IMPORTANT - Understanding Medigap (Medicare Supplemental) Coverage

[GailL1]

This is a very important subject which Medicare beneficiaries need to understand.

This is a good article because it gives the rules of the game in a somewhat easy to understand manner.  It gives examples too.

Hopefully this article will help new enrollee beneficiaries as well as those who are already covered by Medicare a detailed, clearer understanding of the when, what and where of choices we must all make.

Kaiser Health News 07.25.2018 - NO Gaps in Understanding: A Primer on Medigap Coverage

More information, of course, is available on the Medicare.gov site under Medigap coverage and since many of the rules covering Medigap policies are at the state level, it is good to know those, state specifics, rules too.  That info is available in your state - Dept of Insurance or SHIP representative (State Health Insurance Programs).

[alexiss12]

I am changing my primary residence from Pa to Fl within a month. I currently have AARP Medigap supplmental coverage and Part d coverage with my Pa address. I am in Florida right now and saw some doctors recently and want to continue my coverage as in one month I will be visiting Pa seeing a doctor there.Questions

1. If I call AARP and change my address to Florida effective 6/1/19 will I be able to see doctors in either Pa or Fl in June or July or August as I will be traveling visiting family in Pa and then our Fl new address over the summer.

2. Does Fl have any underwriting as I have had AARP (first in NJ and then Pa) since 2006 since I had SS Disability that started in 2006 in NJ. I then moved to Pa and have had AARP continuously 

3. I know Flan F will be more expensive in Fl but will I have continued coverage and what happens if there are any "old" bills from doctors when the Fl Medigap starts. (Is it all he same Unied Health plan account number under AARP only with tge different address and different amount)

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@GailL1 wrote:

This is a very important subject which Medicare beneficiaries need to understand.

This is a good article because it gives the rules of the game in a somewhat easy to understand manner.  It gives examples too.

Hopefully this article will help new enrollee beneficiaries as well as those who are already covered by Medicare a detailed, clearer understanding of the when, what and where of choices we must all make.

Kaiser Health News 07.25.2018 - NO Gaps in Understanding: A Primer on Medigap Coverage

More information, of course, is available on the Medicare.gov site under Medigap coverage and since many of the rules covering Medigap policies are at the state level, it is good to know those, state specifics, rules too.  That info is available in your state - Dept of Insurance or SHIP representative (State Health Insurance Programs).

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[somarco]

@alexiss12 you can call AARP or UHC if you want, but if you are making a permanent change in your address you should call SS.

Medigap follows you whereever you are, whether on vacation, extended visits to family or friends, or relocating.

Your premium will be rerated once you settle in your permanent address. Underwriting may be required if you want to change plans.

You state you have been on SSDI and (presumably) Medicare + supplement since around that time. Are you still under age 65?

When you turn(ed) 65 you get a "fresh start" and can change to any plan with any carrier without going through underwriting.

Plan F is more expensive everywhere, not just in Florida. Since Medicare is primary bills incurred anywhere will be sent to your carrier once adjudicated and approved by Medicare.

When you notify SS of your new permanent address they will notify your PDP carrier. The carrier will send you a letter advising you have 60 days to find a new plan if you want. If your PDP carrier writes drug plan in your new area they will issue new coverage based on your current med's, zip and county.

Hope this helps.

[GailL1]

Good post, somarco which you gave to @alexiss12  but I have an extended question.

So if someone on SSDI that is on Medicare and lives in a state where they have access to reasonably priced Medigap Plan - what would happen if they move to a state that does not give Medigap plan access to those less than 65 - Any problem keeping the Medigap plan that they moved with?  How would premiums be set at the new location?

[somarco]

@GailL1  state rules on Medicare supplement apply to policies ISSUED in that state.

I have clients with policies originally issued in my state. They later moved to a different state and the policy followed them. All of them are 65 and older. In some cases the issuing carrier was not and admitted to the new state. Even though they could not issue a new policy they can (and do) make an administrative change reflecting rates for the new residence location.

Premiums based on rates filed with the new state.

Medigap premiums for folks under 65 vary considerably from state to state. Some states require carriers to offer U65 Medigap plans, some do not. Most of the rates I have seen for U65 supplement plans are ridiculously high. In some cases 10x or more the rate for the same plan @ age 65.

Most folks on SSDI here opt for a more affordable Advantage plan and deal with the networks and OOP as well as they can. The rules here for U65 Medicare supplement plans create a 6 month window for purchasing a plan without underwriting. In a few situations the individual will purchase an HDF plan with a carrier that has a premium in the $80 range. They get better coverage (no networks) and a lower OOP vs what they would have with an MA plan.

Only a handful of carriers, all direct writers (no agents allowed), have reasonably priced HDF plans. Most are $200/month to $700.

Carriers don't like to write U65 Medigap and generally only do so when required by statute.

I don't have first hand experience with folks who purchase a Medigap under 65 because of the affordability issue. While I can tell you what happens to the rates for someone age 65 and older when they relocate, I can only speculate what might happen with a policy issued under the age of 65.

If the new rate following relocation is considerably higher than the issuing state that could create a real problem.

In the example given above where the HDF rate is in the $80 range for a few carriers, the "regular" F plan is around $400 for those same carriers. Other carriers writing U65 F plan premiums start @ $700/month and top out @ $3500 per month.

In many states, including mine, very few can afford a Medigap plan if they are under 65. They end up with an MA plan, original Medicare only + a PDP, or try to qualify for Medicaid.

[drawpoker]

Yes,  a good article you linked,  certainly everyone going on or already on Medicare should read.  But  -  it is by no means to be considered complete. They left a big Gap of their own. 

It glosses over the subject of guaranteed issue rights for one.   When a beneficary has to find a new Medigap insurer through no fault of their own.  Mainly,  it seems to imply the beneficiary has guaranteed issue rights to any of the 10 plans from any other Medigap insurers.   

Not so!  The law presently excludes   Plans G,  M & N from G.I.  status.  With Plans G and N being the 2nd and 3rd most popular (behind Plan F) this is causing renewed attention.  KFF should have brought it up.  (In fact,  we have multiple threads going on right now at BH on this very topic)  

The situation is this:  Plan G is not expected to go off exclusion status until Plan F is closed off to newly-eligibles on Jan 1, 2020.  Then,  Plan G will become the "new" Plan F,  and a new High-Deduct G will also be introduced. 

Immediate problem for holders of Plan G (and wannabees) who may find themselves in a G.I. situation in the next approx 18-month window - nope,  they could not switch their Plan G to a new company.  Or buy new G or Plan N under G.I. protection.  FWIW,  Plan N is not expected to return to G.I. status in 2020.   Unlike G. 

2nd problem I must point out -  the S.H.I.P. program and its consultants is very spotty,  inconsistent,  poorly-trained, and cannot be relied upon in many areas of the country.  Again, in another BH thread,  a Chicago area S.H.I.P. offfice was actually giving out  Wrong information last month.  Incredible,  could have cost the person real $$$ if they had not caught it.   When it was then suggested by a poster that the district office of Congressman be contacted for help,  sure enough,  turns out at least one Congressman's office had no idea how to help.  They promptly wrote back the constituent,  and recommended,  yup,   the S.H.I.P. staff.    So,  the acronym quickly became

Seniors Hopelessly Inept Planning

Yikes   

[GailL1]

@drawpoker

Welcome back - 

I am not following you on the guaranteed issue rights when a beneficiary loses their Medigap coverage through no fault of their own - of which are pretty narrowly defined by Medicare - I thought as long as you had documentation of coverage loss, and one of the Medigap plan losses described as no fault of your own, you had guaranteed issue rights to pick up a new plan (any)within a certain period of time.

Medicare.gov - Guaranteed Issue Rights 

As to those who help beneficiaries with questions - I agree but it isn't just SHIP volunteers - it is also Medicare Customer Service Reps, Social Security Reps, etc.  

As always, it is the actual person who is giving the help and their dedication in being able to do their job by research, learning, clarification and probably hounding too.  As we all know some are better at their job than others in any job.  I give them 1st shot but yes, I have been very disappointed with many of them.

Knowledge is Power - Education gives us the tools to seek knowledge - and internet searches give us the (easier) road to seek out that knowledge.

Some people, no matter their good intentions, just don't have or put forth the effort to learn, all the minute details of a matter and anything government has lots of details.  Course clearly worded question(s)'help as well as knowing any specific lingo - "government speak".

So glad you have returned - hope everything is well with you.

[drawpoker]

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"........you had guaranteed issue rights to pick up a new plan (any)within a certain period of time........"

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Not "any".   G,  M & N are specifically excluded. 

You have to drill further on the medicare dot gov section, Gail.   Click on scenarios under G.I. page and this is what you get: 

You have a guaranteed issue right (which means an insurance company can’t refuse to sell you a Medigap policy) in these situations:

Collapse You’re in a Medicare Advantage Plan, and your plan is leaving Medicare or stops giving care...

You have the right to buy Medigap Plan A, B, C, F, K, or L that’s sold by any insurance company in your state.

You only have this right if you switch to Original Medicare rather than joining another Medicare Advantage Plan.

You can/must apply for a Medigap policy:

• As early as 60 days before the date your coverage will end
• No later than 63 calendar days after your coverage ends

Medigap coverage can't start until your Medicare Advantage Plan coverage ends.

Collapse You have Original Medicare and an employer group health plan (including retiree or COBRA co...

You have the right to buy Medigap Plan A, B, C, F, K, or L that’s sold by any insurance company in your state.

And so forth.  This is becoming problematic for folks who know they are going to lose their group plan at work before 2020 and won't be able to guy Plan G or N,  the two most popular right now behind F.

(thanks for the friendly greeting altho I can't really say I am "back" exactly.

  I see the same old oddballs,  wingnuts and assorted trolls who only want to pick fights are still here -  its very annoying in the Medicare and insurance threads 

[GailL1]

@drawpoker

Thanks for the info - I have not noticed that before - Was it changed when Plan F and C were announced to be closing down in 2020?  Or maybe I never had the occasion to drop down some of special circumstances which assured guaranteed issue.

They need to rename these to "modified or limited guaranteed rights  issue.

So now a person can only buy those specific plans - G, M, N - at their initial enrollment at 65 years old.