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Medigap policies: FL or TX?


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[First, my head is about to explode from reading so much about Medicare!  And I thought the metals of the ACA were convoluted, but wow ….anyway:]


I will be eligible for Medicare in June 2022, and will also purchase a Medigap Plan G policy and a Plan D policy (the cheapest I can find, as I currently have no Rx).  I will not take SS yet, so will pay directly for Plan B premiums. 

Four years ago I moved my domicile from TX to FL to get FL BCBS (nationwide PPO)  insurance.  I would very much like to move my domicile back to TX (lots of reasons), and transitioning  from  ACA to Medicare might make this feasible. 

QUESTION:  where can I find policy comparisons/costs (is there a Medicare equivalent of HealthSherpa?) I want to compare companies and plan prices in 33513 and 77399.

QUESTION:  in general — given that Plan G is standardized nationally — is there a difference among states, other than carriers and premium costs?

QUESTION:   If I enroll in Plan G during my initial enrollment period, and in a subsequent year move domicile to another state, will I be required to have medical underwriting to get Plan G coverage in the new state?

QUESTION:  what can be paid with HSA funds?  plan B premiums (if not taking SocSec?). Medigap premiums?

Any other thoughts about TX vs FL Medicare/Medigap for making a domicile decision?  Thanks!

 

 

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Check the plans carefully.  Some plans offer fixed rate premium for the rest of you life when you sign up.  Others offer a lower premium when you sign up and increase with age.  I was not aware of this when signing up and have an increasing premium which is substantial over what i paid for it.  I am now considering a medicare advantage plan which will save me considerably in the long term.  For example....United Health care has fixed premium plans and Mutual of Omaha are aged based.  Plan G is a good plan IMHO>

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  • 2 weeks later...
On 10/28/2021 at 9:34 PM, whj469 said:

I have a Medicare Advantage plan and don't pay for a supplemental plan. The Advantage plan works well for us. I would suggest looking at that option.

GreyDawg appears to be a fulltimer, and most Advantage plans don't work well for fulltimers because they have only local networks.

But maybe yours does?  If so, what state and what plan?

 

On 10/31/2021 at 10:55 AM, GreyDawg said:

Thank you.  I now have the information I need.

Do tell!

What did you find out about undergoing medical underwriting for a supplement if you change plans because you move to a different state?  I would guess that the answer is "yes" because my understanding is that guaranteed issue applies only during the initial enrollment period, but I'm like you and just now wading into Medicare, which I agree is more convoluted than Obamacare.

Also, did you find a place to easily compare the one million supplement plans?

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5 hours ago, Blues said:

GreyDawg appears to be a fulltimer, and most Advantage plans don't work well for fulltimers because they have only local networks.

But maybe yours does?  If so, what state and what plan?

 

Do tell!

What did you find out about undergoing medical underwriting for a supplement if you change plans because you move to a different state?  I would guess that the answer is "yes" because my understanding is that guaranteed issue applies only during the initial enrollment period, but I'm like you and just now wading into Medicare, which I agree is more convoluted than Obamacare.

Also, did you find a place to easily compare the one million supplement plans?

Our United Healthcare Medicare Advantage PPO Plan for Fulton County, NY (12078) lets us use in-network providers anywhere in the country at home region co-pays.

Here's a good plan comparison site:

https://medicare.com/

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My Advantage plan only works well, because it doesn't cost any extra like buying a supplemental policy, it provides coverage, on an emergency basis, anywhere in the US and a lot of the civilized world. To receive the full benefit of the plan you would need to be in the area for all routine care. When someone I know had a heart attack 1,500 miles away from his and my service area, our plan paid for all of the cost without issue. There are cost like $15 copay for specialist, my replacement pacemaker $200, drug copay $7.50 or less for 90 supply. Any copay is small by my standards. For the two of us supplemental Medicare policy $590 per month or $7,080 per year. My Advantage plan is the only five star plan in Texas. I consider the healthcare that I receive to be above what I would expect. The online portal is excellent and easy to use. The online system that the medical personnel use is state of the art and you receive emails and texts reminders for appointments etc. I have the same PCP since 2008 which is before I was on Medicare. There are more then 740 MDs in the plan and they all work for the plan administrator. This is the very best medical insurance that I have ever had which includes my last healthcare provided my my employer which cost them $940 per month in 2016!

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On 11/11/2021 at 10:55 PM, whj469 said:

My Advantage plan only works well, because it doesn't cost any extra like buying a supplemental policy, it provides coverage, on an emergency basis, anywhere in the US and a lot of the civilized world. To receive the full benefit of the plan you would need to be in the area for all routine care. When someone I know had a heart attack 1,500 miles away from his and my service area, our plan paid for all of the cost without issue. There are cost like $15 copay for specialist, my replacement pacemaker $200, drug copay $7.50 or less for 90 supply. Any copay is small by my standards. For the two of us supplemental Medicare policy $590 per month or $7,080 per year. My Advantage plan is the only five star plan in Texas. I consider the healthcare that I receive to be above what I would expect. The online portal is excellent and easy to use. The online system that the medical personnel use is state of the art and you receive emails and texts reminders for appointments etc. I have the same PCP since 2008 which is before I was on Medicare. There are more then 740 MDs in the plan and they all work for the plan administrator. This is the very best medical insurance that I have ever had which includes my last healthcare provided my my employer which cost them $940 per month in 2016!

I found that plan also and signed up for it, I think you are speaking of the AARP Medicare Advantage HMO/POS through United Health Care, the one with a 5 star rating in Texas. This last year I went on original Medicare in July and selected a drug plan to get me through this year. Next year I'll be on the AARP Advantage plan, yes is does cover emergency care anywhere in the US and since we always are back in the Central Texas area Jan-Apr time frame it works out well for our annual visit with our Primary Care doctor. Our address is Livingston, our PCP we've had for the last 20 years is in Austin and is a part of the plan.

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One word of caution on AARP United Health plans. They want to dump you on their Part D with OptumRx. 

Optum RX is a joke as for service if you are a full timer.  Getting 90-day supplies sent to various locations can be a real mess.  They ignore your shipping instructions and ship them to a past address at random and then will not reship until they get the original shipment back unless you go way up the food chain.  You can get them filled at Walgreens or Walmart, but the cost is higher.  You do not have to use Optum and can obtain an alternate part D.  We use Silver Script and get our Rx from Walmart for the same cost as mail order.

Three times out of four, OptumRx messed up the mail order for me or my wife.  The UHC portion worked fine....never a problem with charges from across the USA.

We went as far as filing a formal complaint with Medicare and all we got from Optum was lip-service.

Ken

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21 minutes ago, TXiceman said:

One word of caution on AARP United Health plans. They want to dump you on their Part D with OptumRx. 

Optum RX is a joke as for service if you are a full timer.  Getting 90-day supplies sent to various locations can be a real mess.  They ignore your shipping instructions and ship them to a past address at random and then will not reship until they get the original shipment back unless you go way up the food chain.  You can get them filled at Walgreens or Walmart, but the cost is higher.  You do not have to use Optum and can obtain an alternate part D.  We use Silver Script and get our Rx from Walmart for the same cost as mail order.

Three times out of four, OptumRx messed up the mail order for me or my wife.  The UHC portion worked fine....never a problem with charges from across the USA.

We went as far as filing a formal complaint with Medicare and all we got from Optum was lip-service.

Ken

UHC sends us reminders from time to time that we could be saving a few dollars with the OptumRx mail service, but we've never considered switching for the reasons you stated. UHC has never given us any hassles with using our Part D coverage at various CVS locations as needed. We  tried Walmart a few years ago, but they screwed up our meds one time to many.

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On 11/11/2021 at 9:55 PM, whj469 said:

To receive the full benefit of the plan you would need to be in the area for all routine care. When someone I know had a heart attack 1,500 miles away from his and my service area, our plan paid for all of the cost without issue.

A heart attack is clearly an emergency, and I would expect that to be covered 1,500 miles away, regardless of the type of plan.

The rub for traveling fulltimers, and what makes many Advantage plans unsuitable for them, is having to be in a certain area for all non-emergency care.  That can work for some people's travel style, but for some, the whole idea behind fulltiming is not being tied to a certain area.  And while routine care can be planned in advance, things can happen that aren't emergencies like a heart attack but nevertheless require treatment, and won't be covered. 

 

On 11/11/2021 at 9:55 PM, whj469 said:

My Advantage plan is the only five star plan in Texas.

What's the name of the plan?

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11 hours ago, Blues said:

, but for some, the whole idea behind fulltiming is not being tied to a certain area.

That is an issue in so many ways. In our system there is no national citizenship but we all must "domicile" somewhere with ties such as vehicle registrations & insurance, driver's licenses, voter registration, and health care, all of which require us to have a permanent tie to some location. The is greatly complicated by the fact that some of us, even in the Escapee membership, continue to claim domicile in an area to avoid the payment of local taxes when they stop traveling and actually spend half or more of their time in some location. I have long thought that Escapees could strengthen their legal position if they were to purge their domicile use. 

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FWIW my wife and I both successfully were able to transfer from Humana Plan F to AARP United Healthcare Plan F supplements.  Yes, we had to answer a set of health-related questions but the things they seemed most concerned about were, fortunately, more serious than the ailments we suffer from.  We've both now been notified of the approval of our applications.

The net result of the change was to save each of us about $60/mo which is a non-trivial amount IMO.

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3 hours ago, docj said:

FWIW my wife and I both successfully were able to transfer from Humana Plan F to AARP United Healthcare Plan F supplements.  Yes, we had to answer a set of health-related questions but the things they seemed most concerned about were, fortunately, more serious than the ailments we suffer from. 

What types of ailments were they asking about? 

I've wondered why anyone would choose anything other than cheapest one, if the benefits are identical.  But then I learned about the three different ways the companies can set premiums, and it's possible that an attained-age rated policy would be cheap at initial enrollment, but the premiums will increase as he ages, and it might become cheaper to switch to a plan whose premiums are community based.  But at that point, he has to apply for acceptance, so there's some risk.  I just recently found out about medical underwriting once the initial enrollment period has passed, and haven't run across anything that explains the types of conditions that would lead to rejection.  That's why I'm asking.

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1 hour ago, Blues said:

I've wondered why anyone would choose anything other than cheapest one,

Because you're basically stuck with what you chose for the remainder of your life.

IMO, market segmentation differences like attained-age and community based are marketing drivel.

When you first sign up for a Medicare Supplement, all people are treated equally, regardless of their health status.

If later in life, you want to switch to a different plan and/or company,  the decision will be all about whether you would be profitable.

So, IMO,  pick the plan you want to be insured by for for life.  If you don't become afflicted with a health problem that would make you unprofitable, you may be able to change plans in the future.  But if your health/prognosis gets worse, you probably will not be able to change plans.

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26 minutes ago, DanZemke said:

So, IMO,  pick the plan you want to be insured by for for life.  If you don't become afflicted with a health problem that would make you unprofitable, you may be able to change plans in the future.  But if your health/prognosis gets worse, you probably will not be able to change plans.

Oh, when I said "plan," I meant a particular policy within a plan.  Like don't all Plan F policies provide the same coverage, and the only difference is the company and the premium?  And why would the company matter, if the policy benefit is paying whatever portion Medicare doesn't cover?  What would make one company better than another if they're all required to do the same thing?

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5 hours ago, Blues said:

What types of ailments were they asking about? 

I've wondered why anyone would choose anything other than cheapest one, if the benefits are identical.  But then I learned about the three different ways the companies can set premiums, and it's possible that an attained-age rated policy would be cheap at initial enrollment, but the premiums will increase as he ages, and it might become cheaper to switch to a plan whose premiums are community based.  But at that point, he has to apply for acceptance, so there's some risk.  I just recently found out about medical underwriting once the initial enrollment period has passed, and haven't run across anything that explains the types of conditions that would lead to rejection.  That's why I'm asking.

I have to admit that when we first enrolled I didn't understand the differences in how premiums would escalate with time.  Our Humana Plan F policies were the cheapest at first, but they are "attained age" policies and increased each year.

As for the questions we were asked they were largely about the diseases you hear medications advertised for every evening on TV.  The biggest surprise was that diabetes wasn't considered an issue unless it had resulted in vision problems.  They asked for the names of specialists we use and they did call to question my wife about one of them.  They asked obvious things like "were you a patient in a hospital in the past 30 days" and that sort of thing.  I wondered if they would ask about my knee replacement and the only question that related to it was "have you been advised to have a joint replacement and haven't yet had it?"

Rather than trying to remember what questions were asked, I can say that two seniors in their 70's on moderate doses of blood pressure meds, cholesterol reducing meds, and diabetes meds didn't seem to bother them.  I guess that makes you grateful for the relatively good health we both have!

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docj,

Thank you for the description of specific questions you were asked.  That was illuminating to me, and I suspect many others.

It wasn't clear to me why those questions needed to be answered.   Was it because you switched from an "attained age" policy to a different one?

 

 

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16 hours ago, Blues said:

Oh, when I said "plan," I meant a particular policy within a plan.  Like don't all Plan F policies provide the same coverage, and the only difference is the company and the premium?


For Medicare supplements, I think that's right. That's the reason, that after selecting the Plan type I wanted, I chose the lowest priced contract available to me.  Some sources will say that your insurer's AM Best rating is important.  In theory, possibly, but it practice, Medicare's financial regulations and take-over processes are so well thought out, that if your insurer went out of business, it would just a minor blip.  You, in effect, are granted a new open-enrollment period, with no underwriting required.

But I haven't really answered what I perceive, was your primary question: "why would the company matter"?  

Trust often trumps price, especially for complex services/products. 

Insurance companies pay the highest commissions to folks that are most effective in helping folks make the right choice.  Especially if it is for their most profitable policies.

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3 minutes ago, DanZemke said:

It wasn't clear to me why those questions needed to be answered.  

Any time that you choose to change Medicare supplemental policies the new underwriter will ask health related questions before you are accepted as a policy holder. For that reason you apply for the new policy before the present one ends on Jan. 1 and if rejected you stay on the existing policy. The questions asked are chosen by the company that you are applying with and are not standard that is asked by all insurance companies. A couple of years ago my wife applied for a lower cost policy and was rejected so continued on the previous one for another year The following year (2020) she again applied to change carriers and was accepted, thus lowering her monthly premiums by nearly $70/month. In all of the cases the existing policy was plan G and the new one was the same. This year we do not plan to change as we were not able to find any competitive plans that were significantly less than what we now pay. 

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