Underwriting
 

When switching from a Medicare Advantage plan you are not guaranteed issue of a MediGap policy if you have preexisting conditions unless you live in one of these four states:
Connecticut
Maine
New York
Vermont
If you are issued a Medigap plan, you may be charged higher rates.
There may be a few exceptions such as if your MA plan is dropped.

Medigap is not Medicare. I am talking about the often repeated misinformation that once on MA, you can’t go back to Medicare. Patently false. Medigap is a whole other subject.

Again, you are talking about Medigap. I am talking about Medicare. Huge difference.

We have the Humana Advantage plan. Unfortunately we have made extensive use of the plan over a number of years and we never felt that we were being denied needed services. My guess is that we would have paid more if we had the traditional medicare plans due to the traditional co pays.
However some plans do give you a lot of "non medical monthly benefits" so I can see that they may not have the desire to fund some medical needs. Just have to be selective of the plan you pick.

True, but as I understand it, Medigap is a supplement to Medicare that covers the 20 percent of coinsurance costs that Medicare doesn't cover. That can be a substantial amount of money that could bankrupt a lot of people. So, switching from an advantage plan to Medicare without Medigap could be a disaster for many people.

I wasn't comparing Medicare Supplemental Plans to ACA plans. Those are not comparable, one is a government benefit that YOU PAID INTO your entire life to get the plan at that cost, the other is a fully-insured plan run by a for profit health insurance company that if it's not subsidized by the government, is going to cost a lot of money.

I was comparing the cost of Medicare Supplement plans to the Cost of Medicare Advantage. It could easily cost $3,000 more and that's not chump change to a number of people.

True, but that’s beside the point. I’m merely refuting her statement that once you sign up for MA you are stuck for life and can’t go back to Medicare.

Supplement plans are run by insurance companies, not the government. Jeez!

I am not articulating myself as well as I should, but my point is that one cannot compare the cost of traditional Medicare, which people paid into their entire lives to get this at age 65 at this price plus Medicare Supplement which will cost about $3000 a year to the ACA plans. Especially if the ACA plan is not subsidized. Of course $3,000 will seem like a bargain compared to the ACA plan, but that was not what I was comparing it to. I was comparing Medicare Supplemental vs. Medicare Advantage. The $3,000 more in premium costs for Supplemental vs. Advantage is not chump change to many seniors.

That's why more far more people are on Traditional Medicare and Medicare Advantage Plans than are on Supplemental Plans. About 20% of Medicare enrollees have Medicare Supplemental Plans. A little more than 50% of Medicare enrollees have Medicare Advantage Plans. The rest are traditional Medicare members, but some people have Medicaid in addition, some have some previous employer coverage in addition, and some just go with traditional Medicare alone.

That increase will only be for one year as they look at your income two years prior to establish your rate each year. It will go back down the following year.

All the local hospitals in the TV area accept Medicare Advantage and while recently traveling to Oregon and ending up in an ER there, the insurance was also accepted. Yes, there are some places that don’t accept this type of insurance, but many places do thus there’s no problem at present to obtain care.

Good thing politics are not allowed to be discussed on this site...

Your complaint that "children" could stay on their parent's plan was and integral part of the ACA by design. It was a bone thrown to help it get passed.

My 2 younger kids could stay on my plan (until age 26), but neither one had to. They were both covered by their employers. Employers found it cheaper to offer health insurance rather than higher pay.

My oldest had to pay her own way.

Your other claim that we spend more with no better results is an outcome of our legal system.

No other industrial country has the medical malpractice industry that is seen in the US.

Docs here MUST practice defensive medicine, and order too many tests or risk being sued.

That doesn't change the fact that what SusanStCathrerine is true...

Totally true. But that $3,000 in savings will rapidly disappear, and then possibly way more, if/when the MA insured individual has a medical event that requires more than basic wellness medical care. There are easily many real world scenarios where spending the $3 grand on a supplemental plan will indeed appear like chump change at the end of the year compared to TOTAL health care expenditures if one opts to choose a MA plan.

Choosing a MA plan, versus Medigap, is akin to gambling one’s finances on their future health care needs. The biggest problem with MA plans is that when you win the gamble, you can save around $3 grand per year, when you loose the gamble it can be catastrophic. That’s not a risk/reward scenario I’m willing to take.

Wrong...

And wrong again...

No one is confusing a Medigap policy with a Medicare Advantage Plan (except for you...)

If you choose a Medicare Advantage Plan, yes, you can switch to regular Medicare (with no penalty), BUT ONLY WITHIN THE FIRST THREE MONTS OF YOUR INITIAL ENROLLMENT.

After that tine period, if you want to switch back the regular Medicare, YOU MUST go thru an underwriting process... PERIOD.

The statement you are attempting to refute is true. UNLESS you go thru an underwriting process...

Maybe you need to do more research

Depends on your official state of residence. Massachusetts (and I think) a few others do not require underwriting for supplement plans.

Interesting, since my Florida Blue MA plan has a MAXIMUM $2,400 out of pocket expense. Not much of a gamble.

Like many insurance plans, these are a great success until you need them.

And the 4 States that are exceptions to the rule have been mentioned, multiple times...

Picking a few nits doesn't change my point, since the person to whom I responded never brought up those 4 States...

There are some terms which have been used interchangeably throughout this thread which are not necessarily interchangeable.

Traditional Medicare: This is standard Medicare, around since the mid-60's when the program was created. There is a Medicare Part B premium of $174.70 in 2024 that is deducted from your Social Security payment, or billed quarterly if you have not yet started taking Social Security. Traditional Medicare basically pays 80% of the Medicare fee after the deductible is met. There is no limit to the 20% patient responsibility.

Medicare Advantage: The government pays a private insurance company to provide your Medicare coverage. Plans often include extra benefits such as dental, gym benefits, and eye care not available from Traditional Medicare, and often for no additional premium beyond the $174.70 already being deducted. There is a limit on out of pocket costs. The plan can require you to have a PCP, referrals, and require you to stay in their network. They can also limit you to a specific service area for non-urgent/emergent care. Medicare Part D is almost always wrapped in as a pharmacy benefit.

Medicare Supplemental (Medigap): This is insurance sold by private insurance companies that pairs with Traditional Medicare to insure the 20% coinsurance or some portion of the coinsurance. Part D coverage has to be bought separately. The benefits to this type of coverage is that it works all over the US with all doctors who accept Medicare and there are no referrals, networks, PCP's and pre-cert requirements beyond what Traditional Medicare requires. There are various plans to choose from, but the most comprehensive typically costs between $250-300 per month depending on Zip Code.

The Medicare Supplemental (Medigap) Open Enrollment time period is within the six months after you turn 65 and go on Medicare Part B. If you buy a plan during this time period, it's not subject to medical underwriting.

If you choose Medicare Supplemental (Medigap) at age 65 when you are first eligible, you can enroll with no medical underwriting. If you subsequently decide you want to switch to Medicare Advantage, you have one year to try it out and you can switch back to your old Medicare Supplemental plan if you don't like it.

If you are on Medicare Advantage, you can switch to traditional Medicare within 90 days of original enrollment. You can always switch back to traditional Medicare from Medicare Advantage during Open Enrollment periods.

I think the point that many folks are talking about here is that there is limited opportunity to buy Medicare Supplemental without medical underwriting if you don't choose it within the first six months of being eligible when you are 65. Unless you live in the four states (Connecticut, Maine, Massachusetts and New York) which don't require medical underwriting of Medicare Supplemental policies regardless of when you enroll.

To clarify, the Traditional Medicare premium is not $174.70 for all enrollees. Depending in your income, it can be more than 3 times that amount for the exact same coverage.

Good explanation. We gave up the IBEW program provided to my husband. In my case it was nine years after first becoming eligible for a Medicare supplement. Yes, we had to go underwriting, which consisted of six questions being answered satisfactorily.

This is correct. If you have a higher income, the Income-Related Monthly Adjustment Amount (IRMAA) may kick in. This applies to both the Medicare Parts A&B premium, and the Part D Prescription premium.

To determine if a surcharge is applied, Medicare looks the last income tax return provided by the IRS. They look at the Modified Adjusted Gross Income (MAGI), which is AGI plus tax-exempt interest. The first MAGI threshold where a surcharge kicks in is at $206,000 for couples filing jointly. The surcharge is $69.90. However, at $258,000, the surcharge is equal to the premium, $174.70. For singles, the threshold is half, so the increased premium starts at $103,000. The top surcharge is an additional $419.30 for couples over $750,000 and singles over $500,000.

I think that if I consistently had an income of $750,000 a year, I am ok with paying $594 a month for Medicare....however, it seems most of the complaints around IRMAA come from people who have a capital gain from the sale of stock or a house and that one event is what causes their monthly premiums to go up. Also, $129,000 for an individual is not really that huge of an income to trigger a doubling of the premium.

Fair point. Everyone’s situation is different and their choices reflect that. However, not all MA plans are equal, especially if you have more than one home and travel extensively. You obviously did your research and selected one of the better ones, most likely not one of the little to no cost plans that offer free stuff to suck you in. We would possibly consider a plan like that if we had a single home, spent almost all our time in that one location, all our doctors participated in that network, and we had the patience to deal with referrals. The reason we strongly prefer a supplemental plan is because we split our time between two far away locations and hope to travel extensively throughout the country. Plus, all Supplemental plans in each lettered category are required to offer identical benefits. MA plans benefits can change each renewal period, making the selection process an annual event. For us, the Supplemental part G plan is ideal. It has a national network, no referrals, an annual deductible/max out of pocket of about $250, and the benefits from year to year are consistent. And after being on Obamacare since its inception, both the cost and benefits of a Supplemental plan are a great relative value.

Here is hoping neither of us will ever need to use our selected plans for anything more than wellness checks : )

AARP UHC Advantage has a huge national network. No pre aprrovals needed and has an out of pocket max. We travel between 2 homes in Florida and Indiana. It works well for us and we use the wellness benifits.

Is Medicare Advantage a failed experiment? No more than Medicare or "health" insurance in general.

The moment you expect insurance to pay for anything non-catastrophic, the wheels come off. Just like when people expect their home insurance to buy them a roof when the old one is still there, and then can't figure out why EVERYONE'S insurance quadrupled in three years. Medicare WILL go bankrupt -- and probably in our lifetime. There is simply not enough money in the Gooberment's magic money machine to pay all the crooks who got in line the moment the word got out about Uncle Sam's deep pockets.

My grandfather was insulin-dependent for the last half of his life. The only "health" insurance he ever had was original Medicare -- a pure catastrophic hospitalization policy that he couldn't have afforded on a Coleman lantern assembly line salary. It never paid a dime for his diabetes. Most of his life he had NO insurance. So he paid for his doctor out of pocket. And he bought his insulin out of pocket. And that was possible because everyone else was doing the same thing, so a doctor's visit was only about $5 in the 60's. And his insulin was pennies a day -- back when they had to slaughter pigs to get it, instead of merely growing it in a vat like they do today, using some eternally-patented process, that for some bogus reason costs 1,000 times more than extracting insulin from pig pancreases.

Even my own daughters' well-baby appointments were only $15, back in the '80's. That wasn't the insurance co-pay, because that farce hadn't been invented yet. $15 was the entire bill. My company only provided hospitalization, which only paid the catastrophic costs of a hospital stay, like for when they were born. It didn't pay for doctors, and therefore, doctors were affordable.

And then Blue Cross invented the "HMO", which paid for everything, so long as it was "in-network". And the wheels came off. By the time I retired, my copay was $35 per visit, and I was paying over $350/month for "health insurance", while my company picked up the rest of the tab -- $1200/month. Effectively, $18,000/year of my salary went to pay for health care BEFORE I EVER EVEN SAW A DOCTOR!

Then I retired, 3 years short of medicare, and was forced to go on Obamacare. Since I was considered "wealthy", I was stuck with the entire cost -- $12,000/year for a $10,000 deductible, which left me on the hook for $22,000, before "insurance" paid a dime for a catastrophe that never came. Well, except for the "free" $12,000 annual physical.

But glory be! I finally made it to 65 and government "Medicare Advantage" insurance, courtesy of some crooked insurance company that gets a big cut from the gooberment to tell me which doctors I can see and which drugs I can take. And it only costs us $500/month for the privilege -- at least until Medicare goes belly-up in 10 years.

Reagan was right. The most terrifying words in the English language are "I'm from the government and I'm here to help".

The 2nd most terrifying words are "I'm from the Insurance company..."

I can agree with many of your points here, but five things really are responsible for the explosion of health care costs, in my opinion.

1. There are so many profit centers all over the American healthcare delivery system. It accounts for 1/6 of our entire economy. Many of these profit centers, including the insurance companies, are publicly traded corporations. When you have a fiduciary responsibility to shareholders, I don’t know how patients can be the number 1 priority.
2. Prescription drug costs are extremely high. We are one of the few countries in the world which allows direct marketing to patients. All those ads cost a lot of money.
3. We have a litigious society and the lawyers want their slice of the healthcare pie.
4. A very legitimate reason is we have added so many new treatments and technologies and it’s all very expensive. We didn’t have a heart transplant until the late 60’s. We didn’t have CT’s and MRI’s and many modern technology. It all comes at a cost.
5. 50% of all healthcare costs go to treat folks in the final year of life. Believe it or not, historically, this was not the case.

There are many more than this, but I think these are the top 5.

I love my Medicare Advantage plan. I never wait for referrals, procedures, appointments, etc. and that is in both Florida and Pennsylvania.

Good post and 99% accurate. However, the IRMA "look back" at tax returns is 2 years, not 1. My wife worked right up to age 65 and was stuck paying double for those 2 years. What's even worse, even though she chose an advantage plan and therefore no part D coverage, the law required her to pay IRMA on part D----not a part D premium, just the IRMA. Just another example of Robin Hood wealth redistribution----well-hidden just like these "dual coverage" advantage plans that forgive the part B premiums and pay for groceries, utilities and rent-----punishing the successful and those that planned ahead by handing it over to others who suck off the gov't teat.

True. We used to be a very independent people.

Yes I call it “euro trash contamination “😂😂😊

Regarding IRMAA, how would you like to go to Best Buy to buy a television advertised for $2,000, but they charged you $6,000 because of your income?

And do that so they can give 2 others a free tv

I think we are essentially saying the same thing, because the most recent tax information that is provided by the IRS is typically two years prior.

IRMAA can be appealed if the change in income is due to a life-changing event, the most common of which is retirement. So if income has dropped precipitously due to retirement, an IRMAA appeal may be successful. But one-time events that spike income for one year, such as a capital gain or ROTH IRA conversion or large withdrawal from an IRA are really not appealable.

I probably disagree somewhat on IRMAA, but I don't disagree entirely. If someone converts to a Roth IRA, their entire IRA is recognized as income, but they may not have taken a penny of it. The IRMAA premium increase could be very difficult for them to afford. I hope that most folks 63 and older are aware of this when they decide on a Roth conversion. I also think that the threshold of $103,000 for an individual is too low. But if a retiree has an income of $300k or more, I am ok with higher premiums because the trust fund is going to stop being able to pay full benefits soon and it is for the greater good. If my wife and I had a joint income of $258k in retirement, we would each have to pay an extra $174.70 for premiums or about $700 total, instead of $350. I am ok with that but I know not everyone is. It is redistribution but that's what a progressive tax code is by definition.

Currently, 7% of Medicare beneficiaries pay some IRMAA surcharge.

As an aside, I think the most unfair tax in America is the tax on Social Security income. For the first 50 years of Social Security, benefits were not subject to the income tax. Reagan changed that, gradually increasing the age for full retirement benefits to 67, and taxing Social Security for the first time. But the thresholds were not indexed to inflation, and are the same today as they were over 40 years ago. In 1985, only 9% of Social Security recipients paid income tax on their benefits, today, it's approaching 60% if not more by now, and especially with inflation, more and more ordinary taxpayers are paying income taxes on up to 85% of their benefits.

I agree. And here is something more unfair: If you are self-employed, you pay 6.4 % SS tax up to whatever the current limit is, and 1.25% Medicare tax, no limit on income. But you pay DOUBLE that since you are your own employer, 15.3% off the top. But wait, there's more-----you pay income tax on that 15.3% that you never see!!!!!! Yes kiddies, that's right. Let's say you made 100,000. You pay 15,300 in FICA, then income tax on the full 100K. DOUBLE TAXATION!!!!! Robin Hood strikes again.

If you are self employed, you get to deduct half of the self employment tax (aka FICA). That makes it essentially the same as if you worked for a company as they would be able to deduct their portion of FICA as a business expense.

1 out of hundreds of thousands.