IT PAYS TO KNOW - MEDICARE MEDIGAP PLANS
Recently I came upon an 86 year old beneficiary that was paying over $ 800 a month for her MediGAP plan. The beneficiary had had this plan since 1st signing up for this coverage along with Medicare Part A & B. Unreal, right - yes, but it could have been taken care of many years ago IF only the beneficiary was aware of the problem and the solution.
This beneficiary was still on one of the MediGAP plans that had been discontinued from new sales many years ago. So needless to say, those remaining in this plan were now older, most likely sicker and fewer in number. So, that is part 1 of the higher premiums.
The state where she lived had also passed some laws during past years concerning coverage under MediGAP plans - the state expanded the choices of MediGAP plans to those less than 65 years old and Medicare eligible because of a disability - this makes premiums higher in every plan affected because it is adding more risk to the insurer. So that’s part 2 of why there was some possible increase in premiums thru the years.
This state had also passed a “birthday rule” expanding the ability of beneficiary’s in the state to switch MediGAP plans WITHOUT underwriting. That’s part 3 of the increase in premiums since this too adds risk and cost to the insurers. But this is also the solution to this beneficiary and these astronomical premiums.
State law governs much of how MediGAP plans work - the Feds outline the benefits of each plan codified by law but state law governs other rules which they can make - like who is covered, choice of plans if under 65 and what stipulations are set into place for being able to switch a MediGAP plan.
The 86 year old beneficiary described above will exert her Medicare rights in her state and switch plans around her birthday in 2025 and will pick another one of equal or lesser value and thus cut a great deal off her monthly premiums.
PAYS TO KNOW - now who could have helped, when asked:
- a knowledgeable friend or family member
- a Medicare plan broker
- a SHIP volunteer or paid state worker
and none of these charge a fee to the beneficiary.