I have been keeping track of how the cost of Medicare deductibles, coinsurance and copays have increase since 2007. It is significant! The current administration has been very aggressive at increasing how much seniors have to pay for Medicare.
The way this cost increase is passed along for those using Original Medicare with Medicare Supplement plans (aka medigaps) is the supplement insurance plan premiums increase. It is way too risky to not have a medigap if you use Original Medicare. People without medigaps are often forced into bankruptcy because Original Medicare does not have an annual cost cap.
The way Medicare Advantage plans pass along the cost is by increasing the cost of things such as premiums, adding deductibles or raising the annual out of pocket maximum cost to the government limit ($6,700). The other way is to pass along cost increases by cutting services by doing such things as shrinking provider networks, the choices for DME devices decrease or zero copay hospital days coverage decrease. Then there is always their favorite ways to do it. They increase the denial of claims because they know sick people are often too overwhelmed to appeal a denial and just pay it or they push physical therapy facilities to discharge patients before they are fully recovered.
No matter how you get Medicare coverage (Original or Medicare Advantage), the policy holder always has to pay the part B premiums unless they are really low income ($18,000/year with no cash assets). There is no insurance to cover the part B cost. The part B fee is paid to the government and entitles you to receive insurance coverage for provider services such as office visits or lab tests. It's your choice how you get that insurance coverage. If you stay with Original/Tradition Medicare it becomes an insurance premium for the government insurance pool. If you enroll in a Medicare Advantage plan, the government gives your part B payment to the insurance company issuing your policy.
A picture is worth a whole lot of words so I created the following analysis. To access this file, you may have to download it:
https://drive.google.com/file/d/1pAF75fHqCqLKcFXo0PxRI52NZJA_8PBk/view?usp=sharing
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New topic, Plato: What's up with the Humana Connect Medigap F plan? VIA Benefits called me Friday about the product; they say it's c. $50 less than my current Humana Medigap F. I just tried the VIA Benefits web site and I'm getting "We're sorry but an error has occurred", so I can't get information there yet.
ReplyDeleteI don't know what that that is. Most medigap plans are defined by the federal government. I do know Humana is offering some "fringe benefits" with their medigaps like silver sneakers and discounts on dental insurance but they must include the standard elements of the medigap they are selling. Since I do not know what state you live in, I suggest you call your state health insurance assistance program (find phone number at www.shiptacenter.org) and ask the SHIP if they know about it. It's good to be wary of making changes because, depending on your state, it can mean you cannot change back.
ReplyDeleteHere is a brochure from Medicare that describes Medigap policies. It is possible the plan they are pushing is a "medigap select" plan because it is offered in some states. It restricts the doctors and hospitals you can use (see page 20): https://www.medicare.gov/Pubs/pdf/02110-medicare-medigap-guide.pdf
ReplyDeleteThanks for you good advice, Plato. Website is still flaky this AM, but VIA is aware of it. I did talk to a Benefits Advisor and Humana Connect is not a SELECT product and it is guaranteed issue all year around; here in California I do have a a window around my birthday to change providers anyway. I appreciate your thoughts, Susan
DeleteI do know some about California. Although you have the right to change your medigap insurance during your birth month (which is CA law) and at other times if the insurance company will do it, that is not "guaranteed issue". Guaranteed issue is federal law and means the insurance company cannot do underwriting for pre-existing conditions at specific enrollment times such as when you first are Medicare eligible. Also, in CA the medigaps are generally not community rated price wise which means they adjust the price of a policy based on your age. Talk to the CA SHIP before you make any changes. Reminder - Via Benefits is an insurance broker and as such makes commissions on sales.
ReplyDeleteCorrection on my last comment. California does provide "guaranteed issue" during the birth month of existing Medicare supplement owners to be able to switch to a different type of medigap.
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