Take the AARP Smart Driver course and you could save on auto insurance! Sign up today.

Reply
Valued Social Butterfly
1
Kudos
1709
Views

Re: Silver Sneakers being droped by AARP recommended insurer

1,709 Views
Message 311 of 603

@ChristineS148307

 

Not condesending and not lecturing - just stating the truth and I will continue to say it.

 

 

The share of all Medicare beneficiaries with Medigap coverage varies widely by state—from 3 percent in Hawaii to 51 percent in Kansas in 2016 (Figure 3, Appendix Table). In 20 states, at least one-quarter of all Medicare beneficiaries have a Medigap policy. States with higher Medigap enrollment tend to be in the Midwest and plains states, where relatively fewer beneficiaries are enrolled in Medicare Advantage plans

 

 

Potential medical conditions for which a Medigap Insurer may deny coverage
without guaranteed issue protections

 

  • ALS (Lou Gehrig’s Disease)
  • Alcohol/drug abuse
  • Alzheimer’s disease or other dementias
  • Chronic lung/pulmonary disorders (e.g. chronic bronchitis, COPD, cystic fibrosis)
  • Cirrhosis
  • Congestive heart failure
  • Diabetes (insulin dependent)
  • Emphysema
  • End Stage Renal Disease (ESRD)
  • Fibromyalgia
  • Heart disease
  • Hepatitis
  • Immune disorders (e.g. RA, MS, Lupus, AIDS)
  • Kidney disease requiring dialysis
  • Mental/nervous disorder
  • Myasthenia gravis
  • Organ transplant
  • Osteoporosis (if severe/disabling)
  • Stroke
  • Advised by a physician to have surgery, medical test, treatment, or therapy
  • Implantable cardiac defibrillator
  • Use of supplemental oxygen
  • Use of nebulizer
  • Asthma requiring continuous use of 3+ medications including inhalers
NOTE: Uninsurable health conditions vary by plan. This list is not an extensive list of all possible conditions/reasons for denial.

SOURCE: Kaiser Family Foundation collection and analysis of numerous insurance companies’ 2016-2017 Medicare supplemental underwriting manuals/guides.

 

see more at the link:

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

 

* * * * It's Always Something . . . Roseanne Roseannadanna
Report Inappropriate Content
1
Kudos
1709
Views
Valued Social Butterfly
1
Kudos
1660
Views

Re: Silver Sneakers being droped by AARP recommended insurer

1,660 Views
Message 312 of 603

@johngraves01

So if the benefit of a fitness program or health and fitness program for ALL seniors is scientifically proven as a preventive measure, why does Medicare not cover it under Part B? 

That's all I am saying - because if it is a valuable preventive care - then everybody should have it, right?  Not just the ones that have access to a Medigap plan that offers it as an extra program.

 

This is the only preventive protocol which is covered under this health and fitness heading - as you can see it does NOT cover everybody and it does not recommend an action other than behavioral counseling interventions.

US Preventive Service Task Force: Healthful Diet and Physical Activity

 

reference the link for all the details. 

Final Recommendation Statement Healthful Diet and Physical Activity for Cardiovascular Disease Prevention in Adults With Cardiovascular Risk Factors: Behavioral Counseling

Recommendation Summary
 
Summary of Recommendation and EvidencePopulation Recommendation  - Grade   B
Adults who are overweight or obese and have additional CVD risk factors

The USPSTF recommends offering or referring adults who are overweight or obese and have additional cardiovascular disease (CVD) risk factors to intensive behavioral counseling interventions to promote a healthful diet and physical activity for CVD prevention.

 

 

If a senior cannot afford the premiums of a Medigap (Medicare Supplemental) plan at all - aren't you being rather discrimatory - this senior gets the benefit because they have a Medigap plan while this other (poorer) cannot afford a plan.  Not all beneficiaries of Traditional Medicare can afford a Medigap plan - some just pay their 20% and deductibles out of pocket and keep down their medical cost.  Others with very low income are supplemented with Medicaid - sure doubt if Medicaid furnishes fitness programs.

 

If this program is important to you, it is available in many Medicare Advantage plans - don't like the plan offering in a particular year - you are free to change your Medicare Advantage plan during the annual open enrollment to whichever one has what you want.

WOW - Just look at what they are offering in 2019 - Avalere Press Release on 2019 Medicare Advantage...

As a result of additional flexibilities granted to Medicare Advantage plans by CMS, Medicare beneficiaries will have access to new types of supplemental benefits through Medicare Advantage,”  “Our research finds that almost half of all Medicare Advantage plans will offer new types of supplemental benefits in 2019.”

 

Supplemental benefits are additional services offered by MA plans that are not covered under Medicare Part A, Part B, or Part D,

 

Beginning in 2019, MA plans are permitted to cover a broader array of items and services as supplemental benefits so long as they are used to diagnose, prevent, or improve the effects of injuries or health conditions, or reduce avoidable emergency department visits. Previously, many of these services designed to improve patients’ day-to-day lives could not be covered as supplemental benefits under Medicare.    

 

Some higlights of a selection to be offering from various MA plans in 2019

  • At least 40% of plans will offer new types of supplemental benefits, such as nicotine replacement therapy (NRT), at no additional cost to beneficiaries. 
  • transportation to physician visits,
  • coverage of over-the-counter drugs,
  • adult day care services,
  • and other supplemental services that promote beneficiary health and wellness. 
  • caregiver support services (e.g., counseling and training courses for caregivers).
  • Other supplemental benefits offered for the first time include in-home support & personal care services,
  • home safety devices & modifications (e.g., shower stools, mobility ramps, night lights, etc.)  
  • social worker phone line,

 

 
* * * * It's Always Something . . . Roseanne Roseannadanna
Report Inappropriate Content
1
Kudos
1660
Views
Conversationalist
1
Kudos
1739
Views

Re: Silver Sneakers being droped by AARP recommended insurer

1,739 Views
Message 313 of 603

You've got that right.  AARP/UHC has reduced benefits (i.e. Silver Sneakers) while increasing their rates for 2019.  This has pushed me into looking for another gap plan, from another insurer.  There is one more point that the moderator (and AARP/UHC) seem to be missing: Silver Sneakers (i.e. going to the gym and working out) is PREVENTATIVE health care. You strenghten your heart, and can work on strengthening your ankles and knees.  By doing so, you can help retain balance and the possibility of falls.  It costs UHC a lot more to cover Part B overages for broken limbs (or worse) than it does to cover a subscriber's gym membership!  Just like going to the dentist and having your teeth cleaned helps maintain oral health, going to the gym helps keep the rest of the body working properly. Many gyms also offer nutrition classes, yoga, and other classes that help keep Seniors healthy.  That's what the Silver Sneakers program accomplishes. That reduces the cost of healthcare for everyone. 

Report Inappropriate Content
1
Kudos
1739
Views
Bronze Conversationalist
4
Kudos
1669
Views

Re: Silver Sneakers being droped by AARP recommended insurer

1,669 Views
Message 314 of 603

Wow, I've been watching all these posts and observe GaiL1's posts becoming more and more condescending to those complaining about losing Silver Sneakers.  I would respond only for myself that I, too, am unhappy with the way this went down-they were NOT as forthcoming about their plans when they should have been.  I too, realize that there is no guarantee that I will get Silver Sneakers forever.  I, too, got my insurance with AARP/UHC because of the Silver Sneakers offering.  I do NOT think it is free.  I know that I paid a higher in premium because of that benefit.  But now they are taking that benefit away AND increasing my premium at the same time.  Please spare me your lecture on how the various insurance plans work and your inability to understand why people are unhappy.  I get all of that.  I'm more unhappy at the tone of your emails that imply that the rest of us are morons and selfish, of which I am neither.

Report Inappropriate Content
4
Kudos
1669
Views
Info Seeker
0
Kudos
1670
Views

Re: Silver Sneakers being droped by AARP recommended insurer

1,670 Views
Message 315 of 603

We have all of the above for preexisting.

lobbying is a good idea but I doubt any expansion under the current administration. 

Report Inappropriate Content
0
Kudos
1670
Views
Conversationalist
0
Kudos
1404
Views

Re: Silver Sneakers being droped by AARP recommended insurer

1,404 Views
Message 316 of 603

Don't get to bogged down because of pre existing condiitons. The underwriting is much more leniant unless you have had a heart attack, diabetes or cancer to name a few. Go and apply. You may be pleasantly surprised. Good luck!

Report Inappropriate Content
0
Kudos
1404
Views
Valued Social Butterfly
0
Kudos
1413
Views

Re: Silver Sneakers being droped by AARP recommended insurer

1,413 Views
Message 317 of 603

Perhaps those who are passionate about this (or any other) exercise program staying within Medigap plans should put forth effort to have this type of program added to the list of medically necessary items which Medicare covers.

 

At least then, all seniors within Medicare would be able to partake of this type of activity, instead of those more wealthy or more elite.

  • Including The ones within traditional Medicare who are so poor that they are supplemented with Extra Help or Medicaid.  NO Medigap policy for them.
  • Including The ones within traditional Medicare who are maybe a bit more well-off but still cannot afford a supplemental or Medigap plan which contains this benefit.
  • Including The ones within traditional Medicare who can only afford some of the lesser coverage Medigap plans because all insurers don't have to cover every plan in any specific area.

Would you get this exercise benefit if you had a Medicare Select plan or a High Deductible Plan F?  Don't think so -

 

Personally, I think people should pay for this program in any Medigap plan that it is offered within, perhaps with a discount for participation - to keep the price down for others who don't need or want such a program but do want Medigap (Gap coverage).  

 

if your doctor orders some type of physical therapy - that is available via traditional Medicare, medically necessary with a doctor's order.  For others it seems like a social network thing - no problem with that but the cost should not be born by others who don't use it - visit a tax payer provided senior center for your comraderie.

 

i will leave this to you all who want the program but don't want to spend money on it - just think about the many seniors who can't afford a Medigap policy at all and this "free" program - think about them every time you go to have fun, socialize or even keep your joints moving - that some poor(er) senior doesn't get this access to this program.

 

However, if it has been proven scientifically that it is a medical necessity - then work on changing Medicare to include it for everybody - NOT just for the ones who can buy an elitist Medigap policy to fill in their cost and get this "free" perk.

 

Medicare is a government health care program for seniors - why should some get access and others not to this program - especially if it is "free" - nothing offered is usually FREE - cost are just passed on to others especially for insurers that are ONLY covering the GAP aspect of Medicare.

 

Join a Medicare Advantage Plan - that way you can get all the extra benefits which they offer - you can change your plan EVERY YEAR with no underwriting to keep up with whatever you want in a plan -'doctors, other providers, medicine,

and any other benefit which thee insurer may offer in any given year.

 

Right now, the way I see it - you all want all your cake and eat it too - to H*** with other seniors that may not be in your class of Medigap seniors.

 

 

 

 

* * * * It's Always Something . . . Roseanne Roseannadanna
Report Inappropriate Content
0
Kudos
1413
Views
Info Seeker
1
Kudos
1460
Views

Re: Silver Sneakers being droped by AARP recommended insurer

1,460 Views
Message 318 of 603

We picked AARP because it included Silver Sneakers which in our community saved us almost $1000 per year in gym memberships. The difficulty now is being unable to change carriers due to preexisting conditions. The selection you make at 65 is important because medical underwriting may make a change difficult to impossible. We have avoided ‘mother may I Medicare’ because we want the choice to pick the best provider not necessarily the one in your Advantage plan.

Report Inappropriate Content
1
Kudos
1460
Views
Highlighted
Info Seeker +
2
Kudos
1942
Views

Re: Silver Sneakers being droped by AARP recommended insurer

1,942 Views
Message 319 of 603

The Medigap plans being offered are considered the "cadillac" of additional Medicare coverage as we are allowed to visit ANY doctor in the US who accepts Medicare and are not corraled into only visiting doctors who are in a Medicare Advantage network. And we also can go to Mayo and my plan G will cover the excess 15% that they are allowed to charge. As such, we are paying for this premium. Many Advantage plans do not have any additional payments because Medicare covers the cost. I believe the whole insurance industry is trying to coerce us into Medicare Advantage plans as they are like HMO's. With Medicare Supplement plans (Medigap) we do not have the option each year to change plans without going through underwriting unless we are still in our open enrollment period. So that is why we are so upset with joining AARP UHC and then losing the 1 benefit we joined for. I just changed to Blue Cross/Blue Shield in AZ that offers Silver and Fit which is comparable to Silver Sneakers at my YMCA, as I just started Medicare this summer.

Report Inappropriate Content
2
Kudos
1942
Views
Conversationalist
1
Kudos
1921
Views

Re: Silver Sneakers being droped by AARP recommended insurer

1,921 Views
Message 320 of 603

Please note that changes can be made to the Advantage plans at any time by the insurance carrier. Silver Sneakers can be withdrawn from Advantage plans in the future just like they currently withdrew it from the Medigap plans. The GREAT disadvantage that I see in the Advantage plans is that they can dictate your network of available physicians and or hospitals and they will in the future after they have converted most people to the Advantage plans. Right now the Advantage plans are offering many benefits that they can change at any time at there discreation.

Report Inappropriate Content
1
Kudos
1921
Views
cancel
Showing results for 
Search instead for 
Did you mean: 
Users
Announcements

Have you taken a memorable trip to a destination others should know about? Post a Trip Report


city skyline captured on tablet

Top Authors