Jim Sellers, former Oregon journalist and state agency employee, writes a regular column to help thousands in Salem deal with the confusing world of Medicare and federal benefits. He’s available to answer your questions.
He knew the mistake he had made, and he wasn’t happy about it. After enrolling in Medicare, the man had not bothered to enroll in health care insurance – and now he needed insurance to help pay the bills. A friend had told him he would need to wait for annual open enrollment in the fall to enroll in a plan.
The Medicare beneficiary made an appointment with a Senior Health Insurance Benefits Assistance (SHIBA) volunteer counselor to ask what he could do. The counselor told him that he could enroll in Medicare supplement (Medigap) insurance. But because it had been more than six months since his Medicare enrollment, he would face a battery of health questions whose answers would help determine the monthly premium.
Those questions aside, the man said the premiums (starting at about $122 a month for the strongest Medigap policy) were too costly. Still, the counselor had good news about Medicare Advantage insurance. Two insurance companies doing business in Marion and Polk counties have Medicare’s five-star rating, giving them the right to take new enrollments at any time during the year.
Between them, those two companies offer a choice of seven Medicare Advantage plans with monthly premiums ranging from zero to $173 a month.
If you would like to make an appointment with a SHIBA counselor, or to ask a question to be answered here, please see the end of this column.
How do Medigap and Medicare Advantage insurance compare when it comes to pre-existing conditions? And if the insured person develops a serious health condition, can her insurance premium increase or could the insurance be canceled?
To put aside one of your concerns: In neither type of insurance will your insurance be canceled if you develop a serious medical condition.
Let’s start with Medicare Advantage insurance. These plans don’t ask about health status, and in fact you can enroll online if you wish. You are entitled to change insurance plans during annual open enrollment, Oct. 15 through Dec. 7, again with no questions asked about health status. Your new coverage would begin Jan. 1.
Circumstances differ with Medicare supplement (Medigap) insurance. For the first six months that you have Medicare Part B, you have guaranteed issue for this insurance. This means the company must sell you a policy and it cannot charge you a higher premium because of heart disease, diabetes or another pre-existing medical condition.
If the Medicare beneficiary no longer has guaranteed issue, the Medigap insurance company may ask a battery of questions about the applicant’s health status. If the company encounters a medical condition it doesn’t like, it can either refuse to sell a policy or sell the policy and charge a higher premium.
The only cause for a Medigap policy to be canceled would be if the insured fails to pay the premium or is found to have responded falsely to a question.
Once a Medicare beneficiary is enrolled in a Medigap policy, the premium cannot be increased if the insured develops a new medical condition. Also, the insured may use the Oregon birthday rule annually to change insurance company or type of Medicap policy with no premium increase resulting from health status.
I’m about to retire and enroll in Medicare and Medicare insurance. My husband (he’s younger than 65) is on my employer health insurance, and will lose that when I retire. Where can he get insurance?
He can enroll in insurance through the Affordable Care Act marketplace, purchasing private insurance. Your household income will determine whether he qualifies to have part of the premium subsidized.
To review insurance options and to enroll, he can go online to Healthcare.gov or call 800-318-2596. Or he could work with an insurance broker. To find a state-certified insurance broker, he would enter his information on the website including that he is interested in Marketplace insurance.
Jim Sellers of Salem is a certified Medicare counselor with the Senior Health Insurance Benefits Assistance (SHIBA) program. To ask a question to be answered in this column, e-mail [email protected] To schedule a free SHIBA phone appointment with a volunteer Medicare counselor, call 800-722-4134.
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