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Re: Silver Sneakers being droped by AARP recommended insurer

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Message 341 of 642

My apology about formerly being in HR. I read this quote but it was from another member: "I worked in a Fortune 100 HR department for 10 years, from which I retired several years ago.  The execs in that dept were interested in one thing:  cutting insurance costs"  This was not your quote and I do apologize for assigning it to you as you did not say it. I do not wish to knowingly include a falsehood in my posts.

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Re: Silver Sneakers being droped by AARP recommended insurer

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Message 342 of 642

Hello everyone,

Please remember to post according to the community guidelines, and refrain from insults and inflammatory comments.

Thank you for your cooperation in making the AARP Community a safe and welcoming place for all.
http://community.aarp.org/t5/custom/page/page-id/Guidelines

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Re: Silver Sneakers being droped by AARP recommended insurer

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Message 343 of 642

@goliath wrote:

First of all are you an employee of an independent health plan advisory service? If not, you are no more an "expert" on these plans than anyone else on this forum, despite being a "former HR person".

 

I've spoken to several independent health plan advisory services who say if you can afford it, stay on the Medigap plans as the "Advantage" plans that you tout, in the end, have many disadvantages, including cost if you develop a debilitating illness, and not being able to pick your own doctor or hospital among other things. They sound good but are not what they appear to be at first glance.

 

Once you leave Medigap for Advantage you may never be able to return to it if you develop "pre-existing" conditions as you must apply to the Medigap insurer you chose and be found acceptable to them, if you didn't initially sign up with them. The bottom line is we all need to make our own decisions but if Medigap programs can/will offer such benefits as Silver Sneakers we should take advantage of the offer and make our displeasure known if they later chose to remove the benefit. Most people recognize when they are being manipulated for additional profit, which is what this is. We SHOULD make our displeasure and our voices heard. I, for one, have had enough of companies whose only consideration is the bottom line.


I will respond to your points -

 

If you are speaking to me  - 

I am a senior, yes, retired - my background is in nursing and then as partner in my late husband's business - nothing to do with HR - we did have to buy our health insurance in the individual marketplace and never went without it no matter the cost.

 

The only reason why I am probably slightly more knowledgeable about Medicare is because I help other seniors with it - signing up, picking their way to get their benefits, picking the whatever plan, handling complaints about services, etc.  I explain it to them and they make their decisions - understanding goes a long way in working with the Medicare system.

 

Ok let's compare cost to the beneficiary in traditional Medicare and a Medicare Advantage plan.

1.  Traditional Medicare has NO cap on out of pocket expenses.  A Medicare Advantage plan has an annual limit on out of pocket cost to the beneficiary - that is the reason some people like Medicare Advantage plans.

 

2.  Everybody pays the Part B premium (representing 25% of the cost of the Part B program). So no difference there.

 

3.  Yes, within a MA plan you do have to work within network of providers but since you can change plans every year if need be - it is not too much of a hassle.  However, MA plans are not everywhere - mainly due to the lack of providers within certain geographical areas.  In Traditional Medicare, as long as the doctor or other health provider accepts assignment - then you are assured that Medicare will pay their 80% of the negotiated fee - leaving you to pay the 20% or set amount depending upon the service.

 

4.  So you say, well, I will just buy a Medigap plan to cover my cost of Traditional Medicare.  What is that cost per month?  $100 per month, $200 per month, $300 or more per month - yes, that's right, your premiums will go up,up,up.

 

5.  Compared to a Medicare Advantage plan that may have ZERO monthly premiums or $30 or $40 perhaps even including the Prescription Drug Plan - which a senior has to pay extra for in Traditional Medicare.

 

Medigap coverage is for those WHO CAN AFFORD IT - only about 25% of seniors in Traditional Medicare have a Medigap policy.  Some of the others have Employer Retiree coverage, others who are poor have Medicaid - then others who cannot afford the monthly premium of a Medigap policy have nothing -'they just pay their cost out of pocket and hope some condition does not break them.

Traditional Medicare use to have a fund called "Bad Debt"'which they would use to pay providers for seniors that did not pay their share cof the cost - the deductibles, the 20%, Etc.  Obamacare did away with the "Medicare,Bad Debt" fund.

 

You can go back and forth between Traditional Medicare and a Medicare Advantage plan all you want - there is no rule preventing anyone from moving from one way to get your Medicare benefit to another way of getting it - it is your benefit.

 

You are right, moving back to the Traditinal Medicare program from a Medicare Advantage plan depending upon the timing could prevent you from getting a Medigap plan or at least one that is reasonably priced if they rate you high.

But a Medigap plan isn't always in the financial borders of a beneficiary especially if their income is low but not low enough for Medicaid.

 

Medigap plans are for those seniors who can pay the higher monthly premiums for this beneficial GAP coverage - and that is all that it is - GAP Coverage.

 

When they offer extra programs like Silver Sneakers with no out of pocket cost to the seniors -'where do they get the money to pay the cost of such a program?

* * * * It's Always Something . . . Roseanne Roseannadanna
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Re: Silver Sneakers being droped by AARP recommended insurer

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Message 344 of 642

First of all are you an employee of an independent health plan advisory service? If not, you are no more an "expert" on these plans than anyone else on this forum, despite being a "former HR person". I've spoken to several independent health plan advisory services who say if you can afford it, stay on the Medigap plans as the "Advantage" plans that you tout, in the end, have many disadvantages, including cost if you develop a debilitating illness, and not being able to pick your own doctor or hospital among other things. They sound good but are not what they appear to be at first glance. Once you leave Medigap for Advantage you may never be able to return to it if you develop "pre-existing" conditions as you must apply to the Medigap insurer you chose and be found acceptable to them, if you didn't initially sign up with them. The bottom line is we all need to make our own decisions but if Medigap programs can/will offer such benefits as Silver Sneakers we should take advantage of the offer and make our displeasure known if they later chose to remove the benefit. Most people recognize when they are being manipulated for additional profit, which is what this is. We SHOULD make our displeasure and our voices heard. I, for one, have had enough of companies whose only consideration is the bottom line.

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Re: Silver Sneakers being droped by AARP recommended insurer

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Message 345 of 642

@NancyR150749

Our healthcare insurers - including Medicare, Medicaid, CHIP or even the VA Health System does not run by "should be"   a preventive measure available to all Medicare Part B participants.

 

It has to be proven by a scientific method and then the cost of it has to outweigh the cost of not having it and whatever results both ways.  That is what determines best practices for anything.  Healthcare is no different.

 

So then there has to be a change to  MEDICARE - put your fight where it really would count for all beneficiaries - doubt it would make a difference but that is based on the financial problems of Medicare.  I am sure they would love to add it, dental and vision too, if they could afford it - but somebody has to pay - Want your Part B premiums to go up even more than they already do?

 

OR join a Medicare Advantage plan where this sort of extra coverage is part of the overall concept.

 

 

* * * * It's Always Something . . . Roseanne Roseannadanna
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Re: Silver Sneakers being droped by AARP recommended insurer

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Message 346 of 642

@ChristineS148307 wrote:

Maybe I missed it, but I don't see anywhere that someone has argued that those without a Medigap plan should not get the Silver Sneakers benefit!  This is simply people who already have the benefit of Silver Sneakers lamenting that they will lose it.  You are creating a false narrative! 

 

 


That is exactly what you and others are saying when you vie for these extra programs in a Medigap plan.  The place for these extra programs is in a Medicare Advantage Plan - where you can pick and chose the plan that meets your needs and wants - that is the place for these extra benefits.

 

Traditional Medicare provides coverage for a wide array of medical and (Part B) drug benefits, but, with its deductibles, cost-sharing requirements, and lack of an annual out-of-pocket spending limit, many people on Medicare purchase Medigap supplemental insurance to help cover their out-of-pocket costs - That's it - the purpose of this GAP insurance..  When these extra programs are mixed within a Medigap plan, which have very specific plan coverage for the gap, the cost for all seniors having them is escalated under that insurer.  You don't really believe that you get something for nothing, do you?  From a private insurer???

 

Medigap plays a major role in providing supplemental coverage for people in traditional Medicare, particularly among those who do not have an employer-sponsored retiree plan or do not qualify for cost-sharing assistance under Medicaid. Medigap helps beneficiaries budget for out-of-pocket expenses under traditional Medicare. Medigap also limits the financial exposure that beneficiaries would otherwise face due to the absence of an out-of-pocket limit under traditional Medicare.

 

Traditional Medicare should be a place where everybody has the same coverage, paid in the same way, with the same rules about what is covered and what is not - it is a government ran healthcare system - there is no choices within it - it is dictated.  I don't care if people buy a Medigap to cover their own GAP in coverage if they can afford one.  It is these extra benefits being included within the Medigap coverage that I have a problem with - especially when it is billed as "free" - and for which all of you seem to have taken up arms.

 

Some are saying that it is preventive care - well it is not sanctioned preventive care by Medicare.

Some say UHC had no right to cancel it - well on all the paperwork I have seen it plainly states that these benefits can be cancelled at any time - fitness, dental, vision.

 

Federal law requires Medigap plans to be standardized to make it easier for consumers to compare benefits and premiums across plans. Adding these extra programs to some Medigap plans takes away this standardization.

 

Medigap is not subject to the same federal guaranteed issue protections that apply to Medicare Advantage and Part D plans, with an annual open enrollment period. As a result, in most states, medical underwriting is permitted which means that beneficiaries with pre-existing conditions may be denied a Medigap policy due to their health status, except under limited circumstances.

Evidently this isn't happening since so many of those commenting here don't seem to have a problem changing plans without a guaranteed issue circumstance.

 

If you want extra programs within your Medicare benefit - then pick the type that can offter the extra programs - GAP insurance is not the place for extra programs OR change Medicare rules so that it is medically necessary and then EVERY beneficiary can get the same shot at it improving their health with the comraderie that goes along with it.  Then the Medigap insurers would pick up all beneficiaries out of pocket for such a service.

 

 

* * * * It's Always Something . . . Roseanne Roseannadanna
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Re: Silver Sneakers being droped by AARP recommended insurer

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Message 347 of 642

But gym memberships should be a preventive measure available to all Medicare Part B participants.  I am 65, and not overweight or obese and do not have additional cardiovascular disease (CVD) risk factors.  I exercise regularly in a gym and eat healthy.  I take these proactive steps to maintain my good health.  Behavioral counseling should also be available to all Medicare Part B participants, as some folks need motivation/help to adopt healthy lifestyles.  Prevention measures are far less expensive than costly medical procedures and pharmacetical drugs!

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Re: Silver Sneakers being droped by AARP recommended insurer

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Message 348 of 642

But gym memberships should be a preventive measure available to all Medicare Part B participants.  I am 65, and not overweight or obese and do not have additional cardiovascular disease (CVD) risk factors.  I exercise regularly in a gym and eat healthy.  I take these proactive steps to maintain my good health.  Behavioral counseling should also be available to all Medicare Part B participants, as some folks need motivation/help to adopt healthy lifestyles.  Prevention measures are far less expensive than expensive medical procedures and pharmacetical drugs!

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Re: Silver Sneakers being droped by AARP recommended insurer

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Message 349 of 642

GaiL1 - why do you keep accusing people of being discriminatory against those who don't have a Medigap plan? 

 

"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." 

 

Maybe I missed it, but I don't see anywhere that someone has argued that those without a Medigap plan should not get the Silver Sneakers benefit!  This is simply people who already have the benefit of Silver Sneakers lamenting that they will lose it.  You are creating a false narrative! 

 

While one can certainly explore the whys, wherefores and fairness (or not) of the differences in plans/options/affordability, etc., that is a different issue and belongs on a different topical thread.  It is a worthy debate but you are creating it yourself and I don't see anyone arguing with you about the unfairness of the plan differences.  That's not what this is about despite your attempts to change the subject.

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Re: Silver Sneakers being droped by AARP recommended insurer

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Message 350 of 642

@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
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