President’s Forum 149 – FULL DISCLOSURE MEDIGAP PRICING, NEW THIS YEAR!

Medicare Enrollment Period Is October 15 - December 7, 2023

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Medicare provides an enrollment period, October 15 – December 7, 2023, that allows beneficiaries to request changes in their original Medicare, Medicare Advantage (MA) and/or prescription drug plans. 

Most people sign up for both Medicare Part A (hospital insurance) Part B (medical insurance) or a MA plan during a period starting three months before turning age 65 and ending three months after turning age 65. This may include the fall enrollment period for some turning age 65. If you miss your enrollment period, you may qualify for a Special Enrollment Period. 

learn about a Special Enrollment Period.

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For most Americans, enrollment in Medicare Part D (prescription drug plan) when signing up for Medicare is voluntary. Many MA plans include a prescription drug plan. If you do not enroll in a prescription drug plan at the time you become a Medicare beneficiary, Medicare calculates a penalty by multiplying 1% of the “national base beneficiary premium” ($32.74 in 2023) times the number of full, uncovered months you didn’t have Part D or creditable coverage. The monthly premium is rounded to the nearest $.10 and added to your monthly Part D premium when you do purchase a prescription drug plan. If you need a Medicare Part D plan years later to help with prescription drug costs the premiums will be very expensive.

The NRLN believes it is important to be prepared for exploring options during the enrollment period. 

In this Forum message, I will provide tips on how to become prepared so you can get the best deal for your senior healthcare coverage. Preparation is important If you are enrolling in Medicare for the first time or at any time during 2023 and in future years. Get prepared before you call a healthcare insurance company, an insurance agent or that advertised 800 number in commercials.

I want to emphasize that you do not need to feel rushed to make a decision during the early weeks of the enrollment period.

THE MOST IMPORTANT STEPS TO TAKE 

  • Read and understand your copy of “Medicare and You 2023”. Learning from it could save you time and money, and it will build competence and confidence. 
  • If you did not receive the “Medicare ad You 2023” in the mail you can requesting the handbook at www.Medicare.gov.
  • Click here to read it online or download and save it to read on later.  https://bit.ly/48Rq4VV

“Medicare and You 2023” | read it online or download and save it to read on later.

Click Here
  • Getting your own copy by mail each year is best. 
  • The “Medicare & You” handbook is your official guide to Medicare. It is easy to read and is updated annually by the Centers for Medicare and Medicaid (CMS). 
  • See Contacts for Information on Page 128 and for a Medicare Card replacement on Page 9. 

The “Medicare and You 2023” handbook recommends that you start the signup or change process by comparing your plan or plans with others. 

When you have your copy of the handbook:

  • first examine your economic situation, your affordability status, 
  • then your current health status and prospects for continued good health 10 years from now, including a health history review of ancestors (just like insurance companies do when they need to decide whether to insure you, or not). 

You do not have to be perfect, just consider what you know and also consider the chance for a serious health condition or acute injury risks. 

  • This exercise is exactly a repeat of what your doctor requires you to fill out every year…. question beginning with… have you ever had…or has anyone in your family ever had …. 
  • These important risk factors should precede hearing insurance sales pitches or calling 800 numbers to make plan comparisons. 
  • We must know what we need before we can buy it.

Equally important is knowing your 2023 and beyond personal budget expectations, family income and costs. 

  • Any pension payments, Social Security benefits and investment income, including IRA and 401k dollars, are critical pieces of the income side of the equation. 
  • Medicare Part B prices are expected to increase in 2024. The costs are projected to go up from the current $164.90 to $174.80.
  • To make a decision between the original Medicare path or the Medicare Advantage (MA) path, it is important to make a choice between MA with out-of-pocket protection and one of the Medicare Supplemental Plans (Medigap) that pay the 20% not covered by original Medicare.

KNOWING MEDIGAP PRICES BY PLAN IS CRITICAL! 

Whether enrolling for the first time or considering switching from MA to original Medicare or from original Medicare to MA, there are important issues to consider. 

  • MA plans have annual out of pocket protection. In 2023, the CMS established out-of-pocket limit for MA plans may not exceed $8,300 for in-network services and $12,450 for in-network and out-of-network services combined. Some MA plans have a lower out-of-pocket cost.
  • Disadvantages of an MA plan are: You can’t chose out-of-network physicians, hospitals or pharmacies without risk of much higher or prohibitive out-of-pocket costs. You will not have access to specialty clinics, such as Mayo, unless your MA plan has a contract to provide you access to the clinic. 
  • Paying a premium for an original Medicare supplement plan (example Medigap Plan G) pays the 20% not covered by original Medicare. 
  • If you have been in an MA plan for more than 12 months and want to switch to an original Medicare supplement plan a health insurer may or may not sell you a Medigap plan. The insurer may reject you due to a pre-existing health condition or charge you a high premium to be accepted.

The NRLN had urged CMS to post prices by zip code for Medigap plans on its website. CMS has made Medigap pricing data available by zip code and plan type.

  • If you have a Medigap plan it is worth checking for savings! Even if you have a pre-existing condition an insurer might accept you if you apply.
  • If you are new to Medicare, make sure you are getting the best deal possible on a Medigap plan.

IF YOU ARE A 1ST-TIME NEW 2023 ENROLLEE LOOKING FOR A MEDIGAP PLAN OR YOU HAVE A MEDIGAP PLAN – YOU CAN NOW SEE SPECIFIC PRICES FOR ALL MEDIGAP PLANS IN YOUR ZIP CODE – MAYBE FIND A LOWER PRICE – APPLY, EVEN IF YOU ARE NOT SURE YOU CAN QUALIFY – BUT, DON’T GIVE UP OLD PLAN UNTIL YOU GET A BETTER DEAL APPROVED – DON’T WAIT, LOOK NOW, APPLY NOW!

An example of the importance of being able to determine the best price for Medigap plans is the experience the NRLN had beginning in 2018 with our Tenessee Valley Retitree Chapter (TVARC). The Tennessee Valley Authority discontinued a company sponsored Medicare supplemental healthcare plan in 2017 and it hired a Private Medicare Exchange (PME) company to manage a Special Enrollment Period (SEP). An SEP is to ensure an unbiased open enrollment period for retirees whose companies terminated supplemental healthcare benefits. The PME offered 14,000 beneficiaries what it and the TVA characterized as quality plans at low market-based prices. 

The TVA Retirees Chapter/NRLN team investigated and found that the PME only offered plans they sold on behalf of selected insurers, resulting in retirees paying 35 – 52% more for the same plan sold by other insurers in the same zip code. In fact, they sold the same plans under commission that could have been purchased direct from the insurer at far lower premiums. 

I hope this message has been useful to you.

Bill Kadereit, President
National Retiree Legislative Network

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