Medicare's minimum threshold, remember that minimum standard merely means part A & part B of Medicare and not any of the supplements. Compared to the advantage plans and/or supplements that have premiums, I'd say the advantage plans that have $0 premiums don't provide much in the way of benefits (that's just common sense).

 

[wolf]

Network dentist is answer to last question. The dental benefit is not that great but better than nothing. As to the first question, there are a number of Medicare Advantage plans with no "additional" premium. You continue to pay the regular medicare premium of $115/mo. Medicare sends that amount plus a subsidy to the company offering the Advantage plan. Once you sign up for the Advantage plan, you no longer have any ties to Medicare. The Advantage plan takes care of everything. You can reverse that or go to a different Advantage plan every year. I think a post just before "wolf" was asking about an Advantage plan with a supplement. Never heard of anything like that. Why would you want to. Generally speaking, if you have Medicare alone, you would be responsible for deductibles and copays because Medicare does not cover you 100%. Hence, the supplements from some company. When I was first retired, megacorp provided the supplement through Blue Cross/Blue Shield for a premium they took out of my pension check. There are many companies out there offering supplements.

Like I said, Medicare trenafers your $115/mo premium along with a subsidy to whatever insurance company advantage plan you choose. That subsidy allows the insurance company to offer many "advantages" over just plain Medicare. The competition between those insurance companies is fierce and they are banking huge profits. That is why there is a move afoot in this administration to reduce or eliminate those subsidies.

I mentioned earlier that you should go to www.medicare.gov where you can review all the plans and make comparisons. Select two or three plans and then get into the details of those.

I disagree with TN__INVEST about not getting much coverage for zero premium. All Advantage plans must provide as much coverage as Medicare. They can't short change you there. You have to understand that the subsidy is everything to the company offering the
advantage plan. Under my Advantage plan, I get as much if not better coverage then I got with Medicare and a supplement and it's cheaper.

Thanks for the long explanation: It answers a lot of questions. After following your advice, I agree with you, (disagree with TN_INVEST). There is a Advantage plan in my zip code, with zero premiums. Benefits are similar to Advantage plans with fairly high premium.

 

[tjscott0]

This makes me uncomfortable for a couple of reasons. Not only am I not a fan of AARP, there are too many reasons to want to 'reach out and touch someone' rather than allow an online comparison.

Yep. All I can tell is they are one of the lower cost provider in my particular zip code. For example, the medicare.gov website cited that premiums for a medigap plan F ran from $97/mo to $396/mo from the varies carriers. The AARP website gave me an online quote of $107.27/mo.

I'm 60. So for the last I have bombarded with appeals to join which I have ignored.

For grins I checked with the State of Texas Dept of Insurance.
2010 Accident & Health Complaint Index
AARP insurance is written thru United Healthcare.
in 2010 there were 1671881 policies in force & 217 justified complaints. A fraction of 1%[.013%] of justified complaits. What confuses me is the state indicates it has a 3.45 complaint index. Anything above 1.0 means more complaints than average.

I can't think of anyway for you to avoid contacting AARP for a quote. Sorry.

 

[Moemg]

True of plans for the employed, but not traditional Medicare. Unless you give away your freedom of choice, you can go to any doctor or hospital who accepts Medicare assignment (their fee schedule). If you get a Medicare F supplement, you can (I believe) go to any doctor or hospital, even if they don't accept assignment.

As long as you have a good supplement any hospital will take you . Without a supplement Medicare alone would not be accepted . I have spent forty years in health care and it took me months to wade through all the Medicare ,Medigap and Medicare Advantage plans . Most people really do not understand it . It's like the tax code for health care .My So is going with an advantage plan but I when the time comes I will be keeping federal Blue Cross /Blue shield just opting for a lesser plan.

 

[kaneohe]

Question about supplement plan coverage: Is is correct that (ignoring deductibles and excess charges) that Medicare covers 80% and supplements cover the remaining 20% so all of the charges are covered.
Some supplements even cover those exclusions mentioned in the first
sentence.

If true, where, if anywhere, is your exposure to something that out-of-pocket caps cover and supplements w/o caps don't? Or are caps useless?

Supplements are pt B supplements so would not cover uncovered medicare A charges so even having supplement OOP caps would not
help?

Are there lifetime $$$ limits on what supplements cover?

 

[Moemg]

Question about supplement plan coverage: Is is correct that (ignoring deductibles and excess charges) that Medicare covers 80% and supplements cover the remaining 20% so all of the charges are covered.
Some supplements even cover those exclusions mentioned in the first
sentence.

If true, where, if anywhere, is your exposure to something that out-of-pocket caps cover and supplements w/o caps don't? Or are caps useless?

Supplements are pt B supplements so would not cover uncovered medicare A charges so even having supplement OOP caps would not
help?

Are there lifetime $$$ limits on what supplements cover?

I really do not know the answer to that so I would write down your questions and bring them up to one of the many insurance salesman that will be contacting you .I do know that my Mom who is 95 has a Blue Cross /Blue shield medigap policy and she has never paid a dime for all her doctor visits , two total knee replacements and two total hip replacements .

 

[FIRE'd@51]

In most states AARP Medigap plans are a sort of hybrid. The premiums are community-rated but have a front-end discount of 30%, which increases linearly from age 65 until 75, then levels off. As I understand it, AARP has done this to make their policies more competitive with attained-age policies, which are typically cheaper in the early years.

For example, in my state (VA), the current community rate is about $160 per month for plan F. With the 30% discount, the monthly premium is $112 for the first year. Assuming a constant $160 per month community rate (no healthcare inflation), one's premium will increase $4.80 per month each year, up until age 75, at which point the monthly premium is frozen at $160. In actuality, because of healthcare inflation, the $160 per month goes up each year, and the discount is applied to the higher number, which affects the annual increases.

I should add that AARP reduces the premium by $2 per month if you set up an automatic withdrawal from you checking account. Also, if both you and your spouse have AARP plans, you each get a 5% discount to your premiums. So in the above example, if you and your spouse take out AARP plans this year, the monthly premiums for the first year for you and your spouse would be 0.95 x 2 x $112 - $2 = $210.80

In terms of coverage, between Medicare parts A and B and a plan F supplement, one has complete coverage (no out-of-pocket expenses, copays, or deductibles) for any Medicare-covered treatment or procedure.

 

[tjscott0]

In most states AARP Medigap plans are a sort of hybrid. The premiums are community-rated but have a front-end discount of 30%, which increases linearly from age 65 until 75, then levels off. As I understand it, AARP has done this to make their policies more competitive with attained-age policies, which are typically cheaper in the early years.

Thanks. I learned sumthin new.

 

[JOHNNIE36]

I really do not know the answer to that so I would write down your questions and bring them up to one of the many insurance salesman that will be contacting you .I do know that my Mom who is 95 has a Blue Cross /Blue shield medigap policy and she has never paid a dime for all her doctor visits , two total knee replacements and two total hip replacements .

My only question would be, how much does she pay per month for the medigap policy (supplement)? No copays? No deductibles?

 

[JOHNNIE36]

Maybe I'm wrong, and if there is anyone out there that knows about this, please chime in. I say AARP does not insure anyone. No supplemental policies or Advantage plans. My Advantage plan is called "AARP Secure Horizons by United Health Care". AARP has nothing to do with the plan. United Health Care has everything to do with it. United Health Care pays AARP to use their name to tie it to their plan and makes it more saleable. It adds a "title" to the plan to enhance sales. I still like the plan, with or without AARP. My Mom and Dad had a supplemental plan and it had the AARP name tied to it and they thought they were insured by AARP. Hence, it had to be the best plan in the world. I found out about this years ago when my automobile insurance was with The Hartford. It was offered through AARP. It was all about The Hartford. I could never have any conversation or complaint with AARP.

 

[REWahoo]

Maybe I'm wrong, and if there is anyone out there that knows about this, please chime in. I say AARP does not insure anyone.

From the AARP Medicare Plans website:

AARP® Medicare Supplement Insurance Plans

Insured by UnitedHealthcare® Insurance Company
​

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The AARP Medicare Supplement Insurance Plans carry the AARP name and UnitedHealthcare pays a royalty fee to AARP for use of the AARP intellectual property. Amounts paid are used for the general purpose of AARP and its members. Neither AARP nor its affiliate is the insurer.
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AARP does not recommend health related products, services, insurance or programs. You are encouraged to evaluate your needs.
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AARP and its affiliate are not insurance agencies or carriers and do not employ or endorse insurance agents, brokers, producers, representatives or advisors.