The Medical Insurance Registration Blitz does not include the option to enter Medigap
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Yves is here. I admit that some readers have either passed the no return of the medical insurance plan or have to make a choice after many years. However, since I am about 93 years old, I am now participating in the seniors TV program, which shocked me at the continuous emergence of medical insurance advantage plans. When I looked at my mother’s card, it said, just below the name of the plan and all of her member ID numbers, the advertisement obscured something:
“Medical Insurance Advantage Plan-Applicable to changes in medical insurance restrictions”
There are also quotes on the card.
Via Harris Meyer.Originally published on Caesars Health News
The annual open registration season for Medicare is here, and millions of beneficiaries-driven by large-scale advertising campaigns and with the help of a detailed federal website-will choose the Private Medicare Advantage plan.
But those who choose traditional medical insurance face key decisions about private insurance. The importance of this choice is often not well communicated.
If beneficiaries decide to use traditional Medicare when joining the plan for the first time, they can choose a private supplementary plan—the Medigap plan—to help pay for Medicare’s substantial deductibles and co-payments for hospitalization, doctor visits, and other services.
But many people don’t realize that in most states, beneficiaries can guarantee Medigap only 6 months after enrolling in Medicare Part B—whether at the age of 65 or when they leave private health insurance and join Part B Time.
Although the Medicare.gov website provides a guide For these Medigap plans—labeled A to N—this is a complicated decision because each plan offers different types of coverage—covering 10 types of benefits. Then there are variants with high deductibles and a limited supplier network. Of course, the premiums vary greatly. And because seniors join these plans throughout the year when they qualify for health insurance, there is much less publicity about these options.
As long as the beneficiaries pay the premium, they cannot withdraw from the Medigap plan.
For many people who choose Medicare Advantage at some point but later decide to switch to traditional Medicare, obtaining Medigap policies may be extremely difficult or impossible.
Many of the people who made planning choices this season may have missed the narrow window to participate in Medigap. This means they may be trapped in Medicare Advantage or their current Medigap plan.
Kensinger, 68, of Bridgewater, New Jersey, retired from an investment management company. He did not know that the opportunity to register for Medigap policies was limited. “No one told me,” he said. “I read a lot of books about Medigap, but I found it a bit confusing.” He wanted an insurance policy because he was leaving his wife’s employer-based health plan.
Brian Cornell, executive federal affairs director of the Leukemia and Lymphoma Association, said: “Not many people who enter health insurance at 65 fully understand that that moment may be their only chance to join Medigap.” “If you miss that short-lived moment Window, you can’t avoid high out-of-pocket expenses.”
Although Medigap plans generally charge higher premiums than Medicare Advantage plans, more expensive plans provide greater out-of-pocket protection.
After the beneficiary’s first 6-month window period, federal law does not prohibit Medigap insurance companies from rejecting applicants or charging very high premiums (if they have a previous illness), which is in line with the Affordable Care Act that applies to people under 65 The insurance market is different. Only four states The insurance company is required to provide Medigap insurance to applicants regardless of their age or health status. Medigap covers nearly 13 million beneficiaries.
In contrast, federal rules require that the Medicare Advantage plan accept all applicants and charge the same premium regardless of their health. This year, the Medicare Advantage plan’s out-of-pocket expenses are capped at $7,550 for in-network care, excluding prescription drugs. Traditional medical insurance does not have a cost cap, but some Medigap plans cover most of these costs, otherwise these costs will be paid out of your pocket.
Tricia Neuman, the executive director of KFF’s medical insurance policy, said that at least in part because of these unequal consumer protections, 17% of the 33 million people with traditional medical insurance do not have supplementary insurance. For serious diseases such as cancer or kidney disease, their out-of-pocket expenses can reach tens of thousands of dollars each year.
Linda Ginsberg of Jacksonville, Fla., unknowingly missed the opportunity to purchase a Medigap policy at the age of 65 last year.
Because she suffers from cancer, the retired medical office manager received medical insurance through Social Security Disability Insurance before the age of 65, and she joined the medical insurance advantage plan. She pays $385 a month in insurance premiums-$4,620 per year-and faces an out-of-pocket cost of $7,000 per year, which does not include her large prescription drug bill. Therefore, before her birthday last year, she called two insurance brokers and asked to switch to traditional Medicare and obtain the Medigap plan, which she thought would provide better and cheaper insurance. The medical insurance rules provide Medigap public registration opportunities for disabled beneficiaries over 65 years of age.
Both agents told her by mistake that she could not change jobs because she had cancer. “They said the insurance company would not take you in, you should stay where you are,” Ginsberg recalled. “They had no idea what time I could have entered without being asked about my cancer.”
Now she is trapped-and very angry. “I think it is illegal to screen for pre-existing diseases,” she exclaimed. “But when you reach the age of health insurance, that’s not the case.”
Part of the confusion is due to the very different rules governing Medigap policy across states. Connecticut, Maine, Massachusetts, and New York require insurance companies to accept any applicant, regardless of age or medical history. According to KFF.
In other states, people over 65 years old can only obtain the Medigap program guaranteed by the federal government under the following conditions Limited situation, For example, if they relocate or leave the Medicare Advantage plan during their first year of Medicare. 28 states ensure that people can get Medigap plans if their employers terminate their retirees’ health benefits.
However, state regulations vary widely in how Medigap insurance companies price their plans. Eight states prohibit charging more for people who are older or sicker. The remaining states allow premiums to be set based on age, which means that older people may not be able to afford the Medigap policy.
The situation is even worse for the nearly 9 million beneficiaries under the age of 65 who are eligible for health insurance due to long-term disability. Only 31 states require insurance companies to sell Medigap policies to this group of people.
Members of one subgroup—kidney dialysis patients under 65—have even more limited access to affordable Medigap policies. Only 14 states Ask insurance companies to provide them with affordable insurance. Since last year, the federal government has guaranteed that they can enjoy the Medicare Advantage plan, but not the Medigap policy. But Holly Board, vice president of government affairs for the American Kidney Foundation, said that the Medicare Advantage plan may not include providers for dialysis patients.
Consumer advocates say that guaranteeing access to affordable Medigap policies is important because beneficiaries with serious illnesses Want to leave them disproportionately The Medicare Advantage plan provides a wider range of options for providers who provide through traditional Medicare.
A sort of Government Accountability Office Report In July, medical insurance officials were urged to check why the rate of beneficiaries switching from medical insurance advantages to traditional medical insurance in the last year of their lives was more than twice that of other medical insurance advantages registrants.
Some lawmakers are already pushing to reform the Medigap market.this Closing the Medigap Act, Recently proposed by the Chairman of the House Fundraising Health Subcommittee Lloyd Dogget (Texas Democrat) will ensure that beneficiaries with pre-existing medical conditions can purchase Medigap insurance policies at any time and will not face higher Premium.
Another house billSponsored by Rep. Jaime Herrera Beutler (R-Wash.) and Rep. Cindy Axne (D-Iowa), Medigap insurance companies will be required to provide kidney dialysis patients under 65 the same as they provide to beneficiaries 65 and over s plan.
Health insurance companies generally oppose bills that require them to guarantee the coverage or affordable pricing of the Medigap plan, believing that this will increase the premiums for current policyholders. The industry lobby group AHIP (American Health Insurance Program) did not take any position on these two bills.
However, neither of these two bills are included in the Democratic Party’s broad legislative plan to expand health and social programs. In a written statement, Doggett expressed disappointment, saying that extending the pre-existing conditional protection to the Medigap market is “one of the remaining important unfinished businesses in the Affordable Care Act.”