Philip Moeller Philip Moeller. Medigap supplement policies have begun to change, moving away from being the plain-vanilla member of the Medicare family. Increasingly, these private insurance policies are likely to cover health-club memberships and perhaps also set up health care provider networks to save money for themselves and their policyholders.
In doing so, the plans are emulating the moves of private Medicare Advantage MA plans. Such plans legally must cover everything provided by basic Medicare but usually feature additional benefits. Given that the same insurers dominate MA and Medigap markets, this development is not surprising.
More than 12 million people had Medigap policies inrepresenting 22 percent of the more than 55 million Medicare enrollees, according to the American Association for Medicare Supplement Insurance.
However, a much higher percentage of people using traditional Medicare have Medigap plans. Also, nearly 10 million low-income Medicare enrollees also qualify for Medicaid, and are not able to afford Medigap premiums. By my rough calculations, this means that 40 to 50 percent of basic Medicare enrollees purchase Medigap plans to help cover things that basic Medicare does not fully pay.
How do I get the Medicare coverage I want with the lowest out-of-pocket cost? Two-thirds of all outstanding Medigap plans are Plan F, according to the Medicare supplement trade association, followed by N 12 percent.
D and G each 9 percentand C 4 percent.
Although benefits differ among these letter plans, every Plan A sold by private insurers must cover the same set of proscribed minimum benefits. As must every Plan B, every Plan C, and so forth. Insurers are free to charge different premiums for their plans, and wide cost variations exist.
Because benefits have been identical within the same-lettered plans, price shopping is the major and usually only factor that should guide consumer selection.
However, this uniformity is changing, meaning that not all same-letter plans offer the same features. For example, I am now the happy owner of a Medigap plan that includes a steep price discount on health-club memberships offered by clubs that participate in the popular Silver Sneakers program. I was surprised that this feature was available, and so was an experienced Medigap broker who helps keep me up to date on Medigap developments.
But more than one Medigap insurer confirmed to me that they now offer these plans in some of their letter plans.
In another development, an unnamed Medigap insurer has just received a Medicare ruling that could lead to it offering policies that include a proprietary network of participating hospitals. Medigap plans are regulated by the states, not Medicare. The insurer sought and received an assurance from Medicare that its plan would not trigger such sanctions. The insurer, whose identity was redacted in the Medicare advisory opinion, set up the system so that consumers are free to use any hospital.
If they use a non-network hospital, the insurer will pay the full amount Dating a player advice vs advise difference between medicare the Part A deductible. Likewise, the insurer said its network was open to any hospital accepting Medicare. This avoided charges that the insurer was unfairly driving business only to hospitals in its network. Saving money through the use of health provider networks is an enormously important trend for Medicare enrollees, and a key element of the movement toward managed care that is appearing in all types of health care.
How much of those savings flows to consumers as opposed to health insurers is a big wild card. Having received this ruling, there is no guarantee about whether or when the insurer will begin offering such plans.
For now, my message to Medigap policyholders is much less cosmic: I have been disabled for several years and on Medicare, and recently had to repair my wheelchair. I have gone to almost every durable medical equipment DMW outlet in Indianapolis. None of them will even help me order parts or cover. This is the only chair that has worked for me. But I agree that the system often seems to deny the best long-term solution in the interest of saving a few bucks today.
These businesses are hired by Medicare to handle claims, with their approval and denial process based on Medicare coverage rules.
There also is a MAC for durable medical equipment. This often appears to be an effort to pass the buck, as neither the MACs or CMS can be easily held accountable by consumers. If you have committed doctors on your side, they can make a big difference in reversing Medicare coverage denials. There are two Medicare nonprofits I deal with that might be willing to help you with your claim.
I should warn you that they are overwhelmed with consumer demand, but perhaps they have encountered your type of problem before and can give you good advice. Please let me know how things go. I wish you the best of luck, and admire your efforts to overcome the challenges caused by your disability.
I am worried about Social Security running out of money. Even though it might be best to collect at full retirement age or, ideally, 70, do you think a person should consider collecting at 62 to make sure they receive least some benefits?
Where can I get honest advice on what to do?
But I see no upside to filing early for fear that future benefits might disappear. First, I have seen no proposals to change the rules that would reward early filing. Second, even if Congress does nothing, benefits can be paid in full until the year On the advice front, my co-author Larry Kotlikoff Dating a player advice vs advise difference between medicare I continue to write about Social Security, so I would immodestly suggest you can follow our articles. Many of these threats will never become legislation, let alone be enacted.
Social Security trust fund will be depleted in 17 years, according to trustees report. From this perspective, you will see a lot of content about how Social Security deficits need to be reduced, often by reducing benefits. I turn 65 next year, but will be working full time and not collecting Social Security until I turn 66 in What do you think about the idea of me dropping my employer plan and signing up for Medicare instead?
It is certainly worthwhile to run the comparative numbers and see. I used to routinely advise people to keep their employer plans when they became eligible for Medicare.
But the rise in high deductible plans has changed my thinking. If you do leave your employer plan, you should be aware that the plan may not have to take you back if you later change your mind. Beyond getting Part B of Medicare and a Part D drug plan, Medigap supplemental policies can be expensive for someone with modest health expenses.
But all it takes is one medical emergency to generate hundreds of thousands of dollars in medical expenses. Among other things, Medigap covers the 20 percent of Part B expenses that Medicare does not pay. You also should look at available Medicare Advantage policies. These plans must cover everything that basic Medicare covers, and also usually include a Part D drug plan.
Lastly, they also have protection against catastrophic out-of-pocket health costs, and thus do not require a Medigap plan. You clearly are a planner.
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Congratulations on being part of a club that is much too small. I am signing up for Medicare Part D for the first time. Presently, I only take a low-cost blood pressure medication. While I am in relatively good health, I have heard horror stories about how friends have found out that they have cancer and, during open enrollment, were denied coverage in a better part D plan that would cover more of their medications.
Is it better to buy the best plan that I can afford, or go with the plan that is low cost and no deductible?