Which Medigap plan is best - Major Decision

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Which Medigap plan is best - Major Decision

Postby btenny » Wed Sep 14, 2011 12:07 pm

The wife and I have to select Medigap insuarance in the next few months and I am debating which type of insurance to buy. I have been posting on the other discussion but thought a separate discussion would be better. So here goes.

We have been very happy with our corporate insurance for 40+ years with small deductables and full doctor choice. So this movement to Medicare and Medigap and Rx multi part insurance has us very concerned. Plus this decision seems irrevocable even if costs go up drastically or service is terrible or Doctor choice goes bad. So here are my questions.

1. Can anyone assage my worries about geting scr**ed over by some insurance company over doctor choice or deductables or other similar stuff in the future and not being able to change Medigap policies due to pre-existing conditions.....

2. It seems like the lower cost Plan F with a $2K + annual deductable is the best bet for my wife as she is in good health and never needs to go to the Doctor. The cost for this is $63 per month versus $166 for regular Plan F. Yes I know that things can change but this seems like a good trade off of risk versus costs . If she is healthy 2 out of 3 years we do OK. Plus Plan F seems to have few added features like Excess charges and Foreign Travel that seem good. Is this good stuff? But the real issue I am concerned with is the company raising the $2K ceiling to $4K or even higher in future years as well as raising the rates. Any thoughts?

3. Or should we choose some other Medigap plan like Regular Plan F or Plan L for other reasons.

Bill
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Postby blacktupelo » Wed Sep 14, 2011 12:24 pm

My wife has had a Plan F policy since March. You'll find that these plan variations are controlled by Medicare, not the vendor. You can change plans annually.

More complicated is to choose a Part D drug program. You really need to know what meds you are taking now and what is covered by each plan's formulary. The online tool from Medicare lets you get the information on what is available so you see everything open to you.
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Postby btenny » Wed Sep 14, 2011 12:50 pm

You may be able to change plans annually but when I sign up I probably will be locked into that plan for life. I have pre-existing conditions and am on a few meds at pre-65. So the notion of any insurance company allowing me to join the pool without excluding those issues is hard for me to believe. So the one time exemption when I turn 65 will be my only chane to get the Medigap policy I suspect..

On the other hand my wife could probably pass a physical for years to come so she could probably change insurance if she was not happy with her initial choice.

Bill
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Postby nisiprius » Wed Sep 14, 2011 1:23 pm

I've only been on Medicare + Medigap for a short time--specifically Medicare A, B, D (the prescription plan), and Medicare supplemental ("Medigap.") So far it has all gone smoothly. All insurance details vary from state to state so don't take this as gospel. In my case, my understanding is that the only question is "does the doctor--or durable medical equipment supplier--or whomever take Medicare assignment?" In my case, so far, the answer has always been a matter-of-fact instant "yes" from the office staff; the typical answer I've gotten is "all of our doctors take Medicare," no pregnant pause or "let me check the list."

The Medigap insurer has no preapproval process and requires no authorization or referral from a PCP. Basically, the doctor bills Medicare first, and then sends the remainder to the insurer.

The overall experience so far has been comparable to my prior HMO experience, which was very good. A little better, actually, since there are no referrals needed and no office visit co-pays. I've called Medicare (Center for Medicare Services) a couple of times, and the "customer service" seemed to be good, and comparable to the insurer's--answered the phone quickly, had all my information in front of them, answered questions intelligently.

It's insane that I now deal with three entities (CMS, the insurer, and the prescription plan insurer), and the prescription plan sends me an eight-page (four-sheet) mailed paper statement every month in order to say that I filled two generic prescriptions for about ten bucks each. There are charts and diagrams to explain where I am in the multiphase process and where I am relative to the deductible and when I enter the doughnut hole, etc... But the bottom line is I visit the doctor and get the tests and get the prescriptions and get a lot of mail that says "Patient's responsibility: $0.00" at the bottom of it.

P.S. With respect to commitment, I'm fairly sure you can change FROM Medicare + Medigap TO Medicare Advantage if you don't like Medigap, it's going the other way that's uncertain.
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Postby kaneohe » Wed Sep 14, 2011 2:47 pm

nisiprius wrote:
P.S. With respect to commitment, I'm fairly sure you can change FROM Medicare + Medigap TO Medicare Advantage if you don't like Medigap, it's going the other way that's uncertain.


I'm in my first 2 wks of learning this stuff but that's my understanding also.
In addition, my impression is that changing from Medigap company X to
Medigap company Y is iffy if you have pre-existing conditions. I've also seen/heard a few times that changing medigap plans within a specific provider may be easier than switching providers/plans simulteously.

Another possible variable is how the Medigap plans base their rates.......
AARP is the only one I've found that is community-based (not age attained or current age). Possibly? these rates may increase more slowly than the others as you age?

Tell me more........need to learn quickly too........
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Postby rwwoods » Wed Sep 14, 2011 5:29 pm

The decision is not irrevocable if you choose the right provider. We have United Healthcare (AARP) and we are allowed to change plan types anytime. My suggestion is to ask a provider to tell you the prices for each plan, then compare the pros and cons of moving from a lower cost plan to a higher cost plan. A lot will depend upon how many times you have normal dr visits. For example, we had Plan J (no longer available to new members) and switched to Plan L for an estimated savings of $800/yr for wife and me assuming no major medical bills. In other words, we are betting that the $800/yr savings will offset any future major out-of-pocket expenses.
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Postby James4639 » Wed Sep 14, 2011 7:20 pm

Here's what I understand about doctor and hospital charges covered by Medicare and MEDIGAP Insurance. It may not all be correct, please correct if you know different. I'm certainly not an expert.

I've capitalized MEDIGAP (private insurance) to highlight it from Medicare (government insurance).

For seven years, since becoming 65, I've been on Medicare Part A (Hospitalization) which is free and Medicare Part B (Doctor bills) which you pay for...normally around $96 per month and is deducted from your Social Security check or deposit, and on MEDIGAP Plan A from Globe life which cost me $95 per month. In the seven years this has gone up around $8.00 monthly.

Doctor bills:
If the doctor accepts the Medicare Part B approved amount which most do, you will pay the first $162 of the doctor's charges yearly. This goes up a little each year. Some of the MEDIGAP Plans pay this charge, some don't. Otherwise, MEDIGAP Plans are very little involved with doctor's bills.

Hospital bills:
You or your MEDIGAP policy (depending on which plan) will pay the first $1,132 for each hospitalization. Medicare Part A pays everything else (except TV and private room charge, etc.) for the first 60 days you are in the hospital. From the 61-90th days, Medicare Part A pays all but $283 per day and from the 91st until the 365th day Medicare Part A pays all but $566 per day. All MEDIGAP Plans pay these charges. There are “reserve days” that I don't understand.

Neither my wife (also on Plan A, another $95) or myself have been in the hospital since retiring and only for childbirths (not mine) before that. We both have had the colonostophy (sp) thing twice since then and my wife had cataracts removed last year. From what I can tell MEDIGAP Plan A has paid less than $300 for everything in the seven years we've had it.
Globe Life only offers Plans A, B, C and F here in Georgia. You indicated that you were quoted $63 a month for Plan F with the $2,000 deductible, I called Globe Life to switch to that plan today since I pay $95 for Plan A, which pays for less things than Plan F. It turns out that they don't offer Plan F with deductible in Georgia. Would you be so kind as to let me know what company offers your plan at that price?

OPINION: I've seen several people in the hospital in the last few years with serious illnesses and have yet to see any of them stay in the hospital for more than two or three weeks. Since Medicare Part A pays for most costs for a hospital stay for the first 60 days with the exception of the initial $1,132, unless you have major health problems, MEDIGAP policies are a waste of money. I wish that any hospital administrators or accountants would chime in with information regarding normal time spent. It seems to me that hospitals tend to get you out quickly.

Sorry for the length...James
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Postby Munir » Wed Sep 14, 2011 7:33 pm

If I understand your situation correctly, I think the main issue for you is to choose the company that you will be with longterm because of pre-existing diseases. It should be easy to change from one plan type to another with the same company, but you are correct that it would be difficult/expensive to change companies in the future because of pre-existing diseases. I have been with AARP for nine years and happy with them- even thought I feel grouchy about the monthly payments.

The Part D medicaiton plan has to be reassessed every fall prior to 12/31 becasue they all change their rates and what they offer every calendar year. No problems there with pre-existing disease.

These descriptions should apply to both you and spouse (there usually is a discount if you both apply to the same company). She may develop a disease anytime which would throw her into the pre-existing disease situation that you are in.
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Postby btenny » Wed Sep 14, 2011 8:06 pm

So far I have found two Medigap policies that work for my wife. Anthem Blue Cross California offers the Medigap Part F High Deductable for $41.30 per month and Humana Arizona offers the Medigap Part F High Deductable for $63.59. Right now I am not sure which plan we will choose. We also got higher price quotes for regular Part F and Part N from both companies as well as quotes from other companies.

Both companies told us we could switch policy types (Part F High Deductable to Part N for example) within their company in the future. But they also said any policy change after initial enrollment would require medical underwriting and TBD what the new policy cost would be at that time. Plus she also said they had the right due to this underwriting clause to also turn down any change.

Bill
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Postby pshonore » Wed Sep 14, 2011 8:41 pm

James4639 wrote:Here's what I understand about doctor and hospital charges covered by Medicare and MEDIGAP Insurance. It may not all be correct, please correct if you know different. I'm certainly not an expert.

I've capitalized MEDIGAP (private insurance) to highlight it from Medicare (government insurance).

For seven years, since becoming 65, I've been on Medicare Part A (Hospitalization) which is free and Medicare Part B (Doctor bills) which you pay for...normally around $96 per month and is deducted from your Social Security check or deposit, and on MEDIGAP Plan A from Globe life which cost me $95 per month. In the seven years this has gone up around $8.00 monthly.

Doctor bills:
If the doctor accepts the Medicare Part B approved amount which most do, you will pay the first $162 of the doctor's charges yearly. This goes up a little each year. Some of the MEDIGAP Plans pay this charge, some don't. Otherwise, MEDIGAP Plans are very little involved with doctor's bills.

Medicare generally pays 80% of the approved doctor's charge; the other 20% is your responsibility. Most Medigap plans do pay that 20%. If you have a lot of doctor visits, that can add up if you don't have a Medigap plan.
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Postby kaneohe » Wed Sep 14, 2011 8:46 pm

btenny wrote:
Both companies told us we could switch policy types (Part F High Deductable to Part N for example) within their company in the future. But they also said any policy change after initial enrollment would require medical underwriting and TBD what the new policy cost would be at that time. Plus she also said they had the right due to this underwriting clause to also turn down any change.

Bill


Thanks, this is useful info......so possibly there is no difference switching policies either changing companies or not........still subject to underwriting.
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Postby kaneohe » Wed Sep 14, 2011 8:50 pm

James4639 wrote:
OPINION: ..............................Since Medicare Part A pays for most costs for a hospital stay for the first 60 days with the exception of the initial $1,132, unless you have major health problems, MEDIGAP policies are a waste of money.


......but isn't that the purpose of insurance to take care of the low probability
high risk major major problem that we hope never comes so that we do "waste" our money?
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Postby nisiprius » Wed Sep 14, 2011 9:55 pm

The material that came with the application for my Medigap policy states that the insurance company expects to pay out $87 in claims for every $100 of premiums. That doesn't seem unacceptably wasteful to me, even if, hopefully, it never amounts to more than a service contract.
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Postby 1530jesup » Wed Sep 14, 2011 10:17 pm

James4639 wrote:OPINION: I've seen several people in the hospital in the last few years with serious illnesses and have yet to see any of them stay in the hospital for more than two or three weeks. Since Medicare Part A pays for most costs for a hospital stay for the first 60 days with the exception of the initial $1,132, unless you have major health problems, MEDIGAP policies are a waste of money. I wish that any hospital administrators or accountants would chime in with information regarding normal time spent. It seems to me that hospitals tend to get you out quickly.
...James


just like investing, most folks do not have a crystal ball as to their future health needs. all it took was a back pain to lead me down the path to where I now see five doctors (oncologist, cardio, pulmonary, etc...) to keep me going. all this after years of exercising, no hot dogs or pastrami sandwiches and tons of fruits and vegetables.

I believe once you pass up that initial sign up period you will be letting yourself in for higher Medigap costs later on.
this is insurance that could become valuable later no matter how healthy you are now.
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Postby AlanK » Thu Sep 15, 2011 9:42 am

If I am reading some of the above comments correctly, people seem to be saying that you cannot switch out of a MA plan and go to regular Medicare. Or, after making an initial choice for regular Medicare, you cannot then choose a MA plan in future years.

I don't think this is correct. I think, each year, there are time periods when you can switch from a MA plan to regular Medicare, or from regular Medicare to a MA plan. When doing the latter, however, medical underwriting is taken into consideration.
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Postby pshonore » Thu Sep 15, 2011 10:13 am

I'm surprised by the large differencs in premium charged for the standard "Letter" Medigaps plans. Here's a link to <b>plans available in CT</b>.

http://www.medicareoptions.info/PDFs/Me ... un2010.pdf

Plan B: Colonial Penn $ 610 Globe Life $181
Perhaps one underwrites and the other does not??

United Health generally looks like the low cost provider. Think you have to join AARP to be eligible though.

The website in the link seems to be a good source of info for CT. I imagine you can find similar sites for your state through Google.
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Postby 1530jesup » Thu Sep 15, 2011 11:12 am

pshonore wrote:
United Health generally looks like the low cost provider. Think you have to join AARP to be eligible though


although I am a member - temporarily, I plan not to re-join - I believe that they do not turn away non-members. AARP is, in my humble opinion, primarily a marketer of insurance that supports senior issues.
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Postby Rtw » Thu Sep 15, 2011 11:57 am

Medigap plans vary state to state. Depending on where you live, one company's rate will be the best while in another state, it may not be the least expensive.

Each plan F is the same as any other company's plan F. Price and financial strength are the only concerns. Price being more heavily favored. Expect pricing of these plans to increase each year. Sometimes it a small increase, some times it's not. As long as you remain in fair health, you can move your medicare supplement (medigap) plan whenever you want. Medicare advantage plans are a completely different story. Gov't is heavily involved in medicare advantage and only allow you to change at the end of the year (same as with part D).

One other issue I would mention. Don't necessarily think your buddy's plan will be the best plan for you. Here are some factors to consider:

Some plans offer spouse discounts
Some plans offer same price no matter what your height and weight are
some plans offer same rates for smoker vs non-smokers
Some plans offer "looser" underwriting guidelines

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Postby FFR1608 » Thu Sep 15, 2011 12:17 pm

btenny wrote:So far I have found two Medigap policies that work for my wife. Anthem Blue Cross California offers the Medigap Part F High Deductable for $41.30 per month and Humana Arizona offers the Medigap Part F High Deductable for $63.59. Right now I am not sure which plan we will choose. We also got higher price quotes for regular Part F and Part N from both companies as well as quotes from other companies.

Both companies told us we could switch policy types (Part F High Deductable to Part N for example) within their company in the future. But they also said any policy change after initial enrollment would require medical underwriting and TBD what the new policy cost would be at that time. Plus she also said they had the right due to this underwriting clause to also turn down any change.

Bill



I too, like the Blue Cross High Deductible plan. Only downside is the book keeping and check writing necessary. The savings is worth the clerical effort for my wife and I. In two of the seven years I have been in the plan I went over the $2000 deductible. Even those years I felt the plan was well priced. Blue Cross is very effective with accurate record keeping and a large pool of caregivers.

The choice of primary care doctors and hospitals is worth a lot to me. And I really value the option of selecting my own specialists. All of my doctors are top tier and I think that the possibility of needing someone who doesn't is rare.

I do understand though that in some places the doctors who don't accept medicare is a higher proportion than San Diego.

Cheers,
David
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Popular Medigap Plans: 'C', 'F' and 'N'

Postby mur44 » Thu Sep 15, 2011 3:58 pm

If you are looking for gold standard for health
insurance, take Medicare Parts A, B and D
with a Medigap plan. Alternatively,
you can choose a Medicare Advantage
plan with drug coverage (MAPD).

If you live in New York or Connecticut,
you have the right to join/change Medigap
plans anytime you wish. No such right
is available in the rest of the 48 states.

You should go visit your State Health
Insurance Assistance Program (SHIP)
that provides free and unbiased counseling
and guidance on how to go about choosing
your options.


Disclosure: I am a volunteer Medicare
Counselor from New Jersey
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Postby btenny » Thu Sep 15, 2011 6:02 pm

Well I am pretty sure we are going to go with the Hi Deducable Part F plan from Anthem BLue Cross for my wife. So far my math says it is a better deal for us if we stay under the $2K deductable 2 years out of 3. Which seems easy in my wifes' case. Plus we have done business for years with Blue Cross though my old employer plan and they were very easy to do business with and settled claims promptly.

Our only concern was state legal residency versus part time residency and where we get our mail. Blue Cross has assured us that we can join and buy this insurance even though we are only part time California residents but legal residents of another state. Right now we go to some doctors in California and some in another state so this state issue was a big deal for us. They said it was not a big deal to them and that we could go to any doctor in any state and keep the same insurance as long as we were a part time California residents.

Now we will wait for the exact policy and the application and see if it is the same as our preliminary data.

Plus we also have to see about a Part D Rx plan. So far that looks like we will go with the Walmart Preferred plan for $14.80 per month via Humana. They cover the one med she takes and are projected to be $200 or so cheaper than the next cheapest provider. The gotcha is my wife hates Walmart and dislikes Humana so if things go bad or the service is poor I will hear noise for months. Yuck... But the savings of $200 or so per year to too good to pass up.

Bill
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Postby anonenigma » Thu Sep 15, 2011 7:17 pm

[quote="Munir"]If I understand your situation correctly, I think the main issue for you is to choose the company that you will be with longterm because of pre-existing diseases. It should be easy to change from one plan type to another with the same company, but you are correct that it would be difficult/expensive to change companies in the future because of pre-existing diseases.

Pre-existing conditions are not a consideration with Medicare. There is open enrollment both around the time of your birthday and, I think, near the end of the year.

As I recall, at open enrollment time you can switch to the same policy at a different company, or to a policy with less coverage, but I'm not sure that you could switch to a policy with more coverage, say from an A to a C.

I'm a fan of the classic F coverage, because it covers fees from doctors and hospitals that don't accept Medicare assignment and because it covers more days in skilled nursing. When I bought it for my late aunt and my mother, the F plan was only a dollar or so more per month than the C Plan.
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Postby Munir » Thu Sep 15, 2011 7:34 pm

anonenigma wrote:
Munir wrote:If I understand your situation correctly, I think the main issue for you is to choose the company that you will be with longterm because of pre-existing diseases. It should be easy to change from one plan type to another with the same company, but you are correct that it would be difficult/expensive to change companies in the future because of pre-existing diseases.

Pre-existing conditions are not a consideration with Medicare. There is open enrollment both around the time of your birthday and, I think, near the end of the year.

As I recall, at open enrollment time you can switch to the same policy at a different company, or to a policy with less coverage, but I'm not sure that you could switch to a policy with more coverage, say from an A to a C.

I'm a fan of the classic F coverage, because it covers fees from doctors and hospitals that don't accept Medicare assignment and because it covers more days in skilled nursing. When I bought it for my late aunt and my mother, the F plan was only a dollar or so more per month than the C Plan.


Prexisting conditions are not a factor with one's initial registration with Medicare-usually at age 65. However, if you decide to change to another company at a later date, they DO matter even with open enrollment periods. The pre-exisitng condition could be excluded by the company you are applying to for a certain period of time or forever. I don't know if this applies if you are changing from traditional Medicare to an Advantage plan.
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Postby kaneohe » Thu Sep 15, 2011 10:22 pm

Munir wrote:
anonenigma wrote:
Munir wrote:If I understand your situation correctly, I think the main issue for you is to choose the company that you will be with longterm because of pre-existing diseases. It should be easy to change from one plan type to another with the same company, but you are correct that it would be difficult/expensive to change companies in the future because of pre-existing diseases.

Pre-existing conditions are not a consideration with Medicare. There is open enrollment both around the time of your birthday and, I think, near the end of the year.

As I recall, at open enrollment time you can switch to the same policy at a different company, or to a policy with less coverage, but I'm not sure that you could switch to a policy with more coverage, say from an A to a C.

I'm a fan of the classic F coverage, because it covers fees from doctors and hospitals that don't accept Medicare assignment and because it covers more days in skilled nursing. When I bought it for my late aunt and my mother, the F plan was only a dollar or so more per month than the C Plan.


Prexisting conditions are not a factor with one's initial registration with Medicare-usually at age 65. However, if you decide to change to another company at a later date, they DO matter even with open enrollment periods. The pre-exisitng condition could be excluded by the company you are applying to for a certain period of time or forever. I don't know if this applies if you are changing from traditional Medicare to an Advantage plan.


I guess it's getting kind of confusing about who said what but my understanding is the same as Munir's........first entry into supplement plan is easy if you do it when you get to Medicare age (do you have to be insured continuously before you get the supplement) but not necessarily easy to change supplement companies thereafter (subject to underwriting: I don't know if this means they can reject you or just charge you outrageous rates for pre-existing conditions).

My understanding is that switching Advantage plans at open enrollment does not have this problem.
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Postby BruDude » Thu Sep 15, 2011 10:28 pm

Applying for a new Medigap policy after initial enrollment is generally pass/fail underwriting where if you answer "yes" to one of the questions you are declined, but if you can answer "no" to all of them, you are accepted. Every state has different rules on switching plans.
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Postby Alan S. » Thu Sep 15, 2011 10:43 pm

The main restriction is going from MA to a Medigap plan of any type. You can drop the MA plan and go to another MA plan or go back to basic Medicare A and B, and select the Part D plan of your choice.

But if your MA plan and others in your area jack up their rates or provide poor service, you must go through underwriting which includes pre existing condition exclusions etc if you want to go to Medigap, and this hassle makes this type of move very impractical for most.

If the MA plan folds because of HHS mandated consolidation in your area, this becomes a qualifying event and frees you up to enroll in a Medigap plan without underwriting, ie guaranteed issue. For some people who are really stuck, it might work to go with the smallest and worst MA plan in your area since that plan has the highest chance of termination. You are then free to go back to Medigap. Perhaps a local health insurance agent might have some insight on which plan may be most likely to terminate. You probably cannot get that info from HHS.

NOTE: May be some variations to the above in certain states.
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Postby john94549 » Fri Sep 16, 2011 12:08 am

OK here's a question for the multitude. I am 64, pushing 64 1/2. Never paid a lot of attention to my health. Although I have good genes (my Mom is 96), I suspect I have many undiagnosed illnesses and could never pass a proper physical. Now, when I "qualify" for Medicare, can I just "buy" Medigap through AARP (which I understand is underwritten by United Health) without a physical exam? I am petrified that if I were to be subjected to a physical, I would be laughed out of the office. I have not had a proper physical since I was in the service, some thirty+ years ago (please don't be judgmental).
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Postby BruDude » Fri Sep 16, 2011 12:12 am

john94549 wrote:OK here's a question for the multitude. I am 64, pushing 64 1/2. Never paid a lot of attention to my health. Although I have good genes (my Mom is 96), I suspect I have many undiagnosed illnesses and could never pass a proper physical. Now, when I "qualify" for Medicare, can I just "buy" Medigap through AARP (which I understand is underwritten by United Health) without a physical exam? I am petrified that if I were to be subjected to a physical, I would be laughed out of the office. I have not had a proper physical since I was in the service, some thirty+ years ago (please don't be judgmental).


Yes, it's guaranteed-issue when you turn 65. AARP/UHC is likely more expensive than other med-supp companies. The benefits are exactly the same no matter which company you use, so you just want the lowest rates. If the company ever goes out of business or exits the market, you get guaranteed-issue rights again anyway.
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Postby john94549 » Fri Sep 16, 2011 12:27 am

BruDude wrote:
john94549 wrote:OK here's a question for the multitude. I am 64, pushing 64 1/2. Never paid a lot of attention to my health. Although I have good genes (my Mom is 96), I suspect I have many undiagnosed illnesses and could never pass a proper physical. Now, when I "qualify" for Medicare, can I just "buy" Medigap through AARP (which I understand is underwritten by United Health) without a physical exam? I am petrified that if I were to be subjected to a physical, I would be laughed out of the office. I have not had a proper physical since I was in the service, some thirty+ years ago (please don't be judgmental).


Yes, it's guaranteed-issue when you turn 65. AARP/UHC is likely more expensive than other med-supp companies. The benefits are exactly the same no matter which company you use, so you just want the lowest rates. If the company ever goes out of business or exits the market, you get guaranteed-issue rights again anyway.


That's what I thought. I'm really more concerned about getting the coverage than about rates. Now, another question. My wife is a cancer-survivor (breast cancer). She has excellent (and cheap) health coverage (PPO just about fully-paid through her employer). Should she get Medigap at age 65 even though she doesn't really need it? I'm just worried she might not be able to get it "later" when she finally decides to retire.
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Postby john94549 » Fri Sep 16, 2011 12:52 am

My Mom (who is 96) has had many run-ins with Medicare, Parts A and B (she's opted out of D, given her generous retiree health benefits). She is very, very happy with AARP/United Health Medigap. My wife points out that dropping me from her health plan, when I turn 65, could save a few bucks.

I simply pointed out the obvious. Assuming $130/mo for part B, $130/mo for Medigap and $50/mo for part D, aren't we talking a diffference of $200/mo for the difference between "PPO" (read:good) medical services and "other" (read:mediocre").
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Postby kaneohe » Fri Sep 16, 2011 11:20 am

john94549 wrote:
That's what I thought. I'm really more concerned about getting the coverage than about rates. Now, another question. My wife is a cancer-survivor (breast cancer). She has excellent (and cheap) health coverage (PPO just about fully-paid through her employer). Should she get Medigap at age 65 even though she doesn't really need it? I'm just worried she might not be able to get it "later" when she finally decides to retire.


I think the search term is "guaranteed issue rights". See p. 22 here
http://www.medicare.gov/publications/pubs/pdf/02110.pdf

Not sure how this works for active employees since everyone I know retired before Medicare age but when we (retirees) got to 65, we had to switch to Medicare and company provided supplement (or advantage) plan. Our supplement plan allows us to go to any doctor and isn't any more expensive than the advantage plan. You might want to ask spouse's HR what happens when she turns 65 and what the various plans cost. If she were in company supplement plan and that plan ended, I think she could switch to independent supplement plan (case 2 on p.22)
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Postby btenny » Fri Sep 16, 2011 11:59 am

John, You and your wife both need to go and register for Medicre at 64.5 years even if you are working. You need to do this before you turn 65 as that is the required time per the government rules. The only way you get enrolled in Medicare is if you tell the government you want to be in Medicare. There is substantial $$ penalty for not registering with Medicare when you turn 65. If you are not drawing Social Security they will not know you want Medicare or are actively employed with a qualified medical plan so they will not register you.

Now as far as physicals. Medicare does not give you a physical nor do the Medigap insurance people when you first enroll at age 65. They will accept you into Medicare Part A and B and Medigap without review of your physical status or any paperwork on you physical status during this ONCE IN YOUR LIFETIME enrollment period without any checking of anything. But when you get older say 68-80 and want to change Medigap insurance polices due to any reason the insurance company can require a physical or a medical questionare and will use that data for medical underwritting and most likely not let you change policies. And they can then use that data to raise you insurance rates as well.....

Bill
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Postby nonnie » Fri Sep 16, 2011 2:02 pm

btenny wrote:So far I have found two Medigap policies that work for my wife. Anthem Blue Cross California offers the Medigap Part F High Deductable for $41.30 per month and Humana Arizona offers the Medigap Part F High Deductable for $63.59. Right now I am not sure which plan we will choose. We also got higher price quotes for regular Part F and Part N from both companies as well as quotes from other companies.

Both companies told us we could switch policy types (Part F High Deductable to Part N for example) within their company in the future. But they also said any policy change after initial enrollment would require medical underwriting and TBD what the new policy cost would be at that time. Plus she also said they had the right due to this underwriting clause to also turn down any change.

Bill


You mention Anthem BC California--does this mean you are a resident of CA? CA has laws stronger than the federal laws, as do many other states, that--at least for me the past several years with many pre-existing conditions --have allowed me to switch companies each year during my birthday anniversary month.

Here's a link to the 30-day open enrollment plan rights in CA:
http://www.cahealthadvocates.org/medigap/other.html

If you do live in CA and want a free, independent answer-- I highly recommend American Retirement Insurance Services. They only work on Medicare policies and only in CA and there is no cost--they get their fees on commissions from the policies they sell but there's no pressure at all.

http://americanretirementca.com/about_us.html
1-800-233-2747

They don't represent every insurance company so you need to take that into consideration when they give you recommendations on the best plan. They will review each year which plan makes sense for you and will also analyze Part D plans for you at no cost. Keep in mind that all Plan "F" or all Plan "D" MUST offer the same benefits so you're basically comparing on cost--some companies add in a small extra benefit or two.

We have a 2-party plan --one of the few I'm aware of that actually gives a break for two persons, most just charge double the one-person rate. It's a Blue Shield Plan F policy which includes free gym membership.

Good luck and check into the extra protection you might have in CA.

You're probably way beyond needing these links but just in case:
http://www.medicare.gov/find-a-plan/que ... -home.aspx

http://www.aging.ca.gov/resources/Fraud ... _edits.pdf
Last edited by nonnie on Sat Sep 17, 2011 3:25 pm, edited 1 time in total.
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Postby kaneohe » Sat Sep 17, 2011 10:21 am

nonnie......good info and links. Thanks. I did speak to ARIS and the person I spoke to said they do carry AARP. Not sure if true or if they spoke in error.
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Postby nonnie » Sat Sep 17, 2011 2:05 pm

kaneohe wrote:nonnie......good info and links. Thanks. I did speak to ARIS and the person I spoke to said they do carry AARP. Not sure if true or if they spoke in error.


Thanks for the update, I'd believe them and I updated my post. No excuses but the more I think about it I think it was USAA--if one is interested in USAA, confirm with ARIS whether they sell those policies. Jeez, I wish I had a thumb drive capable of downloading all the useless 60 year old information in my head--like my phone number when I was 10 years old, although it does make a good password--deleting it and making room for today's information!

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