JustCare

Tag: Medigap

  • Your Medigap options in 2020

    Your Medigap options in 2020

    As of 2020, if you are enrolled in traditional Medicare and need to buy Medicare supplemental insurance (Medigap), you have new Medigap options. If you are enrolled in a Medicare Advantage plan and you think you might want to switch to traditional Medicare down the road, find out about your rights to buy Medigap insurance. Your rights are limited.

    Medigap options now include plans D and G, which offer the most comprehensive coverage that fills gaps in traditional Medicare. However, neither plans D or G cover the Part B deductible. You no longer can buy Medigap plans C or F, which had offered the most comprehensive coverage. If you already have plan C or plan F, you can keep it.

    If you would prefer to spend less on Medigap, Medigap plan A will cap your out-of-pocket costs and ensure your medical and hospital care is covered in full, so long as you see Medicare participating providers. You will be responsible only for the Part A and B deductibles. Medigap plan B covers the Part A deductible.

    You can switch to traditional Medicare each year during the Fall Open Enrollment Period, between January and March during the Medicare Advantage Open Enrollment Period, if your Medicare Advantage plan is terminated, and if you move. However, your federal right to buy Medigap insurance is limited. Your state might offer you additional rights. For information on your Medigap rights from Just Care, click here.

    Here’s more from Just Care:

  • Many people find themselves locked into their Medicare Advantage plans

    Many people find themselves locked into their Medicare Advantage plans

    If you’ve just joined a Medicare Advantage plan this open enrollment period, you have until December 7, and than again between January 1 and February 14, to reconsider. Here’s what you need to know: Once you’re enrolled in a Medicare Advantage plan, you could find yourself locked in. Medpage Today reports that many people mistakenly think they can leave their Medicare Advantage plan.

    In all but four states, however, switching to traditional Medicare is effectively impossible for people with a health condition. Yes, no matter where you live, you can technically switch to traditional Medicare. But, traditional Medicare has no out-of-pocket cap; you need Medicare supplemental insurance to fill coverage gaps and protect yourself financially.

    Except in limited situations, you have no right to buy Medicare supplemental insurance. Without Medicare supplemental insurance, your out-of-pocket costs in traditional Medicare if you have a serious health condition could be tens of thousands, if not hundreds of thousands of dollars. With Medicare supplemental insurance, your costs are minimal.

    Medicare Advantage plans, in contrast, have an out-of-pocket cap. Still, people are often stuck with huge out-of-pocket costs; you could end up spending as much as $6,700 a year out of pocket for in-network care alone. Many people who join and need costly health care only learn how expensive a Medicare Advantage plan can be after they have joined. Moreover, they may discover that their health plan does not cover care from the doctors and hospitals they want to use. Or, they may find that their health plan unduly delays or inappropriately denies them access to the care their doctors say they need.

    Even if you find doctors in the Medicare Advantage plan that you like, those doctors can leave the plan at any time. Or, the plan might raise premiums and deductibles significantly. You can’t rely on the plan for your health and financial well-being.

    Understandably, the data show that people with costly conditions often want to switch to traditional Medicare. If they have Medicaid as well as Medicare, it’s an easy switch. Medicaid picks up the out-of-pocket costs in traditional Medicare. But, if they don’t, Medicare supplemental insurers who sell “Medigap” policies to fill gaps in traditional Medicare coverage are likely to refuse to sell them insurance or charge them exorbitant premiums.

    You do have limited rights to buy Medigap coverage. You are guaranteed Medigap coverage in the first six months of enrolling in Medicare. And, if you join a Medicare Advantage plan, you are also guaranteed Medigap coverage if you switch to traditional Medicare within a year and sign up no later than 63 days after your Medicare Advantage plan coverage ends.

    MedPage Today reports on one man enrolled in a Medicare Advantage plan, who, after surgery to repair a mitral valve and suffering a stroke, ended up with hundreds of dollars a month in copays for his medical services and drugs as well as $295 a day for his hospital stay. He was stunned. Neither the Medicare Advantage ads nor the insurance brokers tell people about these costs or about the difficulty of switching to traditional Medicare and buying Medicare supplemental insurance.

    The American Medical Association, which is working hard to oppose Democratic health care reform proposals, knows well the risks of Medicare Advantage plans. It passed a resolution in 2018 recognizing that “seniors are lured to these advantage plans by misinformation and confusing sales techniques.” The AMA also recognizes that these corporate health plans can delay access to care and can deliver poor service.

    Many people understandably can’t afford the cost of Medicare supplemental insurance and join a Medicare Advantage plan thinking they will save money. They might. But, you should know that you could spend a lot more in a Medicare Advantage plan if you become seriously ill and need costly care. People who get sick too often go bankrupt or forego needed care. The Medicare Plan Finder tool won’t tell you this.

    Here’s more from Just Care:

  • Congress should level the playing field between traditional Medicare and Medicare Advantage

    Congress should level the playing field between traditional Medicare and Medicare Advantage

    To protect people with Medicare and give them meaningful choice, Congress needs to level the playing field between traditional Medicare and Medicare Advantage. Unless traditional Medicare and Medicare Advantage offer the same benefits under the same terms, people cannot make a meaningful choice between them or protect themselves from Medicare Advantage plans that may threaten their health and safety.

    In a previous post, I compiled information from the Office of the Inspector General (OIG), the Government Accountability Office (GAO) and the Centers for Medicare and Medicaid Services (CMS) revealing that some Medicare Advantage plans are threatening the health and safety of their members. But, we do not know specifically which Medicare Advantage plans remain a danger for people with Medicare. All we know is that CMS may award five-star ratings to ones it has found to jeopardize people’s health and safety, and MedPac currently finds these star ratings not trustworthy.

    Yet, many people who want to leave their Medicare Advantage plans for traditional Medicare may not have that choice. A new Health Affairs paper by David Meyers et al., Brown University School of Public Health, reveals that people who want to leave their Medicare Advantage plan for traditional Medicare may not be able to buy supplemental coverage, Medigap, to fill coverage gaps. Because, unlike Medicare Advantage, traditional Medicare does not have an out-of-pocket cap, supplemental coverage is critical to protect people’s health and financial well-being.

    The paper explains that people with higher health care needs are more likely to want to leave their Medicare Advantage plans. But, these same people are the ones least likely to be able to switch to traditional Medicare because it lacks a catastrophic cap and there is no guarantee they can buy supplemental coverage.

    There are some federal protections that guarantee people the right to buy Medigap when they first enroll in Medicare and within one year of enrolling in a Medicare Advantage plan. But, other than during those times, in all but eight states, insurance companies selling Medigap coverage that fills gaps in Medicare can refuse to sell people this coverage or hike up premiums to the point that they are unaffordable.

    The information from the Office of the Inspector General (OIG), the Government Accountability Office (GAO) and the Centers for Medicare and Medicaid Services (CMS) on the health and safety risk of Medicare Advantage plans is likely the tip of the iceberg. They have also found that more CMS oversight and audits of these plans is needed. Moreover, it appears that CMS has not been able to get Medicare Advantage plans to comply with federal regulations over several years.

    To protect people with Medicare enrolled in Medicare Advantage, Congress should  take immediate action. It should impose a cap on out-of-pocket costs in traditional Medicare as well as ensure that Medigap plans are all community-rated and guaranteed issue.

    Here’s more from Just Care:

  • New Medicare Advantage Open Enrollment Period: January through March

    New Medicare Advantage Open Enrollment Period: January through March

    Beginning in January 2019, there is a new Medicare Advantage Open Enrollment Period (MAOEP). You have the right to leave your Medicare Advantage plan and enroll in traditional Medicare and Medicare Part D between January 1 and March 31 of each year. This right is in addition to your right to switch Medicare plans during the Fall annual Open Enrollment Period.

    The Medicare Advantage Open Enrollment Period allows anyone in a Medicare Advantage plan to switch to traditional Medicare or another Medicare Advantage plan. If you are enrolled in traditional Medicare, you do not have the right to switch to a Medicare Advantage plan during the MAOEP.

    If you switch out of your Medicare Advantage plan into a new Medicare plan, your coverage in the new plan will begin on the first day of the following month. If you want to switch to traditional Medicare, make sure that you have supplemental insurance to fill gaps in coverage. If you have Medicaid or retiree coverage that wraps around traditional Medicare, you are set. If you need to buy the coverage, sometimes called “Medigap,” contact your State Health Insurance Assistance Program (SHIP) at eldercare.gov to find out what coverage is available to you.

    Here’s more from Just Care:

  • Shouldn’t traditional Medicare have an out-of-pocket cap?

    Shouldn’t traditional Medicare have an out-of-pocket cap?

    Why shouldn’t traditional Medicare have an out-of-pocket cap? It would eliminate the need for people in traditional Medicare to have supplemental coverage and it would put traditional Medicare on a more level playing field with commercial Medicare Advantage plans, which have an out-of-pocket cap. A Commonwealth Fund report by Cathy Schoen et al. proposes an out-of-pocket cap in traditional Medicare that members of Congress would be wise to consider.

    An out-of-pocket cap in traditional Medicare would simplify things for enrollees significantly as they would not need Medicare supplemental insurance (“Medigap”) to protect themselves from financial risk, if they did not have retiree wrap-around coverage or Medicaid. And, the report authors find that a $3,500 cap–half the amount of the maximum cap in Medicare Advantage plans–would cost about $428 a year ($36 a month), far less than the cost of a Medigap plan. (The average out-of-pocket cap in Medicare Advantage plans is $5,332.)

    The report authors posit that a $10 a month or so increase in the Medicare Part B premium coupled with less than a 1 percent increase in the payroll tax (0.3-0.4 percent) would cover that additional $500 cost. And, with this cap, people in traditional Medicare could choose to drop their Medigap at a savings of $1,500-$2,000 a year, on average.

    Taxpayers and people still wanting Medigap coverage would all benefit from this out-of-pocket cap. Both Medicaid and Medigap costs would come down. The report authors estimate a savings to Medicaid of $2.8 billion a year, for the federal government and states together.

    And, businesses paying for retiree coverage that supplements Medicare would also see a reduction in their costs. The report authors estimate $6.8 to $7.3 billion dollars in annual savings for these businesses. Moreover, people with disabilities, who are sometimes unable to buy Medigap coverage, would have greater financial security.

    Other proposals to redesign traditional Medicare, particularly Republican proposals, raise out-of-pocket costs for people with Medicare. Some propose to raise the deductible. Others prevent Medigap plans from covering as much of people’s out-of-pocket costs as they currently do. The goal of these proposals is to save the government money.

    The report authors also propose to eliminate the high deductible people needing hospital services must pay under Medicare Part A–$1,350–instead requiring people to pay a less costly copayment of either $100 or $350 for each hospitalization.

    Here’s more from Just Care:

  • Your right to buy Medigap coverage

    Your right to buy Medigap coverage

    People with Medicare have the right to switch Medicare plans, from a Medicare Advantage plan to traditional Medicare or vice versa, every year during the Fall open enrollment period. But, inexplicably, people do not have a right to buy Medigap coverage, supplemental coverage to fill gaps in Medicare, whenever they sign up for traditional Medicare. Without supplemental coverage, either Medigap, Medicaid or retiree coverage, you have no protection against catastrophic costs in traditional Medicare. A new Kaiser Family Foundation brief explains the issue in detail.

    Under federal law, only people first enrolling in traditional Medicare at 65 or later have the right to buy a Medigap policy. People under 65 with disabilities enrolled in Medicare do not have that right. In fact, only five percent of them have a Medigap policy. (Even though insurers do not have to sell them a policy, some do.) Most (46 percent) have Medicaid. And, 17 percent have employer coverage to fill gaps.

    People in a Medicare Advantage plan who want to switch to traditional Medicare also have no guaranteed right to buy a Medigap policy under federal law. Curiously, Congress gives these people the right to switch to traditional Medicare during the Fall Open Enrollment period but no limit on their out-of-pocket costs in traditional Medicare and no right to buy coverage to protect themselves against catastrophic costs.

    States have the right to guarantee their residents broader Medigap protections than the federal government. But, most states have never been good at protecting consumers in the health insurance marketplace. So, in most states, you should not assume you can get a Medigap policy if you do not get it when you first enroll in Medicare at 65 or later. Though, twenty-eight states do guarantee people the right to buy a Medigap policy if their employer retiree benefits change.

    If you want to sign up for traditional Medicare during the fall open enrollment season, keep in mind that some insurers are willing to sell people Medigap coverage even though they are not required to do so. AARP plans are often available to people. Contact your state health insurance assistance program or SHIP at 1-800-677-1116 for free advice on whether there are Medigap companies in your state that will sell you coverage.

    Four states give people the guaranteed right to buy a Medigap policy, regardless of their health status. Connecticut, Massachusetts, Maine and New York protect people with Medicare. In these states insurers must sell you a Medigap policy even if you have a pre-existing condition. These states also require “community rating” of Medigap policies so that regardless of your age or health, everyone pays the same premium.

    Congress imposed a catastrophic out-of-pocket limit in Medicare Advantage plans, of no more than $6,700, in recognition of the need to give people enrolled in these plans some health and financial security. Congress should impose an out-of-pocket limit in traditional Medicare–or, better still, eliminate deductibles and coinsurance–to protect people in traditional Medicare. Congress should also require Medigap plans in all states to guarantee coverage to everyone during the Fall open Enrollment period and charge everyone the same amount. After all traditional Medicare and Medicare Advantage plans are all community rated–everyone pays the same premium for their policy.

    Here’s more from Just Care:

  • Medicare Advantage: Disenroll between January 1 and February 14

    Medicare Advantage: Disenroll between January 1 and February 14

    Editor’s note: As of January 1, 2019, you can disenroll from a Medicare Advantage plan between January 1 and March 31 of each year.

    Many people enroll in a Medicare Advantage plan, (a commercial health plan that offers Medicare benefits,) without fully understanding how their health care coverage will work under that plan. Once they learn that they are only covered for care from doctors and hospitals in the health plan’s network, or that the network will not cover their care out of state except in emergencies, or that their out-of-pocket costs could be astronomical, they often want to switch to traditional Medicare. If you want to disenroll from your Medicare Advantage plan, you have the right to leave the health plan during the Medicare Advantage Disenrollment Period, any time between January 1 and February 14.

    Why would you want to disenroll from a Medicare Advantage plan? 

    1. You are not covered for care from doctors and/or hospitals that you know and trust.
    2. You discover that you have long waits to see the health plan’s in-network doctors or those doctors are no longer seeing patients enrolled in the health plan. Don’t trust the health plan’s provider directory.
    3. You do not want to deal with the headache of receiving treatment from out-of-network doctors if you are hospitalized, along with surprise medical bills.
    4. Your out-of-pocket costs for the deductible, if there is one, and copays could be as high as $6,700 for in-network care alone, more than double the cost of Medicare supplemental insurance (“Medigap”) coverage.
    5. Your out-of-pocket costs for care could be astronomical if you need to use out-of-network doctors and hospitals–there is no limit at all on your costs–either because they offer the specialty care you need and that you cannot get from in-network doctors or because you have moved outside of the area your Medicare Advantage plan covers–e.g., a winter or summer home, a family member or friend’s home.

    How do you disenroll from a Medicare Advantage plan?

    1. Notify your Medicare Advantage health plan in writing as soon as possible before February 14th, ideally in January. Call the health plan as well. You will be officially disenrolled on the first day of the following month.
    2. You will be automatically enrolled in traditional Medicare on the first day of the following month, but you will need to sign up for a Medicare Part D drug plan as soon as possible, along with a Medicare supplemental insurance policy, so that you have coverage to fill gaps in Medicare and drug coverage beginning the following month.
    3. You want to be sure you can get Medicare supplemental coverage either through Medicaid or through a private Medicare supplemental insurance plan before you drop your Medicare Advantage plan. Under federal law, Medicare supplemental insurance (“Medigap”) companies do not have to sell you a policy except during your Medicare initial enrollment period at 65 or during your Medicare special enrollment period if you sign up for Medicare after 65.  However, four states–Connecticut, Maine, Massachusetts and New York–require Medigap companies to sell you coverage at any time. And some insurers may sell you coverage even if not required to under the law.  Call your State Health Insurance Assistance Program (SHIP) to learn whether you can buy a Medicare supplemental insurance policy in your state. 

    Tip: You can disenroll from your Medicare Advantage plan at any time if you were misled into enrolling or signed up by mistake or otherwise did not intend to be in the Medicare Advantage plan. Call 1-800-633-4227 (1-800-MEDICARE) to ask to be disenrolled from your Medicare Advantage plan. You can be disenrolled retroactively if you saw an out-of-network doctor because you thought you were enrolled in traditional Medicare. If you have not received any services through the Medicare Advantage plan, you can ask for a special enrollment period to enroll in traditional Medicare, a Part D plan, and a Medicare supplemental insurance (Medigap) plan.

    Here’s more from Just Care: