@MaVolta wrote:
All plans, whether medigap or advantage, are subject to change. Everyone should check their plan updates every year, and make adjustments if needed. You can't just set it and forget it. Be sure to check for changes in your drug coverage and copays, whether it's traditional Part D or advantage Part D.
While Silver Sneakers, and other perks are nice to have, a change to copays or drug coverage could be the real deal breaker.
Medigap plans DO NOT change every year - actually never unless a change is made to traditional Medicare. Medigap plans are only supplemental plans - they supplement traditional Medicare - they are GAP insurance - Medicare makes the rules of coverage.
I have often wondered why some Medigap plans have offered this extra benefit of Silver Sneakers or any other extra type benefit because these are just that - extra - Medicare does not consider this to be medically necessary and thus it is not part of Medicare. Perhaps a special guaranteed issue condition may apply - that will have to be determined by (any) new Medigap insurer which a beneficiary may pick as a new insurer of this gap insurance.
I do hope people who are considering changing their Medigap plan because of this Silver Sneakers elimination will know what they are doing or work with an independent Medicare insurance agent or a knowledgeable SHIP agent so that they are protected - if they can be protected.
Medigap plans DO NOT have an annual renewal. Medigap plans are guaranteed renewable as long as you pay your premiums.
BTW - wonder if any of the affected beneficiaries have filed a Complaint with Medicare ? It may not be of help to you but could knock UHC down a few star ratings.
Another thing which could be considered is that any of these Medigap insurers could do the same thing because this Silver Sneaker program is an extra benefit NOT one dictated by Medicare. The Tivity Health program of Silver Sneakers now has lots of competition starting up now.
Medicare Supplement plans (also known as Medigap plans) are offered by private insurance companies and can help you pay for certain out-of-pocket costs not covered under Original Medicare. These out-of-pocket costs can include Medicare deductibles, coinsurance, and hospital or skilled nursing facility costs after you’ve used up your Medicare coverage. Medicare Supplement plans are only available to people who already have Medicare Part A, which helps pay for hospital services, and Part B, which helps pay for medical services. Medicare Supplement coverage only works alongside Original Medicare and can’t be used to pay for Medicare Advantage plan costs.
https://medicare.com/medicare-supplement/do-medicare-supplement-plans-differ-for-each-state/
Under federal law, you have a guaranteed issue right to buy a Medicare Supplement insurance plan (also known as MedSupp or Medigap) during the Medigap Open Enrollment Period, which begins the first month you have Medicare Part B and are age 65 or older. This means that during this six-month enrollment period, insurers cannot turn you down or charge you more because of a pre-existing health condition.
After the Medigap Open Enrollment Period, insurers can refuse to sell you a Medigap policy, delay coverage, or charge you a higher premium because of an existing health condition. The insurance company may also ask you to submit to a medical underwriting process and deny you coverage or charge you a higher rate based on its findings*.
There are some exceptions to the rule, however. In some situations, you have the guaranteed-issue right to buy a Medicare Supplement policy outside of your Medicare Supplement Open Enrollment Period:
- You have a Medicare Advantage plan, and the insurance company has left your service area.
- Your Medicare Advantage plan has been discontinued or is leaving Medicare.
- You have moved out of your Medicare Advantage plan’s service area.
- You currently have Original Medicare, and your employer coverage is ending.
- You have Original Medicare coverage and a Medicare SELECT plan, and you move out of the Medicare SELECT plan’s service area.
- You lose your Medicare Supplement insurance plan because the insurance company went bankrupt.
- You end your Medigap coverage because the insurance company misled you or was not compliant with the law.
You may qualify for guaranteed issue into a Medicare Supplement insurance plan, regardless of your medical history, if you meet certain criteria such as applying during your Medicare Supplement Open Enrollment Period. Additional guaranteed issues rights may be available and are dependent on your state of residence.
( like the "birthday rule" in California)
*Pre-existing conditions are generally health conditions that existed before the start of a policy. They may limit coverage, be excluded from coverage, or even prevent you from being approved for a policy; however, the exact definition and relevant limitations or exclusions of coverage will vary with each plan, so check a specific plan’s official plan documents to understand how that plan handles pre-existing conditions.
https://www.ehealthmedicare.com/medicare-supplement-articles/changing-medicare-supplement-insurance-...
You are right in that other things need to be considered when making a change but Medigap plans DO NOT have networks of providers like Medicare Advantage plans - Medigap plans cover providers on the Medicare list of providers that accept assignment - IF Medicare pays their part, your Medigap plan pays their part. Medigap plans do not have any drug coverage attached to them - you have to have a freestanding PDP if you use a Medigap plan.
It's Always Something . . . . Roseanna Roseannadanna
