Cost of medigap & medicare combined more than pre-65 coverage (medical, plan)

[TN Lily]

Virginia publishes charts showing available Medigap policies with their cost and other info regarding coverage. We will qualify for Medicare in Dec. 2020 and Jan. 2021. As I understand the Medicare & Medigap, our Medicare Part B will cost $148.50 per month or $1,782 per year per person (projected 2021 cost from an online source). Then we need to add the cost of two Medigap policies - Part G (what I think we would opt for) and Part D. The charts published by Virginia show a vast range of prices. Part G annual premiums for men range from $1,200 (Anthem BC/BS, pre-exist cond. wait of 6 months) to $2,807 (The Order of United Commercial Travelers, no pre-ex. wait). Part D plans are offered by only a handful of the insurers and range from $1,440 to $2,494.

His employer makes taking the Medicare Advantage option attractive as that option will cost us $230 a month versus receiving a Retiree Reimbursement Account of $500 per month to cover Medigap policies. Even though I would prefer the Medigap route versus the Medicare Advantage, the cost in the end may make the decision for us. Going with Medigap policies may cost as much or more than what we are currently paying.

My questions:

First, with respect to Part D plans, how do you find out what drugs are covered by different insurers. I am assuming that the price difference in policies results from more generous coverage by the more expensive insurers.
Second, most of the plans do not have guaranteed issuance. Do the insurers base acceptance on an application or do some require a medical examination?
Third, can an insurer pull out of the market and leave you scrambling for a replacement policy?

Fourth, the booklet Virginia has online shows rates for Medigap policies at age 65, 70, 75 & 80. So every five years, your rate gets jacked up, correct?

Thanks in advance.

[genesiss23]

You can find out what drugs are covered when you look it up. They normally list the status of the drug on their website. Cost of coverage is based on many factors.

[Teacher Terry]

Advantage plans are cheaper for a reason. You need a referral to see a specialist. They use step care. People have died waiting for all of this to happen.

[Jessie Mitchell]

I'm not sure why people tend to think coverage is always cheaper once you qualify for Medicare. My cost in total premium payments (Part B, Medigap plan G, and lowest available cost Part D since I take no meds) is just a tiny bit higher than I was paying in premiums before Medicare. I do have much better coverage (I used to have a $6000 deductible), but the premium cost is a smidge higher, and as I get older, plus rising costs, will continue to increase.

My husband's coverage from his union is currently $400/year. Our cost to cover him will go WAY up when he has to switch to Medicare.

I'm not complaining. Medicare is, in my experience so far, great. But it's not free, or even as cheap, as people under 65 tend to think.

[Unicorn hunter]

Originally Posted by Jessie Mitchell

I'm not sure why people tend to think coverage is always cheaper once you qualify for Medicare. My cost in total premium payments (Part B, Medigap plan G, and lowest available cost Part D since I take no meds) is just a tiny bit higher than I was paying in premiums before Medicare. I do have much better coverage (I used to have a $6000 deductible), but the premium cost is a smidge higher, and as I get older, plus rising costs, will continue to increase.

My husband's coverage from his union is currently $400/year. Our cost to cover him will go WAY up when he has to switch to Medicare.

I'm not complaining. Medicare is, in my experience so far, great. But it's not free, or even as cheap, as people under 65 tend to think.

I think this will be my situation as well. Currently pay $140 per month for an Obamacare policy with a $6,000 deductible...basically a catastrophic coverage plan, as I am pretty healthy. I need to sign up for Medicare/Medigap/Part D in the next couple of months, and the Part B will be about the same as my premium now.....BUT, I am hoping the cost will mean that things are actually covered! Right now, I feel I'm being totally ripped off, just giving money to the insurance company for nothing in return. If they cover dr. visits and lower my prescription price copay to a reasonable amount, it will be worth it. But, yeah, before really checking into the whole Medicare thing, I also thought once you turned 65, healthcare was basically free....not so.

[Ariadne22]

Originally Posted by TN Lily

Virginia publishes charts showing available Medigap policies with their cost and other info regarding coverage. We will qualify for Medicare in Dec. 2020 and Jan. 2021.

Well, you won't be buying anything for a year, but beginning now to explore your Medicare options is not a bad idea. So, here goes.

There is no discrimination on health status when you purchase a Medigap within the six month guaranteed issue period of enrolling in Part B. Therefore, ignore any concerns on waiting periods and preexisting conditions. Read this - Medicare on your Medigap purchase rights:

https://www.medicare.gov/supplements...-i-buy-medigap

Medigap rates vary considerably by issuer depending on pricing method used - attained-age. issue-age, or community rated. Read this - Medicare on how policies are priced:

https://www.medicare.gov/supplements...digap-policies

For what these pricing methods mean to you - long term - read this thread carefully:

//www.city-data.com/forum/healt...i-missing.html

In short, you want an affordable issue-age or community-rated Medigap. Most here choose AARP UHC (community-rated). One poster here found a very good rate on a Transamerica issue-age Plan N. So, take some time to learn the importance of pricing.

Fyi, AARP UHC, the only Medigap insurer which uses community rating in every state (other than states which mandate issue-age or are already community rated) and which commands 35% of the Medigap market has just implemented a new pricing policy for 2020 which lowers even further Medigap costs for younger new enrollees. Price UHC policies in your area, here:

https://www.uhcmedicaresolutions.com...ent-plans.html

UHC also discounts the premium when more than one in a household purchases a Medigap. Thus, the rate quoted will be even lower.

Originally Posted by TN Lily

Part D plans are offered by only a handful of the insurers and range from $1,440 to $2,494.

First, with respect to Part D plans, how do you find out what drugs are covered by different insurers. I am assuming that the price difference in policies results from more generous coverage by the more expensive insurers.

Second, most of the plans do not have guaranteed issuance. Do the insurers base acceptance on an application or do some require a medical examination?

Third, can an insurer pull out of the market and leave you scrambling for a replacement policy?

Fourth, the booklet Virginia has online shows rates for Medigap policies at age 65, 70, 75 & 80. So every five years, your rate gets jacked up, correct?

In answer to your questions,

First, Medicare.gov has a tool which allows you to compare the most cost-effective Part D plans and Advantage plans by your formulary. Part D is nowhere near as costly as the figures you quote. Average premium is in the area of $40-60/mo. Many plans can be bought for under $20/mo. if your medication needs are minimal. Many don't carry Part D at all.

Second, guarantee issuance was discussed above. When you enroll in Part B you will be in a guaranteed issue period for both Medigap and Advantage. Once past the GI period, Medigaps will require health underwriting if you wish to change policies. You can switch Advantage plans every year during Annual Open Enrollment with no health questions asked, other than ESRD.

Third, yes, an insurer can pull out of the market. Medicare provides guaranteed issue rights in just those circumstances - outlined, here:

https://www.medicare.gov/supplements...d-issue-rights

Fourth, the rates are adjusted annually. Insurers don't bother listing rates for every year. To determine your rate by age, divide the difference between the two closest age groups by five, then multiply that figure by years you exceed the lower age group, and add that result to the lower age group figure.

When you read the "What Am I Missing" thread you will learn that insurers raise rates annually, some more often - once for age, once for inflation. Medigap rates are not static.

You may also want to read these:

//www.city-data.com/forum/43835454-post8.html

//www.city-data.com/forum/healt...nary-info.html

If you intend to travel in retirement, you are much better served with a Medigap which allows you to see any Medicare provider anywhere. PPO Advantage plans allow for out-of-network service, but this can become costly should a serious illness develop when you are out-of-network.

If costs are a concern and you are healthy, seriously consider a high deductible Medigap. All the flexibility and protections of a regular Medigap, for at least half the cost. Many here have the high deductible plan and like it just fine. Another reason the high-deductible plan is so attractive is rate increases are very low because they are significantly buffered by the high deductible.

Last, I've read in a couple of places the new Part B premium will be more in the area of $144/mo., not $148. A $13 mo. jump to $148 (9.6%) would be pretty aggressive for CMS. We'll learn soon enough.

If your employer is providing $500/mo. ($250 ea.) towards health costs, that is indeed generous. In VA, a good Medigap shouldn't at this point cost more than $150/mo., at most.

Once you've educated yourself on pricing, you might want to find a good unbiased Medicare insurance broker to discuss further your best options. Beware, many are motivated by commission - and, because of UHC's new lower pricing, I've read not happy because their long-term commissions are reduced. So, keep that in mind when talking to any insurance sales agent.

[TN Lily]

Thank you for all the responses. I've got lots of reading to do.
Again, thank you.