sid nv

An Agent will have a bias to sell whatever plan offers the highest commission, no? Anyway we may well need help from an Agent, as I have not attempted to enroll in any addition insurance yet so I don't know what obstacles will pop up in the enrollment process. We have two working days before we are "termed".

My wife and I camped out at the local security office, and with 50 minutes remaining before the office closed our ticket was called. They said we will be enrolled in Medicare part B from May 1st, so some relief there.

retman

A reputable agent values their reputation, so no I do not believe as a standard mode of operating they are trying to squeeze the largest amount of commission. I was recommended an insurance company that was the lowest cost provider in the state and was the same insurance company I had independently identified. So no complaints there. Also a Medigap plan purchased via an agent provides a benefit to you in that you can engage the agent for assistance in resolving any payment problems you might encounter for example. Your personal Medicare Supplement Open Enrollment period begins on the first day that your Part B becomes effective. If your Medicare Part A and Part B coverage start on June 1st, then your personal enrollment period lasts for exactly 6 months and ends on November 30th.

As for Medigap coverage the standard plans are all exactly the same as required by Medicare. However some insurance cos may offer additional benefits. I have some vision care benefits with my Medigap policy. That is over and above the standard requirements of Medicare for a Medigap plan.

States can add additional benefits for Medigap plans as well. States cannot reduce benefit coverage below that stipulated by medicare. For example should you decide to move from one state to another your Medigap policy moves with you. Should you decide upon review of Medigap plans in your new state where you reside you might like to change plans say for a lower cost or for a lower level plan from G to N in most states you will have to go through medical underwriting. In the case of Maine state law says you can change MEDIGAP PLANS to a plan of "equal or lower coverage without going through medical underwriting". There are some additional requirements including prior continued coverage. That is an additional benefit mandated by MAINE, not a reduction of the standard coverage mandated by Medicare for Medigap plans.

See it's complex...

Steerpike

I second the idea that a reputable agent will place more value on their reputation than on their commission.

Nutmegger

I've worked with the same specialist HI agent for a very long time. When it was time for me to choose my Medicare plans, he steered me to the cheapest options available as he knew I didn't need heavy duty coverage. I check in with him each year and he tells me to hang onto my plan (which is no longer on the market, but grandfathered) as long as my situation doesn't change. In the minefield that is Medicare, a good agent is worth his weight in gold! OP, don't forget that you have the option to change your plans each year during the enrollment season, so mistakes can be corrected.

Steerpike

I'm also using an agent for my non-medicare health insurance needs. She happily helped me sign up for an ACA plan, something I could do myself online but was a PIA.

Giantaxe

I'm 18 months from Medicare eligibility so this is a very interesting thread. I knew about the limitations regarding insurability if you change from an Advantage plan to a Medigap policy. But I didn't realize that in almost all states insurers can increase Medigap policy cost on issue-age or attained-age. For me in California, it appears that insurers can choose what they wish to rate on:

https://cahealthadvocates.org/medigap/medigap-premiums/

I haven't found any figures, but I suspect the percentage enrolled in Medigap policies diminishes considerably by age, whereas Advantage plan enrollment increases.

sid nv

I have caved in to retman's suggestion and made an appointment with an Agent next week. Will let you know how we get on!

retman

Giantaxe,
There are three ways in which premiums are : issue age, age attained and community rated. It is explained on Medicare .Gov.

There is definitely a push towards Medicare Advantage plans by the government and they are becoming more popular due to premium cost potentially being zero for both, medical and drug coverage for some ADVANTAGE plans and other benefits being added. There is the standard $135.50 pm everyone pays whether you chose and Advantage plan or Medicare Original with a Medigap policy. What they don't tell you in all the hype is with the Advantage plan a deductible up to $6,400, plus a defined network of providers. So Advantage plans appeal to seniors on limited income budget from a premium perspective.

sid nv

For the Advantage plan I am looking at, I see in the Evidence of Coverage no deductible and generally no coinsurance. PCP visit $10, Specialist visit $50. Our
current providers are all in-network. Total monthly premium for 2 of us is the part B $135.50 x 2 = $271. Wife's meds total for the remainder of the year is $276, or average $35 per month. My meds are cheaper, but for now let's say $70 for the two of us. Total premiums + meds = $341.

Going the Medigap route, wife's meds total for rest of year on the cheapest part 'D' Rx plan = $1,055 = average $132 per month. The Medigap plan G I looked at is $140 per month. Total premium per month for her = $135.50 + $132 + $140 = $407.50. My meds are cheaper, but for now let's call the cost of 2 of us at around $800.

So looking solely at premiums + drug costs for the 2 of us:
Advantage plan $341 per month. Downsides of Advantage noted.
Medigap plan $800 per month. I have not factored savings on office visits into this.

The medicare.gov website does a great job of coming up with the numbers for Advantage plans and part 'D' costs, complete with graphs showing cost of drugs in each month for the remainder of the year including Donut Hole months.
Unless I missed it, there is no direct comparison available for Medigap plans. They list all the providers for the state, but you have to go to each provider's website to get the costs. The plan G I looked at increases in cost with age. I suspect the older you get, the more likely to switch to Advantage.

Regarding Agents:
There is a downloadable speadsheet at the medicare.gov website that lists Agent/Broker compensation for Advantage plans. All plans list a referral fee for the Agent of $100. For the Advantage plan I am looking at, the initial compensation and renewal fees for the Agent are $0 and $0. There are 2 other provider companies listed which pay the Agent initial compensation of $455 and $482 respectively. If I push for an Advantage plan, it will be interesting to hear the Agent's recommendation.

My preferred Advantage plan provider has an office in town. If the local independent Agent/Broker has an Original Medicare strategy that works for us, then fine. Otherwise I will be walking out and driving round to the Advantage provider's office to sign up.

The only final determination I have today is that the cost of drugs in this country is shocking. The Advantage plan Rx costs come in at 25% of part D cost, so presumably the Advantage plan subsidises the Rx cost from other parts of the plan.

retman

sid nv,

You have raised good points as you delve deeper into Medicare and as you continue to research more and more questions arise. And yes, you have to start researching individual insurance companies offering various Medigap plans to understand exactly what they are offering and what the premiums are. You start to see how complicated it becomes. That is why I after spending considerable time researching decided I wanted to engage the services of a professional insurance broker with way more knowledge than I could possibly gain. So if you have decided to use a broker then I'm my opinion that's a wise decision.

Giantaxe

There's one more wrinkle for Medigap plans that I was also unaware of. If you don't have creditable coverage for the six months preceding application for a plan, they can (do?) impose a six month pre-existing condition exclusion. Unfortunately that may apply to me. I was laid off and am on COBRA coverage that gives me an 8 day gap (ugh!) before the first date I am eligible for Medicare. My plan was to make sure I was on an overseas trip with travel insurance during that time period, but if I want to go the Medigap route I may have to pay for a month's ACA policy to cover those eight days. I am generally good health, but given the way US insurance companies behave I don't feel that comfortable leaving myself open to what they define as a pre-existing condition.

And I will say yet again, that health care access in this country is insanely complex to navigate. Quite how your average punter navigates it is not clear; perhaps they don't.

sid nv

And who decides the exact definition of a pre-existing condition? The private insurance companies do. Great. Just great.

Found a federal program called SHIP that offers Medicare advice. Might be worth a try:
https://www.seniorsresourceguide.com...National/SHIP/

sid nv

retman,

The intent of my post was to counter your assertion that Advantage plans have a deductible of up to $6,400. I read the Evidence of Coverage for the Advantage plan I am contemplating, and it explicitly states that there is no deductible for the plan, and no deductible for Rx. I provided some figures to show that Advantage plans are considerably cheaper than Medigap.
Can you please provide an example of an Advantage plan that that has a deductible of $6,400?

My main concern with Advantage plans is not so much the numbers, but that they may refuse to pay out, per civilservant's example. Insurance that does not pay out on a valid claim is useless.

Giantaxe

Looking at this some more, I may be ok. It appears that the six months of creditable coverage can have a break of not more than 63 days.

retman

sid nv,

I went online to Medicare.gov and reviewed Medicare Advantage plans for my zip code. You are correct. I confused matters be referring to "deductibles" when the correct term is "out of pocket" costs.

On your second point, I have heard Advantage plans have declined to pay. What the circumstances were, I have no idea. Medigap plans do not pose similar problems.

Just to add some background as to why I chose a Medigap policy. I could afford it, the premium is approx 75% cheaper than the health care plan I previously had. I am likely moving to another state and have no idea who my doctors might be, so a Medigap policy with Original Medicare which is portable to other states allows to me to select from all doctors. Some time in the future I may choose the Advantage route.