My husband and I need to pick a Medigap plan and a company. We wanted to go with the G plan, but the representative for Aetna told us that we could only use plan F because my diabetes. I hesitate to call anyone else, because of medical underwriting.
So, I am wondering if anyone found a company that didn’t require medical underwriting for plan G. We don’t mind using plan F but it is more expensive.
I will start MC next year, so have been learning lots.
Here is info I found on F and G plans, although not quite what you asked.
Thanks MM1, but my husband and I have been reading about plans and that is why we wanted to go with G. It costs less.
I am just wandering if others are denied plan G, because of the medical underwriting, The companies know that diabetes can be very expensive, so they automatically turn us down. I guess I should just be glad that F is good too.
You are smart to be researching Medicare before you need it.
Marilyn, I know that you’ve been Medicare age (65) for several years now. Have you been covered by a supplemental plan already? If so, what plan is it? (Rereading your post more carefully, it is probably the Plan F offered by Aetna.)
Most states do not allow Medigap Plan switching without passing medical underwriting. Some states (seven, I believe) permit switching without underwriting under an arrangement known as the “birthday rule.” The 'birthday rule': a gift to Medigap enrollees? | medicareresources.org
- California: You have 60 days from the first day of your birth month to change to another Medigap plan with the same level or a lower level of benefits. You can also change insurance carriers during this time. This is an updated birthday rule that took effect on January 1, 2020. Prior to that the special enrollment period was only 30 days long.
- Idaho: You have 63 days from your birthday to change to another Medigap plan with the same level or a lower level of benefits. You can also change insurance carriers. This birthday rule starts on March 1, 2022.
- Illinois: You have 45 days from your birthday to change to another Medigap plan with the same level or a lower level of benefits. This only applies to plans with your current insurance carrier. To qualify for this birthday rule, you must be 65 to 75 years old. This birthday rule took effect on January 1, 2022.
- Oregon: You have 30 days from the first day of your birth month to change to another Medigap plan with the same level or a lower level of benefits. You can also change insurance carriers. This birthday rule took effect on January 1, 2013.
- Nevada: You have 60 days from the first day of your birth month to change to another Medigap plan with the same level or a lower level of benefits. You can also change insurance carriers. This birthday rule took effect on January 1, 2022.
- Louisiana: You have 63 days from the date of your birthday to select a different Medigap plan with equal or lesser benefits. This only applies to plans with your current insurance carrier. (Legislation under consideration in 2023 would extend this to include affiliates of your current insurer.)
- Kentucky (effective starting in 2024): Legislation enacted in 2023, allows a Medigap enrollee to switch to another insurer’s Medigap policy (same benefits as the plan they already have) within 60 days of their birthday.
If you live in one of these states, you may want to take advantage of these birthday rules as long as you understand how they work.
When I first signed up for Medicare supplemental insurance, I chose a G plan offered by United Heath Care AARP. After a few years, I did not like the pricing trend and wanted to shift to another company’s supplemental Plan G. I did so, avoiding medical underwriting, using Oregon’s birthday rule.
If I were you, I would seek out the help of a SHIBA (senior health insurance benefits assistance) counselor before making any changes. SHIBA is non-profit unbiased advice that is available in every state. There is plenty of bad advice out there during the annual Medicare open enrollment period. Pressure tactics are often used. The big money of Medicare Advantage plans induces agents to get you to switch!
I am sorry Terry, I should have been more explicit. For the last few years we have only had Medicare A and B, because we were using a state medical plan which my husband could continue to use after retiring from the University. It is an excellent plan that we have used for almost 50 yrs.
This year the premiums have risen to $1,100 a month for the two of us and we don’t want to pay that much. We have talked with two people who have taken the training to consult with people who are choosing Medicare plans. Both have said that we could start a Medigap plan. We have just received two different answers about whether we could use plan G.
Thanks for suggesting that we talk with a SHIB counselor. We will do that on Friday. The first advisor we talked to dislikes the Advantage Plans and was happy that we didn’t want to use them. He was actually pushing the G plan.
I read through all the information that you posted earlier and found it to be very helpful. I have also watched several YouTube videos. Thanks for your help! I really appreciate it.
With your situation, you may still be in the “special enrollment period” that people qualify for when they are first eligible. That may mean that you are under “guaranteed issue” and medical underwriting does not apply.
All these rules are just complicated enough and the consequences are economically substantial that good unbiased advice is important. I suspect that you can select a plan G if you want. It may also mean that you could select a Plan N. Again, you are best advised to “measure twice and cut once.”
A SHIBA counselor will definitely know the answers to your specific and uncommon situation. Please let us know how it turns out.
I pay about $155/month for my plan G in which premiums are determined upon attained age (controlled by state law). I’m 70.
F is no longer available unless you were already on Medicare 2 years ago, but new people can’t choose thst plan anymore.
That alone makes me think it’s worth having. I won’t have that option when I retire, but likely the plans will all change by the time I turn 65 in 7 years
All of the medigap or supplemental plans are privately insured. So they get to make their own rules, some states have passed laws that allow changes around your birthday. But they can insist on underwriting if they want to.
I got life insurance by going through underwriting. I had a nurse show up at my home to check my weight and waist measurements. They checked my cholesterol and a1c and lipid. I needed to give access to my medical records to look at my prescriptions and diagnosis’.
It was a lot but it was the only way I could get life insurance. I was accepted a a very good rate, just one tick above the average non diabetic,but now that I’m older and still diabetic,the rates are not worth it. And in reality, we don’t need it anymore, my daughter is grown, houses are paid off…
I wonder if they have an underwriting process thst assess your actual health in an attempt to be underwritten.
It’s a really difficult decision, because those plans limit you in some ways. I was thinking I would just go w Medicare part b and d and pay the copays, but I also realize it’s not that simple.
Right now I’m in good health except for diabetes, we really don’t have much in the way of medical bills.
I have private insurance right now. I just finished treatment for cancer. I had it when I was 26 and it came back. This time it was pretty easy. I had some infusions of non chemo meds, and I had a few radiation treatments. No surgery like I had 30 years ago.
I bet this would have been much more expensive if I was on Medicare… I only paid $350 for the whole process with my private insurance.
If I had to pay 20% of the scans and radiation treatments, I assume that would be 10 thousand dollars.
So I have 7 years to figure this all out. I’m not looking forward to it.
Hi Timothy. We have been enrolled in Medicare for quite a few years now, so I think we can choose plan F.
When I mentioned that I take insulin, I was told that I would be rejected by most or all of the companies. We are also 74 and 72.
At our age we definitely need supplemental insurance. My husband just had a knee replaced and that was very expensive. You have a few years to see if you think you will need a plan to pay the 20%.
I am so glad that you are cancer free again!
I wonder how the rules will change in 7 years.
True – all the supplemental insurers can and do set the prices of their policies but the coverage that they offer is standardized. What does this mean?
All Medigap policies are standardized. This means, they offer the same basic benefits no matter where you live or which insurance company you buy the policy from. There are 10 different types of Medigap plans offered in most states, which are named by letters: A-D, F, G, and K-N. Price is the only difference between plans with the same letter that are sold by different insurance companies. What else should I know about these lettered plans?
In some states, you may be able to buy another type of Medigap policy called
Medicare SELECT
. If you buy a Medicare SELECT policy, you have the right to change your mind within 12 months and switch to a standard Medigap policy.
Important: In Massachusetts, Minnesota, and Wisconsin, Medigap policies are standardized in a different way.
Every Medigap policy must follow federal and state laws designed to protect you. It’s important to watch out for illegal practices by insurance companies, and protect yourself when you’re shopping for a Medigap policy.
The above is copied from Medicare.gov.
This standardization permits consumers to make rational comparisons and selections.
By the way, Happy Thanksgiving!
Last night a United Healthcare agent called unexpectedly. I asked about medical underwriting and he said that taking insulin doesn’t mean I wouldn’t be able to get a plan. Then he asked if I have any more health issues. I was surprised and replied no. This morning I am finding that uproariously funny. No, I am 72, a type 1 diabetic for 64 years and am fit as a fiddle. What a joke. I didn’t mention that my husband has had cancer 5 times. Not a chance either of us could pass medical underwriting.
I wonder if this is really true or to what extent it may be true. I don’t think it can be true for type 1 diabetics. Maybe there is an awareness among the insurance companies that some T2Ds successfully get and stay off insulin. Maybe some small percentage of insurance plans allow some insulin using diabetics, maybe paying very high premiums, to secure supplemental policies.
I suspect that some insurance companies may leave the door open a crack to gaining this insurance but they likely let very few to no one through it. I don’t know the actual answer to this question but I am aware of the money-dominated characteristic of these companies.
I watched a YouTube video this morning all about medical underwriting. The speaker said that 80% of people undergoing medical underwriting pass and can get Medigap policies. But, it you are a diabetic taking more than 50 units of insulin that disqualifies you. I take 17 units so that wouldn’t be a problem, but you can’t take more than 2 kinds of insulin. I take three because I also use Afreeza. You can’t
be taking blood pressure meds which I do.
So, even though I have never been hospitalized because of diabetes, I guess I am disqualified.
Also if you have been treated for cancer within the last 2 yrs, you don’t pass. They also look at any medication you might have taken in the last two years. My husband is healthy, but he is being treated for skin cancer at the moment. His last three cancers have been skin cancer, with much more serious cancers in the past.
I have a call into the woman from Aetna who said that we can be covered under policy F. I also am trying to talk to a SHIBA representative.
Signed up for a plan F policy a few minutes ago. Relieved
So, you eventually decided to get the Plan F over the Plan G that you were considering earlier. Both are good choices.
Now we found out that the prescription plan will cost hundreds a month. Our insurance guy here had said it would be less than 10.00 a month. So confusing.
Marilyn, You can use the Medicare.gov website, show the exact list of Rx’s and pharmacies that you prefer and discover the best value for you. Remember that you needn’t include your Part B Rx supplies like the Dexcom on that list.
In the end, original Medicare with a supplement and an Rx plan leaves you in charge. With the “advantage” plans you would have to wait for prior approvals for almost any treatment or test.
I’ve T1D and switched from a G to a F Plan last year - but not for the coverage or the premium.
There is no financial benefit to using one company’s basic Plan B Supplement Plan over another besides the premiums you pay. Premiums vary between companies but the coverages are identical for all basic type F Plans and all type G plans. If your doctors accepts Medicare, they get paid the same. Medicare forwards the approved copay charges to the supplement carrier (which is 20% for both F and G.)
Medicare is phasing out Plan F in a misguided attempt to to “motivate” people to see doctors less often. The only difference between F and G is the annual deductible. It’s included in the Plan F premium, not the plan G premium so for a given carrier Plan G premium should be ~$20/mo cheaper than Plan F in 2024.
That is the only difference, and 2-3 visits are enough to cover the Part B $240 deductible. After that there are no more uncovered Part B charges.
Only if you are switching from an Advantage Plan to regular Medicare, may carriers require you to qualify for a Medicare B Supplement.
Unless you were previously enrolled in a Medicare “Advantage” (Part C) plan, there are NO pre-existing condition restrictions on what Part B Supplement plan you can enroll in. If you weren’t I’d suggest you use the Medicare.gov site to compare premiums and sign up. (You may find that Plan F isn’t available to you. )
Some companies add on “features” like discounts for preventive dental care and eye exams - gimmicks to get you to go to doctors in their network who seem to always find something that isn’t “preventive” care, and for which you pay a "discounted price.
Some companies, like Blue Cross Blue Shield have G “Select” Plans. If you are hospitalized at one of their “select” hospitals, the plan will cover the Part A deductible. In my region every major hospital is “select”.
Personally, I like the medicare.gov site and the annual booklet I’m sent in September. I have yet to have a question that these didn’t answer more clearly and unambiguously than any rep - in writing.
I’m skeptical about all insurance company representatives. The ones who are the employees of those companies are biased. The ones who are independent insurance reps are paid by the insurance companies to sell you their plans even though it doesn’t affect your premiums.
We went to Medicare.gov several times in our search for advice. We too found the site to be quite helpful. We have had Medicare A and B for years. Because we were going from a state plan that we have have been using we were able to get a Medicare plan. We ended up with plan F so that we wouldn’t have to undergo medical underwriting. We both would have been turned down.
We are quite satisfied with F and with the prescription plan that we ended up choosing. It was a steep learning curve, but we came out happy with our choices.
I strongly suggest you do due diligence regarding Advantage plans. More and more info is emergiing about their over reliance on prior authorization (even requiring PA’s for refills on insulin for peple with a confirmed Dx of T1D - and limiting the refill to their definition of 30 days worth). MA plans are quick to hit the denial button. And audits are revealing that the MA plans overcharge Medicare for the “services” rendered - some have charged Medicare for tests/procedures/care not provided to a patient. I was glad to see this post - we are looking for coverage for my partner to supplement his Medicare. Even though I am a health policy nerd, I wasn’t aware of the Plans "further down the alphabet - beyond Part D). MA plans may work well for those without expensive/chronic medical issues - but for those of us who do have ongoing medcial expenses - watch out
We decided to not even look at the Advantage Plans, because if needed we may want to go out of our area to get medical care. We don’t want anyone telling us that we can’t use a certain doctor or hospital. We like as much freedom as possible regarding our health.
We are comfortable with the F plan and liked the G plan also.
I hope that you and your partner find a plan that works for him.
Thanks for the warning.