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Re: FYI: 2020 Medicare Cost At A Glance

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Message 1 of 7

@GailL1 the answer to switching plans within the same carrier is . . . it depends.

 

As a general rule,  E of I (evidence of insurability) is required when changing plans. THIS ALSO APPLIES if you are with a subsidiary carrier and want to change to another subsidiary.

 

Omaha has 5 or 6 subsidiary carriers, Aetna 4 or 5. So if you wanted to switch from Omaha1 to Omaha2 E of I required.

 

Exceptions include:

You live in a state with birthday or anniversary rules

You live in a state where underwriting is prohibited

You live in a state with a carrier of last resort

You qualify for GI under the Medicare Trial Right rules

You qualify under other Medicare GI rules

 

So most folks WILL have to satisfy E of I to change but some may not.

 

Hope this helps

 


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Re: FYI: 2020 Medicare Cost At A Glance

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@somarco 

A question on switching a Medigap plan.

If a beneficiary stays with the same insurer and wants to switch to a lesser coverage Medigap plan - say from Plan F or G to a High Deductible Plan F or even Plan K or L - would they be subject to underwriting?


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Re: FYI: 2020 Medicare Cost At A Glance

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@jimbohretired wrote:

Wondering if u all are being hit by significant increases in medical premiums and if so have you considered switching to  any of the advantage programs.

We have Medicare as our primary and United as our secondary. We both are seeing about a 20% increase in costs this year.

Also our long term care insurance increased approximately 65% this year with my premium going from about $1850 to  $3100. WOW

Our secondary hospital / Doctor increased approximated 20%. Our overall medical premiums including  medicare  is now over $9000 a year. With my long term care insurance total out of pocket is over $12000 per year not includind our out of pocket for medical/medication copays.

 

Anyhow would be interested in hearing from those using medical advantage 

plans - are u satisfied with your care as pricing is significantly less.

 

The one concern I would have is qualtiy of care if one of us has a significant medical issue. As an example, my wife has  had a kidney transplant  at the Mayo which would not have been covered  aat that facility with an advantage plan.

 

Anyhow am interested in any input u have.

 

 

 

 


Medigap cost can vary greatly and from year to year depending

LTC insurance plans are also subject to increases based on many factors depending upon your policy details.  Age, coverage amounts, amounts being paid out of the total plan.  Insurers have actually found that LTC policies are not a good product for them so many insurers are writing no new policies,

 

A Medicare Advantage plan covers the same benefits as Medicare BUT IN A DIFFERENT WAY.

The premiums are NOT for just "gap" coverage  (as a Medigap plan is) - they are complete coverage Medicare insurance.  Although premiums may be low to even none, there are co-pays, co-insurance, deductibles to be covered - your out-of-pocket cost.  So when doing your comparison between traditional Medicare wit gap coverage and a Medicare Advantage plan, consider what you will be paying in all out of pocket cost.  It usually works out better when you are relatively healthy - less so as more and more covered and necessary medical services are needed.

 

I believe one of the problems beneficiaries make when picking a Medigap plan at the initial enrollment period is that they pick the very best coverage plan because that is time when the premium cost is most reasonable - the lowest.  But because original Medicare is a plan with few cost controls, gap premiums increase sometimes to the point where they may be unaffordable to many of them.  There are several other Medigap plans available where there maybe some out-of-pocket cost and have lower premiums but they should not be discounted if the beneficiary can afford these OOP cost - if they cannot afford these out of pocket cost, they may not be able to afford the escalating premiums of the other more cost inclusive Medigap plans later on.

https://www.medicare.gov/supplements-other-insurance/how-to-compare-medigap-policies 

 

So If I were you - I would consider checking the other Medigap plans available with your insurer and see if that is feasible for you in your situation and that you can change plans (to a lesser coverage one) but underwriting might also play into this.

 

Medicare Advantage plans control their cost by managing care with geographical area confines, network of providers, sometimes step therapies, more pre-approvals perhaps, co-pays, co-insurance and deductibles - sometimes with an included Part D formulary coverage.  About 1/3 of all Medicare beneficiaries have choses this type of coverage - mainly because it does fit their pocketbook.

 

As to your LTC coverage - you can always check your policy and with the insurer to see if your benefits can be reduced and acceptable to you for a reduction in premiums - But IMO, cost in these types of policies are gonna continue to rise - we are all getting older and many will need more hands on daily care later in life - this type of care will become more expensive juat because it is labor intensive and the folks supplying it will demand higher pay, their liability and employment insurance will rise.

 

Remember that you and your wife are different in your health care needs so what might be best for one of you, may not be good for the other - picking a plan should be a personal choice, not a couple thing.

 

Also remember, that original Medicare WITHOUT a Medigap plan (any of them) does open you up to a lot of out of pocket medical cost if the situation arises - original Medicare has NO annual or lifetime limit on these out of pocket cost - Medicare Advantage plans do have a annual limit.

 

Seems like you know the big differences in original Medicare and Medicare Advantage - I don't think there is any right or wrong answer because it just depends on the person, their health, their finances - and as is the case of all insurance, it is money paid for protection - it is always a guess as to what, if any,  situation might arise.

 


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Re: FYI: 2020 Medicare Cost At A Glance

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Message 4 of 7

@jimbohretired no easy or quick answers to your questions.

 

Tackling LTC first, the reason why your premiums jumped so much is because carriers that jumped into the market early guessed at sustainable rates and they lost. Not enough data at that time for actuaries to plot claim trends.

 

Can't say why your UHC Medigap premiums jumped so much. Rates, etc vary by state, your age and so forth.

 

If you are in good health you can change anytime and should shop around. Preferably with the help of an agent that knows carrier rates for ALL the plans in your area.

 

The only carriers where I have seen double digit increases are those who withdrew from the state. Omaha, Aetna, Cigna plus some smaller carriers often will raise rates by 15% or more. And sometimes soften the blow a bit by 2x yearly increases of 9% each time.

 

As for Advantage plans, there is no free lunch.

 

The entry fee is often $0 but you pay every time you receive care. Play by their rules. Only use providers THEY approve. Abide by the pre-authorization rules.

 

Most plans cap your OOP for health care at $6700 per year. That only applies to IN NETWORK APPROVED health care claims.

 

You can't use your plan everywhere. Many specialty care centers like Mayo generally don't participate in Advantage plans.

 

Advantage is a pay later system. Have a lot of $$$ laying around and only use providers they have chosen for you.

 

If you have Dr Welby now and like him Dr Kildare may be your next best choice because he is in network and Welby isn't.

 

I have HDF and pay $56 per month. Can use any provider in the US. No excess charges. Out of pocket limited to the $2340 deductible. 

 

Can't understand why anyone would want an Advantage plan when for a few dollars there are more favorable options.

 

Just now read your last line about wife kidney tx and Mayo. You know this and now others do as well.

 

Be well.


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Re: FYI: 2020 Medicare Cost At A Glance

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@jimbohretired 

"...We have Medicare as our primary and United as our secondary. We both are seeing about a 20% increase in costs this year....".

 

20% increase??? . We have AARP (UHC) as a secondary and it is going up 2.5%. We have the plan F.  Am I missing something or didn't do my third grade arithmetic?


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Re: FYI: 2020 Medicare Cost At A Glance

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Message 6 of 7

Wondering if u all are being hit by significant increases in medical premiums and if so have you considered switching to  any of the advantage programs.

We have Medicare as our primary and United as our secondary. We both are seeing about a 20% increase in costs this year.

Also our long term care insurance increased approximately 65% this year with my premium going from about $1850 to  $3100. WOW

Our secondary hospital / Doctor increased approximated 20%. Our overall medical premiums including  medicare  is now over $9000 a year. With my long term care insurance total out of pocket is over $12000 per year not includind our out of pocket for medical/medication copays.

 

Anyhow would be interested in hearing from those using medical advantage 

plans - are u satisfied with your care as pricing is significantly less.

 

The one concern I would have is qualtiy of care if one of us has a significant medical issue. As an example, my wife has  had a kidney transplant  at the Mayo which would not have been covered  aat that facility with an advantage plan.

 

Anyhow am interested in any input u have.

 

 

 

 

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FYI: 2020 Medicare Cost At A Glance

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Message 7 of 7

Here is a brief summary of all the various Medicare cost for 2020 as a reference -

  • applicable premiums,
  • applicable IRMAA premium assessments,
  • co pays.  
  • Penalty base for part D

 

Medicare.gov - 2020 Medicare Cost


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