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Honored Social Butterfly

Changing AARP / UHC Supplemental (Medigap) Plans with No Underwriting

I understand from reading a few posters here that UHC allows people to switch their AARP /UHC supplemental plans without underwriting.  Is this correct?

 

I am asking because a friend of mine was trying to switch her mother from an old Plan I (this is an old plan, not offered since 2010) to a Plan N and they told her that IF the plan was not "modern" then there would be underwriting.

 

So I am just mentioning this here to see if anybody has had any experience with this because I know several others who are considering switching their AARP/UHC Plan F after 2020 if rates start to go up somewhat drastically or if they just want to change.  BUT IF this is the case about the underwriting, they may want to consider earlier.

 

?????????????????

It's Always Something . . . . Roseanna Roseannadanna
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I am 72 and currently have Anthem Plan F.  I want to switch to AARP/UHC Plan G.  When I fill out the application and start answering questions about eligibility I encountered the question quoted below,  Does anyone know what is significant about the dates?

 

"If you are currently enrolled in a Medicare supplement insurance plan and enrolling between October 22, 2021 through February 28, 2022 (for a plan effective date of November 1, 2021 through March 1, 2022), you may be guaranteed acceptance into any available AARP Medicare Supplement Plan (A, B, C, F, G, K, L or N). If this describes your situation, please answer "Yes" to the question below ("Do you have guaranteed issue rights"). Later in the application, please make sure you answer "Yes" to "Do you have another Medicare supplement policy in force?" You will be contacted later to provide proof of your current Medicare supplement coverage. This proof could include one of the following:

 

A recent letter or notice from your current insurer showing that you have the coverage.

A copy of your current Insurance ID Card.

A copy of your insurance policy page with your name and plan code."

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Bronze Conversationalist

@DavidG501020 the ability to move from one plan to another is, in some cases, state specific.

 

This link explains GI rights in general

https://www.medicare.gov/supplements-other-insurance/when-can-i-buy-medigap/guaranteed-issue-rights

 

In addition to the CMS rules, and state rules, occasionally carriers throw a party and will take anyone who can fog a mirror.

 

A few years ago BX and MOO did this for a short while and lost their shirts.


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Social Butterfly

.

What state do you live in?

 

Even though Medicare is a federal program, some states have their own unique rules and terms for Guaranteed issue Rights.

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California.

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Social Butterfly

.

  • “California – California Medigap rules abide by the birthday rule. The California birthday rule allows you to change policies within a 60-day window. The birthday rule begins 30 days before your birthday and ends 30 days after.”

To be safe contact the California Department of Aging for an unbiased, one-on-one, no cost counseling and assistance to you as a Medicare beneficiary.

 

If those dates you mentioned don’t link in some way to your birthday I don’t have any idea.

Contributor

Over a year ago, I spoke with a UHC rep who said that if someone had plan F and wanted to enroll in plan G, they'd be subjected to medical underwriting.  He also said that if UHC found this then necessitated a higher premium for the plan G (higher tier?), then that person would also then have a higher premium for their plan F should they decline the plan G.  

That doesn't make sense to me and I checked with our state insurance commission which seemed to agree with me.

Recently I spoke with a BCBS rep and asked a similar question and was told a different answer.  That person said that the beneficiary could decline the Plan G rate and continue with their Plan F (i.e. no increase in premium due to underwriting issues).

 

Anybody have any good info on this one?

 

 

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We just got off the phone with United Healthcare and was told the same thing.  Why medical underwriting is required does not seem to make sense.  We were told that we have 30 days to reject the plan G and cancel it and keep Plan F.

 

very confusing since the only difference between the two plans is payment of the Part B Deductible.

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Honored Social Butterfly


@bd77157315 wrote:

 

very confusing since the only difference between the two plans is payment of the Part B Deductible.


Are you switching insurers?  If so, that is another difference.

It's Always Something . . . . Roseanna Roseannadanna
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Glad to hear someone else heard same thing.  Especially since I was told something different a year ago.  I may call the Insurance Commission and see if I can get any add'l info on why the underwriting. 

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Honored Social Butterfly

@jo7269379, @bd77157315 

 

Medigap insurers have some leeway especially if they want to give a special deal to a selected group for a selected period of time.

 

Like the group of current Plan F owners who might have wanted to switch to Plan G since Plan F is being discontinued to new enrollees beginning January 2020,  - some of the insurers did that without underwriting for awhile; consider that the deal.  But they don't have to continue that especially if the (state) rules say that they can underwrite beneficiaries wanting to switch from one plan to another or sign up late; after their initial enrollment period.

 

Medicare.gov - When Can I Buy Medigap? 

 

Medicare.gov - Switching Medigap Policies 

 

You state may have some special buying / switching / underwriting rules or NOT -

many times you can just go on your states Dept on Insurance website and they may describe their Medigap policy.

 

 

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@jo7269379 UHC is changing their plan change / no underwriting rules on a state by state basis. What they do in GA may or may not be the same in OR.

 

The ability to change UHC plans without underwriting appears to be phasing out.

 

I would think that "peeking at your health records via an application" and deciding to change your rate on your EXISTING plan would not be allowed. I have never heard of a carrier doing that. If you qualify for a new plan then change. If you don't keep what you have.

 

Most (if not all) states prohibit an insurance carrier for singling  you out for a rate increase based on your claim or health history.

 

Each carrier has their own guidelines. What UHC does is not the same as Aetna, Blue or any other carrier.

 

UHC doesn't tell Blue what they are doing and vice versa.

 

Nor does Macy's tell Gimble's their trade secrets.


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Just spoke with rep at UHC who said that changing from F to G necessitates a new application and therefore medical underwriting.  Changing from F to N does not require a new application.  Once you complete application, this triggers the underwriting and after they approve and provide new rate, you can decline if you want to.  Medical underwriting does trigger a request for medical records from your Dr. though.

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Newbie

I just got off the phone with UHC and I switched from PLan F  to Plan G, in under 10 minutes. The agent asked my a  few questions, I did not have to complete any new forms. I just saved about $300, net of the $185 deductible. I am happy and it was a positive experience with UHC

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@susi1e wrote:

I just got off the phone with UHC and I switched from PLan F  to Plan G, in under 10 minutes. The agent asked my a  few questions, I did not have to complete any new forms. I just saved about $300, net of the $185 deductible. I am happy and it was a positive experience with UHC


You did go down a bit in plan coverage from Plan F to Plan G - and you stayed with the same insurer so they can actually check your claim history instantaneously. if need be - 

The situation would be totally different if you were changing insurers, as it is, you are still paying the premiums to the same entity.

BTW, the Part B deductible for 2020 is now $ 198

Long as you are happy . . .. .with the insurer, the plan and the (current) premium

 

It's Always Something . . . . Roseanna Roseannadanna
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What do you mean by the statement, 'you do go down a bit in coverage'?  The only difference between Plans F and G are that you have to pay the part B deductible with Plan G.  The schedule of benefits show no other differences.

 

Thanks.

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@bd77157315 wrote:

What do you mean by the statement, 'you do go down a bit in coverage'?  The only difference between Plans F and G are that you have to pay the part B deductible with Plan G.  The schedule of benefits show no other differences.

 

Thanks.


Adding more "skin to the game" is going down in coverage even if it is only paying the Part B deductible ( $ 198 in 2020) out of your own pocket.

 

According to Medicare (CMS) this small change in discontinuing Plan F beginning in 2020 for new enrollees and thus its 100% coverage for Part B coverage saves a bundle of Medicare bucks.  Reason being beneficiaries think twice about spending that deductible amount and the related healthcare - cause it comes out of their pocket.  Thus the logic of "skin in the game" - save health care dollars, by using their healthcare when they really do need it, as differing from want.

 

Under Plan F, there is no out of pocket for Part B services as long as you see a doc that accepts Medicare's assignment price. So some benficiaries could decide to self-refer themselves to various specialist if they want (notice I didn't say need).  They do not even need a referral from their primary care doc. even if their primary doc is well equipt to handle many, maybe most, of these situations.

 

Thus no new (regular) Plan F enrollees for 2020 - however, Plan F also offers a high-deductible plan and it is still available.  But  If you choose this option, this means you must pay for Medicare-covered costs up to the deductible amount of $2,300 before your Medigap plan pays anything.

 

Just little (control) things like that help to save health care $$$$.

 

 

 

 

It's Always Something . . . . Roseanna Roseannadanna
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I live in Missouri and it is Not a community rated state?

 

The respected resource link below may clear up some of the confusion on MediGap Plans:

 

www.kff.org/medicare/issue-brief/medigap-enrollment-and-consumer-protections-vary-across-states/

 

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Honored Social Butterfly


@JohnL900627 wrote:

I live in Missouri and it is Not a community rated state?

 

The respected resource link below may clear up some of the confusion on MediGap Plans:

 

www.kff.org/medicare/issue-brief/medigap-enrollment-and-consumer-protections-vary-across-states/

 


The AARP/United Heathcare Medigap plans are issued as GROUP coverage in most every state - that the reason why they are (most) all community rated.

In your state of Missouri - UHC issues NO individual Medigap plans - they all have to be the AARP/UHC brand and thus membership in AARP is required to participate in this group.

 

Ths is the Mo. Guide dated 09/2018.

 

https://insurance.mo.gov/seniors/documents/MedigapRateGuide_000.pdf

 

The KFF link which you provided also states this when talking about the rating methods:

 

The remaining 38 states and the District of Columbia do not require premiums to be community rated; therefore, Medigap premiums in these states may be subject to issue-age and attained-age rating systems, depending on state regulation. Medigap insurers are permitted to offer community rated policies in these states, but most do not.

 

 

It's Always Something . . . . Roseanna Roseannadanna
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Great clarification, Thanks. I might add for other readers that joining AARP is not at all expensive and has many other benefits.

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For readers: Here is an interesting market share breakdown of the top medicare supplement insurance providers:

 

  1. UnitedHealth Care — 34%
  2. Mutual of Omaha — 10%
  3. HSCS — 5%
  4. Anthem — 5%
  5. Aetna — 4%
  6. CNO Financial — 3%
  7. Cigna — 2%
  8. Humana Group — 2%
  9. BCBS of MA — 2%
  10. BCBS of MI Group — 1%
  11. Others — 32% (Comprises 4.06 million enrollees)

In my experience, which dates some 25 years from managing my parents as well as my own affairs, AARP/UHC has somewhat more expensive premiums, but they prevail in popularity because they pay right up to the end without all the arm wrestling and hoops that many of the other providers present with claims.

 

Bottom line: Don't just assume that all plan G plans for example are the same just because it looks that way on paper. Look at the satisfaction and complaint rankings that most states tabulate for providers within their states.

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@JohnL900627 wrote:

 

In my experience, which dates some 25 years from managing my parents as well as my own affairs, AARP/UHC has somewhat more expensive premiums, but they prevail in popularity because they pay right up to the end without all the arm wrestling and hoops that many of the other providers present with claims.

 

Bottom line: Don't just assume that all plan G plans for example are the same just because it looks that way on paper. Look at the satisfaction and complaint rankings that most states tabulate for providers within their states.

 

 


As mentioned in another reply, there is "NO ARM WRESTLING" when dealing with a Medigap carrier. They pay claims and pay on a timely basis. There is no second adjudication process. None.

 

Consumer complaints about Medigap almost always regard renewal rate increases. Not claims. Not provider acceptance.

 

Most of those complaints could have been avoided if the consumer had done proper research on something OTHER THAN a consumer forum. 

 

It is rare when consumers have something GOOD to say about a carrier but COMPLAINTS roll in like thunder


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Honored Social Butterfly


@JohnL900627 wrote:

For readers: Here is an interesting market share breakdown of the top medicare supplement insurance providers:

 

  1. UnitedHealth Care — 34%
  2. Mutual of Omaha — 10%
  3. HSCS — 5%
  4. Anthem — 5%
  5. Aetna — 4%
  6. CNO Financial — 3%
  7. Cigna — 2%
  8. Humana Group — 2%
  9. BCBS of MA — 2%
  10. BCBS of MI Group — 1%
  11. Others — 32% (Comprises 4.06 million enrollees)

In my experience, which dates some 25 years from managing my parents as well as my own affairs, AARP/UHC has somewhat more expensive premiums, but they prevail in popularity because they pay right up to the end without all the arm wrestling and hoops that many of the other providers present with claims.

 

Bottom line: Don't just assume that all plan G plans for example are the same just because it looks that way on paper. Look at the satisfaction and complaint rankings that most states tabulate for providers within their states.


Where did you get your data and how resent is it?

 

Your above statement is confusing - what a specific Medigap plan is suppose to pay is set in stone - there isn't a lot of leeway with the design - IF Medicare pays, they are suppose to pick up their part.

 

That is a far cry from the actual caliber of an insurance company - as we can see from all the different ones working in any field of insurance.

 

I find it hard to research on a mobile device, which I am on now, but I am pretty sure that CMS only gives Medigap plan insurers a specific amount of time to pay once Medicare pays and forwards the remaining claim to them.

 

Yes, everybody that is considering any sort of an Insurace product should make sure that the insurer is and stays on solid financial ground and works as agreed.

 

It's Always Something . . . . Roseanna Roseannadanna
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Providers have up to 12 months to file a claim with Medicare.

 

Patient see's provider.

 

Provider files with original Medicare.

 

Medicare adjudicates the claim and either approves or denies.

 

If approved, the claim is transmitted electronically via crossover to (most) Medigap carriers. Since the claim is pre-approved, there is no second guessing. No hassle. They pay their portion, usually in 5 business days or less once received from Medicare.

 

People who claim their doctor will not accept their Medigap plan, or say a particular supplement carrier does not pay claims, are most likely referring to an Advantage plan.

 

If Medicare denies the claim is never sent to the supplement carrier so nothing is paid by them either. The patient owes nothing unless they signed an Advance Beneficiary Notification form.

 

Quite often choosing a Medigap carrier is based on name recognition more than anything else. Rate stability over the long haul is a better criteria than picking a carrier because you know their name.


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Unlike most Medigap insurers, who set premiums based on your current age (attained-age rating) or your age when you first buy the policy (issue-age), AARP/UnitedHealthcare uses community rating in most states except very few like Florida.

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United Healthcare/AARP – Discount Program

 

    

  1. Age 65 and Older Only:

 

 

  1. Beneficiaries who are WITHIN 3 years of their 65th birthday (or within 3 years of their Medicare Part B start date, if later) will pay the Base Rate reduced by the *Early Enrollment Discount.

 

*The Early Enrollment Discount    -   The discount will be 30% at age 65, 27% at age 66, reducing by 3% after each 12 month period until the discount decreases to 0% when they will pay the Base Rate thereafter (e.g. 67-24%, 68-21%, 69-18%, 70-15%,

71-12%, 72-9%, 73-6%, 74-3%, 75-0%). 

 

  1. Rates for members who enroll MORE than 3 years AFTER their 65th birthday (or more than 3 years after their Medicare Part B start date, if later) will be based on their responses to underwriting questions.

                                                   

1)         Applicants who DO NOT have a serious health condition will receive the *Early Enrollment Discount as long as they enroll WITHIN 6 years after their 65th birthday (or within 6 years of their Medicare Part B start date, if later.)

                                                

2)         Applicants who DO NOT have a serious health condition and enroll MORE than 6 years after their 65th birthday (or more than 6 years after their Medicare Part B start date, if later) will pay the Tier 1 rates, (which are 10% higher than the Base Rates.)

                                                                          

3)         Applicants who are enrolling MORE than 3 years after their 65th birthday (or more than 3 years after their Medicare Part B start date, if later) whose responses indicate they HAVE a serious health condition will pay Tier 2 rates, (which are 50% higher than the Base Rates.)             

                    

 

  1. Guaranteed Issue Situations -  In Guaranteed Issue Situations:  1) companies cannot turn you down for Medigap Plans A, B, C, F, K or L  because of poor health, and 2) must cover all of your pre-existing conditions, and 3) can’t charge you more for the policy because of past or present health problems. (See Medicare Publication No. 02110, Choosing a Medigap Policy:  A Guide to Health Insurance for People with Medicare for a listing of the Guaranteed Issue Situations). 

 

 

Contact Company Directly For “YOUR” Premium Amount

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The 30% discount is not uniform across all states. I believe it only applies in community rated states.


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As evidenced by the other responses in this thread, there is no consensus. 

 

CMS (Medicare) has one set of rules. States are allowed flexibility to deviate from federal laws but only if their plans and rules are not more restrictive than federal guidelines. Some states have been granted the ability to design non-standardized Medigap plans.

 

CMS offers guidelines about when a carrier may NOT use underwriting to determine acceptance but is silent on deviations such as anniversary or birthday rules (which are state specific). Nor do federal guidelines apply to rate making.

 

UHC has for many years allowed changes from one plan to another without underwriting. This was a company practice, not contractual. I am not aware of any other carrier that has this feature.

 

Moving from one plan to another without underwriting allows the policyholder to "play the system" to their advantage. Carriers understand this adverse selection and make allowances for it in their pricing.

 

UHC also has more liberal underwriting than most carriers and is willing to issue a policy that would be denied by other carriers. There is also a price for this, considerably higher than "standard" rates if you go in this direction.

 

UHC has in fact decided to eliminate the seamless move from one plan to another in some states. They are also dropping Silver Sneakers in several states.

 

Neither of these "benefits" were contractual and could be modified or changed at any time.

 

Only one thing is true. You can change your Medicare supplement plan any time you want. Same carrier or different carrier. Same plan or different plan. But in most states underwriting may be required. There are no "one size fits all" rules or guidelines.

 

If you rely on an oral representation and don't verify it against the policy verbiage you may find yourself disappointed in the future. Oral advice by a carrier representative, someone at Medicare.gov, SHIP, and agent or the person who styles your hair is worthless unless that promise is backed up in writing by the carrier.

 

I visit a lot of consumer forums and most of what is considered advice by forum participants is incorrect, incomplete, confusing or all of the above.

 

Don't get me wrong. Occasionally there are some gems but most of the responses are questionable at best.

 

There are Medicare experts out there but they are hard to find. Consider yourself fortunate if you do stumble across a good one.

 

Don't just assume that because someone is a volunteer or is paid a salary that they are unbiased and knowledgeable. Likewise don't avoid advice from an agent because they are paid a commission. How someone is paid is not an issue. The only thing that matters is the advice is sound and you are allowed to make a decision without pressure to "act now".

 

Ask questions. Listen to the answers. Make notes. Whether you choose to buy direct from a carrier, through Medicare direct, from a volunteer or an agent. Trust but verify.

 

Approach this as if you are interviewing someone for a job. That job is to be your advisor, not just now but ongoing.

 

Good luck.

 

 


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Your points are informative and yes, all this is still confusing-we need a Bachelor's degree in understanding medicare which of course changes every year! But I will still opt for it as it is far better than any socialist medicare-for- all which will drive our doctors and healthcare professionals who are already seeking other more lucrative and less demanding ways to pursue their professions.

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All good info and advice. It is ashamed that healthcare has to be so complex in the USA.

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