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  • slipslidingaway (194 posts)
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    Medigap polices …

    my understanding is that you have one shot to pick the best policy, which we need to do in the next month or so, without questions of health history which might lead to possible denial or higher costs in some states. We looked at the Medicare Advantage plans and they limit providers which is not in our best interests, so the focus is on the best Medigap policy.

    In our case he will be transitioning to Medicare prior to his 65th birthday as he has been on disability for two years, most Medigap policies require that you be ‘of age” to apply. So your choices are very limited because you are under 65. There is a small window of time in which you can purchase the policy of your choice without having to worry about being denied or paying more because of pre-existing conditions.

    Did the ACA forget about us older folks who now find ourselves in this gap? Did the pre-existing clause in the ACA forget about those caught in between?

    I think we will be OK as the time is measured in months, but I do wonder about others facing a similar situation in the future who have a longer window and cannot buy a preferred policy as their first policy  not subject to medical history,  subsequent policies can be more expensive or denied is my understanding.

    Which leads me to wonder if the ACA has left a gap of pre-existing conditions for seniors moving into the Medicare world?

    As far as I can tell for Medicare part D, we would be better off paying cash at Costco for the current drugs. Estimates given based on current prescriptions were close to 6K per annum, when speaking to advisor. Today we went to Costco with a list of current drugs and walked away with a cash price of approximately 1K per annum. We never know what the future holds and will sign up for a drug plan, again from my understanding drug plans can be changed in the future, maybe once per year, but the enrollee is not subjected to medical questions and cannot be charged more for the plan or denied coverage.

    If anyone wishes to share their experiences and knowledge regarding Medigap plans or drug plans it would be most appreciated.

    Thanks :)

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11 replies
  • KauaiK (3530 posts)
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    1. Here's what I learned

    You have two choices on Medicare.  Straight Medicare which is they pay 80% you pay 20%.  There are insurance companies who will manage your Medicare – Managed Care.  I found, however, there was a LOT of care missing; not on their approved treatment list AND you have to you their Docs.  For example, I was in the middle of Chemotherapy and most “managed care” groups did not cover Chemo.   (Yikes!)   And I would have to change Docs midway thru.

    I went and have stuck with Straight Medicare Parts A & B.   For the Medigap (Part F) I found a really good policy with AARP that was affordable.  (AARP membership is $14/Anl).  AARP also has a good Part D (prescriptions) program.  However, depending on your income, you may qualify for assitance from your State or Feds in which case they assign you a Part D provider.  The Rx’s under this program are never more than $10.

    BTW:  The materials the Gov’t mails to you are overwhelming.  Plus Insurers bombard you with materials.  I got on line; talked to friends; and called companies asking direct questions and got better info.  In the big thick Medicare book go directly to the back to see who the carriers are in your area / state.  The balance of the book is like reading the Tax Code.  If you can’t sleep, try to read it and you’ll be out cold in no time.


    Critical thinking is the vaccine for charlatans of the world who exploit ignorance - JPR's own So Far From Heaven.

    • slipslidingaway (194 posts)
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      3. Thanks KauaiK! When you speak of managed care is this Medicare Advantage…

      or a Medigap policy that might not cover chemo?

      Medicare Advantage looks cheap, but my husband has already had two transplants for AML so yes covering chemo is a given, also we want to be able to go out of state if need be, it appears Medigap policies allow more freedom. Since there could be health questions in regards to history, not good, I figure we have one shot to get this right. We have lived with people at Hope Lodge in NYC for months at a time, too many were limited in their choices of providers, in fact PNHP had an article recently about people not being served at the major academic centers in NYC in contrast to Boston.

      We are looking at F and G policies, I did find a good article in consumer reports about policy ratings and prices.

      Very much appreciate your reply, we need to be on our toes, seems to be every moment. My husband’s previous employer was supposed to cover HC insurance for life if you took a buyout, they changed that last year, we know contracts can be broken. Nothing is set in stone.

      In addition our life insurance policy from Met Life, which we had until 2020 to convert to another policy is being ‘called early.’  Met Life sold their retail policies to Mass Mutual and we have until the beginning of March, three years early, to convert his policy, another contract broken.

      If anyone is reading this and has a convertible Met Life policy check into it NOW! Too many plates spinning at once, in addition to worrying about the next check up on Friday at Sloan Kettering.

      Thanks again!!!



      The second link deals with Medigap policies so we’ll loo for a best fit in regards to holding costs down in the future while still allowing the broadest providers.

      “The type of premium pricing method you choose will affect your future costs
      A policy that looks inexpensive when you first buy it at age 65 could end up being the most expensive when you hit 80.

      Insurance companies use three different ways of setting premium prices. In some states you may have a choice of only one or two.

      Community-rated (also called no-age rated). The same premium is charged to everyone, regardless of age. Medigap experts say these plans are the least expensive over time, though not necessarily when you first purchase them.

      Issue-age-rated. The premium is based on your age when you buy the policy. It won’t go up as you age, but will increase due to cost inflation.

      Attained-age rated. The premium starts low but goes up as you get older. Over time, this type of policy is the most expensive.

      Learn more about policy pricing.”


      • KauaiK (3530 posts)
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        4. I would strongly suggest you go to the AARP site and check for yourself.

        Managed Care is an insurance company who manages your Part A and Part B Medicare for you – for example a Blue Cross.  Their coverage is a LOT different that straight Medicare.

        My friend (in another large state) walked thru it with me.  You can compare coverage and prices.  I found a Plan F medi-gap coverage at WAAAY less that I thought I would pay.  Same thing on Plan D Rx coverage.  AARP is like a great big group policy so the premiums are less and coverage is better.   I have not had one problem.

        I am leery of Managed Care products b/c they look inexpensive up front but you end up paying in the end b/c they refuse to cover.

        There is NO pre-existing conditions when to go INTO Medicare whether its straight Medicare or Managed Care.


        Critical thinking is the vaccine for charlatans of the world who exploit ignorance - JPR's own So Far From Heaven.

        • slipslidingaway (194 posts)
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          6. Will do! I do think the managed care, as far as I know Medicare Advantage looks

          cheap up front, but could prove more costly in the future. We do have another minor constraint with the teaser of a Health Reimbursement Account, HRA, from a previous employer, so trying to see what fits best. But hey the previous employer has already changed the terms two years ago, part of an early retirement, they were supposed to be the secondary insurance, now they offer a fixed sum if we go through their exchange. Remember when some said the ACA would transfer more responsibility from employers to people, well it seems they first do that by reneging on promises to retirees. As if our lives were not complicated enough. Any contract can be broken!

          Which is why I feel we need to get to this right the first time.

          I think this is a worthwhile conversation for all transitioning to Medicare, there are a few of us old folks still lurking.

          Many thanks for your contributions!

  • GloriaMundi (639 posts)
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    2. You should sign up for Part D coverage…

    …because if you don’t sign up for it when you first start on Medicare, you will pay a penalty forever after when you do sign up.  The penalty is prorated for how long it was that you did not have coverage for drugs.  I did not need drugs so did not get Part D for 3 years.  Don’t remember it ever being explained either.  Oops.  Now I’m paying an extra $12.00+ per month forever.  Nice system.  I guess the drug companies probably wrote the law themselves.

    Anyway, do get your Part D coverage, is my advice.

    As for Medicare Advantage, the Advantage plans pick up some of the 20% you would be on the hook for with just Medicare.  Like other private insurance, they have HMO and PPO models and different networks so you have to shop around (assuming you actually have alternatives).

    The Medigap plans are more expensive, but they pick up the full 20% that Medicare doesn’t pay.  For people with ongoing issues this might be the best option.  But it isn’t cheap.

    • slipslidingaway (194 posts)
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      5. Thanks, he will sign up for Medicare D, but appears you can change policies each

      year and they cannot deny or raise rates based on medical history, at least that is what I have gathered???

      Medicare Advantage is definitely cheaper on first glance, but we cannot be tied to the lack of providers, I know you can switch to a Medigap plan, but given my husband’s history we do not want to chance a denial or increased premiums if/when we switch.

      A problem is that you can only buy a Medigap C policy if under 65, and he needs to transition before 65, being eligible for Medicare because of a disability. But the C policy might not be the best going forward, seems you have one shot when becoming eligible without possibly being denied for a policy or having increased costs. But I think/hope we have that resolved today.

      Gosh, HC costs/treatments have totally taken over our lives for the past 7 years. That being said we are VERY fortunate, we had a great HC policy and were able to manage and save for retirement, never thought we would use that so rapidly that for HC. But we are here, many people are not. :(


    • GoodWitch (956 posts)
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      7. Not if you have existing prescription coverage through a spouse's job

      I called Medicare and asked about this last week. My husband is a few years younger than I am and has health coverage through his employer, including prescription. I was told I could continue on his prescription plan as long as he and I had coverage, but if he lost coverage or retired, I’d have 63 days to sign up for Part D or pay a penalty.





      Make America THINK again
      • GloriaMundi (639 posts)
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        8. Well yes but the point is, you have to have Part D coverage…

        …from the beginning of your Medicare coverage or you will pay a penalty, permanently, once you sign up for it.  I am fortunate enough not to need any regular medications so did not realize that when I started my Medicare.  This year I thought, hey, I’m not getting any younger, probably should get drug coverage.  That’s when I found out about the penalty.  So while Part D coverage isn’t “mandated”, they’ll take it out of your hide for the rest of your life if you don’t get it right away.

        I thought it was important to put it out there so others who see this thread do not make that same mistake.

        • GoodWitch (956 posts)
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          9. Ok, Medicare told me there was no penalty for me because I had equivalent covera

          coverage. No penalty would kick in unless my current prescription plan ends and I fail to sign up for Part D within 63 days.

          Make America THINK again
          • GloriaMundi (639 posts)
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            10. Yes, if you have coverage there is not penalty…

            …and apparently there is a grace period for you to switch.

            But again:  the point I was TRYING to make, for those who are about to embark on the adventure of getting Medicare coverage, is DON’T make the mistake I did and decline Part D coverage, because if you do, you will pay a penalty for the rest of your life once you do opt for Part D coverage.

            It would have been much simpler had they just required the insurance to cover drugs too, rather than making it a separate thing and then having separate rules for it.


  • slipslidingaway (194 posts)
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    11. Thanks for comments everyone, from what I have read here and speaking to …

    friends there is a real difference between those who had problems going into those older years and those who did not need care/drugs that could drive the choice of policies.

    Today I will just say that all the news was good, so good that my husband had 5 shots for childhood illnesses, after a transplant, you need to go through all the vaccines again after a bone/stem cell transplant. This is the second allogeneic transplant in six years, I do wonder if he would have been eligible for a second transplant at the age of 63 in another country, but for now we are focused on the future and taking another step forward.

    But I also wonder if the outcome might have been different for those whose paths we crossed at Hope Lodge in NYC and could not go to best hospitals. Recently on PNHP  there was an article citing a study that showed people in NYC compared to Boston had less of an advantage at the leading academic centers/hospitals. In essence HC was being rationed by economic status, not a surprise, just disheartening.

    IMO this was a decent article, with lots of subsequent links. Appears we need to choose wisely at the onset of our golden years, the ACA might not have extended the pre-existing clause to those moving to Medicare.

    Thanks again and please share your knowledge for those who follow.


    “….Medigap plans can turn you down or charge you more for pre-existing conditions at certain times
    In every state, you have a guaranteed right to buy a Medigap policy for six months starting the first day of the month you are at least 65 and enrolled in Part B. During this grace period, the insurance company is not allowed to turn you down or charge you more because you have a pre-existing condition. This is called “guaranteed issue.”