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Disagree with your statement on plan g. I have read many times some insurers are to be avoided due to "closing the books" and in a few years and facing large price increases down the road. Mutual of Omaha is one that has been know to do this IIRC.
What does this whole "closing the books" thing mean..?
Last edited by southkakkatlantan; 08-20-2023 at 11:57 AM..
I'm 44 but my mom turns 65 in 3 months and 1 week.
I'll be helping her apply for her Medicare coverage.
I'm still researching options but I can say off the bat I really prefer she have as much flexibility as possible. She's one year post stroke and prior to that event she never had any established PCP or care team ever. So it's highly possible she may go through a 'trial and error' period of docs for a bit as we find who to establish future care with.
I'm currently thinking Part A/B + D + G.
I know no one individual can advise me as to exactly what to do, but any tips on how to select the right plan for her?
Of note, she is pending both Medicaid and disability fyi which I do (prayerfully) believe she will eventually get.
Why are you trying to get SS disability, which requires too much paperwork, when she is already qualified to go on regular SS. Won't the benefit amounts be the same?
In regards to another post, yes, if she is low income, they will cover her medicare premiums, in some states.
Why are you trying to get SS disability, which requires too much paperwork, when she is already qualified to go on regular SS. Won't the benefit amounts be the same?
Not according to the social security or disability rep I've been speaking to. Disability pays higher than an early retirement check. FRA is 66 and 8 months.
Needless to say she has applied for her early retirement anyway (she was forced to in order to reopen her disability case which social security contacted us about doing a week or two after she was initially denied). And if disability comes through and it is higher, then great because the more the better.
My mother's stroke happened when I went out of the country (I'd been trying to get her to come with me but she just happened to stay behind in the US). My last ER visit for myself was actually on a trip to my mom's state to visit her, so I am a bit paranoid about needing services outside of the location you reside in, which is part of the reason I am a bit leery of going the Advantage route (outside of my originally posted reasons).
Medicare Advantage plans must provide emergency & urgent care coverage when travelling outside your home territory. It's non-emergency/urgent care needs away from home that can vary from plan to plan. You may need to either return home for care, or wait until your trip has concluded to obtain non-urgent care, with some plans.
What does this whole "closing the books" thing mean..?
Sometimes, a Supplement carrier will close a particular plan to new enrollees after a period of time, so they have "closed the books" on that plan. Not being open to new enrollees who may be younger and healthier, that plan is now stuck with a closed pool of older not as healthy group, and that can cause premiums to increase significantly at time goes on. They sometimes open a "new" plan to new enrollees, so they can offer lower premiums up front, trapping older, sicker enrollees in their "closed" plan. This is one of the downsides to going the Supplement route. Right when someone needs it the most, the premiums are becoming unaffordable.
If someone now caught in that closed risk pool can't afford the continually rising premiums, and also can't pass underwriting for a lower-cost Supplement, it may force some to switch to Advantage, for affordability reasons.
Medicare Advantage plans must provide emergency & urgent care coverage when travelling outside your home territory. It's non-emergency/urgent care needs away from home that can vary from plan to plan. You may need to either return home for care, or wait until your trip has concluded to obtain non-urgent care, with some plans.
RE: the bolded, I read the below and took the info to mean that neither Medicare Advantage nor Medicare Part A/B actually would pay for emergency care (let's specifically use the EU as an example - see the 3 situations described on page 1 which do not seem to be applicable to say a vacation to Paris), but that Plan G would offer coverage (see page 3 which mentions up to $50k lifetime coverage via certain supplemental plans only):
Sometimes, a Supplement carrier will close a particular plan to new enrollees after a period of time, so they have "closed the books" on that plan. Not being open to new enrollees who may be younger and healthier, that plan is now stuck with a closed pool of older not as healthy group, and that can cause premiums to increase significantly at time goes on. They sometimes open a "new" plan to new enrollees, so they can offer lower premiums up front, trapping older, sicker enrollees in their "closed" plan. This is one of the downsides to going the Supplement route. Right when someone needs it the most, the premiums are becoming unaffordable.
If someone now caught in that closed risk pool can't afford the continually rising premiums, and also can't pass underwriting for a lower-cost Supplement, it may force some to switch to Advantage, for affordability reasons.
Hhhhmmm...this is interesting.
I will have to look into this further as I am not sure how to mitigate such a thing.
Being eligible for both Medicare and Medicaid is called Medicare dual eligible.
This goes beyond just choosing a particular Medicare plan.
Beneficiaries Dually Eligible for Medicare & Medicaid
Medicare providers can’t bill QMB [Qualified Medicare Beneficiary] beneficiaries for Medicare cost-sharing. This includes Medicare deductibles, coinsurance, and copayments. In some cases, a beneficiary may owe a small Medicaid copayment. Medicare and Medicaid payments (if any) (and any applicable Medicaid QMB copayment) are considered payment in full. You’re subject to sanctions if you bill a QMB above the total Medicare and Medicaid payments (even when Medicaid pays nothing)
Do You Need Medicare Supplement Insurance if You Qualify for Medicare and Medicaid?
The short answer is no. If you have dual eligibility for Medicare and full Medicaid coverage, most of your health costs are likely covered.3 As a result, having a Medicare Supplement Insurance plan wouldn’t necessarily be beneficial to you, in fact, an insurance company is not allowed to issue a Medicare Supplement insurance policy to a Medicare beneficiary who receives full Medicaid health coverage! The purpose of Medicare Supplement Insurance is to cover the cost left by deductibles and coinsurance in Original Medicare, but as full Medicaid coverage should cover the majority of those costs, a Medicare Supplement Insurance policy isn’t necessary
"If you have Medicare and qualify for full Medicaid coverage:
Your state will pay your Medicare Part B (Medical Insurance) monthly premiums.
Depending on the level of Medicaid you qualify for, your state might pay for:
Your share of Medicare costs, like deductibles, coinsurance, and copayments.
Part A (Hospital Insurance) premiums, if you have to pay a premium for that coverage.
You'll automatically get Extra Help with your drug costs. Learn more about Extra Help.
Medicaid may pay for other drugs and services that Medicare doesn't cover.
If you're dually eligible, you’ll automatically be enrolled in a Medicare drug plan that will cover your drug costs instead of Medicaid. With drug coverage, you'll never pay 100% of the cost for drugs covered by Medicare."
Being eligible for both Medicare and Medicaid is called Medicare dual eligible.
This goes beyond just choosing a particular Medicare plan.
Beneficiaries Dually Eligible for Medicare & Medicaid
Medicare providers can’t bill QMB [Qualified Medicare Beneficiary] beneficiaries for Medicare cost-sharing. This includes Medicare deductibles, coinsurance, and copayments. In some cases, a beneficiary may owe a small Medicaid copayment. Medicare and Medicaid payments (if any) (and any applicable Medicaid QMB copayment) are considered payment in full. You’re subject to sanctions if you bill a QMB above the total Medicare and Medicaid payments (even when Medicaid pays nothing)
Do You Need Medicare Supplement Insurance if You Qualify for Medicare and Medicaid?
The short answer is no. If you have dual eligibility for Medicare and full Medicaid coverage, most of your health costs are likely covered.3 As a result, having a Medicare Supplement Insurance plan wouldn’t necessarily be beneficial to you, in fact, an insurance company is not allowed to issue a Medicare Supplement insurance policy to a Medicare beneficiary who receives full Medicaid health coverage! The purpose of Medicare Supplement Insurance is to cover the cost left by deductibles and coinsurance in Original Medicare, but as full Medicaid coverage should cover the majority of those costs, a Medicare Supplement Insurance policy isn’t necessary
"If you have Medicare and qualify for full Medicaid coverage:
Your state will pay your Medicare Part B (Medical Insurance) monthly premiums.
Depending on the level of Medicaid you qualify for, your state might pay for:
Your share of Medicare costs, like deductibles, coinsurance, and copayments.
Part A (Hospital Insurance) premiums, if you have to pay a premium for that coverage.
You'll automatically get Extra Help with your drug costs. Learn more about Extra Help.
Medicaid may pay for other drugs and services that Medicare doesn't cover.
If you're dually eligible, you’ll automatically be enrolled in a Medicare drug plan that will cover your drug costs instead of Medicaid. With drug coverage, you'll never pay 100% of the cost for drugs covered by Medicare."
This is all very good and very important information -
I appreciate you sharing. Thank you so much.
As I'll be applying for my mom's coverage in like a week, I don't think I should risk forgoing the selection of her Medicare supplement considering her Medicaid is still pending. I say this because we've already been waiting about a year and a half and I am not convinced it won't take over another year and a half or more to get. I am open to hearing thoughts and opinions on this though.
Disagree with your statement on plan g. I have read many times some insurers are to be avoided due to "closing the books" and in a few years and facing large price increases down the road. Mutual of Omaha is one that has been know to do this IIRC.
You are correct.
Quote:
Originally Posted by southkakkatlantan
What does this whole "closing the books" thing mean..?
Quote:
Originally Posted by southkakkatlantan
I will have to look into this further as I am not sure how to mitigate such a thing.
You mitigate this by purchasing a community-rated or issue-age policy.
Basic information on Medigap supplement pricing:
Quote:
Originally Posted by Ariadne22
You need to know as much as an agent when it comes to policy pricing in order not to be convinced to buy a lower priced attained-age policy which will subject you to excessive rate increases as you age. Therefore, you should familiarize yourself with pricing.
Medigaps have three price structures: community-rated, issue-age rated, attained-age rated.
In the long run, community-rated or issue-age do the best job of controlling prices as you age. In most states, only United Healthcare uses community rating, discounting rates for those under 86. Thereafter, whether age 86 or 106, rates do hot increase because of age. AARP UHC has a huge share (35%) of the Medigap market because of its community rated pricing.
Know that attained-age policies can appear attractive b/c of initial low premiums, but premiums for those policies can easily increase significantly in very short order, becoming unaffordable in your 80's. Insurers close attained-age risk pools frequently, locking you into an older sicker risk pool group, whereas community-rated policies maintain open risk pools. With an attained-age policy, unless you live in a guaranteed issue state your health may preclude switching a less expensive plan. The only option available then is an Advantage plan.
You can get the same flexibility of a full Medigap with a high-deductible Medigap at half the price or less. Many here have the high-deductible plan. Medicare pays its 80%, you pay 20% until you reach the deductible, currently $2,700, after which Medicare pays 100%. Medicare reimbursements are very low, so your 20% share of routine services is small. You would need a major medical issue to reach the $2,700 deductible. Agents don't push those policies b/c the commission is very small. Attained-age pricing is acceptable in an HD plan because the deductible largely mitigates insurer risk keeping rate increases very low and often nonexistent. I had an HD plan whose rate went down. I currently have an HD plan as do many on this forum.
Otherwise, unless in a guaranteed issue state, do not purchase a full Medigap w/attained age pricing. At that point, either choose AARP UHC - or explore issue-age plans which may be higher priced at first but are subject only to increases in medical inflation, not age. AARP does institute age and inflation increases to age 86 - but the community risk pool keeps these increases manageable.
Regular Plan N if you do not require care from nonparticipating providers (excess fee coverage) can also provide significant cost savings primarily b/c of the small doctor copay (not to exceed $20) - both through AARP UHC or issue-age through another carrier. Those here with Plan N have found Plan N covers their needs very well, with very small out-of-pockets ($20 doctor visit; $50 ER). Most doctors are participating providers so the lack of excess coverage isn't an issue.
When we contact the separate underwriter for Plan G, is that something that can be done the same day as applying for the above Parts A/B/D? Or do we have to wait for confirmation of actual enrollment in Original Medicare first? I'm trying to understand if the Supplemental enrollment period starts at the same exact time essentially (meaning can I apply for Plan G for her the same day I apply for parts A/B [and D])...or not...
The supplement carrier will need your mother's Medicare number. Medicare should be able to provide that within one-two months of application. You have a guaranteed issue right to purchase a Medigap within six months of enrolling in Medicare Part B without Medical underwriting.
As I'll be applying for my mom's coverage in like a week, I don't think I should risk forgoing the selection of her Medicare supplement considering her Medicaid is still pending. I say this because we've already been waiting about a year and a half and I am not convinced it won't take over another year and a half or more to get. I am open to hearing thoughts and opinions on this though.
This is wise thinking. She will not be fully covered until she either has a supplement or is approved for Medicaid. She can always drop the supplement when she is approved for Medicaid.
Last edited by Ariadne22; 08-20-2023 at 02:27 PM..
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