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Medicare Late Enrollment Penalties: The Importance of Enrolling on Time

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Joining Medicare Part B is not required, but enrolling at the wrong time can be very costly in the long run due to Medicare late enrollment penalties.  If you don’t enroll on time, Medicare late enrollment penalties will be assessed (see below) and it is a mistake you will be paying for, for the entire time you have Medicare Part B or Part D prescription drug coverage.  I know that signing up for Medicare can be overwhelming and confusing, but there are certain rules that must be followed regarding the timing of your enrollment.  Once you understand how the Medicare late enrollment penalties work, you will have a better idea of how to stay clear of them.

 Who Gets Part A and Part B Automatically?medicare late enrollment penalties

  • If you are already receiving Social Security benefits (starting the first day of the month you reach age 65; unless your birthday is on the 1st of the month, in which case they will start on the 1st of the prior month;
  • If you are already getting Railroad Retirement Board (RRB) benefits;
  • If you have ALS (Amyotrophic Lateral Sclerosis, Lou Gehrig’s disease)(starting the month your Social Security benefits begin);
  • If you are disabled and under 65 or receive certain disability benefits from the RRB. These benefits must have been received for a period of at least 24 months.  You will get your Medicare card three months prior to your 25th month of getting disability benefits;

Your red, white and blue Medicare card will indicate whether you have Part A (hospital insurance) or Part B (medical insurance), and the effective date.  You will receive it three months prior to your 65th birthday or on the 25th month of disability benefits (see above).  If you want to keep Part B, you do not have to do anything.  However, if you choose to waive your right to Part B, you may have to wait to enroll at a later date, and in addition, pay a late penalty for the duration of time you have

Part B (see below).

Who needs to sign up for Part A and Part B?

  • If you are not presently collecting Social Security benefits or Railroad Retirement Board benefits. –  You will need to sign up for Medicare three months prior to your 65th birthday.
  • If you have end-stage renal disease (ESRD)
    • Contact Social Security for more information, or online at Medicare.gov/publications and search for the booklet entitled, “Medicare Coverage of Kidney Dialysis & Kidney Transplant Services.”

Note:  If you live in Puerto Rico, you are not automatically enrolled in Part B.  You will have to complete form CMS-40B to enroll.  Contact Social Security or RRB for more information.

When can I enroll in Part A and Part B?turning 65 paperwork

  • Initial Enrollment Period – during the 7-month period that begins 3 months prior to the month you turn 65, including the month you turn 65, and ending 3 months after the month in which you turn 65; If your birthday falls on the 1st day of the month, your coverage will begin on the 1st day of the prior month.
  • Special Enrollment Period – if you are still working and covered under a group plan (your own, your spouse’s or a family member’s)
    • Anytime you are still covered by a group health plan
    • During the 8-month period starting the month following the end of employment or coverage, whichever occurs first

Note:  If you are disabled, your employer must have 100 or more employees to get a Special Enrollment Period.

               Also, if you are on Cobra, there is no Special Enrollment Period when it ends.

  • General Enrollment Period: If you did not enroll during your Initial Enrollment Period, and you do not qualify for a Special Enrollment Period, you can sign up from January 1 – March 31 each year.  In that case, your coverage will begin on July 1 of that year.  Please see below for late enrollment penalties.

What are the Medicare late enrollment penalties for not getting Medicare Part B?

It is very important that you enroll in Medicare Part B when you first become eligible, otherwise you will incur a penalty.  The penalty is 10% for each 12-month period that you didn’t sign up for Part B, but could have done so (excluding a Special Enrollment Period).

Example:

Mr. Banks Initial Enrollment Period ended October 25, 2014.  He waited to enroll in Part B until April 2017, during the General Enrollment Period.  In this case, Mr. Banks waited a total of 30 months to sign up.  This included two full 12-month periods).

What are the Medicare late enrollment penalties for not getting Medicare Part D?

A late enrollment penalty is incurred any time there is a lapse of 63 or more consecutive days when you do not have Part D, or other creditable drug coverage.  Creditable drug coverage can include drug coverage from your current or former employer or union, TRICARE, Indian Health Service, the Dept. of Veterans Affairs, or health coverage.  Your plan is obligated to tell you each year whether your drug coverage is creditable.

Note:  You will not have to pay a late enrollment penalty if you get Extra Help.

This late penalty is 1% of the “national base beneficiary premium” ($34.10 in 2016), then multiplying that by the number of months that you were eligible but did not sign up for Medicare Part D, and you were without other creditable prescription drug coverage.  This amount, which is rounded to the nearest $.10, is added to your monthly premium.

Note:  This amount may increase each year, since it is based upon the “national base beneficiary premium,” which may increase yearly.Part D Plans

Example:

Mrs. Johnson was eligible to enroll in Medicare Part D by June 2013.  She does not have prescription drug coverage from another source.  She enrolled in a Medicare prescription drug plan during the Open Enrollment Period in 2015.  Her coverage started on January 1, 2016.  Since Mrs. Johnson did not have creditable prescription drug coverage from July 2013 to December 2015, her penalty in 2016 is 30% (30 months x 1%) of $34.10 (the national base beneficiary premium for 2016), which is $10.23.  As mentioned, the monthly penalty is rounded to the nearest $.10, which will result in a penalty of $10.20.  This amount will be added to her plan’s monthly premium as long as she has Part D, and this amount may increase each year.

Can Medicare late enrollment penalties be disputed if I don’t agree?

Yes.  You may request reconsideration or a review of your Medicare late enrollment penalties.  To do this, you must complete a reconsideration request (your drug plan will send it to you) by the date indicated in the letter.  You will then be able to provide information, i.e. creditable prescription drug coverage, that will support your case.

As you can see, there may be monetary consequences to not signing up during the appropriate enrollment periods.  In addition, these penalties are for the entire duration that you have Medicare Part B or Part D, not only a one-time charge.  So, it is very important that you know when you are eligible and how much time you have to sign up in your particular situation.  For further information about enrollment periods and late penalties, call 1-800-MEDICARE (1-800-633-4227).  TTY users can call 1-877-486-2048.

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65Medicare.org is a leading, independent Medicare insurance contact us blueagency for people turning 65 and going on Medicare. We have worked with 10,000+ Medicare-eligible individuals over the last 10+ years, assisting with understanding and comparing the plans. You can get a list of Medigap quotes in your area. Or, if you have any questions about this information, you can contact us online or call us at 877.506.3378.

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Does Medicare Cover Preventive Care?

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Preventive care to avoid illness can be achieved in numerous ways, i.e. exercising, living a healthy lifestyle, not smoking, eating right and maintaining a healthy weight.  However, another important way of keeping illness at bay, is by having preventive screenings for diseases.  Medicare offers a multitude of screenings to help discover disease and health problems early.  It is in the early stages of a disease that treatment works best.  Some of these screening services include wellness exams, vaccinations, laboratory tests and screenings for cancer and other diseases (see below).  In addition, there are counseling programs to educate you on your health and programs for tracking your health.

HOW MUCH OF THE COST WILL BE COVERED BY MEDICARE?preventive care covered by Medicare

If you are enrolled in Medicare Part B, these preventive care services will be covered.  However, what you pay out of pocket for them varies depending on if you have Original Medicare or a Medigap plan or Medicare Advantage plan.  You will pay more if you see health care providers who do not accept assignment.  However, for some preventive screenings, you will have to pay a deductible, coinsurance or both.  Assignment is an agreement by your doctor, provider or supplier to be paid by Medicare, to accept the amount that Medicare deems reasonable for the service, and not to bill you for any additional amounts other than the Medicare deductible and coinsurance.

Once you enroll in Medicare Part B (Medical Insurance), you are entitled to a “Welcome to Medicare” preventive visit.  It is a one-time preventive care measure, which has to be performed within the first 12 months that you are enrolled.  Not only is it an excellent way to catch up on all your important screenings and vaccinations, but at the same time you can discuss with your doctor, your family history and how to stay in good health.

After you have had Medicare Part B longer than a year, you will be eligible for a yearly “Wellness” visit.  There is no cost to you if your doctor accepts assignment.

At this visit, you will be able to:prevent illness with Medicare-covered screenings

  • Review your family history, discuss your medical history,
  • Review and update your current providers and medications
  • Have your weight, height, blood pressure and other routine measurements taken
  • Test for any cognitive impairment
  • Receive a personalized assessment for your health
  • Risk factors and treatment options
  • A preventive care screening checklist for which tests you can have and when they should be performed

Please note that you do not need to have a “Welcome to Medicare” visit prior to getting your yearly “Wellness” visit.

Preventive care & screening services

As mentioned above, Medicare covers several screening and preventive care exams, some of which are outlined below:

  • Abdominal aortic aneurysm screening:

This is a preventive care ultrasound for people at risk. A referral from a doctor or other practitioner is required.  You are at risk if you have a family history of abdominal aortic aneurysms, or you are a male 65-75 and you have smoked at least 100 cigarettes in the past.  This is a one-time screening.

  • Bone mass measurement (bone density):

A bone density test determines if you have osteoporosis, which would cause your bones to become more fragile and more likely to break.  It is covered once every 24 months (more often if medically necessary).

  • Breast cancer screening (mammograms):

If you are age 40 or older, Medicare covers screening mammograms once every 12 months to check for breast cancer.  In addition, Medicare also covers a baseline mammogram for women 35-39. Note: If medically necessary, diagnostic mammograms are covered under Part B, more than once every 12 months.  However, you will have to pay 20% of the Medicare-approved amount including the Part B deductible.

  • Cardiovascular disease screenings:

Once every 5 years, Medicare covers the following preventive care screenings to detect conditions that may result in heart attacks or strokes – cholesterol, lipid, lipoprotein, and triglyceride levels.

  • Cervical and vaginal cancer screenings:

Pap tests and pelvic exams are covered by Medicare Part B, once every 24 months.  This also includes a clinical breast exam.  If you are at high risk, or you are of child-bearing age and had an abnormal pap test in the past 3 years, then Medicare covers these screenings once every 12 months.

  • Colorectal cancer screenings:

One or more of the following preventive care tests may be covered to detect precancerous growths or cancer early:

  • Multi-target stool DNA test (generally covered once every 3 years if you meet certain conditions)
  • Screening fecal occult blood test (covered once every 12 months if you are 50 or older)
  • Screening flexible sigmoidoscopy (generally covered once every 48 months if you are 50 or older or 120 months following a screening colonoscopy).
  • Screening colonoscopy (generally covered once every 10 years or high risk, every 24 months); or 48 months following a flexible sigmoidoscopy. There is no minimum age.  Note:  If a polyp or other tissue is removed during colonoscopy, you may have to pay 20% of the approved amount for the physician’s services, in addition to a copayment if in a hospital as an outpatient.
  • Screening barium enema (generally covered once every 48 months if you are 50 or older, or high risk every 24 months), if used instead of sigmoidoscopy or colonoscopy. As above, you may have to pay 20% of the approved amount for physician’s services and a copayment in an outpatient hospital setting
  • Prostate cancer screenings:

The PSA (Prostatic Specific Antigen) test and digital rectal exam are covered by Medicare once every 12 months for men over 50 years old (starting the day after your 50th birthday).  The PSA test is at no charge.  However, the digital rectal exam is covered up to 80%, and you pay 20% of the Medicare approved amount, plus Part B deductible.

Please contact Medicare for a complete list of the preventive screenings available to you.MyMedicare.gov

You can find personalized Medicare information online by registering at “MyMedicare.gov”.  There you will have access to your preventive care health information, 24/7, every day.  You will be able to monitor your preventive care services, and get a list of Medicare-covered tests and screenings that you are eligible for.  You can even print out an individualized “on-the-go” report for your next doctor’s appointment.  This report comprises the preventive services and other services available to you which detect and prevent illnesses from progression.

Another way of getting access to your health information is by utilizing Medicare’s “Blue Button.”  This feature enables you to download claim information for a period of 12-36 months for Parts A and B and 12 months of claim information for Part D.  This is a useful tool for gaining knowledge about your health care and help you make more informed decisions.

You can always call Medicare at 1-800-633-4227 and get information 24 hours/day including weekends.  TTY users call 1-88-486-2048.
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65Medicare.org is a leading, independent Medicare insurance contact us blueagency for people turning 65 and going on Medicare. We have worked with 10,000+ Medicare-eligible individuals over the last 10+ years, assisting with understanding and comparing the plans. You can get a list of Medigap quotes in your area. Or, 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 Is Silver Sneakers?

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WHAT IS SILVER SNEAKERS?Silver Sneakers Medicare

If you are about to turn 65, you might have heard about “SilverSneakers” and wondered what it is and how it works.  Well simply put, Silver Sneakers Medicare is a fitness program for seniors.  Let me elaborate on that.  The primary mission of the program is to help seniors reach a standard of living that applauds optimum health and wellness. It is aimed at getting the elder generation, including baby boomers moving about and feeling better about themselves.  It provides memberships at local fitness centers to qualifying Medicare recipients.  There are over 13,000 fitness locations across the country, offering access to all club amenities, i.e. indoor/outdoor pools, steam, sauna, whirlpools, weights, fitness classes for all levels (led by certified instructors). There are program counselors who serve as informational resources and personal trainers available to guide you during your workout.

Get quotes on Medigap plans that may include Silver Sneakers

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Who Is Eligible to Join SilverSneakers?

  • Anyone 65 and over who is on either a Medicare Advantage or Medicare Supplement Plan that includes the SilverSneakers benefit. You can check your eligibility by going online to https://tools.silversneakers.com/Eligibility, and you will find out whether you are eligible.
  • Plans vary depending upon which state your plan is located in. Some insurance companies include this benefit with all of their plans, and some do not.
  • The SilverSneakers.com website can provide you with a list of all of the participating companies and the plans that include Silver Sneakers Medicare program.

  How Does SilverSneakers Work?medicare plans

  • Upon the effective date of your plan, Silver Sneakers Medicare enrollment will be notified that you are enrolled, and you will automatically receive a membership card in the mail. With this card, you can go to any participating fitness facility, show your SilverSneakers card and sign up.  You will then receive a membership to that facility, along with access to all of the amenities that facility has to offer (see above).
  • Although you will already have a SilverSneakers membership card, you will be given a card from that specific facility to be scanned each time you come there.
  • You can go as often as you would like. There are no restrictions as to minimum or maximum visits.
  • Participate in all sorts of classes from low impact to high intensity. Try a yoga class, or how about a spin class?  Maybe Pilates?  If you are a swimmer, perhaps you want to try out a water aerobics class?  There are treadmills, ellipticals, bicycles, weights, exercise balls and many other ways you can partake in your membership.  It is all up to you!

 Where Are These Participating Locations?

  • On the SilverSneakers.com, there is an interactive map pinpointing all of the participating locations. All you have to do is put in the zip code of where you would like to work out, and you will find a list of the closest facilities.
  • You can even narrow this list down to amenities, classes and gender specific categories. Some fitness centers are larger than others and have more amenities.
  • If you want to break up your fitness routine, try going to different gyms. You will never be bored!

Can I Go To A Participating Facility If I’m Traveling Out Of State?

  • You can go to any participating facility at any time, whether in the city in which you live or if traveling outside of your usual geographic location. Just put in the zip code of where you want to work out, and a list of locations will be generated.
  • Some facilities will let you use your card from your home facility, no matter which location (i.e. YMCA). While most others will give you a card from their facility to use at their location exclusively, whether one time or multiple times.

In addition to the benefits outlines above, HealthwaysFIT.com is available to members online.  This resource enables you to monitor your fitness regime and track your progress, find healthy recipes, view exercise videos and much more.  There are seminars and special events centered around health, wellness and fitness.

Compare Medigap plans for your zip code – find out which plans have Silver Sneakers and get the best deal

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To summarize, the advantages of becoming a SilverSneakers member are numerous.  Not only can you improve your physical well-being by exercising, learning good nutrition and living a healthy lifestyle, but you can benefit socially as well.  SilverSneakers members become part of a network of other senior citizens and baby boomers with like-minded goals to improve their health and get fit.  You can find a new workout buddy to motivate and encourage you, or make a new friend to socialize with.  The community is composed of a diversity of people from all walks of life, professions and cultures.  It is an easy way to enjoy your workout and make new friendships at the same time!

If you have any questions about SilverSneakers, you can contact customer service by phone at 866-584-7389, Monday-Friday, 8 a.m. to 8 p.m. ET, or by email at support@silversneakers.com.

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65Medicare.org is a leading, independent Medicare insurance contact us blueagency for people turning 65 and going on Medicare. We have worked with 10,000+ Medicare-eligible individuals over the last 10+ years, assisting with understanding and comparing the plans. You can get a list of Medigap quotes in your area. Or, if you have any questions about this information, you can contact us online or call us at 877.506.3378.

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Does Medicare Cover Dental?

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If yomedicare dental plansu are turning 65 or going on Medicare for the first time, you will probably want to know the answer to the question: Does Medicare cover dental?

Most people are accustomed to having some coverage for dental in their individual or group insurance plan prior to going on Medicare. Although dental coverage is usually relatively limited, many people are surprised to learn that it is virtually non-existent when you go on traditional Medicare. However, there are a few options for Medicare dental plans, which we’ve outlined below.

Does Medicare Cover Dental at All?

The short answer to this is, in general, no, there is no Medicare dental coverage. Medicare does not cover any dental except in unique cases. Traditional Medicare (Part A and Part B) does not cover dental care, dental check-ups, dental supplies or dental procedures like fillings, crowns, extractions, dentures and other services. Outpatient services and procedures are generally covered under Medicare Part B; however, Part B does not cover any dental.

Medicare Part A (inpatient) will pay for some complicated dental surgeries or emergency procedures in limited scenarios. A few exceptions to Medicare’s non-coverage of dental are: extraction of teeth associated with preparation of the jaw for radiation or reconstruction of the jaw as a result of an accident.

So, if Medicare dental coverage is non-existent for all dental services and procedures, what are your options?

Ways to Get Dental Coverage with Medicaredoes medicare cover dental

If you are on Medicare and want to have dental coverage, you do still have some options, which are itemized and explained below:

  1. Stand-alone dental insurance: Medicare Dental Plans. There are a handful of companies offering Medicare dental plans for people on Medicare through stand-alone plans. These plans often “come with” vision and hearing coverage (routing vision/hearing are also not covered under traditional Medicare).Premiums for this type of coverage can vary widely, but generally speaking, are in the $20-40/month range. One crucial thing to look for when comparing this type of coverage is whether the plan has a network of acceptable dentists. Some plans do; some do not. Since these networks can change over time, for most people, it is preferable to be in a plan that gives you freedom to select whichever dentist you want. Another important thing to consider is whether there is a waiting period for services/procedures. Some plans have relatively extensive waiting periods, and you may not be able to avoid that, but it is definitely something you should be aware of before enrolling in a dental plan.

    Get Quotes on Medicare Dental Plans

    Medicare Dental Plan Coverage Information and Quotes

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  2. Medicare Advantage plan. Medicare Advantage plans are a privatized version of Medicare, in which a private insurance companies delivers your Medicare benefits. These plans can add “extras” like dental coverage, sometimes at an additional cost to you.In recent years, there has been a trend towards reducing the amount of dental coverage found in these plans. Now, many of the plans only cover very limited dental, such as 1-2 cleanings a year with nothing paid towards more comprehensive services. It is crucial to understand WHAT an Advantage plan covers for dental, not just whether it does/does not cover dental.

    Morever, it is typically not a good idea to choose an Advantage plan “just” to get dental insurance, as there are many other considerations with this type of plan from a medical perspective. If comparing Medicare with Medigap vs. Advantage plans, make sure you understand the vast differences in these types of coverage, including doctor availability, out-of-pocket costs, and insurability considerations in the future.

  3. Be a cash payer. A third and final option for dental care when you are on Medicare is to be a cash payer. This does not involve getting a Medicare dental plan at all.  This is not a coverage option, obviously, but still may result in some cost savings for you as you pursue dental services. Some dental practices give discounts to cash payers, so you may be able to realize some savings by doing it this way. Before planning to go this route, it is a good idea to talk to the billing/insurance staff at your dentist’s office and see if they give any sort of preference to cash payers or any financial advantages to doing it this way.

    When you take into account the premiums and limited coverage associated with the stand-alone dental plans and the risks associated with the Advantage plans, you may decide that being a cash payer regardless of how much dental care you need is a better choice for you. One consideration here is how frequent of a dental care user you are. If you are just going to the dentist a couple of times a year in most cases, it may make sense to forego paying for additional dental coverage. Keep in mind, though, that if you do sign up for dental coverage later, there will likely be a waiting period before you have coverage.

Medicare Dental Coverage for Seniors

If you decide you do want to have some dental coverage and want to purchase a stand-alone Medicare dental plan, it is a good idea to compare multiple plans as there are variance in how they work. As mentioned above, some plans allow you to see any dentist, whereas others have a network that you must stay within.

Additionally, some dental plans have lengthy waiting periods, whereas others have moderate waiting periods before you are covered. It is vital to understand this and consider it when comparing the plans.

Here is a link to one dental plan that you can consider that has been a good one for some of our clients: Dental/Vision plan. Or, you can request some quotes for a variety of options:

Medicare Dental Plan Quotes

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65Medicare.org is a leading, independent Medicare insurance contact us blueagency for people turning 65 and going on Medicare. We have worked with 10,000+ Medicare-eligible individuals over the last 10+ years, assisting with understanding and comparing the plans. You can get a list of Medigap quotes in your area. Or, if you have any questions about this information, you can contact us online or call us at 877.506.3378.

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Health Care Reform Should Follow the Medigap Model

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health care reformAs debate rages on in Congress about reforming, repealing, replacing, and/or repairing the Affordable Care Act, there are no easy solutions, and frankly, there’s not much hope for a reasonable and lasting outcome. With that current environment in mind, we would put forth the idea that there IS a successful health insurance model out there that lawmakers should look to when crafting legislation to change our health care system.

It’s not the much-discussed single-payer solution. On the contrary, it’s a private insurance program, available to those on traditional Medicare, called Medigap. Medigap plans are plans that fill in the “gaps” in traditional Medicare, helping consumers pay for the deductibles, copayments and coinsurance that are not covered by Medicare. Medigap has a stable history and many characteristics that could carryover into health care reform.

Simplicity of Plan Choices: Standardization

The first and foremost characteristic of Medigap plans is Federal standardization. In all but a few states, the plans are Federally-standardized, meaning that insurance companies that offer the plans have to offer plan designs set forth by the Federal government.

These plans go by letters and are very easy to understand and use. The Medigap coverage chart shows all the plans. Shoppers can choose the level of coverage that they want, then proceed with comparing rates and companies to make a selection that is appropriate to their level or need and financial means.medigap coverage chart

With Medigap, there are 20-30 companies offering plans in most states, and insureds can choose the level of coverage they want, then compare rates and company reputations – either on their own or through an independent agent. The level of competition in the Medigap market – with so many companies offering plans – has also contributed to keeping rates low over time.

Adding this level of simplicity to health care reform would, undoubtedly, strengthen the level of buy-in and make comparing plans immensely more straight-forward and easy to accomplish.

Initial Open Enrollment Period

Medigap plans offer a one-time 6-month open enrollment period when you first turn 65 or start on Medicare Part B. During this time, you are allowed to choose a Medigap policy with no underwriting and no exclusions based on pre-existing conditions. This period ensures those with health problems have a chance to get on a plan without the possibility of rejection by the insurance company.

It offers an incentive to being covered and purchasing the coverage one wants/needs when available. After all, insurance should be just that – insurance against potential future loss (in this case, potential future illness or injury), not an opportunity to cover yourself right before you need it.

The initial open enrollment window would “reward” people for being forward-thinking and making smart financial decisions instead of punishing all stakeholders with higher rates because people are naturally more inclined to only get insurance when they “need it”, if given that opportunity.

Underwriting Outside of Open Enrollment

On the other hand, this initial open enrollment window also introduces the idea of a “penalty” of sorts if you don’t elect to get a Medigap during your initial open enrollment period. Outside of the open enrollment period, you typically have to “qualify medically” to obtain a Medigap plan.

While allowing everyone to be covered whenever they want to be would be great, it’s not a viable solution in theory. Insurance companies cannot be expected to take on the claims of the sickest of the sick that choose to only get insurance at the time that they need it.

Moreover, unless they are made to it, many insurance companies simply aren’t willing to play on that playing field. You need to look no further to the reductions in options in many states, as insurance companies have pulled out of offering individual health plans altogether.

In the Medigap market, the use of an initial open enrollment period and underwriting outside of that period has led to stability over time. Compared to the individual health insurance market, particularly since 2014, Medigap rate increases have been particularly stable with the national averages coming in around 5-8%.

No Government Subsidies

All of the success in the Medigap market has been accomplished without any government involvement or oversight, with the exception of setting the standardized plans chart. The insurance companies receive no subsidies for offering Medigap plans or paying claims, and Medicare consumers receive no subsidies for purchasing a plan.

There is not a need for them, as sensible standardization and underwriting have insured that rates stay stable and companies can successfully offer them.

Does Medigap Work Everywhere?

In most parts of the country, these characteristics of Medigap plans have allowed there to be lots of choices (competition) and stable rates.

However, states do set their own rules regarding some aspects of Medigap. Not surprisingly, there are a few states that have “adjusted” the normal Medigap rules to allow for “guaranteed issue” to all buyers at any time – NY and MA, for example. In those states, rates are typically double (or more) the rates in most other states and there are very few insurance companies participating in offering Medigap plans. Sound familiar?

In states where the actual free market is allowed to work, however, people who follow the clearly set-forth rules about when to buy a plan are rewarded by having excellent coverage for a reasonable price. Most studies have shown that over 90%+ of people are happy with their Medigap coverage. Premiums for Medigap are generally in the $100-150/month range, depending on where you live and your age.

So, what about the people who simply cannot afford Medigap? There are certainly some people for whom Medigap is not an option for financial reasons. There are other options, however, including Medicare Advantage, which has considerably lower premiums, or staying with traditional Medicare. Likewise, health care reform could easily put into place other options for people who could not or did not purchase “traditional” health insurance.

Overall, discussion of health care reform will continue to be at the forefront of the national discussion. There is a viable model available for study in Medigap plans – they’ve stood the test of time and continue to be a reasonable and successful (for policyholders AND insurance companies) option for those on Medicare. We should stop punishing everyone with high rates and few choices and move towards a system that rewards those people that make sensible and prudent financial choices.
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65Medicare.org is a leading, independent Medicare insurance contact us blueagency for people turning 65 and going on Medicare. We have worked with 10,000+ Medicare-eligible individuals over the last 10+ years, assisting with understanding and comparing the plans. You can get a list of Medigap quotes in your area. Or, if you have any questions about this information, you can contact us online or call us at 877.506.3378.

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