by Lance and Isaac Reedy
Note: We have updated this article from a year ago. Unfortunately, Medicare supplement rates continue to increase. The good news is that if your health is stable, you may be able to qualify for a lower cost plan.
One of the most annoying things that happens in life, especially if you are on a fixed income, is some expense that has a rate increase. Unfortunately, health costs continue to rise including Medicare supplement (Medsupp) premiums. For a more detailed explanation about the causes of these increases, please read our companion article, Causes of Medicare Supplement Premium Increases.
During the past year most companies have had rate increases of some extent or another and some more so than others. What can be done about these rate increases? The solution, of course, is to have us shop on your behalf for lower rates. Remember, you can change your Medsupp plan any month of the year, providing that you medically quality. More about medical qualification shortly.
If you have Plan F with Company X, a good solution is to switch to Plan G or even Plan N. Again, this is assuming that your health is stable and that you can qualify for another plan.
For those people with declinable health issues the solution to this situation may be to switch to a Medicare advantage plan during the fall Annual Election Period (AEP also known as Medicare open enrollment) that runs from October 15th through December 7th. We will have more information forthcoming about the AEP in the next issue of Northwest Senior News and also via a paper newsletter for those do not have email access.
Why is it much easier to switch to a Medicare advantage (MA) plan?
The only health question on an MA application is kidney failure. You could have had a recent stroke, been treated for cancer in the past two years, or have multiple sclerosis, and you can still qualify for an MA plan. Those conditions would generally cause a decline on a Medsupp company’s application.
However, switching to an MA plan may not be feasible for many people, especially if you live in a county that has no available MA plan. The following are some examples.
- Idaho: Clearwater, Idaho, Lewis, Benewah, and Shoshone counties in northern Idaho are prime examples of counties with no MA plans.
- Montana: Counties such as Park, Glacier, Toole, Hill, Blaine and others have no MA plans.
- Wyoming: Most counties have no MA plans.
- Washington: Some of the smaller or more rural counties have no MA plans available.
- Oregon: Please contact us.
While there are some distinct advantages of MA plans, there are also some negatives. Here are some of them.
- You have copays for most of your medical services.
- Your medical providers generally need to be in the plan’s network.
- The specialty clinics such as Mayo, Virginia Mason, and Fred Hutchinson generally do not take MA plans.
- You will have higher out-of-network copays (often as high as 50%) if you are out of the plan’s service area or network.
- More recently there is the hassle of getting prior authorization for major Medical services.
How do I qualify for a new Medicare Supplement plan?
To qualify for a new Medsupp plan, you will need “No” answers to the following health questions. The language for each company’s application will be a little different, but in general, here are the most common ones.
1) In the last two years have you had or been treated for circulatory or heart disease including a heart attack, heart bypass surgery, stent placement or pacemaker implantation?
2) Have you been treated for internal cancer or melanoma in the last two years? (Does not include most skin cancers.)
3) Have you had a stroke or mini-stroke in the past two years?
4) Have you been diagnosed or treated for COPD, emphysema, or chronic bronchitis in the past two years?
5) Have you been hospitalized more than two times in the last two years?
6) Have you been diagnosed with any type of dementia, Alzheimer’s, or Parkinson’s disease? Note: One of our companies will take people with these conditions providing that there are no other major issues.
7) Do you have any planned surgeries such as joint replacement surgery of cataracts recommended to be completed in the next twelve months?
8) Do you have any auto-immune disease such as AIDs, HIV, multiple sclerosis, rheumatoid arthritis etc? (Other diseases may be included depending on the company.)
These are the major categories. A company may request additional information.
Routine prescriptions such as blood pressure, cholesterol, and type 2 diabetes meds are usually okay. Most companies have a drug decline list. Examples of what could be on such a list are opioids and many cancer related drugs. Most companies require that you list all prescription meds on your application. Certain combinations of drugs such as ones used to treat diabetes (particularly insulin) and hypertension may be a problem.
Why do we pre-qualify before applying?
If you have a medical condition that is iffy, we can shop for the company that is most likely to accept your application. For example, if we know that Company X will decline your application due to a medical condition or drug on their decline list, then applying to that company would be a waste of your time. We’ll look for a different company. Through the years, we have learned that a health issue that may not fly with one company can go through with another. For example, there is one company that does not decline Alzheimer’s disease, Parkinson’s disease, rheumatoid arthritis, or multiple sclerosis.
We are rapidly getting into our crazy time of the year as we have to go through our annual recertification process for MA and Part D prescription plans. However, we will endeavor to contact as many of you as possible by phone. Please feel free to move to the front of the line by contacting us at (208) 746-6283 or (888) 746-6285, or by email at firstname.lastname@example.org.. If you have a health situation that you believe may be an issue, contact us anyway, and we’ll see what we can do. End