Traditional Medicare - question about switching providers of medigap and also part D

[tominboise]

I will be signing up for Medicare in early 2025 (turn 65 in March). I plan on taking traditional medicare and also getting a medigap plan. My question - say I choose a high deductible medigap plan in 2025, but decide to choose a different medigap plan in a future year - does this open me up to the pre existing condition trap?

Regarding part D - if I choose to not take part D in 2025 but in future years decide to take part D, does this come with a pre existing condition trap? Or I take part D in 2025 but switch providers in future years?

 

[rodi]

I am not an expert, nor on Medicare yet (have another 18 months or so). But I read all the threads here.

Part D, my understanding is that by delaying signing up for part D, then signing up later, you pay a penalty/higher fee when you do sign up. So the advice I've read is to sign up for the cheapest plan D available when you first go on Medicare. You can switch plans at open enrollment if the prices change or you need a better/different plan for the drugs you are on.

For the Medigap plan, for example a plan G High Deductable. You can switch to a same or lesser plan at open enrollment... but not to a better plan. My understanding is that you would not be able to switch to plan G (not high deductible) if you were on a plan G HD, or a plan N, or one of the other letters.

My husband is on Plan F HD (which is no longer available to new enrollees.) If he were to switch to a lesser plan he would not be able to switch back.

Others are more expert on this - but that is my understanding.

I'm planning on signing up for a plan G or plan G HD when my time comes in 2026.

 

[tominboise]

Does one even need a Part D if they use the Costco pharmacy, for instance? I guess the answer is, if I need an expensive prescription in the future, it wouldn't be covered and neither would the $2000 OOP limit apply.

 

[Chuckanut]

In regards to not getting Part D immediately.... If you have prescription coverage from another source that meets Medicare requirements/standards you can sign up for Part D later on and pay the normal rate from the provider.

If you don't have a prescription plan that meets Medicare requirements/standards, you can sign up for Part D later, BUT, YOU WILL PAY MORE FOR THE PART D COVERAGE FOREVER. How much more depends upon how many years you did not have Plan D and/or a Medicare approved coverage from another source.

They want to avoid people not buying Plan D when their prescription needs are inexpensive, then signing up when they find out they need Expensivia at $5000 a month for the rest of their life. No gaming the system.

The above is my understanding. I am just some guy on the internet and not a Medicare or Plan D expert. I could be wrong.

 

[tominboise]

In regards to not getting Part D immediately.... If you have prescription coverage from another source that meets Medicare requirements/standards you can sign up for Part D later on and pay the normal rate from the provider.

If you don't have a prescription plan that meets Medicare requirements/standards, you can sign up for Part D later, BUT, YOU WILL PAY MORE FOR THE PART D COVERAGE FOREVER. How much more depends upon how many years you did not have Plan D and/or a Medicare approved coverage from another source.

They want to avoid people not buying Plan D when their prescription needs are inexpensive, then signing up when they find out they need Expensivia at $5000 a month for the rest of their life. No gaming the system.

The above is my understanding. I am just some guy on the internet and not a Medicare or Plan D expert. I could be wrong.

That's what I suspected. Thanks for clarifying.

I have an ACA insurance plan now that I like and is cheaper then Medicare will be. Too bad I have to switch.

 

[Sunset]

Sign up for a part D, there are in most places really cheap plans. Ours is costing $0 per month this year. I think last year it was $7 per month.

Far cheaper than the penalty a relative pays of $11 per month (JUST FOR THE PENALTY) for life, for signing up late, plus that person has a cost per month for an actual plan D.

 

[Chuckanut]

Sign up for a part D, there are in most places really cheap plans. Ours is costing $0 per month this year. I think last year it was $7 per month.

Far cheaper than the penalty a relative pays of $11 per month (JUST FOR THE PENALTY) for life, for signing up late, plus that person has a cost per month for an actual plan D.

Good idea. Find a zero cost or a very low cost plan D and sign up. But, be careful. My current 2024 plan was about $3.50 a month. In 2025 it jumps to about $33 a month. I suspect they did that to "convince" me to switch to one of their zero monthly premium Medicare (dis)Advantage plans. But, that's a whole other thread.

 

[Gallaher]

I just signed up for traditional and medigap. Total cost $185 month.
I take no meds and got part D for $0.
Note: if you don’t sign up for D initially you will suffer a life sentence of penalties but I think Part D is usually cheap….like $30 a month….a 10% penalty is $3. Still sign up right away and spare the aggravation.

 

[Pluperfect]

My question - say I choose a high deductible medigap plan in 2025, but decide to choose a different medigap plan in a future year - does this open me up to the pre existing condition trap?

I'm assuming you're in Idaho. A couple of years ago Idaho adopted the "birthday rule" for changing supplements, which is a period of 63 days after your birthday every year during which you can change to a supplement with similar or lesser benefits without undergoing underwriting.

Here is an excellent explanation of how it works, with a chart of what plan changes are allowed:

doi.idaho.gov/shiba/new-to-medicare/medicare-supplement-medigap/recent-changes-to-medicare-supplement-law-and-rules/

It even includes this: "'Dead-pooling' refers to an unfair trade practice where consumers are locked into their current plan while their insurance company offers a new plan to new consumers."

I'll also note that supplements in Idaho seem expensive to turning-65 enrollees, but that's because the new law also changed to community rated pricing, which means everybody pays the same amount for a given supplement, regardless of age.

 

[mf15]

We have F-HD,the problem is as you get older and older you have to pay the hosp bills yourself,getting to be a pain. Hosp billing is a mess, For my pacemaker is august I have 28 page EOB from Cigna. That being said still have not hit the total OOP deductible,nor not many bills from the hosp yet. If could do over probably go with plan N, even though still under $70/month for F-HD.

 

[audreyh1]

We’re paying more up front to avoid HD plans because I know how complicated high deductible billing can be. Lots of experience with high deductibles from ACA plans and got real fed up with it. Definitely thinking about our older selves and trying to make things easier.

 

[Chuckanut]

We’re paying more up front to avoid HD plans because I know how complicated high deductible billing can be. Lots of experience with high deductibles from ACA plans and got real fed up with it. Definitely thinking about our older selves and trying to make things easier.

Good point. I am on plan F. My bills go to Medicare then the Supplement provider. By the time I see a cost number it's almost always paid and I owe $0. That said, I am careful not to abuse the system. I know that ultimately, I(we) will pay one way or another, so there is no point in going to visit the Dr just because it's free of an immediate cost.

 

[tominboise]

We’re paying more up front to avoid HD plans because I know how complicated high deductible billing can be. Lots of experience with high deductibles from ACA plans and got real fed up with it. Definitely thinking about our older selves and trying to make things easier.

That is how I am inclined to go. I would rather pay more and not worry about the HD issues. It's not cheap though. Around $215/month for a Plan G from Regence.

 

[REWahoo]

We’re paying more up front to avoid HD plans because I know how complicated high deductible billing can be. Lots of experience with high deductibles from ACA plans and got real fed up with it. Definitely thinking about our older selves and trying to make things easier.

^ This.

We were on HD plans for the first 5-6 years, came to the same conclusion and made the switch.

 

[audreyh1]

That is how I am inclined to go. I would rather pay more and not worry about the HD issues. It's not cheap though. Around $215/month for a Plan G from Regence.

I’m sure it depends on the region but I’m paying $100 less than that.

 

[sengsational]

Tracking against a deductible can be a pain, certainly. One thing I encountered, and I suspect is rampant is hospitals "forgetting" to add every code to the Medicare claim. Say you have an encounter with 10 codes, they file 9 of them and get paid for those. The 10th code stays at the chargemaster rate, say $200 (whereas the Medicare price is $20). The "the billing system" naturally puts you on the hook for it. If you don't notice, and pay it, not only did you pay the insane price, it also didn't count against your high deductible.

Contrast that to the low deductible where, when you get above that low amount, you know something is wrong and you simply challenge the hospital billing bureaucracy with the "not possible" argument. You tell them "sharpen your pencil", and leave it unpaid.

 

[Gallaher]

A word of encouragement, I am reasonably intelligent, not brilliant, college educated and I was shocked at how challenging it was to get through the Medicare sign up mess.
I asked friends and relatives for input, did internet research for months and I am still not sure I have my best plan.

 

[5Miler]

I just signed up for traditional and medigap. Total cost $185 month.
I take no meds and got part D for $0.
Note: if you don’t sign up for D initially you will suffer a life sentence of penalties but I think Part D is usually cheap….like $30 a month….a 10% penalty is $3. Still sign up right away and spare the aggravation.

FYI - You are underestimating the Part D penalty. See link for details and examples from Medicare site.

I went through this last year as I had been using the VA for prescriptions so had 5 years of no Part D. I then signed up for a low cost plan ($0 this year) and had to wait for Medicare to clear me of penalties as VA coverage counted as creditable coverage.

 

[Pluperfect]

I’m sure it depends on the region but I’m paying $100 less than that.

If tominboise is indeed in Idaho, then supplements are community rated (and not the bogus AARP/UHC community rated). If he pays $215/month for a Plan G from Regence, a 90-year-old will pay the same for that plan.

 

[jpeter1093]

I just signed up for traditional and medigap. Total cost $185 month.
I take no meds and got part D for $0.
Note: if you don’t sign up for D initially you will suffer a life sentence of penalties but I think Part D is usually cheap….like $30 a month….a 10% penalty is $3. Still sign up right away and spare the aggravation.

Medicare alone costs $174.70/month; so you're only paying 10.30/month for a Medigap plan? Wow! Which plan and provider is that?

 

[Agapostemon]

I turned 65 two whole weeks ago and signed up for my Medicare largely relying on advice I read on this board (and the Bogleheads) about a year ago. Turns out in Massachusetts, the Medigap plans are vastly simplified. You can get Core, which doesn't cover the Medicare deductible, or Supplemental, which does. Both options cover the coinsurance. I have no medications, so I just picked the cheapest Part D available. Having bought our dental insurance through the Health Connector for the past decade, I switched to an individual plan.

After assembling all the pieces of Traditional Medicare, I have a more visceral feeling for the appeal of "All-in-one" MA plans.

The pieces are:
Medicare Part A - 0
Medicare Part B -185
Medigap: Blue Cross Blue Shield Medex Core w/ Vision & Hearing Riders - 112.57
Part D: Wellcare Value Script - 12.40
Dental: Delta Premier 61.75
Total: 371.72

Sure beats my share of our unsubsidized ACA insurance, which would have been 1434.82!

The best part is I have a small pension starting up at the end of the month which nets out to 414 after withholding.

I like being 65.

 

[jpeter1093]

I turned 65 two whole weeks ago and signed up for my Medicare largely relying on advice I read on this board (and the Bogleheads) about a year ago. Turns out in Massachusetts, the Medigap plans are vastly simplified. You can get Core, which doesn't cover the Medicare deductible, or Supplemental, which does. Both options cover the coinsurance. I have no medications, so I just picked the cheapest Part D available. Having bought our dental insurance through the Health Connector for the past decade, I switched to an individual plan.

After assembling all the pieces of Traditional Medicare, I have a more visceral feeling for the appeal of "All-in-one" MA plans.

The pieces are:
Medicare Part A - 0
Medicare Part B -185
Medigap: Blue Cross Blue Shield Medex Core w/ Vision & Hearing Riders - 112.57
Part D: Wellcare Value Script - 12.40
Dental: Delta Premier 61.75
Total: 371.72

Sure beats my share of our unsubsidized ACA insurance, which would have been 1434.82!

The best part is I have a small pension starting up at the end of the month which nets out to 414 after withholding.

I like being 65.

Which Medigap plan do you have?

 

[a60dan]

Good idea. Find a zero cost or a very low cost plan D and sign up. But, be careful. My current 2024 plan was about $3.50 a month. In 2025 it jumps to about $33 a month. I suspect they did that to "convince" me to switch to one of their zero monthly premium Medicare (dis)Advantage plans. But, that's a whole other thread.

The increase is due to the “Inflation Reduction Act” eliminating the “donut hole” and reducing the maximum out of pocket to $2000.

 

[a60dan]

I will be signing up for Medicare in early 2025 (turn 65 in March). I plan on taking traditional medicare and also getting a medigap plan. My question - say I choose a high deductible medigap plan in 2025, but decide to choose a different medigap plan in a future year - does this open me up to the pre existing condition trap?

Regarding part D - if I choose to not take part D in 2025 but in future years decide to take part D, does this come with a pre existing condition trap? Or I take part D in 2025 but switch providers in future years?

It matters what state you are in. Here in NY, we can switch Mefi-gap plans without underwriting. It is recommended to keep a plan at least 6 months to avoid a “pre-existing condition” waiting period.

 

[jasg]

My question - say I choose a high deductible medigap plan in 2025, but decide to choose a different medigap plan in a future year - does this open me up to the pre existing condition trap?

At least in Washington State, you can switch Medigap plans at ANY time - not just open enrollment. Since the plans are standardized at the Federal level, that may be true nationwide.

After ten years on F-HD, I just switched to a standard G. Premiums on F were rising faster than G. No problems switching, no underwriting or exclusions.

I even had a Premera BCBS person tell me I could switch away from High Deductible if a big expense was anticipated and then go back to HD.