long term strategy Medicare

[MarkL413231]

My brother and his wife seem to change Medicare Supplements almost every year to stay ahead of price increases.  Seems like the only one who makes with this ever change in plans is is their broker.  Now I understand that number of claims, the strength of the Insurance provider can play a role; but, what about pricing model?

Maybe staying with a mainstream insurance company, paying more in the beginning, means paying less in the long run? Has anyone done any trending on this theory over multiple years to determine which pricing model makes the most sense? At first blush, if someone can afford it, the issue age seems to make the most sense to me starting at age 65 or 66..

As far as the short term goes, it seems to make sense for me to wait until the 7-month of my IEP to enroll in a Medicare Part B so Medicare Part B premiums won't kick in until 6-months after I turn 65, then go with a Medicare Advantage Plan for up to 12 months before switching back to original Medicare and going with a Medicare Supplemental Plan G within that first 12 months.  The purpose would be for me to save on Medicare premiums the first year and to have the best possible coverage after that.  Does this make sense?

Keep in mind, I have VA HealthCare so I don't feel exposed as far as not having a Medicare Part B for 6-months past my 65th birthday.  I just wish VA Healthcare was creditable coverage for a Medicare Part B; but at least it is creditable coverage for a Medicare Part D.

[somarco]

@MarkL413231 you have a few things right, and a few wrong.

In most states, insurance brokers don't get front loaded Medigap commissions . . . rather, they get the same commission for 6 or 7 years . . . and it is typically half what MA plans pay. 

While you COULD change Medigap plans anytime you want, most states allow carriers to underwrite applications where the beneficiary is beyond their 6 month IEP.

Changing Medigap policies frequently potentially opens you up to post-issue underwriting allowing a carrier to review medical files to see if there was a material misrepresentation of your health at time of application.

Some states don't allow issue age policies, some don't allow attained age policies, some allow both. Almost all states allow community rated plans but those seem to be scarce due to potential adverse selection.

Timing your Part B enrollment can cost more money than it saves. Make sure you understand Medicare effective dates before trying to squeeze a few dollars out of your budget.

https://www.medicare.gov/basics/get-started-with-medicare/sign-up/when-does-medicare-coverage-start

It also seems you may not completely understand how VA and Medicare work together. I suggest you read this as well.

https://www.medicare.gov/basics/get-started-with-medicare/sign-up/when-does-medicare-coverage-start

CMS has rules about what you can do when. You need to understand them before you get tripped up.

As Mick Jagger said, "You can't always get what you want"

[MarkL413231]

Your generalized response at least explains why Medicare Brokers seem to push harder on MA plan.  Trying to pin down representatives with Medicare on my specific questions has not gone well for me.  But let me ask you something, are you saying that even if I went with a Medigap plan from the very beginning, switching to the same Medigap plan to another carrier can make pre-existing conditions count against me beyond age 65? 

I do understand that the availability of Medicare Supplemental Plans, as well as pricing plans, vary by geographical area.  As far as data available for me to trend, UHC was the community plan that I used in my personal analysis with an issue age policy.  UHC starts off with 40 discount points, and then the points available go down by 3 points every year, so that's where I came up with my drastic increase in costs for a Medigap Plan G as compared to an Issue Age policy.  Obviously, there are a lot of different variables besides the pricing model that can affect premium amounts.  In writing to the forum, I was curious about what others, including Veterans, thought in terms of their own experiences with Medicare.  

I completely understand how VA and Medicare are separate entities.  Thanks to the mission act, if I were to end up in a non-VA Hospital, the VA would pay.  If I were on a Medicare Part B premium, VA would pay my out-of-pocket expenses. For me, more is less, delaying a Medicare Part Premium for 6 months past my 65th birthdate is money I can use to pay my other bills. 

As the law currently reads, VA Healthcare is not considered creditable coverage for the purposes of a Medicare Part B, and in my particular circumstances, I know that I will not qualify for VA Healthcare down the road.  That's why, I plan in enrolling in a Medicare Part B when it comes time to avoid the Medicare Part B penalty which can compound 10% every 12-month period after the initial enrollment period. 

[ReTiReD51]

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I’d suggest before you go too far you need to understand what the Medicare insurance rules are for your state.

Best place to find that information is your states Department of Insurance and the Senior Health Insurance Information Program, SHIIP. They offer free unbiased (they don’t sell insurance), one-on-one counseling and assistance for eligible Medicare enrollees. Their counsellors are skilled in all things Medicare.

I’ve talked to individuals who wish they would have learned a little more about Medicare before selecting a Medicare Advantage plan instead of Original Medicare and then find out later because of their state’s rules it’s impossible or at least not feasible to opt out of their MA plan.

Measure twice cut once.

[MarkL413231]

I did consult Shiba Oregon previously and they were great!  However, I will call them again to insure I am on firm ground with what Medicare calls "trial right".  That's being able to enroll in a Medicare Advantage Plan the first year, then switching back to original Medicare Part B and a Medigap plan in the prescribed period where pre-existing conditions won't count against me.  

So many Medicare rules, if's, and's or buts, I don't want to rely on hindsight to tell me what I should have done!  Would of, could of, should or is a futile exercise in what could have been!

[GailL1]

Just a few comments

1.  The reason why Medicare Part B isn't creditable coverage with Medicare is because when there are budget problems, the VA can modify those priority ratings for those of higher income, no service-connected illness or injury and manipulate them for those who aren't critical of their services and thus the VA health benefit isn't set in stone due to this budgetary influence.

It is a good idea, if and when possible, for those with VA health care to have Medicare Part B (and get it when 1st eligible to avoid the LEP) - that opens up many more providers to them if need be.

2.  State insurance laws and regulations play a big part in how Medigap plans (Medicare Supplemental policies) function at the state level.  Some states may have a time specific period where one can change their policy to an equal or lesser one without underwriting.  Some states may open up all of the alphabet plans to those less than 65; others don't, or they may restrict them to just a couple of plans.  Do they set the type of ratings these insurers use in their state?  I don't know.  Some national plans like AARP UHC use the same rate type all over the country, I believe, community rated, I think.  However, calculations are still based on the area/state because health care cost do vary up and down even with Medicare.

You may want to review the rules of your state on Medicare Supplemental or Medigap plans at the state's DOI website just to make sure there isn't a rules condition there than could affect you and your plans.  

3.  I have always been under the impression that Community Rated is the rating type that would be the least volatile in premium increases just because the pool is large(r) and with a wider span of enrollees in age and therefore, in health status.   I don't know of any specific analysis on the different rating types but for those which are based on age, especially attained-age, one should should expect larger increases later in life.

4.  Yes, your VA Medication benefit is really good however, just remember that there may be some meds that aren't covered.  The VA has its own formulary, all VA docs use this formulary, so if you are visiting a doc outside the VA system, make sure that doctor is also using that formulary to assure that any med they prescribe will be covered.

5.  Waiting until the very last month of the initial enrollment period for Part B sounds like a good plan - just don't miss it - the late enrollment period premium penalty is pretty harsh and it last forever.

6.  I am not sure that your plan to get a MA plan and then go back to Traditional Medicare with a Medigap plan is a good idea (the 12-month plan).  Several things could throw a wrench in that plan.  While you can always switch from traditional Medicare to a MA plan and then even back to traditional Medicare. However, a Medigap policy may not always be available to one, or at a non-underwritten price premium, once the initial enrollment period has passed.  It is a bit risky and could use up any planned savings real quick.

Medicare.gov - When Can I Buy A Medigap Policy - Guaranteed Issue Rights

I think sitting down with a LOCAL, KNOWLEDGEABLE MEDICARE insurance broker who also understands the VA system would be worth its weight in gold to you - There is no cost to you for such a consult and they could always see something that you might be missing just in the various state rules or even another type fed/state benefit like the Medicare Savings Program, if you qualify.

Medicare is a program that has lots of twist and turns in eligiblity and timeline within their various programs - a trip up could be costly and it really takes knowing a lot about you personally to advise you on any specific - that's why I am suggesting sitting down with a LOCAL, KNOWLEDGEABLE, MEDICARE insurance broker for that consult.  Yes, state DOI have people in the SHIP (State Health Insurance Program) to answer questions - maybe they would do but then again maybe not - depends on their knowledge - in your case, Medicare and VA.