Medicare, Supplemental, Advantage, and other Insurances, Oh My Aching Wallet

[StatisticalOutlier]

3 hours ago, shapeshifter said:

But if I did just have "free" Medicare, and then, if I got cancer again and needed insurance to help pay for treatment, my rates would be higher than if I was applying for coverage without that medical history.

The rates wouldn't be higher because of your medical history.

Just so people know:  "free" Medicare is Part A (hospitalization).  It's free if you've worked long enough to qualify, which most people have. 

Part B (medical coverage) has a premium of $174.70/month, and unless they're poor enough to qualify for Medicaid, anyone on Medicare (whether Original Medicare or an Advantage plan) must pay it.

Nobody who gets free Part A can disenroll from it.  People can disenroll from (or never sign up for) Part B and/or Part D (prescription drug plan), but if they later want to enroll or re-enroll in Part B and/or Part D, they'll pay a lifetime penalty based on the amount of time they didn't have that coverage--it's added to their Part B or Part D premium every month for the rest of their lives. 

But the penalty is calculated the same way for everyone, is based on the amount of time they were without coverage, and is not affected at all by anyone's medical history. 

 

[Yeah No]

8 hours ago, StatisticalOutlier said:

Please try to remember to report back after the call.  I like to hear anecdotal evidence.

Will do. It should be interesting to see if there are any lower cost prescription plans that might work for us, although I'm not that optimistic about that right now.

[shapeshifter]

3 hours ago, StatisticalOutlier said:

Nobody who gets free Part A can disenroll from it.  People can disenroll from (or never sign up for) Part B and/or Part D (prescription drug plan), but if they later want to enroll or re-enroll in Part B and/or Part D, they'll pay a lifetime penalty based on the amount of time they didn't have that coverage--it's added to their Part B or Part D premium every month for the rest of their lives.
But the penalty is calculated the same way for everyone, is based on the amount of time they were without coverage, and is not affected at all by anyone's medical history. 

I may be misremembering or have originally misunderstood, but I thought when I signed on with Medicare Advantage through the soon-to-be defunct Excellus plan a couple of years ago, that I was told it would cost more too if I had not been paying for Part B previously?
Or is it just that the Part B would be higher?

And do you know if the imposed delay time (if having a Part B gap) has a formula or schedule? Like: Is it the same amount of time as having not had Part B? I definitely remember being told by various Medicare advisors that the delay time was unknown — but maybe they just meant it was dependent upon any as-yet unknown time of a gap??

Anyway, apparently the new (presumably more expensive) plans are not going to be announced until October 15. At least that’s what the recording said when I called the number on the snail mail letter that arrived yesterday.

[StatisticalOutlier]

I'm a little confused because you were talking about higher rates due to a pre-existing condition, and now it sounds like you're talking about higher rates due to disenrolling from Part B for a period of time and then re-enrolling.

Here's the page about the financial penalty for periods when you were eligible for Part B but chose not to have it:

https://www.medicare.gov/basics/costs/medicare-costs/avoid-penalties

You're also using the term "delay time," as if when a person goes without Part B, he won't be allowed to enroll for a certain period of time based on the time he went without Part B.  That's not the case.  However, people can't disenroll and then re-enroll whenever they want--they can re-enroll only during specified periods during the year.  Maybe that's the delay they were talking about?

And for what it's worth, in New York, all plans have community-based pricing, which means that everybody with a given plan pays the same premium regardless of how old they are.  Most plans elsewhere are age-attained pricing, which means a 65-year-old on a given plan would have a lower premium than a 90-year-old on that same plan.  In New York, the 65-year-old and the 90-year-old would pay the same for that plan.

New York also has guaranteed-issue rights (no medical underwriting) for supplements year-round (one of only three states that do that), but that doesn't apply to you because you favor Advantage plans, which have to take any applicant regardless of their medical condition.

[shapeshifter]

33 minutes ago, StatisticalOutlier said:

And for what it's worth, in New York, all plans have community-based pricing, which means that everybody with a given plan pays the same premium regardless of how old they are.  Most plans elsewhere are age-attained pricing, which means a 65-year-old on a given plan would have a lower premium than a 90-year-old on that same plan.  In New York, the 65-year-old and the 90-year-old would pay the same for that plan.

New York also has guaranteed-issue rights (no medical underwriting) for supplements year-round (one of only three states that do that), but that doesn't apply to you because you favor Advantage plans, which have to take any applicant regardless of their medical condition.

I am in NY State. None of this👆 seems like what I understood 2 years ago when I went with the Advantage plan. I guess I need to spend time on the phone with the New York State Health Insurance Information, Counseling and Assistance Program (HIICAP) and/or on the medicare.gov site under "Supplements & Other Insurance" to look for "Medigap policies."
This 👆 is what the letter says I should do.
But apparently not until October 15.

[StatisticalOutlier]

You can go to senior65.com and see for yourself.  All you have to enter is a date of birth, gender, and zip code (you can leave the other fields blank) to see premium prices for Medigap supplement policies (which are what people on Original Medicare get, and are not available to people on Advantage plans). 

I did it for zip code 10003 (my zip code when I lived in New York City), for a Plan G supplement (the most comprehensive coverage currently available).  The monthly premiums for a 65-year-old female are:

$306 with "Top Insurance Provider" (which is AARP/United Healthcare)

$476.04 with Mutual of Omaha

$605.88 with Humana.

I also got quotes for a 75-year-old female, and a 100-year-old female, and they're the same as for the 65-year-old female. 

Then I did it for a male at all three of those ages, and they were the same as for a female. 

In New York state, everyone in the community on a given plan by a given company pays the same premium.

What kills me is that because New York has guaranteed issue rights (medical underwriting is prohibited for Medigap supplement plans), I can think of absolutely zero reason to choose anything other than the lowest cost premium option for whatever Medigap plan you want because there is no difference whatsoever in the coverage of Medicare costs among the policies offered by different companies. 

And customer service should never come into play because if a service is covered by Medicare, Medicare pays its 80% of the approved charge, and the supplement has no choice but to pay its 20%.  (Unlike Advantage plans, which can refuse to cover treatment.) 

There are studies that show that a lot of people never review their Medicare coverage choices.  For people in states that don't have guaranteed-issue rights for Medigap supplements, it's a bit of hassle to switch supplements and there's the risk of being denied based on your health (which is no big deal--you just keep the one you already have, and accept that you don't have a cheaper option because you can't qualify). 

But in a state like New York, where you can switch supplements at any time, it's just crazy that someone would pay $600 a month for an identical product that would cost $300 a month.  But people probably don't even know it's possible to change, or (inexplicably) don't care that they're paying more than they have to.  And people being people, they'll say they like their supplement company, even though there's nothing to like or dislike about it--the supplement company has no discretion over anything it does when it comes to paying Medicare claims.

If I lived in New York you better believe I'd be checking at least once a year, and probably every six months, to see if I can get my supplement at a cheaper price just by changing companies. 

But people just don't do it, just like they don't review their Part D prescription drug plan every year, even though Medicare has a website that does all the work for you if you enter your drugs, and I think it even enters drugs for you if you do it when logged in to your account.

And for the record, I use senior65.com because it's one of the few websites that will give you actual quotes, instead of taking all your information and then saying they'll call or email you.  Bah on that.  (Of course I never enter my actual information anywhere, and I apologize to the people who own the gmail addresses I make up.)

And I use senior65.com just to get the lay of the land, because they represent only a handful of companies, and they don't offer policies everywhere.  In that way, they're just like all other agents (usually it's in the fine print where an agent divulges that they don't represent all companies that have policies in your area).  But if it's somewhere they do sell policies, I can instantly get the actual premiums for the big companies like MoO and Humana, and see for myself, for example, that in New York, the policy premiums really are community-rated, and age and sex have no bearing on premiums.

 

 

 

[Yeah No]

4 hours ago, StatisticalOutlier said:

You can go to senior65.com and see for yourself.  All you have to enter is a date of birth, gender, and zip code (you can leave the other fields blank) to see premium prices for Medigap supplement policies (which are what people on Original Medicare get, and are not available to people on Advantage plans). 

I did it for zip code 10003 (my zip code when I lived in New York City), for a Plan G supplement (the most comprehensive coverage currently available).  The monthly premiums for a 65-year-old female are:

$306 with "Top Insurance Provider" (which is AARP/United Healthcare)

$476.04 with Mutual of Omaha

$605.88 with Humana.

I also got quotes for a 75-year-old female, and a 100-year-old female, and they're the same as for the 65-year-old female. 

Then I did it for a male at all three of those ages, and they were the same as for a female. 

In New York state, everyone in the community on a given plan by a given company pays the same premium.

What kills me is that because New York has guaranteed issue rights (medical underwriting is prohibited for Medigap supplement plans), I can think of absolutely zero reason to choose anything other than the lowest cost premium option for whatever Medigap plan you want because there is no difference whatsoever in the coverage of Medicare costs among the policies offered by different companies. 

And customer service should never come into play because if a service is covered by Medicare, Medicare pays its 80% of the approved charge, and the supplement has no choice but to pay its 20%.  (Unlike Advantage plans, which can refuse to cover treatment.) 

There are studies that show that a lot of people never review their Medicare coverage choices.  For people in states that don't have guaranteed-issue rights for Medigap supplements, it's a bit of hassle to switch supplements and there's the risk of being denied based on your health (which is no big deal--you just keep the one you already have, and accept that you don't have a cheaper option because you can't qualify). 

But in a state like New York, where you can switch supplements at any time, it's just crazy that someone would pay $600 a month for an identical product that would cost $300 a month.  But people probably don't even know it's possible to change, or (inexplicably) don't care that they're paying more than they have to.  And people being people, they'll say they like their supplement company, even though there's nothing to like or dislike about it--the supplement company has no discretion over anything it does when it comes to paying Medicare claims.

If I lived in New York you better believe I'd be checking at least once a year, and probably every six months, to see if I can get my supplement at a cheaper price just by changing companies. 

But people just don't do it, just like they don't review their Part D prescription drug plan every year, even though Medicare has a website that does all the work for you if you enter your drugs, and I think it even enters drugs for you if you do it when logged in to your account.

And for the record, I use senior65.com because it's one of the few websites that will give you actual quotes, instead of taking all your information and then saying they'll call or email you.  Bah on that.  (Of course I never enter my actual information anywhere, and I apologize to the people who own the gmail addresses I make up.)

And I use senior65.com just to get the lay of the land, because they represent only a handful of companies, and they don't offer policies everywhere.  In that way, they're just like all other agents (usually it's in the fine print where an agent divulges that they don't represent all companies that have policies in your area).  But if it's somewhere they do sell policies, I can instantly get the actual premiums for the big companies like MoO and Humana, and see for myself, for example, that in New York, the policy premiums really are community-rated, and age and sex have no bearing on premiums.

I tried that website but got nowhere for several zip codes in different counties in CT. It kept telling me that "The selected zip code and county do not correlate with our database. Please click on "edit your info" to make sure your selected county is accurate." The county and zip code are accurate! I did it for a few zip codes in NY State and they worked. 🙁

BTW I found out that CT and NY are similar in many ways and both charge the same premium regardless of age or pre-existing condition.

[StatisticalOutlier]

17 hours ago, Yeah No said:

I tried that website but got nowhere for several zip codes in different counties in CT. It kept telling me that "The selected zip code and county do not correlate with our database.

Maybe their agents aren't licensed to sell in Connecticut?  I have no idea.

But finding supplement premiums in Connecticut is easy because they're community-rated, and there are only a handful of companies that offer them.  It looks to me like the premiums are good state-wide, and not dependent on zip code, which wouldn't surprise me in a state the size of Connecticut.

https://portal.ct.gov/-/media/cid/1_lifehealth/medicare_supplement_insurance_rates.pdf?la=en

If only supplement shopping were this easy in the rest of the country.

The high-deductible G is compelling.  I'm a very light consumer of healthcare, and paying $50 a month instead of $250 a month, in exchange for a deductible of $2800, sounds like a deal to me.  I like the luxury of my regular Plan G, where I have to look at bills only until I meet my $240 deductible, but for $200/month, I'd pull out my green eyeshade.

However, I don't know how the increased deductible works if someone changes plans, which people in Connecticut can do whenever they want.  Is the deductible satisfied through Medicare (like the Part B deductible), or is it specific to that exact plan by that company?  Having the deductible reset in the middle of the year if you switch to a different company would be a drag.  It's definitely something I'd get firm information about if considering a high-deductible plan.

[shapeshifter]

I just signed up for the renamed version of my going-away Excellus Advantage plan.

They took away the $500/yr flex card, and the monthly premium went up from $19 to $35. 

I have until some time in December to do something else without any breaks in coverage.