WHY DO YOU THINK THAT CMS DISCONTINUES CERTAIN MEDIGAP PLANS

[GailL1]

 I hope everybody knows what a Medigap plan is. (Medicare Supplemental Plan) - It is NOT Medical insurance, it is financial protection insurance.  A Medigap plan makes NO health decisions, it’s ONLY function is to cover some or most all of your out of pocket cost on Traditional Medicare depending upon the Medigap plan that a beneficiary has chosen.  

Why is a Medigap plan advisable when a beneficiary has chosen Traditional Medicare as to the way they want to get their benefits.  Simply because Traditional Medicare has NO limit as to a beneficiary’s out of pocket cost.  So unless one has a Medigap plan or some other coverage that acts as a supplement to Traditional Medicare, the beneficiary could be on the hook for a good amount of out of pocket cost.

Other plans for which a beneficiary is eligible could also act in covering some or all of these Traditional Medicare out of pocket cost.  Like Medicaid, some retiree coverage, CHAMPVA for dependents or widow/widowers of eligible Veterans,  Military coverage where Medicare works with these benefits, perhaps some other government retiree health coverage.  

 A Medigap plan simply works like this - a claim is filed with Traditional Medicare, Traditional Medicare covers their part of the cost and then send the processed claim onto the private insurer Medigap plan that is on your file for their processing - they then pay their part of the Medicare approved service - all or part depending on the Medigap plan the beneficiary has chosen. 

 A Medigap plan only works with Traditional or Original Medicare.  It has NOTHING to do with a Medicare Advantage plan which is Medicare Part C.  In fact, it is illegal to have both - a Medicare Advantage plan and a Medigap plan.  

About every 10 years, the Center for Medicare and Medicaid Services discontinues some Medigap (Medicare Supplemental) plans sold in the open Market.   Why do you think they do this?  Why to save money, of course.  

How does it save money, you may ask - by discouraging seniors to use it so plentiful because these plans are the most lucrative in benefits at the time.

So now we have others that step up to be the next best in plentiful benefits - like Plan G - so in a few years, do you think that plans like Plan G which only straps the beneficiary in paying the Part B deductible will be discontinued ?  Maybe, Maybe not - since paying the rising Part B deductible can be a sort of deterrent all it’s own, since their is NO limit as to how high it rises - it covers 25% of the cost of Part B with the government out of the General Fund making up the other 75%. 

Yes, those that have them, can keep them but with no new, younger and hopefully, healthier beneficiairies coming into these   plans - the premiums will rise as those who still have them get older, perhaps sicker and begin to use it more and more.

Some people are opting for a High Deductible Medigap plan - currently open to new purchasers is only (1) -   the Plan G High Deductible.  This options save a TON in premiums but of course, it does have a deductible that is paid for incrementally as claims come in - in 2024, the High Deductible was $ 2800 and 2025, the HD is $ 2870.

So what is the future gonna hold for Medigap Plans in your opinion?  I am sure you are pleased with their function but what do you feel about your current premiums?  Is there a concern that you might not be able to afford these premiums in the future IF YOU DO NOT LIVE IN A STATE THAT HAS EXPANDED SOME SORT OF GUARANTEED ISSUE PERIOD WHERE YOU CAN CHANGE PLANS WITHOUT UNDERWRITING.  But in fairness, premiums are much higher in the states that have this benefit.  

Historically, it is the most plentiful plans that are discontinued - The ones thus far have been (from memory and this is not all of them): 

Year Discontinued	Medigap Plan Discontinued
2010	Plan J
2010	Plan H
2010	Plan I
2010	Plan E
2020	Plan F
2020	Plan C

[CharlesC296805]

Please do some additional research, like using the Medicare.Gov website on Guarantee Issue Right and for other explanations on how Medicare works. Yes, a Medicap plan is supplement insurance, because when the claims are filed, they are PAID by private Insurance companies, like Aetna, Humana, etc.

This Guaranteed Issue right is for every state, not just a few.

You get a 6-month “Medigap Open Enrollment” period, which starts the first month you have Medicare Part B and you’re 65 or older. During this time, you can enroll in any Medigap policy and the insurance company can’t deny you coverage due to pre-existing health problems. After this period, you may not be able to buy a Medigap policy, or it may cost more. Your Medigap Open Enrollment Period is a one-time enrollment.  It doesn’t repeat every year, like the Medicare Open Enrollment Period. 

[GailL1]

@CharlesC296805 

OH, I know Medicare and Medigap -You have correctly stated the Federal rules  but you are discounting the number of states that have expanded all or certain Medigap enrollment periods WITHOUT UNDERWRITING.

Several states allow Medicare beneficiaries to switch(over 65)  Medigap plans without underwriting, including: 

• Guaranteed issue states

  Connecticut, Maine, Massachusetts, and New York require guaranteed issue protections for all Medigap beneficiaries ages 65 and older. 
• Birthday rule states

  California, Idaho, Illinois, Nevada, Oregon, and Oklahoma have birthday rules that allow beneficiaries to switch to a different plan with the same or lesser benefits without underwriting. 
• Open enrollment states

  Connecticut, Maine, Massachusetts, and Washington have year-round open enrollment for Medigap. 
• Anniversary rule states

  Missouri has an Anniversary Guaranteed Issue Period that allows beneficiaries to switch to the same plan from any other carrier within a 60-day window around their plan anniversary. 
• State-specific open enrollment

  Massachusetts has a two-month open enrollment window from February through March. 

  I believe that Louisiana recently also became a birthday rule state that allows Medigap enrollees to switch to a different plan with equal or lesser benefits within 63 days of their birthday. This rule only applies to plans offered by the same insurer.

  Those are the ones that I know about currently.

  But that isn’t my question - I just listed that fact since it seems that more and more states are opting for this added enrollment out side of the Fed rules.

  My question:  So what is the future gonna hold for Medigap Plans in your opinion?  What’s gonna be the next one(s) that CMS cancels from being sold in the open market?