Wherever two or more people on Medicare parts A and B are gathered, the conversation inevitably turns to health and the best insurance plans. Medicare beneficiaries want to know all their coverage options and may experience buyer’s remorse if their plan isn’t meeting their needs. Some people whose Medicare Advantage plans requiring networks, referrals, regulations and cost sharing, may wish to have greater access to providers that accept Medicare without restrictions or conditions to meet. They would like to make the transition to a Medicare supplement and have flexibility to receive care from any provider that accepts Medicare. These plans are referred to as Medigap plans because, depending on the plan chosen, the plan fills any gaps in payment not paid by Medicare, for a monthly premium. With Medigap plans, once you’ve paid your plan’s monthly premium, contingent on which plan you select, you’ll not pay additional costs. The plans are standardized and accepted nationally, providing freedom and flexibility in seeking healthcare.
If they contemplate leaving their Medicare Advantage plan and moving to a Medicare Supplement, the decision is clouded by the prospect’s facing the dreaded “U” word: underwriting. Medicare regulations permit the private insurance companies to apply medical underwriting to decide if you’ll be enrolled in the plan, and the rate you’ll pay. You’ll answer medical questions when applying, and the company will review your medical records regarding illnesses, surgeries, conditions and lifestyle to determine acceptance and if you’ll pay a higher premium to have coverage.
Here’s how you’ll avoid underwriting. If you enrolled in a Medicare Supplement during your Open Enrollment Period, the 6-month period when you are at least 65 years of age, and enrolled in Part B, the plan must accept you without underwriting, regardless of what health conditions you may have. It is the most desirable time to enroll in a supplement.
But if you did not enroll in a Medigap plan during your open enrollment time, you may still be permitted to enroll without medical underwriting in certain situations. If your current Medicare Advantage or existing supplement plan leaves the service area, if you’ve been covered by employer insurance and the plan is terminated, or you relocate to an area where your plan does not operate, you are eligible to purchase a Medigap plan without underwriting.
You also have a guaranteed issue right if you enrolled in a Medicare Advantage plan during your Open Enrollment Period and decided to drop the Advantage plan in the first year you were enrolled. Guaranteed issue rights apply if you’ve been in the plan less than 12 months.
At this time of year, Medicare beneficiaries are inundated with mail and may overlook important changes to their plans. Do read your carrier’s correspondence carefully and review the Annual \
Notice of Change sent by your plan to learn what changes will take place. If you do receive a letter stating that your plan will no longer be available in your area, it’s important to save the letter and may be helpful to retain the envelope the carrier sent. Often you might be required to provide the letter should you wish to change from an Advantage plan to a Medigap or supplement plan.
If switching to a Medicare supplement, you’ll be adding on a Medicare prescription drug plan (Part D) to fulfill the requirement that each person on Medicare have prescription drug coverage.
For some beneficiaries, such changes provide a valuable opportunity to receive their Medicare benefits in a new way to meet changing needs through the Guaranteed Issue provision of Medicare. Don’t overlook any opportunity to obtain the best coverage for yourself. Therefore, to quote Tom Peters, “if a window of opportunity arrives, don’t pull down the shade.”
Leah Sugar Kari, retired pharmaceutical representative, specializes in showing Medicare eligible people their insurance options. Reach Leah for comments at (520) 484-3807 or email firstname.lastname@example.org. (TTY users dial 711.)
Leah Sugar Kari, AMR, FHIAS, is a licensed insurance agent specializing in Medicare products.