New to Medicare and secondary medical plan coverage

[g936417g]

New to Medicare and secondary medical plan coverage

First, I would like to thank all those who have posted questions and answers related to Medicare, and related Advantage and Supplemental Plans.  Very informative!  Simply having the ability to have access to a AARP user community forum that covers a variety of issues facing seniors is by itself worth the annual AARP premium.   For the last few weeks, I’ve been trying to educate myself before I have a meeting with a Medicare plan agent who will guide me through the selection process and options I have to chose from.  Anyways, here is what I’ve decided to do and I am looking for any confirmation based on my research.  Thanks for any feedback!

I am choosing a Medigap Plan G vs any of the Advantage Plans Available:

• Best if monthly premium is not a concern (disclosure: my former company provides a annual stipend or allocation for Medicare eligible retirees that can be used to help offset secondary HC insurance premiums)
• Peace of mind knowing services will be covered and freedom to select HC providers
• Appears that Premiums based on Community Rated is better than Attained Age Plans
• Larger is Better when it comes to Supplemental Insurance Carriers as the financial health of  the carrier matters and their ability to absorb or spread costs over a larger population
• Customer service matters

• Better to select a Medigap plan now when you are eligible for guaranteed enrollment vs later down the road when that option may not be available or you may be subject to underwriting

In Michigan, I am able to select from 5 carriers who offer Medicare Plan G.  I am selecting the AARP sponsored Supplemental Plan G offered through United Health Care.  Two of the carriers were regional and one was strictly a Michigan based Company.  AARP premiums were in the middle of the 5 companies.  In reviewing the various Plan Documents and future rates, it was obvious that the Community based rates were much lower going forward than Attained Age Plans.  I guess that could change over time but when I looked Community based rates at 5-year increments were always significantly lower.

Will also be choosing a Prescription Plan pretty much based on (have not yet made a decision):

• Are my prescriptions covered and what is their Tier Rating
• Balance between monthly premium, deduction threshold, and number of prescriptions falling under Tier 1 or Tier 2
• Deduction Amt may not be a concern if your prescriptions are all Tier 1 or Tier 2
• Preferred vs Standard Pharmacy matters when it comes to co-pays (sadly it looks like I will have to change pharmacies as for most providers Rite-Aid is not a preferred provider)
• Easy enough to change prescription providers during future open enrollment periods without fear of penalty

I have decided not purchase a Vision and/or Dental plan.  Didn’t really seem to be worth the premium for the limited coverage or benefits provided.  Chances are I will be no worse off simply paying all such expenses out of pocket vs paying monthly premiums.

Thanks again.  I apologize for the long winded post!

[GailL1]

@g936417g 

Like @ReTiReD51 said . . . . Good Job.

The only comment I have for your consideration when you discuss with your agent is where you said these things:

• Larger is Better when it comes to Supplemental Insurance Carriers as the financial health of the carrier matters and their ability to absorb or spread costs over a larger population

In Michigan, I am able to select from 5 carriers who offer Medicare Plan G.  I am selecting the AARP sponsored Supplemental Plan G offered through United Health Care.  Two of the carriers were regional and one was strictly a Michigan based Company.  AARP premiums were in the middle of the 5 companies.

My comments for consideration:

Yes, Community-rated is suppose to be the lowest overtime, so I have read,  However size and base of the insurance company should make no difference with a MEDIGAP plan - they all cover the exact same things; the exact same Medicare providers for the exact same % because all of that is governed by Medicare - not the insurance company - Plan G and all the other alphabet Medigap plans is standardized by Medicare based on the Plan you choose for this "GAP" insurance.  So if they are all community rated, you can pick the lowest premium price one and be fine.

IF something were to happen to the insurer that you pick for your Plan G, Medicare has you covered there by offering you a guaranteed issue period to find another one.

Medicare.gov - Medicare Guaranteed Issue Rights

Note this situation at the link:

 As @ReTiReD51 said, your state governs a lot of the premium setting approvals or any special conditions on who can get coverage for a Medigap plan (like can a disabled person less than 65 on Medicare get a Medigap plan) or any special benefits for you - like in California and Oregon, they have a "birthday rule" that gives a person in those states a chance to change their coverage after their birthday for a few days to one that has the same or lesser benefits - without underwriting. So you might just read thru this to see if there is anything in your state that is special:

Michigan Dept of Insurance & Financial Services: (Consumers) - Medicare Supplement Policies 

I am not a professional, just years of reading, so just my thoughts - perhaps a real professional will be around soon to give your synopsis a once over... . . . if he charges you a nickel 😀, give him this one  😀

Good Luck and Welcome to Medicare - the thrill and excitement never ends.  😀

[ReTiReD51]

“I am not a professional, just years of reading” … @GailL1 

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@Gail I’ve said this before and I’ll gladly repeat it again, you are very knowledgeable when it comes to just about anything Medicare. Even if you’re learning it for the first time yourself. You always take time to research someone’s questions/concerns about Medicare. I think you provide honest practical information and links to try and answer someone’s question.
And best of all you don’t have that “get out of my yard” attitude. You always answer questions thoughtfully and with patience.
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You’ve helped to educate a lot of people about Medicare.

[g936417g]

This may answer your question to my assumption does size may matter when selecting a Medigap provider.  I happened to have a communication today with a independent Medicare agent and asked a similar question. As you pointed out, Medigap plans across providers are basically the same except for premiums.  See their response below in italics:

Me: In addition, several of the other providers were Regional or Michigan based Companies who pale in comparison to the size and financial health of United Health. "You got it." Me: In this case I am under the impression (right or wrong) that bigger may be better.  Thus, United Health would have the financial resources and a bigger population to absorb unexpected Medicare Plan G expenses incurred by some enrollees resulting in smaller future premium increases for the population as a whole.  Is that even a valid assumption? "Yup. They also have that AARP endorsement and ability to add features to the Medigap program (such as their Renew Active plan, etc) – and they just don’t want to really make 4.5M seniors on the plan angry and get AARP riled up. Reality. BCBS for example has 300,000 in their “pool”.  Pools of insureds are important related to claims."  

Me: Based on that response I would think the size and financial health of the company providing a Medigap Plan Policy can be part of the selection equation.  Premiums do vary across providers for the exact same coverage.

[ReTiReD51]

@g936417g Having a mass group of 4.5million senior members with United Health Medicare insurance plans was a major reason I too went with a lettered United Health plan.  I figured the more resources a company has there might be a chance of smaller premium increases.  Time will tell.

[GailL1]

@g936417g 

Thanks for letting us know what the agent relayed.

Of course, AARP UHC Plan G is probably bigger - they pull from a national audience.

However, somethings the agent may have missed:

You must maintain your membership in AARP to participate in an AARP branded Supplemental Plan - an added cost but a minimal cost at present, IMO.

An AARP endorsement - also a profit making relationship and a disclosure that some provider offers are subject to change and may have restrictions.

AARP UHC Supplemental Plans Disclosure 

IF it is not in your contract as a covered benefit without any change or restriction notices - then it may not be around for the long haul - This may not discourage you from this choice but you do need to be aware of it.  This would be things like the Renew Active plan.  The only thing 100% sure to be maintained overtime is what is

within Plan G itself as defined by Medicare and what might be in the contract without any limitations.

Some people here have been through this when the beloved benefit of Silver Sneakers (exercise program for seniors) was dropped by many Supplemental Insurers a year or two back.  A bunch of angry and disappointed seniors to say the least:  https://community.aarp.org/t5/tag/Silver%20Sneakers/tg-p/board-id/bf59 

Just make sure you understand what is in the contract and what is outside of it that can be changed or modified by the insurer.

The size of the insurer's group in a particular Medigap Plan is of course, important but what is also equally important is the age and health of the group.  Yes, supplemental plans that constantly bring in younger and healthier members to balance out the older and sicker will benefit premiums over the long haul - to me, this is regardless of how they rate - community rated, plan entry-age related or attained age related. 

The question one has to ask ones self here is which insurer is gonna attract more of that younger and healthier group of seniors?  Will it be the one that has the lowest premiums or the one that is bigger in scope, bears the name of a national association, or give some other benefit for a period of time enticing seniors to their ranks. 

Supplemental plans especially in the same general area pay basically the same amount for services in that general area.  Medicare (Part B) pays 80% of the Medicare approved amount.  The Medicare approved amount for a specific service is the same in a specific area - that's how they set the approved amount - by area.  Then a Plan G will pick up the remaining 20% once that Part B deductible is met.

Same with Hospital cost (Part A) and what they pay based on the Medigap Supplemental Plan of choice.  That's all the same with everybody on Plan G supplemental especially in the same area. 

With BIGness also comes more public exposure - both positive and negative.  UHC is one of the biggest if not the biggest - in all types of health coverage - employer provided for their workforce, employer retiree coverage, Medicare Advantage plans of all types, Medigap Supplemental Coverage, and I think Managed Care plans.  Do they get some negative national exposure - Sure Do, especially in the Medicare Advantage plan scope.

You are in the home stretch now - you have picked your plan and now you have to pick your insurer -

Plan G covers the same benefits regardless of insurer.

Understand what and how anything else is covered in the contract or whether it is even in the contract at all.  These things may change.

We are all victims of the future - and what that holds in cost. 

I am sure that you will do just fine in whatever choice you make now - pass that, I am not sure that there are any assurances.

[ReTiReD51]

@g936417g 

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It sounds to me like you’ve done your homework well no matter what insurance company you decide to go with. I wish more people would take an interest if only for their own good in learning the basic FACTS of Medicare and subsequent insurance plans before they make a decision that in all likelihood could be with them the rest of their life. A lot depends on the Medicare rules in the state you live in. Good Luck!