If you have Plan D with UHC, did you have mid-year premium increases like my UHC Plan G?

[Ghaeilge1975]

 A friend of mine said her Plan D with Bakers has not had any mid-year increases since she has had it since 2021 like my UHC Plan G.  

Wondering if mid-year is only specific to Plan G UHC?  Anyone have UHC Plan D mid-year increases?  

My Plan G with UHC had a mid-year premium increase of 12% and another 4% starting Jan 1, 2025.  

I am thinking of changing to a Plan D not necessarily with UHC.  Will I have an issue switching?  I don't understand what underwriting means and if it will affect me.

Thank you.

[GailL1]

@Ghaeilge1975 

Medicare PART D is your Prescription Drug Coverage - you buy a PART D plan of your choice that meets your medication needs.  There is no one PLAN D.

Medicare PLAN G is your Medigap plan or supplemental coverage for Medicare PART A or PART B.

The two are very different.

Part D plans rarely, if ever, have premium price increases during the year because they are set by a bid-based rate by the government offices of  CMS (Center for Medicare and Medicaid Services).  Very similar to how they set Medicare Part B premiums for each year - based on utilization of Part B.  Having a PART D plan is mandated by Medicare.  

Medicare Supplemental policies or Medigap isn’t health insurance - it is supplemental coverage and acts as gap coverage - it is mostly for financial protection of the beneficiary who has chosen Traditional Medicare as to how they receive their benefits. A Medigap plan pays ONLY for some or all of your out of pocket cost for Medicare Part A and Medicare Part B (depending on the Medigap plan one picks)  - It does NOT have anything to do with Medicare Part D - the prescription drug plan.  It is a personal choice as to whether a beneficiary decides on a Medigap plan; coverage is NOT mandated as a part of Medicare. 

Premiums for a Medigap plan are set by the insurance company that sponsors the specific plan the beneficiary has chosen.  Premiums usually rise once a year but can go up several times a year if necessary.  Some reasons premiums may rise are:

• an increase in premiums as a result of a declining premium discount which came initially with the plan - very common with AARP/UHC Supplemental Plans
• a change in the basis of the rating method used by the insurer to set premiums - community rated / attained age rated / issue age rated
• an increase in medical inflation and higher use
• more benefit coverage that is legislated by the government

You can change your Medicare Part D plan (prescription drug coverage) several times during the year if applicable to these enrollment period rules.

Medicare.gov - Fact Sheet - Understanding Medicare Advantage & Medicare Drug Plan Enrollment Periods 

The Annual Open Enrollment Period for Medicare Part D plans and Medicare Advantage plans is coming up soon - October 15 - December 7 for coverage to begin on Janualry 01, 2025.  If you need to switch sooner under the Special Enrollment Period rules, the new plan would be effective the following month after you sign up and pay your 1st premium.

You can find the Part D plans that are available to you on the Medicare.gov website by putting in all your meds and checking the various plans that come up based on your location, preferences and needs.  OR you can discuss your situation with you state SHIP counselor - State Health Insurance Assistance Program.  OR you can see or talk to a Medicare Insurance Broker or Agent - some are independent and write for many different companies and some, like UHC, are captive agents that only write for one specific insurer.  There is no charge for the later to the beneficiary.

Underwriting is ONLY applicable to Medigap plans (Supplemental coverage) like your Plan G -  Federal law says that a Medigap plan only has to approve you without any health condition considerations during your initial enrollment period.  After that period, an insurer for a Medigap plan can scrutinize your health to determine your premium, or even not cover a specific condition for a period of time OR even refuse coverage to you.  The process they use to do this scrutinizing is called underwriting.  Now your state law may also have a bearing here past your initial enrollment period - some states give specific other times and conditions when a beneficiary can switch Medigap plans.  Your state (usually Dept of Ins.) can give you any details on this - they usually have some details on Medigap laws in the state if you want to check this out with your state.

If you have Medicare coverage based on Social Security Disability, then when you turn 65 years old, you get an additional initial enrollment period or do-over in picking a Medigap plan.

You really do need to read “Medicare and You” - OR at least see a SHIP Counselor OR see/talk to a Medicare Insurance Broker or Agent.  

There is no charge to you to see or talk to a SHIP counselor or Medicare Insurance Broker or Agent - they can give you some options and then you still have to do the picking based on your needs and/or pocketbook.  Without all your specific info on your meds and your medical needs and pocketbook, nobody can really evaluate what might be the best of all the options for you because there may also be some other specifics that could make a difference to you too,

Good Luck 

[Ghaeilge1975]

 Hi Gail,

Thank you for your reply.  My friend has Medigap Plan D and I have Medigap Plan G.  I was thinking of switching to Medigap Plan D from my Medigap Plan G.  I do have Part D Prescriptions and those premiums stay the same throughout the year.

 Medigap plans:  A, B, C, D, F, G, K, L, M, N.  I have Plan G with UHC and my friend has Plan D with Baker's.  Her Medigap Plan D has not had premiun increases like my Plan G with UHC.

 I often wondered why they have PART D AND PLAN D - CONFUSING.  Would be nice if the  prescription was named Part P instead of both having the same alpha letter D.

 After thinking about my medigap increases with UHC two years now, maybe change to Plan D (hope they don't have premiums increases) or high deductible Plan G.  

 Thanks for always helping.  I've been reading the posts and see your name and replies and appreciate your contributing posts and knowledge.

Just don't know what to do...

[GailL1]

Sorry,I misunderstood you - Yes, have both as “D’ labeled is confusing - but we are on the same page now.

Medicare.gov - Medigap Plans compared 

1.  Just make sure that the differences in the (2) plans don’t affect you -  there is little difference except the Part B excess charges.

2.  See if your state has legislated additional guaranteed issue periods for switching Medigap plans without underwriting - some have; most don’t.

3. If you are healthy, you can probably pass underwriting - 

4.  If you aren’t too healthy, they the insurer does have a right to offer you the Medigap plan that you want but at a higher premium, or they migh disqualify your pre-existing condition for a period of time.  OR they can refuse you coverage for the Medigap you want to switch to -

5.  Sometimes insurers will open up their Medigap plans or specific plans to those that want to switch without underwriting.  A Medigap plan broker - an independent one - will know if any of these are available to you.  Or a captive agent if you know what company you want to go with - like Bakers

You just have to try - but don’t cancel the one you have now UNTIL you have the Contract / Expalanation of Coverage and the Card from the new company - then cancel the old one - this may mean that you have to double up on premiums for one month.  

Idon’t know anything about Bakers - if this is them they have a pretty informative website and talk about independent agents.

Bakers Insurance Group (BIG) - Medigap 

What state are you in?  That is gonna make the big difference in underwriting.

[Ghaeilge1975]

 Hello,

 I am in NJ and just read and learned about underwriting and the birthday rule which NJ doesn't have.  

 As a retiree with my company, I can only go through Via Benefits for my medigap insurance to keep the benefit my former company offers.  So in order to change from UHC Plan G to another company and possibly Plan, I most likely will have underwriting.  I am learning a lot from all the posts and replies and appreciate your replies to the posts for your extensive knowledge.

Will write to my legislators to see if they or whoever in NJ might consider the birthday rule for Medigap.

Thank you for your reply again on this topic.

[GailL1]

@Ghaeilge1975 wrote:

Will write to my legislators to see if they or whoever in NJ might consider the birthday rule for Medigap.

+++++++++++++++++++++++++++++

Just a cautionary word here - be careful what you ask for - 🤓

Because of the nature of this sort of legislation, the states that have such a policy legislated, be that a birthday rule or even a rule that is even more liberal [like New York), the premiums for Medigap policies become very expensive.

As an example - 

New York.gov - Dept of Financial Services - 2024 Medigap Plan rates 

These are community rated standardized plans - where everybody pays the same amount.  

I am sure you can see why this happens in these states - similar to - you pay to play.

Let us know how it all comes out.

[Ghaeilge1975]

 Oh my!  Thanks for the caution and NY charts.  My eyes are wide open now but must say retiree health care costs are something I never knew about.  My working years, fortunate to have low cost health care.

 Thanks again for your taking the time to help.  Much appreciated.