Guaranteed access for Medigap policies

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Good Listener
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Guaranteed access for Medigap policies

Post by Good Listener » Tue Sep 18, 2018 6:32 pm

For those who know about Medigap policies, in almost all states there is no guaranteed access and it is subject to underwriting, mean you may never be able to get a policy if you can't pass underwriting. New York and a few others have guaranteed access and I understand that several other states are looking into this. Guaranteed access means that you can get any Medigap policy once you are age 65 without underwriting.

Does anybody with familiarity with this, I think in New York for one, know if this means that one can at any time switch from one Medigap provider to another, switch plans, switch from Medicare Advantage to Medigap, etc? Basically ithat t's not only guaranteed access for an initial policy but anytime one wants one can get any Medigap policy within that state, regardless of what they have or dont have currently?

Specifically, the person I am referring to is 66 and has Plan F with Aetna. Does guaranteed access mean that this person could shft to plan G with that same carrier or a different carrier. Or if she tried Medicare Advantage and didn't like it then be able to pick up a regular Medigap policy in the future?

Thank you

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Re: Guaranteed access for Medigap policies

Post by drawpoker » Tue Sep 18, 2018 6:43 pm

You're lumping together a whole lot of different issues here.

New York state observes year round open enrollment. It is also one of the 9 states that require Medigap insurers to use the community rating method of selling Medigap policies (that means everyone pays the same, a healthy 65 year old just joining Medicare who wants Plan G pays exactly the same premium as a frail, sickly 85 year old who wants G)

However, in NY, in one wishes to switch either companies or policies, they may do so at anytime but there will be a six month (or longer) waiting period for pre-existing conditions. So that knocks out the guaranteed issue option you are seeking of absolutely no medical underwriting.

Massachusetts, which follow its own rules, not federal, for Medicare supplements, does have a recognized form of guaranteed issue year round so you can jump back and forth between Plans (the core or what is called Supp1) without penalty or underwriting.

Edit" For the person you are asking about, Aetna has their own policies on existing policy holders wishing to switch down from F to G. The only way to find out is to ask. As for your other question, a new Medicare beneficiary has the option of a one year trial of a MA plan. If, after the year is up, they want to switch back to Original medicare with Medigap, they can do so, falling under guaranteed issue. They may exercise that option only once, however.

To complicate matters further, presently Plans G and N are not under the federal protection of the guaranteed issue option. For beneficiaries in a situation that makes them qualify for a guaranteed issue status G and N are closed off to them. They would have to choose another Plan. G is not expected to go back on G.I. eligibility until Jan 2020.
Last edited by drawpoker on Tue Sep 18, 2018 6:55 pm, edited 3 times in total.

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nisiprius
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Re: Guaranteed access for Medigap policies

Post by nisiprius » Tue Sep 18, 2018 6:47 pm

I can't answer your question. I ended up on Traditional Medicare with Medigap (and have been very happy) because at the time, in my state, I couldn't get a straight answer to a similar question. The printed material, the insurer's website, and what the insurer's rep told me were significantly different.

I believe that a problem with this kind of question is that insurance law is state law, so the details vary from state to state, and laws governing health insurance have been subject to frequent change.

But in a way, that's my point. You need to be very careful in your planning because even if you manage to understand what the law in New York is now, if your 66-year-old tries Medicare Advantage, likes it for several years, then Aetna changes the plan, and she doesn't like it... by that time, the answer to the question "can I go back to traditional Medicare" may not be the same as it is now.

Yeah, sucks.
Last edited by nisiprius on Tue Sep 18, 2018 6:49 pm, edited 2 times in total.
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Re: Guaranteed access for Medigap policies

Post by Good Listener » Tue Sep 18, 2018 6:49 pm

@drawpoker...Thank you for your response.

Edit" For the person you are asking about, Aetna has their own policies on existing policy holders wishing to switch down from F to G. The only way to find out is to ask.

I asked. They underwrite....

Yes it sounds like the Massachusetts model is more like what I am talking about. In my case, the initial guaranteed access was not missed but plan F was selected. There is speculation that plan F may increase in premiums way higher than G so it may be desired to shift to plan G. Basically I am asking if having a prior Medigap might disqualify one from guaranteed access for a different one or does guaranteed access mean it is a free for all for ever? I see what nisiprius says and yes things could change. And BTW, I have posted several times that I HATE Medicare Advantage, having been put into one as a retiree for 2 months but got out in time for Original Medicare plus a supplement in NJ, which doesn't have guaranteed access yet.

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Re: Guaranteed access for Medigap policies

Post by dm200 » Tue Sep 18, 2018 7:07 pm

If you are concerned about the risk of being on an Advantage plan and not being able to get a Medigap policy if you don't like the plan and not being able to get a Medigap plan - be aware that you can try an Advantage plan for up to one year without affecting the ability to get a Medigap plan.

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Re: Guaranteed access for Medigap policies

Post by drawpoker » Tue Sep 18, 2018 7:11 pm

dm200 wrote:
Tue Sep 18, 2018 7:07 pm
.... can try an Advantage plan for up to one year without affecting the ability to get a Medigap plan.
Not true. Anyone leaving a MA plan and wishing to go to Medigap is unable to purchase Plan G (the second most popular) or Plan N. They are both closed off by law, look it up on the Medicare dot gov site.

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Re: Guaranteed access for Medigap policies

Post by dm200 » Tue Sep 18, 2018 7:47 pm

drawpoker wrote:
Tue Sep 18, 2018 7:11 pm
dm200 wrote:
Tue Sep 18, 2018 7:07 pm
.... can try an Advantage plan for up to one year without affecting the ability to get a Medigap plan.
Not true. Anyone leaving a MA plan and wishing to go to Medigap is unable to purchase Plan G (the second most popular) or Plan N. They are both closed off by law, look it up on the Medicare dot gov site.
OK - this site/page - https://www.medicare.gov/find-a-plan/st ... tions.aspx . I am addressing the situation where a newly Medicare eligible participant enrolls in an MA plan when first eligible for Medicare.

#4: (Trial Right) You joined a Medicare Advantage Plan or Programs of All-inclusive Care for the Elderly (PACE) when you were first eligible for Medicare Part A at 65, and within the first year of joining, you decide you want to switch to Original Medicare. Any Medigap policy that is sold in your state by any insurance company. As early as 60 calendar days before the date your coverage will end, but no later than 63 calendar days after your coverage ends.

Note: Your rights may last for an extra 12 months under certain circumstances.

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Re: Guaranteed access for Medigap policies

Post by drawpoker » Tue Sep 18, 2018 8:11 pm

Here's the correct page from Medicare.gov to address this. You have to click on each item to expand the text on the page/

___________________________________________________________________________________________________________
expandYou have Original Medicare and a Medicare SELECT policy. You move out of the Medicare SELECT policy's service area.
expandYou joined a Medicare Advantage Plan or Programs of All-inclusive Care for the Elderly (PACE) when you were first eligible for Medicare Part A at 65, and within the first year of joining, you decide you want to switch to Original Medicare. (Trial Right)
expandYou dropped a Medigap policy to join a Medicare Advantage Plan (or to switch to a Medicare SELECT policy) for the first time, you’ve been in the plan less than a year, and you want to switch back. (Trial Right)
You have the right to buy:

The Medigap policy you had before you joined the Medicare Advantage Plan or Medicare SELECTpolicy, if the same insurance company you had before still sells it.

If your former Medigap policy isn't available, you can buy a

Medigap Plan A, B, C, F, K, or L that’s sold by any insurance company in your state

You can/must apply for a Medigap policy:
As early as 60 calendar days before the date your coverage will end
No later than 63 calendar days after your coverage ends
_______________________________________________________________________________________________________

Note that Plan G and Plan N are noticeably absent from the list of plans.

https://www.medicare.gov/supplements-ot ... sue-rights

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Re: Guaranteed access for Medigap policies

Post by nisiprius » Tue Sep 18, 2018 8:16 pm

Well, see, that's exactly the kind of thing that was driving me crazy when I was looking at Medicare Advantage plans.

If you ask "can I switch back if I don't like it," things get derailed while you listen to is a series of complicated and confusing rules and options that take a while to figure out--before you realize that they are sort of beside the point because they are only good for the first year or something.

Now, honestly, how often have you been able to form a real opinion of a plan in one year? It takes a while before you discover whether or not you are getting hit with surprise bills, whether or not customer service is any good when you have an actual problem, and so forth.

What you really want to know is whether you can go back to Traditional Medicare several years down the road. That's the likely scenario, not that you pick a plan that's so terrible that you discover it stinks within the first few months.
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Re: Guaranteed access for Medigap policies

Post by dm200 » Tue Sep 18, 2018 8:20 pm

nisiprius wrote:
Tue Sep 18, 2018 8:16 pm
Well, see, that's exactly the kind of thing that was driving me crazy when I was looking at Medicare Advantage plans.
If you ask "can I switch back if I don't like it," things get derailed while you listen to is a series of complicated and confusing rules and options that take a while to figure out--before you realize that they are sort of beside the point because they are only good for the first year or something.
Now, honestly, how often have you been able to form a real opinion of a plan in one year? It takes a while before you discover whether or not you are getting hit with surprise bills, whether or not customer service is any good when you have an actual problem, and so forth.
What you really want to know is whether you can go back to Traditional Medicare several years down the road. That's the likely scenario, not that you pick a plan that's so terrible that you discover it stinks within the first few months.
Yes - a year may not be enough. However, as we get into the Medicare years - most of us (even if healthier than 'average') see Physicians and providers often enough to reach some degree of a conclusion.

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Re: Guaranteed access for Medigap policies

Post by jalbert » Tue Sep 18, 2018 10:32 pm

In some states, a fair number of providers are not accepting new patients who are on original Medicare (part A, B, & supplemental). You have to be an established patient with the provider when you turn 65 to use original Medicare, or be on a Medicare Advantage plan if you are a new patient. If this trend continues, original Medicare may ultimately become the option that limits care to being provided by the most narrow group of providers of the options.
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Re: Guaranteed access for Medigap policies

Post by drawpoker » Tue Sep 18, 2018 11:06 pm

Good points.

Compounding the problem, there is a real shortage of PCP docs in many areas of the country. Those few going into that field of medicine can afford to be picky, declining Medicare patients in favor of banking on those patients with "better" insurance.

In my area, it is not just a Medicare or insurance issue. The very best PCP docs have "closed panels", meaning, they are not accepting new patients of any sort, regardless of what type insurance.

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Re: Guaranteed access for Medigap policies

Post by dm200 » Wed Sep 19, 2018 11:19 am

drawpoker wrote:
Tue Sep 18, 2018 11:06 pm
Good points.

Compounding the problem, there is a real shortage of PCP docs in many areas of the country. Those few going into that field of medicine can afford to be picky, declining Medicare patients in favor of banking on those patients with "better" insurance.

In my area, it is not just a Medicare or insurance issue. The very best PCP docs have "closed panels", meaning, they are not accepting new patients of any sort, regardless of what type insurance.
Compounding the problem, there is a real shortage of PCP docs in many areas of the country. Those few going into that field of medicine can afford to be picky, declining Medicare patients in favor of banking on those patients with "better" insurance.

In my area, it is not just a Medicare or insurance issue. The very best PCP docs have "closed panels", meaning, they are not accepting new patients of any sort, regardless of what type insurance.
From what I understand, there are huge differences in different areas of the country. In this area (Northern Virginia suburbs of Washington DC) there are large numbers of Physicians (both Primary Care and Specialists). A great many PCPs, though, will not accept new Original medicare patients, but will continue existing patients who go on Medicare. Original Medicare folks, then, who do not have a PCP - can have a challenge in finding an acceptable (to them) PCP. A friend of ours was "stranded" when her single doctor practice physician retired. One strategy is to have a PCP in a group practice so that when one PCP leaves, you can go to another in the practice. Medicare Advantage plans in this area are heavily advertised and promoted - and (from everything I can tell) if you enroll in an MA plan - there are many PCPs to choose from. I went to Kaiser seven years ago when I became eligible for Medicare. Our previous group had the policy no new Medicare patients. However, out of curiosity, I looked at the Humana MA physicians available - and I saw that my previous PCP participated in Humana MA.

I have no medical credentials - but I also conclude that some very popular Physicians (with patients) are not that "outstanding" objectively as Physicians, while some of the "least popular" ones (with patients) can be excellent medically. I regularly read the Washington (DC) consumer Checkbook that has patient ratings of Physicians. One PCP that I had a low opinion of 40 years ago when I was a patient - received 100% outstanding ratings from his patients - even as he practiced well into his 80's. My conclusion is that many Physicians are popular with patients because they tell the patients what the patient wants to hear - even if not medically correct. One friend of ours, for example, switched away from the Physicians I have because the Physician told our friend that she was very overweight and needed to lose weight. My opinion was that the friend is objectively very overweight - perhaps obese.

The general trend for most PCPs and practices is increasing use of Physicians Assistants and Nurse Practitioners. In some states (just changed here in Virginia) Nurse Practitioners can see patients independent of working directly with a Physician. Not sure of all the details, but that can work for some folks. Locally with our Kaiser plan, however, the opposite was done. Here, about ten years ago, Kaiser eliminated Nurse Practitioners from the Primary care "team" and hired a lot more Physicians (Internal medicine or Family Medicine) for adults and when I have an appointment with Primary Care - the only medical professional I see is a doctor (MD or DO).

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Re: Guaranteed access for Medigap policies

Post by jebmke » Wed Sep 19, 2018 11:34 am

dm200 wrote:
Wed Sep 19, 2018 11:19 am
My conclusion is that many Physicians are popular with patients because they tell the patients what the patient wants to hear - even if not medically correct.
I agree; plus, a lot of people don't know how (or are unwilling) to manage their relationship with their physician so they probably end up over-consuming medical services thereby creating the impression that their doctor is "doing something."
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Re: Guaranteed access for Medigap policies

Post by Broken Man 1999 » Wed Sep 19, 2018 11:40 am

I'm very happy with our Humana Medicare Advantage PPO, through my retiree benefits. No complaints with pricing or performance.

A question, though. Suppose I am rocking along, and my retiree insurance is no longer offered. Do people get a "fresh start" so to speak if they experience a change such as losing retiree insurance? IOW, would a move from retiree insurance to a market-based Medigap plan require underwriting?

I can actually choose a Medigap plan currently via retiree insurance, but the cost is much greater, $0/yr for an HMO, $630/yr for our PPO, two Medigap plans offered at $3500/year.

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Re: Guaranteed access for Medigap policies

Post by dm200 » Wed Sep 19, 2018 11:47 am

jebmke wrote:
Wed Sep 19, 2018 11:34 am
dm200 wrote:
Wed Sep 19, 2018 11:19 am
My conclusion is that many Physicians are popular with patients because they tell the patients what the patient wants to hear - even if not medically correct.
I agree; plus, a lot of people don't know how (or are unwilling) to manage their relationship with their physician so they probably end up over-consuming medical services thereby creating the impression that their doctor is "doing something."
While, probably, a great many folks are not able (for one reason or another) to be deeply involved in their own healthcare - nonetheless I am (somewhat) amazed at how many folks who are capable of doing so - decline or refuse to be involved. Lots of folks I know take many drugs every day - perhaps 6 or more - and have little or no understanding of what they take or why - and, I think, often are not taking correctly. What I do (and have always done) is know exactly what drugs I take and why. I also do my best to take them as prescribed (with or without food, morning or evening, etc.). I do the same with any supplements recommended or that I take. I also regularly review all such medications and supplements with prescribing physicians or PCP every year. I monitor (online) all tests and feedback. I also can do about half of things by email with my PCP - where in person would otherwise be necessary. It is my strong opinion that, net on balance, my approach helps me BOTH medically AND financially as well as overall lowered costs to the "system".

Some Physicians seem to resent patients who are very involved and ask a lot of questions. My PCP, however, is very responsive to my involvement and, now, after discussing just about anything, asks me, "What do you think?" ;)

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Re: Guaranteed access for Medigap policies

Post by dm200 » Wed Sep 19, 2018 11:52 am

Broken Man 1999 wrote:
Wed Sep 19, 2018 11:40 am
I'm very happy with our Humana Medicare Advantage PPO, through my retiree benefits. No complaints with pricing or performance.
A question, though. Suppose I am rocking along, and my retiree insurance is no longer offered. Do people get a "fresh start" so to speak if they experience a change such as losing retiree insurance? IOW, would a move from retiree insurance to a market-based Medigap plan require underwriting?
I can actually choose a Medigap plan currently via retiree insurance, but the cost is much greater, $0/yr for an HMO, $630/yr for our PPO, two Medigap plans offered at $3500/year.
Broken Man 1999
Good question. My "guess" is that, since you are on an MA plan - for over a year, going to Original medicare would require some kind of medical underwriting for a Medigap plan UNLESS there were no other MA plans you could be enrolled in.

Glad Humana MA is working so well for you. Some longtime friends of ours are on a Humana MA plan in this area and are very happy as well.

What I learned about some of these retiree benefit MA plans is that some of them have very low (sometimes zero) deductibles, low copays and low max out of pocket.

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Re: Guaranteed access for Medigap policies

Post by bertilak » Wed Sep 19, 2018 12:03 pm

I have some experience with changing Medigap plans.

Back when I first signed up I chose N over F after some detailed work with a spreadsheet.

Now, a few years later, I decided to switch to F but could not get consistent answers saying if or if not that was even possible and if so, what about underwriting requirements. Here is a summary of answers I got over the past couple of years:
  1. Can't be done. No changes allowed under normal conditions.
  2. Plan F no longer available.
  3. Can be done during some enrollment period but underwriting required.
  4. Can be done without underwriting and at any time, but I have to switch insurers, from BC/BS to Humana.
You have to be careful who and what you ask!

Answers 1 - 3 were given by BC/BS.

Answer 4 was given by the medical insurance exchange that manages the subsidy from my employer. They organized the switch but it still required over 2 hours on the phone through various levels of specialists and finally Humana themselves. I think I had to talk to 4 or 5 people, sometimes in a 3-way call. I had to be very careful about answers to their questions as they tended to jump to conclusions. Biggest confusion was whether or not the new plan was replacing an existing plan. Part of the time was spent making (in parallel) the same change to my wife's policy.

Process nearly complete: I do have both phone and email confirmation that the switch "took" but am still awaiting the actual new ID card in the mail, at which time I am to call BC/BS to cancel my existing policy as of the date my new policy comes into effect.

Why the change from N to F? Theoretically N would save me a couple of hundred dollars a year, but the amount depended on the number of office visits and on at least one intangible: "Excess Charges." I wanted something that was well bounded and required less attention to lots of nit-picky details.

Note on Plan F availability: It IS available, but expected to be dropped in the future (unknown date). If and when dropped, existing customers will be grandfathered in.
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Re: Guaranteed access for Medigap policies

Post by nisiprius » Wed Sep 19, 2018 12:32 pm

bertilak wrote:
Wed Sep 19, 2018 12:03 pm
...I have some experience with changing Medigap plans... [Horror story.]
And, an existing plan member who is trying to make a specific change is much more likely to get correct answers than a prospective buyer, asking hypothetical questions prior to purchase. The prospective buyer hasn't got a chance.
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Re: Guaranteed access for Medigap policies

Post by dm200 » Wed Sep 19, 2018 12:42 pm

nisiprius wrote:
Wed Sep 19, 2018 12:32 pm
bertilak wrote:
Wed Sep 19, 2018 12:03 pm
...I have some experience with changing Medigap plans... [Horror story.]
And, an existing plan member who is trying to make a specific change is much more likely to get correct answers than a prospective buyer, asking hypothetical questions prior to purchase. The prospective buyer hasn't got a chance.
Almost everyone wants to "sell" you on "buying" what they are selling. Therefore, you are unlikely to get the unbiased "truth".

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Re: Guaranteed access for Medigap policies

Post by drawpoker » Wed Sep 19, 2018 5:57 pm

Broken Man 1999 wrote:
Wed Sep 19, 2018 11:40 am
......happy with our Humana Medicare Advantage PPO, through my retiree benefits........A question, though. Suppose I am rocking along, and my retiree insurance is no longer offered. Do people get a "fresh start" so to speak if they experience a change such as losing retiree insurance? IOW, would a move from retiree insurance to a market-based Medigap plan require underwriting?.......
No, it would not. If your retiree health plan gets yanked out from under you that is one of the qualifying events that gives you status to a "guaranteed issue" period. This is regardless of age or where you live, it comes under federal law.

You can buy any Medigap policy that is offered in your area without medical underwriting except for Plan G and Plan N.
Those two are presently excluded from the list available under guaranteed issue.

(And, pleeez, don't ask why - that would require a whole new thread :? :? :? :?

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Re: Guaranteed access for Medigap policies

Post by Broken Man 1999 » Thu Sep 20, 2018 9:45 am

drawpoker wrote:
Wed Sep 19, 2018 5:57 pm
Broken Man 1999 wrote:
Wed Sep 19, 2018 11:40 am
......happy with our Humana Medicare Advantage PPO, through my retiree benefits........A question, though. Suppose I am rocking along, and my retiree insurance is no longer offered. Do people get a "fresh start" so to speak if they experience a change such as losing retiree insurance? IOW, would a move from retiree insurance to a market-based Medigap plan require underwriting?.......
No, it would not. If your retiree health plan gets yanked out from under you that is one of the qualifying events that gives you status to a "guaranteed issue" period. This is regardless of age or where you live, it comes under federal law.

You can buy any Medigap policy that is offered in your area without medical underwriting except for Plan G and Plan N.
Those two are presently excluded from the list available under guaranteed issue.

(And, pleeez, don't ask why - that would require a whole new thread :? :? :? :?
Thanks for the info! So far MegaCorp has delivered very good insurance plans to the retirees. We were very fortunate in that we had pensions and 401k plans, along with retiree insurance. Now there is no retiree insurance for management, no pensions either, just an OK 401k plan.

Workers today need to be stashing away what they can. Definitely a tougher path than many of us walked. Not much room for error, for many today.

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Re: Guaranteed access for Medigap policies

Post by dm200 » Thu Sep 20, 2018 4:57 pm

And we all know I hate Medicare Advantage !
And ... there are many of us here that love our MA (and similar MC) plan(s) in our area(s).

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Re: Guaranteed access for Medigap policies

Post by dm200 » Thu Sep 20, 2018 5:22 pm

Not an "actuary" - but the more folks and circumstances are allowed for folks to enroll in medigap plans at older ages, the higher the costs will tend to be for those Medigap plans. Then, the existing folks who enrolled in those Medigap plans at the beginning of their Medicare eligibility will need to pay more because of the late enrolees allowed.

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Re: Guaranteed access for Medigap policies

Post by drawpoker » Thu Sep 20, 2018 6:00 pm

Good Listener wrote:
Thu Sep 20, 2018 4:51 pm
[
...... And we all know I hate Medicare Advantage !
[/quote]

Yes. The consensus among most BHs is Medigap lets you sleep better at night. But look on the bright side.

The gumbmint keeps dumping more money every year to subsidize the insurers with their MA plans. Even tho the majority of sr. citizens have Original Medicare with supplement, the percentage keeps going up and up every year for MA enrollments. This actually works in our favor.

The more people who sign up for Medicare Advantage plans the better in the long run for those of us paying Medigap premiums. It will put more costly claims against the MA insurers if this trend continues.
Let them go ahead and sign up everyone they can find. Increase their pools of insured.
Shrinking pools of people carrying Medicare supplement plans translates to shrinking claims/ loss ratios which will help to keep our premiums more stable. :D

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Re: Guaranteed access for Medigap policies

Post by Broken Man 1999 » Thu Sep 20, 2018 6:03 pm

dm200 wrote:
Thu Sep 20, 2018 5:22 pm
Not an "actuary" - but the more folks and circumstances are allowed for folks to enroll in medigap plans at older ages, the higher the costs will tend to be for those Medigap plans. Then, the existing folks who enrolled in those Medigap plans at the beginning of their Medicare eligibility will need to pay more because of the late enrolees allowed.
That is probably true of any type health insurance. Medicare Advantage plans aren't shielded from high costs either, I would believe. If a person has been in such a plan, as they age the same thing will happen, higher costs. If those attempting to go to a Medigap plan can't succeed, the same costs will be borne by the Medicare Advantage plans they must remain holding.

No matter what type plan you hold, I would wager they all will get pricier in the future.

Broken Man 1999
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Re: Guaranteed access for Medigap policies

Post by LadyGeek » Thu Sep 20, 2018 7:26 pm

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Re: Guaranteed access for Medigap policies

Post by dm200 » Fri Sep 21, 2018 10:38 am

drawpoker wrote:
Thu Sep 20, 2018 6:00 pm
Good Listener wrote:
Thu Sep 20, 2018 4:51 pm
[
...... And we all know I hate Medicare Advantage !
Yes. The consensus among most BHs is Medigap lets you sleep better at night. But look on the bright side.
The gumbmint keeps dumping more money every year to subsidize the insurers with their MA plans. Even tho the majority of sr. citizens have Original Medicare with supplement, the percentage keeps going up and up every year for MA enrollments. This actually works in our favor.
The more people who sign up for Medicare Advantage plans the better in the long run for those of us paying Medigap premiums. It will put more costly claims against the MA insurers if this trend continues.
Let them go ahead and sign up everyone they can find. Increase their pools of insured.
Shrinking pools of people carrying Medicare supplement plans translates to shrinking claims/ loss ratios which will help to keep our premiums more stable. :D
[/quote]

We shall see. I wonder if MA plans may lower utilization costs (without endangering health) of those enrolled?

Yes - I tend to agree that a fairer (perhaps) judge of MA plans is how they do (and will) handle costs when more older, sicker folks are enrolled?

In my Medicare plan, because of its features and structure, I believe I do not need to see my providers (PCP and specialists) in person nearly as often, since I can do a lot with email and telephone appointments.

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Re: Guaranteed access for Medigap policies

Post by cashmoney » Fri Sep 21, 2018 11:38 am

dm200 wrote:
Thu Sep 20, 2018 5:22 pm
Not an "actuary" - but the more folks and circumstances are allowed for folks to enroll in medigap plans at older ages, the higher the costs will tend to be for those Medigap plans. Then, the existing folks who enrolled in those Medigap plans at the beginning of their Medicare eligibility will need to pay more because of the late enrolees allowed.


Exactly and also In general the healthier gravitate towards MA plans and the MA plans ,unlike original medicare, are proactive in keeping consumers healthy because they get more funding if they do due to the star rating system.Enrollment in MA has grown from 5% to about 35% since 2006 and is projected to keep on growing.In addition older folks and the high utilizers of health care are the ones who are most likely to have a medigap policy so this risk pool is going to continue to get worse and in states where the medigap have an annual open enrollment IMO its going to get even worse .

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Re: Guaranteed access for Medigap policies

Post by dm200 » Fri Sep 21, 2018 12:03 pm

cashmoney wrote:
Fri Sep 21, 2018 11:38 am
dm200 wrote:
Thu Sep 20, 2018 5:22 pm
Not an "actuary" - but the more folks and circumstances are allowed for folks to enroll in medigap plans at older ages, the higher the costs will tend to be for those Medigap plans. Then, the existing folks who enrolled in those Medigap plans at the beginning of their Medicare eligibility will need to pay more because of the late enrolees allowed.
Exactly and also In general the healthier gravitate towards MA plans and the MA plans ,unlike original medicare, are proactive in keeping consumers healthy because they get more funding if they do due to the star rating system.Enrollment in MA has grown from 5% to about 35% since 2006 and is projected to keep on growing.In addition older folks and the high utilizers of health care are the ones who are most likely to have a medigap policy so this risk pool is going to continue to get worse and in states where the medigap have an annual open enrollment IMO its going to get even worse .

Time will tell
. With the increased portion of MA participants, as those folks age there will be increased utilization and costs. In this area, MA plans (Kaiser and Humana especially) are heavily advertised and promoted - and I do not perceive any targeting of healthier folks. Just a few years ago, many here predicted "gloom and doom" for MA plans as some changes were made to cause MA plans to receive lower reimbursements - but that did not happen. From my observation and experience, MA plans are better able to do some things to control costs without actually decreasing care and/or increasing risks. A friend on a Humana MA plan told me that (at no charge to him) Humana sends a nurse to his home to do some sort of followup/screening - since he has Type 2 diabetes. In our Kaiser plan, email, telephone and "virtual" house calls (with a smartphone) have no copay and can "cost" Kaiser a lot less than all the direct and indirect costs of an in-person appointment.

Another trend (not sure how widespread) is that employers (a shrinking number) who still provide retiree health benefits "mandate" participation in MA plans - BUT with much lower maximum out of pocket annual limits. A very large County adjacent to us mandates a MA plan for County retirees and a slightly different MA plan for School retirees. These retiree plans eliminate one of the major disadvantages of an MA plan - maximum out of pocket annual costs.

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