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I am looking to get on to Medicare early next year and while reading up on this topic, I see this line, “All plans with the same letter have the same coverage, but prices can vary based on the insurance company” repeated often regarding the Medigap policies.
For example, when I look up Plan G for my state (SC), I see that there are “47 plans” and the premiums range from a low of $90 all the way up to (gulp) $493.
If all the “plans offer same coverage”, then why would one opt for a higher premium plan? What is the value add or incentive to go with a higher premium plan? Why would everyone not go for the lowest premium plan especially since Medicare sets the rules they all offer “same coverage”? Is there something obvious that I am missing?
Thanks!
Per KFF article recently published:
Four states (CT, MA, ME, NY) require either continuous or annual guaranteed issue protections for Medigap for all beneficiaries ages 65 and older, regardless of medical history.
A lot of terrific information here, but one thing I’d really stress is understanding what exactly your state allows regarding switching supplemental plans without underwriting. Some states are extremely generous (such as no restrictions with switching); some states allow some flexibility (such as allowing a subscriber to go from a plan with a lot of benefits to a plan with less benefits); and, some states are very restrictive and allow very little room to maneuver changes without underwriting.
Just for clarification the ability to change after a trial of a Medicare Advantage plan within one year of your initial qualification for Medicare is a federal law/rule which state law cannot trump. After that state laws, such as in Massachusetts and Maine I believe, can allow switching later. I believe this is pertinent to only a handful of states.
You can also switch back within one year if you change from Medicare to Medicare Advantage. It’s called Guaranteed Issue Right and I used it last year, but it seems to be little known.
In this article, Lucretia Ryan mentions the four states where you can swap back from Medicare Advantage to traditional Medicare and still get a Medigap policy regardless of preexisting conditions:
https://humbledollar.com/2024/03/what-advantage/
As I research more on this, figured I would share any useful data that I find. Here is a table that has the historical premium increases across Plans G, G HD & N.
https://www.csgactuarial.com/news/average-medicare-supplement-rate-increases-continue-trending-higher-in-2024/
Average 5Y increases are 6.14% for G, 4.84% for N and 1.98% for G HD.
I’ll put in another plug for Plan G High Deductible, for relatively healthy individuals in states that have them. My high deductible plan saves me $1,974 annually and my maximum additional deductible is $2,560. I think of the cost savings as a form of health savings account (HSA). And what is the worst case? An extra cost of $586 in bad health years, based on current deductibles. Just two years in, my “HSA” is untouched and could now cover several years of worsening health. The possibility of being locked into a high deductible plan also does not worry me, as I view the insurance as a guard against catastrophic expenses.
As for the author’s original question, I purchased my plan from a nationally-known insurer that seemed most responsive to my questions, had an easy website to navigate, and had the second lowest premiums.
Jo Bo – I am trying to work with our state SHIP. The difference for me (between a Plan G vs. G HD) would be $963. I noticed that while Plans G & N here have a “community pricing” (which I view as arresting the annual premium increases with the exception of inflation) whereas G HD all have just the “attained age”. Good perspective though, thank you!
Recommend reading the interview of David Himmelstein regarding Medicare Advantage (link below). It gives another perspective on Medicare Advantage plans. Spoiler alert – he’s not a fan. He also co-authored an excellent article in JAMA Network, linked below as well, but it’s behind a paywall.
https://fair.org/home/its-time-to-take-medicare-advantage-off-the-market/
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2819817?
I did a lot of research before electing to get a Medicare supplement plan G, and if you can afford it, it’s a good option, especially as medical expenses typically increase with age.
If you have any other lettered plan other than plan G (or plan F, which is no longer sold), make sure to ask if the medical practitioner accepts Medicare assignment (not just “Medicare”). And it has to be the specific practitioner, not the practice itself. The receptionist answering the phone won’t make the distinction; best to talk to the billing department or practice manager. That way you can avoid the excess billing charge (aka “balance billing”) from providers who don’t accept Medicare assignment, but will see people insured by Medicare. Also, some states have put restrictions on balance billing. See the article below, current as of 2022, so some things may have changed.
https://www.aarp.org/health/medicare-qa-tool/define-term-medicare-assignment.html
Since almost none of the comments answer the author’s question, I will try.
I went on Medicare very recently and chose regular Medicare and a supplement/medigap policy. I checked with a large medical practice that is associated with a large hospital and asked, “Do you care which Medigap company I use?” The answer was a quick, decisive “No, they are all the same.” Which is what the govt’s CMS website also says.
So I went with the cheapest premium, which in my area was Globe Life. I checked their premium history and saw they did not have large price increases in more than 10 years.
I also read a lot recently about how financially dependent AARP has become on United Heathcare, so I was sceptical about trusting them on this subject.
FWIW, I chose an N plan. The G plan seemed like overkill — its main selling point is they cover “excess charges.” But I asked a dozen different people already on Medicare and none of them ever experienced that. And the extra premium for G vs N was about $75 a month for me.
Hope this helps a little
as long as you don’t exceed $75 a month in part b copays.
United Healthcare was the most expensive plan G in my area. Kickback?
The G plan also has no copays. The PCP I was seeing when I went on Medicare, who had been my PCP for many years, did charge “excess”.
Except the annual Part B deductible.
The deductible is not a copay.
I am a super fan of our Medicare Supplement HIGH DEDUCTIBLE (HD) part F, which my husband and I have had for about six years. (New enrollees are only eligible for HD part G, which should work the same way.) I do not understand why I never see anyone talking about this HD insurance. The charts I have seen showing the lettered options for Medicare supplements show the HD option with an asterisk and comment at the bottom. I read through all of these comments and found just one mention of HD F or G when Dan Malone briefly referenced Stephanie Abt.
We purchased ISSUE AGE high deductible part F polices that were a little more expensive initially, but the price is only supposed to increase due to inflation – unlike ATTAINED AGE policies which would have increased in cost as we got older. Our agent indicated the break-even point should be around age 82 for us.
We get all of the thorough coverage of part F (or G), except that we first have to pay the standard deductible ($240 for 2024) and the Part A hospital deductible, if applicable, ($1,632.00 for 2024). Then we pay 20% of our greatly reduced medical bills (the amounts Medicare allows) until we reach our annual (high) deductible ($2800.00 for 2024). Any deductibles we’ve paid count toward this high annual deductible. Then every Medicare approved medical claim will be paid in full by the insurance company. We can chose where and with whom we get our medical care and we are fully covered throughout the United States.
In exchange for being willing to pay up to the annual high deductible, we have saved thousands of dollars compared to the premiums we would have paid for part F or G plans. They were about $200 a month at the time we enrolled – or about $2,400 annually for each of us. I’m confident these premiums would have increased over the past six years, too.
Our HD part F policies cost $588.60 each the first year. Then our premiums changed as follows: $500.40, $450.00, $450.00, $459.00, $459.00 and $518.40 in 2024. Yes, we are each still paying less than our initial premium amount – still under $50 a month.
Initially our standard deductible was $183.00, the hospital deductible was $1,340.00 and our annual (high) deductible was $2,240.00. Every deductible increases every year, but the deductible amounts are set by Medicare, not our insurance company.
I had known medical expenses when I purchased my policy. I would have annual doctor visits to a specialist that always billed around $500. My insurance always reduced the amount paid to about $300 by them and $40 by me. With Medicare, my final cost has always been under $100 – all paid by me, but applying toward my standard deductible. So I discovered the first year that my medical bills with my HD plan F weren’t going to cost me as much as I had expected!
We have had three unexpected surgeries between us, but have only reached our high deductible amount once. We have still saved thousands of dollars.
It is my understanding that this high deductible option is not available in all states. We live in Iowa. At the time we purchased our policies, only three insurance companies offered it. A friend lives in Colorado. A couple of years ago I was able to help her find a HD policy. If I’m remembering correctly, she had more than three options.
I would definitely recommend that you consider a high deductible part G Medicare supplement if it is available in your state – especially during your initial open enrollment period! If you know you will have high annual medical bills, it might not be the best option for you. A little number crunching should help you make that determination.
Thanks for the suggestion!
A caveat – You are married to your Medicare supplement plan. While this is a low premium dollar choice, you want to select a plan that has the lowest cost for your health. So what happens if your health changes in the future? While it is possible to change from a high deductible plan to something else, you will be subject to medical underwriting and you might not qualify for another plan. That would leave you with a larger portion of your medical costs.
A high deductible supplement works well for someone that expects to stay in good health with low medical expenses. Also, if you have an HSA from your working years and have invested those funds to create a nice balance, a high deductible plan may be a good choice.
You are not married to your plan in NY and a couple of other states. You can switch plans without medical underwriting and no difference in premium then if it had been your original plan. Very few people are aware of this.
Medicare A – covers hospitalization (premium, if you have one, comes out of your social security – most people do not)
Medicare B – covers doctors offices and some other stuff (premium comes out of your social security)
For the A & B if you are signed up for them but not yet choosing to take social security you pay these premiums online at medicare.gov paying 3 months at a time, or you can pay by mail.
Medicare supplement (also called gap plans) – cover a percentage or all of Medicare A deductibles and Medicare B copays (except for a deductible –
Medicare F covered that but you can’t enroll in that anymore). Be aware that you have to get your vaccinations at a pharmacy as those aren’t covered in the doctor’s office. You can only change this after the original sign up period if you pass medical underwriting or if you live in a few states and at times, if you move to a different state. Premium is paid directly to the company. The medical coverage has to meet certain minimum standards that are identical for each alphabet letter. Different plans might have “add ons” that they are not required to otherwise have.
Medicare D – drugs (you can change that yearly during the enrollment period). Premium can be paid directly to the company or come out of your social security.
Medicare Advantage plans – you also need to buy Medicare B, most are only good in a limited geographical area.
If you also qualify for Medicaid or Medicaid premium assistance this can change your decision making. MAKE SURE you understand those rules completely. Your state’s SHIP office can give you advice. This is free.
YOU DO NOT NEED TO DEAL WITH AN AGENT (who gets a commission which may influence their advice) to sign up for a plan. You can do it yourself for free as well on line or over the phone with the company you choose. Agents may or may not volunteer information that you don’t know enough to ask about. Your state SHIP office (Senior Health Insurance Information Program) has no financial conflict of interest but just like anywhere else the quality of information you get depends on the knowledge of the person helping you.
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MEDICARE PLANS – MEDIGAP (you also need Medicare B to get these)
Medigap plans have one of 3 insurance risk pools which will substantially affect your premiums when you are older. Plus, unless you live in just a couple of states, you are trapped for life (unless you move out of state and your gap plan isn’t offered there by that company) in your choice if you fail medical underwriting. You may pass it now but may not in the future. Medical expenses usually go up as you age due to the odds of having more things wrong with you the older you get.
1) Age attained. This means that everyone in that premium pool is the same age. This gets the most expensive as you age.
2) Age signed up. This means usually you are in a risk pool of people in around a 5 year age range (as many people who work have health insurance that continues until they retire and may not retire until 70+). This spreads the risk a bit and means premiums are likely to be a tiny bit lower #1 as you age.
3) Community risk pool. Everyone of all ages is in the same risk pool. Usually you get your premiums subsidized by a declining subsidy by the company the first 5ish years so the rates are competitive with #1 and #2 above but then as you age these rates are far lower than #1 and #2 above because the pool members are not all close in age.
Watch out for the “extras”. For example AARP United Health Care, until recently offered only one version of each alphabet letter. These had a “free” fitness club membership for many fitness clubs. Now they offer a version by a subsidiary (so technically considered a “different” company so you can’t just switch unless you pass medical underwriting – more on that in a minute) that doesn’t include those “extras. At my age, 70, it is $69.98 cheaper so that “free” fitness isn’t actually free. Because I fail medical underwriting I can’t switch unless I am willing to pay up to 3 times the “regular” premium which means staying in what I am in is cheaper. Some companies won’t let you get their plan at all if you fail medical underwriting, others charge you far more.
Medical underwriting – you have 3 mo before and 3 mo after you turn 65 (or at whatever age you stop having “credible insurance” – WHICH WOULD NOT BE CORBRA!!!) to sign up or switch between plans without having medical underwriting be a consideration. After that then they can require you to pass medical underwriting. Remember that your medicare starts AT THE BEGINNING OF THE MONTH you turn 65 (or whatever age you are signing up – so COBRA ends the first day of that month – don’t be caught with no insurance that month). As an aside social security starts the month AFTER you choose to sign up. I waited until 70. My birthday was in October. My first check was then in November (and to make that worse I didn’t know that, had not planned for that, and I am one of the get your money the 3rd Wednesday of the month people)
Be sure you find out if your gap plan has one premium for the entire year or ups the cost twice a year. With some your renewal is the only time your premium goes up, others your premium goes up twice a year.
Medicare gap/supplement plans are required to pay their share if Medicare pays for their share so no arguing with the gap/supplement plan about coverage. You only have to argue with Medicare about denials.
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MEDICARE D
You sign up (and can switch between companies with no penalty) each fall during the usual sign up period (if you are just starting medicare then when you sign up for medicare deadlines apply – sigh up late and you pay a 10% penalty for life). The catch is that you have to know what your meds are in advance to find the cheapest plans. Opps if something bad happens and you need something not on the formulary or it is in an expensive tier. The different companies offering this can choose which drugs to cover and at which tier. As a result you have to check each company for each drug you are taking to see your cost (you can do that on the medicare.gov site where you type in your drugs and they figure it out for you for any plan available in your area without having to retype in your drugs). The big catch is that the companies are only required to keep those costs and tier the drugs are in for ONE MONTH. Then they can change that (that being said most do not do that with most drugs).
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MEDICARE ADVANTAGE PLANS – IF YOU DON’T ALSO HAVE MEDICAID
Be very, very careful with these. They can stab you in the back financially. Look carefully at the copays, out of pocket limits and deductible. Advertising tends to be deceptive and focuses on what they offer and not the “total” cost is if you need much care (due to copays, out of pocket…). Remember too that you have to factor medicare B premiums into this (they cover drugs so you don’t need Medicaid D – but again what is in the formulary varies between plans).
Usually the network is narrow within a geographical region and in many cases you can’t get care outside of that network or geographical region. Many hospital systems and doctor systems only accept a couple of medicare advantage plans. BE SURE YOUR DOCTORS AND PREFERRED HOSPITAL SYSTEM(S) ACCEPT THE PLAN YOU ARE CHOOSING. If they do not then you will be forced to change doctors and hospital system(s).
If you want to have a second opinion out of network good luck with that. If you want treated out of network (for example want to be treated for cancer at a top cancer center that isn’t where you live and/or doesn’t accept your advantage plan) good luck with that. As others have mentioned there are more problems with pre-approvals (although the government is trying to do something about that). Who and what is in network can change from year to year. make sure you understand the rules for switching in and out of advantage plans and the implications for medical underwriting (again there are several states where you can change each year without having to pass medical underwriting).
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FOR ALL PLANS
If your company no longer offers you plan in your area or drops the specific plan you have, then you can change plans without passing medical underwriting as long as you meet the deadlines. (There are a couple of other very rare reasons why you can change without having to pass medical underwriting). If you pass medical underwriting then you can switch once a year all you want (and in several states can switch without having to deal with medical underwriting regardess of whether or not you’d pass that but read those rules carefully).
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WHAT NO PLANS COVER – assisted living, nursing homes, long term in home aides (you can sometimes get short term with a doctor’s prescription) so be sure you have long term care insurance, also purchased separately at any age. Make sure you buy enough years. Once you go through all your assets (some special rules for spouses and a jointly owned home) then you can get Medicaid which covers nursing homes and aides but not assisted living. Also if you have to use Medicaid, after you die they can go after any assets you have left to pay for what you used which mean your heirs will inherit nothing. If you transfer your assets 5 years or less to your heirs before you get Medicaid then Medicaid can and will take them away from your heirs.
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IF YOU HAVE MEDICARE PLUS MEDICAID – that is usually what the zero premium advantage claims plans apply to (because medicaid subsidizes medicare B premiums, covers the copays, deductibles, etc.; you don’t need to buy D as drugs are covered depending on the individual plan forumlary). Generally you can’t use Medicaid out of state anyway so you need to think through if you want to be able to have Medicaid paying your premiums for regular Medicare B premium. so you can have the larger Medicare network in your entire state (and be treated out of state without Medicaid covering what Medicare B does not) or whether you will sign up for an Advantage plan that has the “extras” but a significantly more limited network.
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NON-MEDICARE COVERED ITEMS WITH TRADITIONAL MEDICARE VS COVERED WITH ADVANTAGE PLANS – as you are figuring in costs look to see what vision and dental insurance will cost and factor that into your choices and total financial costs. Also it may be worth joining COSTCO, SAMS CLUB, etc for their cheaper glasses, hearing aids, etc. Factor that into that cost. MAKE SUIRE YOU KNOW THE ADVANTAGE PLAN FINANCIAL LIMITS FOR THESE EXTRAS.
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BEWARE – Because these decisions can be one and done AND THEN OFTEN YOU ARE TRAPPED FOR LIFE after the initial change period (with the exception of several states as mentioned earlier), spend the time to carefully compare all choices, alternatives, your current health and potential future health, health of family members and those in the generations above you, longevity, how much you have for retirement beyond social security (thus how much medical financial risk you can take for medical), the quality of local health care and need to go out of state or out of network for the best care, etc.
Start far enough in advance of when you are required by law to sign up that you have time to figure this out, get help to figure this out, etc. if this seems overwhelming. Read the fine print. Sign up on time. For example if you don’t with Medicare D you pay a 10% penalty for life. If you don’t with a gap plan you may be forced to pass medical underwriting, etc. to either sign up or if a plan lets you sign up you may pay far more.
Make sure, if you forget to pay bills on time on occasion, that you set yourself for auto debit because if you lose your medigap for failure to pay your premium and then you may find you have to pass medical underwriting to get it back. The “grace period” all plans you pay for is short.
Some states require complaints against medical insurance companies to be reported and they then post the percent of complaints. Google for those.
Again your state’s Senior Health Insurance Information Program (SHIP) can help answer questions and they don’t have any financial conflict of interest in whatever decision you make. They can also tell you about the Medicaid financial assistance plans for premiums and or having outright Medicare and Medicaid. If you qualify for both make sure you apply for SNAP (food stamps) as likely you can qualify for that too (the amount you get depends on what SNAP figures your “net” income is – a percentage of your medical expenses, including mileage is subtracted from your income for the purposes of qualifying for SNAP and how much you can get).
Take the time to make a careful decision and start well in advance of when you have to sign up so you have the time to make a good decision. Sign up before the final deadline to do so as then you will have time to change your mind without having to pass medical underwriting.
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Disclaimer – I don’t sell insurance. I don’t volunteer for SHIP. I just did my own research prior to signing up for Medicare (and in my case G and D even though I was eligible to sign up for F – those premiums were going to skyrocket with no younger people in those plans which, as I have compared them, is what is happening. I signed up for a community risk pool medicare G gap plan, I have changed my D more than once as I check the prices yearly). I do have a PhD and taught management and health care administration so I am more used to researching what I need to know more about.
GOOD LUCK making the choices best for you and your circumstances.
Liz, I have to compliment you for offering such as thorough review of the many Medicare plans and choices. I would offer a further comment to your points about Medicare Advantage plans that may be helpful. Medicare Advantage plans are private insurance company plans that “wrap” their insurance coverage around the underlying medicare coverage. The result, as demonstrated in the many media advertisements, is enticing portrayals of relatively lower costs by limiting copays, deductibles and doctor visit costs. The question everyone should ask when reviewing any Advantage plan: what is the insurance company getting in return for offering lower costs? The answer in general terms is they control their expenses by denial of coverage for a wide variety of often medically necessary, but expensive, procedures. If you have a serious illness, the treatment for which would otherwise be covered under traditional medicare, you may find that treatment or specific procedure is denied for coverage. Given that insurance is (or should be viewed as) fundamentally about limiting major medical expenses which primarily arise from serious illness, this is a gamble. Using traditional medicare without an Advantage plan wrapping is for most people a better choice. No one wants to be confronted with a cancer treatment recommendation or need a specific type of heart surgery and the insurance company promptly denies coverage due to a host of legally permitted reasons (e.g., there is insufficient evidence that the procedure has shown (yet) benefit over a lower cost treatment)…
This statement is incorrect:
”If you have a serious illness, the treatment for which would otherwise be covered under traditional medicare, you may find that treatment or specific procedure is denied for coverage.”
I used to perform prior authorizations for a medical management company. If the patient meets Medicare criteria the insurance company is required to cover it per law. The problem is having to fight the insurance company while your health potentially deteriorates.
There have been more than a few HD forum and blog posts with tons of comments about this complex decision. All so valuable, especially your recent research/experience, Liz. My head started spinning at “trapped for life” and I realized for now it’s best if I just copy the links and some text from these advisory posts and go back to them early next spring four months before my 65th birthday when I will be really focused on the choice. I also now know about the SHIP advisors and certain helpful books.
When I used to wish for a simple “Medicare for All” solution for healthcare insurance, I didn’t picture for-profit UnitedHealthcare Advantage in the mix, underwriting vagaries, and yearly changes to D and G, along with the rest of the alphabet soup of options. As I said, setting this aside for now…
Liz, thank you very much. Very informative!
Glad you found it useful.
And the church said… AMEN.
Thanks.
My wife and I have had MA plan with UnitedHealth offered from our state group retirement. We changed residence out of state and had no medigap plan offered by our state retirement plan. Initially had no problem with obtaining physician coverage (learned quickly that ppo version was accepted widely but not the HMO version of the same company.). We were notified this summer that the hospital group and associated physicians would no longer accept our Medicare advantage plan. There are other hospitals in our county that still accept our current MA plan but for emergency care we likely would be transported to one that does not accept our MA plan. We are planning to change to medigap G with the next allowable coverage change and considering the high deductible option with G.
I have read “Medicare for the Lazy Man” – Doug Jones. Interesting information. He also offers to broker policies.
Have they definitively failed to reach agreement? UH had that issue with one of the university hospital chains in my area earlier this year but reached agreement just ahead of the deadline. Now they are in dispute with the other but I expect the same outcome.
However, I would recommend Plan G, provided you can both pass underwriting.
We have received notification that there now has been an agreement. Not all of the sub specialists accept the coverage however. I had to find a separate ENT physician outside of the system for coverage last year. I understand advantage plans pay physicians at a poor rate and anticipate there will be fewer physicians accepting advantage plan coverage going forward. Therefore hope be able to change to medigap. My wife and I have few health issues so far.
UH is also quite expensive $586/ month covering both of us.
That is really, really expensive for a MA plan. Good luck with the change.
When wife and I started Medicare 18 months ago we did a ton of research. Medicare advantage looked be a great value if you don’t mind the guard rails that the plans have. A limited budget may mean that the low cost over rides having to deal with the guard rails. The risk is that the MA provider has more room to control where you go, who you see, and what you get.
We chose Medicare and G (specifically AARP/UHC G). We wanted health care coverage that was similar to what we had over our working careers.
Part D is a yearly choice. If you currently have limited prescription drug needs, get the cheapest plan available. Ours started off at $11/month each. This year that same plan dropped to $0.00/each. As your needs change upgrade to a better plan at the yearly anniversary.
I believe that sometimes you get what you pay for.
Mark, thank you. AARP & UHC G or N is what I am considering as well. How has been your experience so far?
In our state there are 2 variants of UHC (there is “UHC Insurance” with higher premium and there is “UHC Insurance of America” with a lower premium). I suspect this is “a version by a subsidiary” that Liz was referring to. I like this AARP UHC offering since they are the only company offering a “community” pricing. BUT UHC insurance of America has a “Company complaint Index” of 5.03 [The National Complaint Index is always 1.00. This means a company with a complaint index of 2.00 has a complaint index that is twice as high as expected in the market] per NAIC. Whereas UHC insurance’s complaint ratio is 0.54.
So the higher priced policy has a lower complaint score while the lower priced policy has 5.4x the index.
BTW I found this link to NAIC that seems to have lots of data on the insurance companies broadly, and more specifically on Medicare supplemental plans (and even more specific on the plans). In case any of you are interested
https://content.naic.org/cis_consumer_information.htm
I have been with Medical Advantage plans in California for almost 15 years. There are no premiums and I receive free dental exams, eye exam, and prescriptions. I also got a $200 credit when I ordered eyeglasses at Costco! This past January, my wife and I decided to switch to Medicare and a Medi-Gap Plan G. Cost for both of us about $500/month (I am 79 and she 76). With Medicare, no free dental exams or eye exams, and prescription coverage only by buying Part D. Once we switched to Medicare, we went to a primary Medicare doctor who was highly recommended but was terrible to work with. I won’t go into details. Back we went to Medical Advantage after 1 month. I don’t see why so many are against Medicare Advantage…less cost, doctors on the payroll, free extras and a company to call when advice is needed. Am I missing something? I read that over 50% of those 65 or over are using Medical Advantage?
“People on Medicare Advantage swear by their plan when they buy it, and swear at their plan when they need it.”
Denial of prior authorization requests is the biggest reason to avoid Advantage plans, as KFF explained in this article last month. And denials continue to grow as a percentage of claims over the past several years, which means the situation will likely only get worse in future years.
Another reason is the increasingly limited network of physicians and facilities in most HMO Advantage plans, especially in rural areas.
And the final reason is that you will likely have much higher out-of-pocket costs under Advantage if/when you eventually get sick, than you would have had under a Medigap plan. So yes, you may save money in the early years while you are relatively healthy, but it gets considerably expensive on Advantage when you get sick.
Those three reasons, in that order of priority for me, are why I do not recommend Advantage to anyone other than those who simply cannot afford the $130 – $200 monthly premiums needed to purchase a Part B Medigap policy plus a Part D prescription drug plan.
Also, don’t forget that agents receive considerably higher first-year and renewal commissions on Advantage plans than from Medigap plans ($626/$313 Advantage vs. 22%/11% Medigap, first year/renewal).
I live in the armpit of the nation and we are consistently the worst in the nation for health care. I have had to get second opinions at MD Anderson Cancer Center and the Cleveland Clinic (both out of state, the first 8.5 hours from where I live and the second is in the same are my family lives where I grew up) and in ALL cases locally they were wrong and/or didn’t even know about the most recent chemo/treatment choices.
I think it depends on where you live and who accepts your advantage plan for what makes the best choice. With an Advantage plan in my state I’d be limited to care in 4 counties (includes the state’s capital with a low ranked university medical center, joint commission D rated) and that means I’d not get even close to good care. People don’t live as long in this state for good reasons, not all of them related to failure to expand medicaid.
Others have pointed some my points (below) out already but here are $0.02, FWIW (keep in mind that I am eligible for Medicare early next year, so most I have below is based on reading and/or talking to folks who are in Medicare)
The government gives the medicare advantage plans more money than they allocate otherwise per person for medicare A. That accounts for some of the “extra money” BUT as for profit companies expect to have money for their shareholders they have to “save” money somewhere so they can make a “decent” profit so their stockholders are happy. That “somewhere” can affect your care. Research documents that it is routine for MA plans to reject, for example, residential rehabilitation after major surgery and instead send you just to physical therapy and if you are lucky have an aide come a couple hours a week to help out (so you better not be living alone). There is a lot of “noise” about the rate of treatment plans, referrals, etc. rejected and the time it takes to appeal it, what they force people to do first before they will finally approve it, etc. which does compromise care. Whether or not that will be fixed is unknown. With gap plans if Medicare pays for it then the gap plan is required by law to pay their part.
I think Medicare Advantage works better in major metropolitan areas where there is a large population and a large medical community as I assume most providers are in network due to the large population of patients who have Advantage plans. But I do not think they work as well more rural areas where you would have to travel long distances to see specialists for diagnoses such as cancer.
+1
I started with Original and now I use MA. I live in a major metro. My numbers show I would save about thousands annually.
It’s not easy for most to find a great MA. I started looking for one that have all my MDs. Only 2 out of 60+ had it. Only one had $25 for a specialist MD visit.
The max out of pocket is $5000 per year. It covers all the major hospitals in my area, most of the MDs, at least all the one I want and even new MDs I visited this year under the PPO.
Aetna Signature PPO
Monthly premium: Instead of $155+15 =$170, it is zero = rounding $2000. BTW the $170 was $150 the year before under original. I asked couple of friends in their 70 and it’s about $250.
Primary PCP=MD(actually it’s per a group of MDs) = 0…Specialist=$25 (all my MDs and others are there + all doc in the box). Original has $240 deductible, I don’t. This means up to 10 specialists I’m ahead.
Prescriptions Tier 1-2 = no deductible. I have one prescription tier 3. Under Original I paid $1800, so far I paid zero in advantage.
Dental: preventive and comprehensive $2200 to any Dentist, including out-of-network, no deductible.
Vision: free eye check + $260 for glasses = $330-350. Already used it.
Extra Supports Wallet amount + High‑Value Provider Bonus ‑ additional $90 quarterly = $360 annually (you get a card). Already got the debit card and it’s working. On the same card above more for food + utilities = $90 per quarter = $360 annually. Together, it’s $720
Silver sneakers=free membership to LA Fitness = 35 *12 = $420
Fitness reimbursement (camping, rowing, running equipment + classes) = $600. Already bought shoes and other stuff I buy every year.
Hearing aid = $500
Transportation+ meals = Several told me they used it for surgeries and after that. My friends used that when they went for a surgery.
2000(premium)+1800(prescription)+2000(dentist)+350(eye)+720(wallet support)+360(LA fitness)+600(health equipment) about $7800.
Aetna encouraged me to let a doctor visit me at home and check my total wellness. I got another $50. Months later, when I did my annual checkup, I got another $100.
Customer service is amazing. Not all MA are equal.
What did I spend so far: I saw 7 specialists (usually I see only 2-3) = $175. I thought something was wrong with my heart and I did 2 days of intensive checkups (Nuclear + stress + Ultrasound). I had to pay $225 out of pocket.
I also asked several friends who had all kinds of surgeries, and the highest they paid was $1000 for 2. I also contact a broker that sells that plan. He has had close to 950 on this plan for years and told me that the highest out of pocket in over 10 years was about $2000.
After lots of calculations, I decided it’s too good not to join a good MA. Remember, everything I have done for decades is based on real numbers, never emotions. I can easily pay the $5000. Just premioum and prescriptions were about $3800. Most don’t have a Tier 3 prescription, but it’s another proof that MAs are not all equal.
Suppose you are lucky and have only Tier 1+2. premium+prescriptions premiums = $2300 and another $100-200 for the prescription drug co-pay = $2500.
You said, “The max out of pocket is $5000 per year.”. IF you hit that max you may well be spending more than Medicare B+G as B if you have G only has a $240 out of pocket. Depending on the state of your vision, hearing and teeth, you may still spend less. Medicare D in 2025 will have a $2000 max out of pocket.
As you point out the math varies by person and what you need. The big catch is medical underwriting for switching back and forth (outside of the limited switching that is allowed by law between MAs and gap).
It was Aetna who balked at paying for the MRI I required to verify the extent of my cancer, then not only refused to pay but did so by ignoring my appeal completely. Fortunately I was in the free look window and could change to traditional medicare with a high deductible plan G supplement (medigap.)
My biggest loss was the humiliation of realizing I had made a bad decision. I look at the $600 I paid for that MRI they wouldn’t authorize (at their in-network inferior provider with older machines, so I ended up redoing it 6 weeks later) as a very cheap price for avoiding a lifetime of regret.
Tom,
I agree with you. We’ve used MA for almost a year and we are glad with the choice we made
Yes, I believe you are missing something. In a nutshell Medicare Advantage plans generally require preauthorization and while some will be much better than others, the cost savings usually comes with some significant disadvantages if you get really sick and want anything other than the care that they’re willing to provide. Here’s a link to recent Humble Dollar article (and resulting comments) that do a good job expanding on what I just said: What Advantage? – HumbleDollar On a personal note, with traditional Medicare and a supplement I was recently able to go out of state to a recognized cancer center of excellence and get a test not available in my town of 3 million people. I then chose to have the treatment at that same cancer center of excellence (Mayo Phoenix). No referrals, preauthorizations, nor explanations needed. I got to choose the cancer center of excellence, the treatment plan, and the doctor I wanted to do my surgery. That autonomy was priceless to me.
I think having a Plan G without a large deductible and copays would facilitate your ability to go out of state for treatment for an extended time as you have the peace of mind that you won’t face a large medical bill when you get home.
Generally MA is more restrictive on access and most follow an HMO model with limited providers and pre authorization and necessity review.. People in California are used to that model since it is where the concept started with Kaiser.
However, if you are willing to accept all that it can be a good deal. I’ll stick with Plan G though. I like the open access even at a higher cost.
My wife and I went to a well respected company (and a friend of ours) in our town that recommends (sells) different Medicare plans. When we sat down I slid our packet containing our SERS school retirement Medicare Advantage advantage plan towards him. He slid it back and said “Take it”. I asked him if there was anything he’d like to show us and he said “No. Anything I have for that price would give you have the coverage and any coverage I can offer you would cost twice as much”.
Am I missing something?
My wife is a retired teacher with the state. We will have the option of a Medicare Advantage plan. I was originally reluctant because of all the cons that folks attribute to these types of plans. However, I think a state MA plan can be a hybrid that can have some of the features of the health plan you had before retirement. It even conforms to Part D coverage so no extra cost for that. This is in contrast to the Old-Celebrity-TV-advertised plan that is wrought with loopholes. The two plans have the same name of Medicare Advantage but seem to be in different categories. But, to be even-handed, we are healthy, live in a city, and take no medications at this time, so that gives it our customized preference.
If it’s issued by the state it’s probably a good deal. However, the problem with MA plans is that they aren’t static. The premiums may go up, the coverage may go down, the doctors that are in-network this year may be out next year – or next month. If you want to switch to Medigap later you may fail underwriting.
If price is your only concern, take it. Is it subsidized by the school system? If you are concerned about deductibles, co- pays and most importantly look closely at your access to any physician and health care facility you do or may wish to use, most MA plans restrict access to their network. It’s potential total cost that matters, not just premiums.
Like many on HD, we opted for Traditional Medicare Plus Part D and a G plan Medigap Policy.
So far we have had ZERO Issues with getting Medical Care using Medicare & our Med Sup.
My Part D provider is also pretty decent, but they aren’t as efficient with their EOBs as I am use too. I am currently in the Donut Hole and I am looking forward to that aspect of Part D eventually being rectified. It is true a PITA.
I also have nothing but positives to say about Boomer Benefits.
Neither Medicare nor supplemental plans have anything to do with obtaining medical care.
However with Medicare Advantage plans they do. I think that was the (unstated) comparison the commenter was making.
Can doctors choose not to participate in Medicare?
Yes. Most do participate, although some don’t “accept assignment”, meaning you can be required to pay up to 15% over the Medicare approved amount. Some Medigap plans cover the 15% and some do not. The practice I was with when I went on Medicare did not accept assignment.
Medicare can be complicated, but don’t overthink it. Stick with Medigap from a well known carrier. Compare premiums for the same plan.
Compare the likely out of pocket risk in a year among the plans you are considering with the fixed premium differences.
Your greatest risk annual cost risk as I mentioned may be Part D.
I volunteer with the Senior Health Insurance Information Program in Iowa, and we are provided with information that goes beyond what you find on Medicare.gov and provides the loss ratio and rate increases for the last several years as well as the company market share. This information can tell you if you should expect large rate increases or if the company has an incentive to stop doing business in your state. Contact your state department of insurance to access the SHIP program in your state. It’s free.
When you buy a Medicare Supplement, you are paying for the price, service, and reputation of the company, since the plan will be the same.
Also remember, if you are new to Medicare, you have a guaranteed issue opportunity. If you want to change companies next year, you will be subject to medical underwriting and you may have limited choices as a result.
Mark, thank you. Where can one get this info on “loss ratio and rate increases” for a given insurance company?
Unfortunately, I am not aware of a publicly available source for this information. I would suggest calling the Department of Insurance in your state and asking if they can help.
Mark, thanks to you and few others for suggesting reaching out to our State SHIP, I managed to get the pertinent data.
I am guessing a higher MLR – “medical loss ratio” indicates that “premium dollars that a health plan spends on medical claims and quality improvements, versus administrative costs” is a good thing? I also see 2 measures, one at the national level and one at the state level. One of the plans, for example, “Farm Bureau Health Plans – Member’S Health Insurance Company” has MLR of 96.7% at the national level and 56.29% at the state level. Do I then read this as, the state overhead is much higher than the national level?
Thanks!
Great information Mark, thanks. I’ve considered volunteering for SHIP as an addition to VITA tax prep. Would you be willing to share some info on what it is like, hours worked, challenges, etc.
Thanks, Rick.
Like VITA, training is a major time commitment. Initially, we had an online program of 6, 4 hour sessions held once a week. That is held alongside a weekly mentoring session with another volunteer putting the learning into play with real clients. Once you are certified to “solo” there is an annual training session for the new year. Also, when issues appear, such as a major carrier dropping entire counties from the network, there will be additional information. During open enrollment, I volunteer 2 days a week and can fill each day with appointments. The rest of the year I spend an afternoon each week with 1 or 2 people to help.
Time with clients is quite varied. A typical session takes about an hour, followed by 15 minutes or so of documentation. During Open enrollment, you can be busy as you choose. Most of this is helping people re-evaluate their Medicare Part D coverage, but there are also those new to Medicare, those with problems interacting between Medicare and Medicaid, and random questions. Helping those new to Medicare or confused by TV ads are probably the most rewarding.
The first challenge is ensuring people understand Medicare. Remember it was modeled after the old indemnity plans of the 1960’s and nothing like insurance for those under 65 today. Combine that with the choices of traditional Medicare versus a Medicare Advantage plan and you find the challenge is to help the client climb the learning curve.
Another challenge is helping clients through the maze of insurance companies, government agencies (both state and federal,) and their medical providers. The learning curve never ends.
Hi Mark and Rick, I, too, volunteer for the national SHIP program in my state (KS, known as Shick). I have enjoyed volunteering. Not sure of the VITA tax prep training, but our training was extensive: first online, then passing a test and criminal background check, then all day training (virtual or in person) plus yearly all-day update trainings. There is so much to absorb about Medicare that at first it is daunting. But there are excellent training sessions and in my case, terrific fellow volunteers who share their insights. So many nuances in individual situations. I think having a financial perspective helps, too – not that we offer financial advice, but we can explain consequences.
For example, one friend was retiring and her advisor told her to withdraw a chunk of funds for a new car. But the advisor didn’t mention that ‘a chunk of funds’ would increase her income/AGI and in two years she and her husband could both be subject to an income adjustment on Medicare Part B premiums. She was not a happy camper.
THere are calls to handle throughout the year. Those turning 65 or new to Medicare take more time whether in person, Zoom calls or group presentations. I am still seeking the holy grail of how to visually depict the choices in Medicare to mitigate the confusion. The busy season is the annual open enrollment. We are gearing up for a very busy time with expected changes in prescription drug pricing (Part D) and some Medicare Advantage changes. Some insurers are exiting the market; nearly all MA will be making changes due to financial pressures.
With the 2 years later medicare premium B increase, depending on what is going on, they can file a change of circumstances to lower that. Another group affected is those whose student loans are written of. They get a 1099-C and that is considered ordinary income which is taxable and as such as would affect Medicare B premiums 2 years later.
I would love to see that info as well. I am considering become a TAX Volunteer and I would love to help folks with Med Sup as well.
Rick is 100% correct. Selecting the “best for you” plan is a giant PITA, because it is so unnecessarily complicated. Especially Part D.
Mark’s advice is sound! Thanks Mark.
Whatever Medigap (supplement) insurance company you pick for your Medigap plan check to see how many “closed block of business / closed risk pool” (deadpool) policies the company has.
This is done because the current book of business have people who have become older and therefore have more illnesses meaning more claims (higher loss ratio). Insurance companies close that book and raise the rates to cover the increasing losses. Then, they open a new book with younger, healthier folks and charge a lower premium do to lower claims ratios. After a couple of years, rinse and repeat.
In most states you will be unable to change supplement insurance companies without medical underwriting. A few states have a birthday rules that allows you to change Medigap plans without medical underwriting around your birthday.
They also trap you (AAPR United Health Care did this a year ago) by having a separate legal entity open the new version of the plan so you have to pass legal underwriting to switch to it even if they don’t close the “old” one. In this case they opened one without the free “extras” which made it $70 cheaper (so not free). On the flip side at least their plans are community risk based and not age attained or age signed up. Those don’t need to close their plans as each risk group age or age range is a separate entity.
Thank you Paul, is this info publicly accessible – “closed block of business / closed risk pool” a given insurance company?
We have gone through this in the past year. Dick and Kathy gave excellent advice. We used a national broker, Boomer Benefits, to help learn about our choices and sign up. We ended up going with traditional Medicare and plans G and D. Many states also have programs called SHIP to help also. I am a cancer survivor so wanted the most comprehensive coverage I could get with the most choices in where I could go. Chris
In addition to the previous helpful comments you may want to look at the CMS publication if you have not already done so for a high level overview –
2024 Choosing a Medigap Policy:
A Guide to Health Insurance for People with Medicare
https://www.medicare.gov/publications/02110-medigap-guide-health-insurance.pdf
While my wife and I selected plan G, plan N was a close contender for the reasons described in the video in the following link and in Dan Malone’s reasoning in his below comment-
https://www.youtube.com/watch?v=GRLgcxTEKs4&ab_channel=IwasRetired%21
My expectation is that Plan G will be the plan that is most selected and thus will have the largest pool of insured individuals long term to average the future costs that premiums are based upon. I also selected the largest Medigap insurance carrier in my state even though they were not the lowest premium for similar reasons. I did not want to select a carrier that could some day decide to leave my state or to stop writing Medigap insurance when we are older and potentially unable to deal with the possible complexities of having to make a carrier change.
Best wishes for a smooth transition to Medicare.
Bill
Bill, thank you very much for the links and your thoughts. The YouTube link is very helpful!
An additional recent podcast regarding Medicare choices that may help-
https://friendstalkmoney.org/podcast/unlock-medicare-your-guide-to-open-enrollment-with-philip-moeller/
I bought and read the original book Mr. Moeller wrote, Get What’s Yours for Medicare, over six years ago which was helpful to me in making my initial decisions regarding Medicare insurance.
I think the podcast was a fair overview and I learned that on 10/8/2024 an updated and revised version of the book, Get What’s Yours for Medicare – Revised and Updated: Maximize Your Coverage, Minimize Your Costs, was published. I have just bought the Kindle version of the revised book and look forward to reading it.
I am in exactly the same position, starting Medicare early next year. Like Dick, I was planning on a Plan G Medigap policy, but recently decided to use Plan N. Why?
I am relatively healthy, so Plan N’s lower premiums should allow overall lower annual expenses than Plan G’s higher premiums. And even if something significant happens to my health, the copays necessary on Plan N are not high enough ($20 office visit; $50 ER) to create an issue or bust our budget. And I happen to believe that patients who must pay a copay tend to be more careful in their healthcare usage, which is a plus for Plan N patients as a group.
The bigger reason is that Plan N is not guaranteed issue, while Plan G is. What’s the upshot of this difference? Start this video at minute 7:24 to learn what Federal Guarantee Issue is, how Plan N is not one of the plans that is guarantee issue, and what difference that can make in your future premium increases: https://www.youtube.com/watch?v=SP2JABN8RL8&t=1s
Very few people are able to use a guaranteed issue right, other than when they first sign up. The increase in people opting for Plan G rather than Plan N was due to the closure of Plan F, not to guaranteed issue. Also, the more people in the plan the better. A problem for those in Plan F, now closed to new enrollees, is that the pool of insureds is getting older and sicker and therefore their rates go up. That’s why those who could pass underwriting switched to Plan G. If people opt for Plan N because they are not subject to underwriting, that pool will be sicker, too.
Kathy, I believe you misunderstood what I wrote, or have not been able to watch the Abt video link I included yet.
The issue is not that Plan N isn’t subject to underwriting; in fact, it is just the opposite. Because Plan N is not subject to the guaranteed plan issue rules, Plan N is not required to take the “sicker pool” that you refer to. Plan G, and the other guaranteed issue plans, do have to take the “sicker pool.”
If you watch the video, I think you may better understand this issue.
I did watch it. I am pointing out that guaranteed issue, after the initial sign up period which applies to all plans, applies to very, very few people. You can read the list of circumstances on the medicare.gov website.
BTW I just saw few of her video’s (including the one you suggested above). She does a great job explaining, what is arguably a complicated topic. Thank you for sharing this link
Stephanie Abt is the best Medicare communicator online. Accurate and concise, she adds insights and details — like Plan N not having Federal Guaranteed Issue Rights like Plan G — that Medicare books and most online Medicare agents do not mention. (I listened to a couple of dozen online Medicare agents, none of whom matched Stephanie).
Boomer Benefits is a very good service. However, when I pointed out to the Boomer Benefits agent assigned to me about the effect of Plan N not having guaranteed issue rights, his reply was, “You’re right. I never thought about that.”
Stephanie also evaluates Plan G-High Deductible (Plan G-HD), which carries the lowest premium of all Medigap plans. If you are willing to accept the risk — fairly minimal really — to spend up to your deductible amount in years when your health expenses tend higher, Plan G-HD can be a terrific option. If you are in bad health, have cancer, etc., or otherwise expect to incur medical expenses in excess of the Plan G-HD deductible amount on a regular basis, it would obviously not be a good choice for your circumstances.
Plus, any agent willing to tout benefits of Plan N or Plan – both of which have lower monthly premiums and therefore result in lower agent commissions — scores high in integrity.
I wish Stephanie wrote a Medicare column for HumbleDollar. She’s analytical, has integrity, and considers all the angles!
Of course the big problem is that we don’t have a crystal ball to see what we will need in 20 years… and likely fail medical underwriting if we don’t fail it already. That is one of the problems with making your decisions based on your health today. People need to look at family health, longevity, etc. going back as many generations as they can to have some sense about what is going likely going to happen as they age.
Do you pay the commission as part of your monthly premium. If so why not just do your own reasearch (as I did), as you apparently are and save money?
Hi David,
If you know how to save the agent’s commission please let us know.
My understanding is that almost all Medigap companies sell through agents, with the commission “baked in” to the premium. So even if I purchased directly from these companies, I would still pay the same price as what I would pay using an agent.
The exception, in my state at least, are policies marketed on Medicare.gov as “direct” plans — meaning they are sold directly to the insureds without going through agents. Unfortunately, in my state those policies are not priced attractively — or at least not right now.
Thank you Dan, that’s one more nuance that I just learnt. My state also appears to have 2 companies that are “direct to consumer” and both are slightly higher than the AARP UHC plan.
UHC is “community price” and is $126 whereas Transamerica (issue age) and Globe Life and Accident (attained age) are both offered direct and charge $158 & $179 respectively.
These are for plan G.
I believe all the brokers get paid by the insurance companies. I don’t think this is transparent to the consumer. We can certainly try and do this on our own but given all the nuances and if we get this wrong, then sounds like we are stuck with the plan for a while. I haven’t spoken to any brokers yet but I am planning to.
Brokers are paid by the insurance company, meaning they will likely steer you to the company paying them the most.
You sign up for Medicare Advantage plans annually, you can switch Medigap plans at any time, provided you can pass underwriting.
Dan, thank you very much. I have narrowed down to these 4, D, G, M, N and am evaluating them. I too liked M & N (M of course has the trade off 50% part A deductible and N as you point out required co-payments for office visits and ER).
IMO Medigap Plan G is the way to go. I have had it for four years. Never paid more out of pocket than the Part B deductible. Never a denied or questioned claim.
In most states Medigap is regulated by insurance commissions and most approve their premiums. Some states add underwriting requirements that add costs.
I can’t think of why anyone would take any premium that varies from the average. There are reasons – probably not good ones – for very high or low outliers.
There are different ways to set premiums such as community rating and age entry meaning you pay more the older you are when you enroll with carrier. You need to check the plan.
Costs vary by location. Overall around $200 +- is typical. $90 is very low. The variable can be caused by internal factors with the insurer. Perhaps they mispriced in a previous year, had a bad experience year and need to make up the losses.
If you take prescription medication making that choice for Part D is where to focus research. That can be complicated and depends greatly on the Rxs you take and the plan design regarding formulary for brand, and generic drugs.
Dick, thank you. After reading your comments, I went back and reread the page. Looks like the “pricing” part has 3 categories,
Quick glance tells me that all of the lower priced plans #2, where the premiums go up as one gets older.
Once you enroll with an insurer (say for Plan G), do folks typically stick with them the whole time? Or switch to a different insurer but within Plan G?
It can get complicated. Here are the rules from Medicare. https://www.medicare.gov/health-drug-plans/medigap/ready-to-buy/change-policies
Thank you
In most states if you want to switch you will be subject to medical underwriting and can be refused. You are only protected during the initial sign up period and a few very specific circumstances. I would recommend going with Community Pricing – you’re lucky to have that option.
Agree with reading “Medicare for Dummies”. See my previous articles on Medicare and Part D. Note that next year your out of pocket costs for drugs will be capped at $2,000.
Kathy, thank you for your insights. I parsed the data and it turns out that just 1 company is offering “Community Pricing” and 4 plans. 2 with no “room mate discount” and 2 with. And one of them is “standard” and the other is “Level 2”. And the level 2 plans are significantly (high 400’s per month) higher than standard (mid 100’s).
Insurance Company Pricing Type
AARP – UnitedHealthcare Insurance Company of America (Standard) Community Pricing
AARP – UnitedHealthcare Insurance Company (Standard) Community Pricing
AARP – UnitedHealthcare Insurance Company of America (Level 2) Community Pricing
AARP – UnitedHealthcare Insurance Company (Level 2) Community Pricing
Level 2 is for people who fail underwriting.
Ah thank you, that explains a lot. AARP – UHC is the only offering this “level 2” plans. And just one company offering “community” and one offerting “Issue age”
AARP – UnitedHealthcare Insurance Company of America (Standard) Community Pricing
AARP – UnitedHealthcare Insurance Company (Standard) Community Pricing
Transamerica Life Insurance Company (Direct) Issue Age Pricing
Per federal law you can switch plans from a supplement to Advantage or vice versa within the first year without underwriting. You can also switch from a supplement to an Advantage plan at any time if an Advantage plan that is rated five stars becomes available in your area. Don’t remember rules about possibly returning to original plan but it’s covered in Patrica Barry’s book. What my wife and I did since we are both healthy was begin with a five star rated Advantage plan. We took “Advantage” of the lack of premiums, dental, eye, and exercise equipment sections of the plan, then switched to a plan G supplement just before the year was up.
Right. The ability to switch to Medigap without underwriting the first year you are on an “Advantage” plan is one of those specific circumstances I mentioned. I, too, used that option last year after my former employer switched all of us to an “Advantage” plan.
The problem is not switching to an “Advantage” plan, it’s switching to and between Medigap plans. A few states, like California, make it easier but most don’t. I am putting quotes around advantage because in general the advantages accrue to the insurance company and not to the insured person.
I believe Massachusetts is another, and possibly Maine, which allow you to switch at any time, and underwriting is not allowed.
On the surface that sounds good, but not permitting underwriting simple drives up premiums to the extent it permits (encourages) adverse selection by people who failed to act at times allowed for enrollment and change.
Thank you
I don’t know the answer, but you are correct that all the plans under a letter have to meet the same coverage criteria. They may have different levels of customer service, but unfortunately Medicare does not rate supplement plans like the do Advantage plans.
One resource that I highly recommend when deciding what to do regarding Medicare signup is to read Patricia Barry’s book entitled Medicare for Dummies. She is considered one of the country’s experts on the subject. The book is clear, concise, and plainly written.
Good Luck!
David, thank you. Will look for this book.