Garrett Ball

What To Do When Your Medicare Advantage Plan Drops You?

October 4, 2024 By Garrett Ball Leave a Comment

As we are approaching the start of the Annual Election Period (AEP), many people are getting letters in the mail from their Medicare Advantage plans containing coverage details for the following calendar year. Big changes are coming on some of the plans. However, others are getting a letter that can be even more ominous – a “Non-Renewal Action Notice”. This notice is required by Medicare when your Advantage plan is leaving the program altogether, not renewing their plans in your area, or making some other change that will end your coverage under that plan.

While this can be unsettling to some, there are protections in place, and you do still have options. Read on to learn more about what to do when your Medicare Advantage drops you.

What Type of Plan Can You Get When Your Medicare Advantage Non-Renews?

When your Medicare Advantage plan drops you, you have two options for coverage moving forward. We’ve detailed both of those options below:

A New Medicare Advantage Plan: One option that you have when your Medicare Advantage plan non-renews is to choose a new Medicare Advantage plan that IS going to be offered in your county for the following calendar year. You can do this during the annual election period (October 15-December 7) and it would take effect on January 1 of the following year. The transition would be seamless in that the current plan will cover you through the end of the calendar year, and the new plan would start on 1/1.

It is very important, when considering/comparing Advantage plans, that you do your due diligence to make sure that the plan you are choosing is accepted by your doctors, covers your medications and just altogether meets your medical coverage needs. There are many variables to consider when comparing this type of plan.

Return to “Original” Medicare with a Medigap Plan: The 2nd option that you have when your Medicare Advantage plan non-renews is to return to “original” Medicare (Part A – hospital coverage; Part B – doctor/outpatient coverage) and add a Medigap plan, sometimes called a Medicare Supplement. Medicare gives you a mandated “guaranteed issue” right into certain Medigap plans, when your Medicare Advantage drops you through no fault of your own. So, many Medicare beneficiaries take the opportunity, when dropped by their Advantage plan, to get the comprehensive Medigap coverage that they may have not otherwise qualified for.

Normally, to switch from an Advantage plan to a Medigap plan, you would have to go through medical underwriting and get approved. However, this is one of the few instances that would allow you to make this change with no medical underwriting or restrictions. Medigap plans pay the 20% that Medicare does not cover, and the most comprehensive Medigap plans (Plan F and Plan G) essentially pay all of your medical costs with no co-pays or out of pocket (with the exception of the Medicare Part B deductible of $240/year on the Plan G). Moreover, the Medigap plans do not ever non-renew and don’t change from year to year. They also do not have networks so you can go anywhere in the country that accepts Medicare.

How Do You Get Another Plan After Your Medicare Advantage Plan Drops You?

So, if your Medicare Advantage drops you for 2025, you have options to get another plan. Here are a few tips:

You should save all documentation that comes to you via mail regarding your plan’s changes, as you may need it to prove your eligibility for another plan.
Make sure you read any documentation carefully and observe all deadlines and requirements.
When choosing a new Advantage plan, make sure that the Advantage plan is accepted by your doctors/hospital. Also, make sure that your medications are covered under it and review any restrictions on coverage.
If choosing a Medigap plan, the plans are standardized (same coverage with every company) so you should compare the rates and pick the one with the best rates and ratings. A Medigap broker can provide you with a list of all the options.

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65Medicare.org is a leading, independent Medicare insurance agency for people turning 65 and going on Medicare. If you have any questions about this information, you can contact us online or call us at 877.506.3378.

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What Happened to CSI Life Medigap and Central States Medigap?

May 24, 2024 By Garrett Ball Leave a Comment

CSI Life Medigap and Central States Indemnity, and Central States Health and Life Company of Omaha were all companies owned by Berkshire Hathaway that played a fairly prominent role in the Medigap market for a few years. However, the Medigap market is in a constant state of flux. There are new companies that enter the market from time to time, and of course, there are companies that exit the market. As of 12/31/2022, all three companies had pulled out of selling Medigap policies.

What Happens to Existing CSI and Central States Policyholders?

With Medigap plans, any time your company stops selling new plans, you are still “grandfathered in” to your current plan. So that is the case for existing CSI Life Medigap and Central States Medigap policyholders. As long as the company has not completely gone out of business due to inability to pay claims, then your policy will continue to be serviced and you can keep the policy.

You do have the option to change plans if you’d like to do so. You would, however, be subject to the normal underwriting guidelines applicable in your state. This just means that you would have to answer some basic medical questions to be eligible to change. There are some states that have annual open enrollment rules, though, which would allow you to change without being subject to medical underwriting (What is the Medigap Birthday Rule and Which States Have It?).

Should You Change Plans if You Have a CSI Life or Central States Medigap Plan?

For existing CSI Life and Central States Medigap policyholders, you have the option of either keeping your existing policy or changing companies, if eligible, to a different insurer offering the same Medigap policy. All Medigap policies are standardized, and in most states, the plans go by the standard Medigap coverage chart. This makes it easy to compare plans “apples to apples” and switch to a “like” plan without sacrificing coverage if there is a better premium available elsewhere.

When a company stops offering plans, existing policyholders are in a closed “block”. This means that no new, often younger, policyholders are being added, and this can lead to more frequent and/or larger rate increases in the future (How Much Do Medigap Premiums Increase Each Year?).

So, it is usually prudent to compare your Medigap options and at least consider changing your plan if your Medigap company stops offering plans and if you are eligible to do so. You can get a list of Medigap options here.

Why Did the Central States Companies Stop Selling Medigap?

Companies entering and existing the Medigap market is not an unusual occurrence. Typically, when they stop offering plans, no real reason is given. It could because they did not find this line of business as profitable as projected or that they intended to focus more on other lines of insurance or segments of their business. In the case of CSI Life and Central States, their official release did not give specific reasons. They did announce another affiliate, Central States Health and Life Insurance of Omaha, but that affiliate company also pulled out of Medigap a couple of years later.

Will This Happen with Other Companies that Sell Medigap?

The short answer is “yes”. It has happened, is happening and will likely to continue to happen, as new companies enter and exit the Medigap market all the time. There is no way to know for certain if a specific Medigap company will exit the market at any given time. The best predictor of future stability is past stability, but even that is not always certain. As always with Medigap, it is a good idea to compare current prices, company ratings and past rate stability when comparing and choosing a Medigap policy.

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ACE Medigap Plan – Is It a Good Option for You?

February 21, 2024 By Garrett Ball Leave a Comment

ACE Medigap plans are one of the new options to pop up on the Medigap insurance scene. If you are researching Medigap plans, you will see some unfamiliar names show up in your research, and ACE is one of those names that may not be as familiar to most people. But, does that mean it should not be considered a viable option? Is it worth your consideration? Let’s take a look.

ACE Medigap Coverage – What Do They Cover?

First and foremost, ACE Medigap plans are the same as other Federally-standardized Medigap plans. They go by the regular Medigap coverage chart. This means that there is no difference in coverage with ACE plans vs. other plans from other companies. In other words, an ACE Plan G would be the exact same as a Plan G from any other company.

Typically, in most states, ACE offers both the Plan G and the Plan N (Choosing between Plan G and Plan N). Plan G is the most common and comprehensive Medigap plan, paying everything that Medicare A & B do not cover except for the Medicare Part B deductible (currently $240/year). Plan N is also a popular option, however, because it gives a lower premium in exchange for some minimal co-pays and out-of-pocket costs.

In some states, ACE Medigap does also offer the high deductible Plan G as an option. This plan is different than the regular/standard Plan G. It is a high deductible alternative with a $2800 that must be met before the plan pays anything.

Who Is the ACE Medigap Company?

ACE as they are commonly called has the full name of ACE Property and Casualty Insurance Company. They are a Chubb company. Chubb operates in 54 countries and is one of the largest insurance companies in the United States. Medigap plans are one small part of what they do – they are also active in commercial insurance, property and casualty, life insurance, reinsurance and other types of insurance.

They have more than $225 billion in assets and had $57.5 billion in premium written in 2023. ACE inherits Chubb’s solid ratings from AM Best (A++) and Standard and Poor’s (AA).

Medigap plans are a relatively new offering through ACE and Chubb. They started offering them in 2021 in most states. However, they are well-positioned in the markets where they operate, having a low premium and solid rating.

What Makes ACE Medigap Unique?

As previously mentioned, ACE Medigap plans are the same as the Federally-standardized plans offered through other insurers. However, there are few aspects of the ACE plans that are unique:

Competitive pricing in most markets – ACE plans are one of the lowest priced offerings in many areas of the country where they are available.
Household discount just for being married or having a household resident – In most states, ACE Medigap plans offer a 7% discount just for being married or having a household resident. In other words, it is not required that two people in the same household have a plan with them in order to qualify for this discount (state-specific laws may vary so it is always advisable to check with your broker for your exact rate). Should You Use a Medigap Broker?
No waiting period for pre-existing conditions – There are no waiting periods for pre-existing conditions under ACE plans. This applies whether you are applying during your initial open enrollment period or if you already have a Medigap plan and are just looking to reduce your costs.
Great financial strength ratings – As outlined above, ACE has very high AM Best ratings (A++), one of the highest of any Medigap plan available. This gives assurance that their plans are backed by a solid company with a solid financial backing.

Should You Consider ACE Medigap Plans?

If you are in the market for Medigap, whether new to Medicare or just looking to get a better rate, ACE Medigap plans are certainly a viable option to consider. It is always prudent to check the rates for all plans in your area before selecting a Medigap plan. You can get a list of the Medigap plans, with prices and company ratings, delivered by email here: Medigap quotes by email.

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Choosing Between Medigap Plan G and Plan N

February 21, 2024 By Garrett Ball 1 Comment

Medigap Plan G vs. Medigap Plan N

There are several factors which should be considered when choosing between a Medigap Plan G or Plan N. It basically comes down to making an informed decision based upon your personal situation, finances and lifestyle. Below I will explain some similarities and differences between these two plans, so that you will be better informed to make your choice.

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What Do Plan G and Plan N Have in Common

There are many similarities between Plan G and Plan N. In fact, they are more alike than they are different (which may be why you are considering these two plans). Many people consider them to be the two best Medigap plans. Here is a list of the primary similarities:

Medicare Part A deductible IS covered
Medicare Part B deductible of $240 (2024) per year is NOT covered
Hospitalization, skilled nursing facility care, blood, hospice care, foreign travel ARE covered
An application must go through medical underwriting unless you are enrolling during open enrollment or have a guaranteed issue situation

What are the Differences Between Plan G and Plan N

Although there are many similarities, there are also a few significant differences between Plan G and Plan N:

Plan G has:

No Part B doctor/outpatient copays
No emergency room copay
No Part B excess charges of 15% (the difference in cost between the Medicare-approved payment amount for services and the amount your health care provider charges). They cannot charge more than 15% above the assigned rate and still be reimbursed by Medicare.

Plan N has:

Part B doctor/outpatient copay of up to $20 per office visit
Part B copayment of up to $50 per each emergency room visit. Note: If you are admitted to the hospital, then this copayment is waived.
Part B Excess charges of up to 15% (if the provider charges Part B excess charges and does not accept Medicare “assignment”)

Medigap Plan G Premiums vs. Medigap Plan N Premiums

In most states, Plan G generally runs about $20-25 more per month than Plan N (More about Plan G prices). Depending upon the condition of your health, it might be a better idea to sign up for Plan N, even though there is a copay and may be 15% in excess charges associated with it.

Example 1: Tom is a 72-year old man, who lives a healthy lifestyle. He does not take any medications, except for vitamins and herbs, and works out almost daily at the YMCA. The only time he sees a doctor is when he goes for his annual physical. In his case, it would be more cost effective for Tom to choose Plan N over Plan G. Why? Because even though he will have had to pay a copay and perhaps more if his doctor doesn’t accept Medicare assignment, it will amount to less than if he paid that higher premium for Plan G.

Example 2: Linda is 69-year old woman, who lives a sedentary life. She’s a smoker, slightly overweight, and has high blood pressure. She only works out about 1 to 2 times per week. She’s on medication for her blood pressure, and takes an antidepressant daily as well. She visits her doctor at least four times a year, if not more. In Linda’s situation, it would be more beneficial for her to enroll in a Plan G. Why? Because by the time she adds up all her doctor visits, possibly incurring lab copays and 15% in excess charges, she will have paid out more annually, even though her monthly premium is lower.

Other Considerations Between Plan G and Plan N

When choosing between Plan G and Plan N, another consideration that you must make is about the future. The initial open enrollment selection of a Medigap plan is not necessarily a “final” choice. You can always change plans or companies in the future. However, and this is an important and commonly misunderstood point, you have to answer medical questions and be “approved” if you change plans later.

So, what this means is that, even if your current health dictates that you enroll in a Plan N (or possibly even in an Advantage plan), you should think about that decision on a long-term basis. What you enroll in initially, if you have or develop health problems, may be what you keep out of necessity.

Choosing the right plan to meet your needs may either be an easy decision or more complicated than you imagined it to be. The bottom line is that it all depends on your current personal health profile and what you anticipate your health status to look like in the near and distant future. You may have an elective surgery coming up that might increase the amount of times you will need to see a health care provider. Your finances may also be impacted. So, these are all things that should be taken into consideration in your final decision between Plan G and Plan N.

Bottom-line, there is no right or wrong answer to choosing between Plan G and Plan N. The right decision depends on your unique situation. What we do is provide the list of options – companies, rates, and ratings – for both Plan G and Plan N so you can make an informed choice. Get a list of Plan G and Plan N quotes, delivered by email, here.

medigap coverage chart

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High Deductible Plan G – Considerations and Cautions

October 20, 2023 By Garrett Ball 7 Comments

The Medigap plan known as high deductible G, or HDG, is a relatively new option for Medicare beneficiaries. It is only available to those who turned 65 or went on Medicare on or after 1/1/2020. For people turning 65 in 2020 or after, it is a new option and one that some companies are aggressively marketing. There are some definite plusses about the high deductible Plan G; however, there are also some things you should be aware of if considering this plan.

How Does High Deductible Plan G Work?

High Deductible Plan G works very similarly to other Medigap plans. Like other Medigap options, the plan works with regular Medicare Part A and B and fills in the gaps in Medicare. There are no networks on HDG or any other Medigap plans – you can use the plan at any doctor or hospital that accepts Medicare.

High deductible Plan G has a deductible of $2800 (for 2024 – this deductible changes each year). What this means is that, when you use medical services, Medicare will pay their 80%, and you will be responsible for the other 20% until you meet the $2800 deductible. In other words, you will pay 20% of Medicare-approved charges up to $2800 per calendar year.

After you have paid out $2800 in a calendar year, your HDG plan will act exactly like a “regular” Plan G. The plan will pay what Medicare does not pay (the 20%). HDG, like standard Plan G, does not cover the Medicare Part B deductible ($240/year in 2024); however, that deductible goes towards the larger HDG deductible so you would have already met it by the time you reach the $2800 HDG deductible.

The deductible for HDG resets each calendar year, so you would have to start over with meeting the deductible each year. High deductible Plan G, just like any other Medigap plan, can never be cancelled for reasons other than non-payment of premium. The plan is ‘guaranteed renewable’ and does not have to be renewed annually, nor does it have any sort of annual renewal period.

What are the Advantages of High Deductible Plan G?

The appealing thing about the HDG is the premium. It is considerably lower in premium than the traditional Medigap plans – usually about half of Plan N rates and up to $100/mo lower than Plan G rates (rates vary considerably depending on the state and your age). That is the most significant advantage of HDG – it can save you a good bit of money off of the premiums on other Medigap options.

Additionally, it is easy to use, just as any Medigap plan. You don’t have to file claims or worry about whether claims will be processed/paid. The Medicare “crossover” ensures that everything will work seamlessly, once you have met the deductible.

Medigap rates vary considerably from one area to the next (Why Do Medigap Premiums Vary?), and the premiums are determined by other factors like gender and age. But to give you a general idea, we’ve included current (as of October 2023) High Deductible Plan G rates for the lowest premium company in a few different areas (rates are for a 65-year-old female):

Bradenton, FL = $67.77/mo
San Antonio, TX = $31.82/mo
Charlotte, NC = $30.60/mo
San Francisco, CA = $38.12/mo
Denver, CO =$46.61/mo
Lansing, MI = $34.15/mo
Richmond, VA = $35.82/mo
Harrisburg, PA = $34.47/mo
Topeka, KS = $29.39/mo

*Note: Rates are subject to change at any time. They do not go by the calendar year and can change from month to month. There’s no “enrollment period” for Medigap plans other than the one when you first start on Medicare. For current Medigap rates specific to your area and situation, get Medigap rates by email or call us at 877.506.3378.

What Are the Downsides of High Deductible Plan G?

While High Deductible Plan G is very appealing in terms of monthly premium, there are some factors to be aware of if you are considering this plan. First and foremost, the plan does not pay anything until you have met the initial HDG deductible. You are responsible for any and all out of pocket costs that aren’t covered by Medicare (the 20%).

Second, and maybe most importantly, you do always have to ‘qualify medically’ to switch from one Medigap plan to another after your initial open enrollment period, which is when you first turn 65 or start on Medicare (NOTE: There are a few states that have unique annual open enrollment periods). So, while HDG may be a good fit for someone who has few health problems or doctor visits when they turn 65, it is important to think about your initial Medigap selection on a long-term basis since there is no guarantee that you can change plans in the future. Weekly, we talk to someone who is trying to ‘upgrade’ their Medicare coverage from an HDF or Plan N or Advantage plan but is unable to do so due to some health condition or ongoing medical treatment.

Lastly, you should be aware that the deductible on the high deductible Plan G changes every year. In the last five years, it has gone from $2200 to $2800, a 27% increase in that time period. It is not likely that this trend of the increasing deductible will lessen over time.

This is not to say that High Deductible Plan G is not a good option in some situations – it is. However, it is crucial to think through and be aware of the future implications of selecting HDG and be okay with it on a long-term basis.

How Do I Enroll in a HDG?

If you do decide that a High Deductible Plan G is the right plan for you, you should definitely compare rates from different insurers rather than jumping at the first offer on this plan. There are fewer companies that offer this plan than some of other plans. Some states only have 3-4 companies that do this plan, as it historically has not been a plan with a large market share (between 3-4% historically by most reports). That said, you should compare multiple options since rates can vary considerably on Medigap plans. If you want a list of plans and rates by email, you can contact us through our website or by phone.

Once you pick a HDG, you can enroll online or by phone through us or through another broker like us (Why Use a Broker).

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