Denial of coverage from a Medigap plan after health underwriting to switch plans

[Ariadne22]

Originally Posted by loves2read

My husband’s sister is 18 yrs older than he is—she is late 80s and he is 71 later this month.
She was living in Victoria TX and moved in with her son in Austin TX area earlier this year.
I think they are still using an address in Victoria because she wanted to continue to see her doctors in Victoria vs newer ones in the Austin area
Can she get in trouble doing that?
She has some in the Victoria area and maybe is using his address even though she is living with the other son who has homes in Austin area and in Rockport TX—vacation home...

Eventually, yes, she won't have coverage when plan discovers she's moved. Normally, they say you can't live outside their service area longer than six months, iirc.

If she is on an Advantage and no longer lives in that plan's service area, she needs a whole new plan. The plan documents clearly state you must notify them when you move outside their service area.

On getting in trouble - well or sooner later the Advantage plan will find out about it. If she develops something serious, they could use the out of service area as an excuse to charge more or not cover.

Really, she needs fix this and buy a Medigap or find another Advantage plan. She's GI on Medigap because she's moved out of the plan's service area, so it's no hassle.

You’re in a Medicare Advantage Plan, and your plan is leaving Medicare or stops giving care in your area, or you move out of the plan's service area.

You have the right to buy

Medigap Plan A, B, C, F, K, or L that’s sold by any insurance company in your state
You only have this right if you switch to Original Medicare rather than joining another Medicare Advantage Plan. You can/must apply for a Medigap policy:

• As early as 60 days before the date your coverage will end
• No later than 63 calendar days after your coverage ends

Medigap coverage can't start until your Medicare Advantage Plan coverage ends.

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

Then she can continue to see her old doctors - assuming they take Original Medicare as well as the old Advantage plan. She and her son should find a good Medicare insurance broker and straighten this out.

In the Austin area, she could get a community-rated AARP UHC Plan F for $278.30/mo. hd-F is also included in the GI,

Originally Posted by SCGamecock

When CMS refers to Plan F they mean both versions unless they say otherwise. With F-HD being a GI plan,

//www.city-data.com/forum/56515310-post18.html

so she could cut that premium in half or more. Medicare still pays its 80%, she pays 20% up to $2,340, thereafter plan plays 100%. If she doesn't run up gross Medicare charges anywhere close to$11,700, the hd-F might be a good choice - affordable and allows her to keep her doctors - again assuming they take Original Medicare.

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

At this point in her life, does the cost of a Medigap really matter? The older I get, the less I worry about money. Death finds us all, and those years go pretty quick.

[Nausikaa]

Originally Posted by Ariadne22

How far back is "a while back?"

BC is probably an attained-age plan and will get pricey as the years go on. If the mole removal took place within the past two years, that may be why UHC raised the premium. Wait a year or two and reapply with UHC. People here have done that with success. Your goal should be to find a plan that will be affordable into your 90s. Community-rated plans are, attained-age are not. Based on rate filings here in WI, by age 85 BC is expensive - like $4k/year for an 85 y/o. v. a UHC plan at $3K.

Thanks for the advice. Yes we had thought about reapplying later, We did not have time to do anything about it as we were going on a trip out of the country, and will not be back until December 12. One episode was about four years ago, and the other was two years ago, Not a mole, but just from sun exposure on his head. DH is from Florida, too much sun! We presently live in SC.