Category: Medigap

Medicare’s Open Enrollment Is Open Season for Scammers

By Susan Jaffe  | Kaiser Health News | November 11, 2021 | This KHN story also ran in The Washington Post.

Finding the best private Medicare drug or medical insurance plan among dozens of choices is tough enough without throwing misleading sales tactics into the mix.  Yet federal officials say complaints are rising from seniors tricked into buying policies — without their consent or lured based on questionable information — that may not cover their drugs or include their doctors.

In response, the Centers for Medicare and Medicaid Services has threatened to penalize private insurance companies selling Medicare Advantage and drug plans if they or agents working on their behalf mislead consumers.  The agency has also revised rules making it easier for beneficiaries to escape plans they didn’t sign up for or enrolled in only to discover promised benefits didn’t exist or they couldn’t see their providers.

The problems are especially prevalent during Medicare’s open-enrollment period, which began Oct. 15 and runs through Dec. 7. A common trap begins with a phone call like the one Linda Heimer, an Iowa resident, received in October. [Full story in The Washington Post and Kaiser Health News.] 

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Under New Cost-Cutting Medicare Rule, Same Surgery, Same Place, Different Bill

By Susan Jaffe  | Kaiser Health News | March 21, 2021 | This KHN story also ran in The Washington Post

For years, Medicare officials considered some surgeries so risky for older adults that that the insurance program would cover the procedures only for patients admitted to the hospital. Under a new Medicare policy that took effect this year, these operations can be provided to patients who are not admitted. But patients still have to go to the hospital. The change saves Medicare money while patients can pay a larger share of the bill — for the same surgery at the same hospital.  [Full story in The Washington Post and Kaiser Health News.] 

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As Medicare Enrollment Nears, Popular Price Comparison Tool Is Missing

By Susan Jaffe  | Kaiser Health News | October 8, 2019 | This article also ran in the

Millions of older adults can start signing up next week for private policies offering Medicare drug and medical coverage for 2020. But many risk wasting money and even jeopardizing their health care due to changes in Medicare’s plan finder, its most popular website. 

 For more than a decade, beneficiaries used the plan finder to compare dozens of Medicare policies offered by competing insurance companies and get a list of their options. Yet after a website redesign six weeks ago, the search results are missing crucial details: How much will you pay out-of-pocket? And which plan offers the best value?  [Continued at Kaiser Health News, San Francisco

 Chronicle  Chicago Tribune and The Seattle Times]…

A Few Pointers To Help Save Money And Avoid The Strain Of Medicare Enrollment

By Susan Jaffe | Kaiser Health News | Oct. 17, 2017 | This article also ran in   and 

Older or disabled Americans with Medicare coverage have probably noticed an uptick in mail solicitations from health insurance companies, which can mean only one thing: It’s time for the annual Medicare open enrollment.

Most beneficiaries have from Oct. 15 through Dec. 7 to decide which of dozens of private plans offer the best drug coverage for 2018 or whether it’s better to leave traditional Medicare and get a drug and medical combo policy called Medicare Advantage.

Some tips for the novice and reminders for those who have been here before can make the process a little easier. [Continued at Kaiser Health News, USA Today and The Washington Post]

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Buying Supplemental Insurance Can Be Hard For Younger Medicare Beneficiaries

By Susan Jaffe | February 3,  2016 | Kaiser Health News in collaboration with Money magazine

Danny Thompson’s kidneys have failed and he needs a transplant but in some ways, he’s lucky: Both of his sons want to give him one of theirs, and his Medicare coverage will take care of most his expenses.

Danny Thompson    (Heidi de Marco/KHN) 

Yet the 53-year-old Californian is facing another daunting obstacle: He doesn’t

have the money for his share of the medical bills and follow-up drugs, and he can’t buy supplemental insurance to help cover his costs.

“It’s frustrating to be in the shape I’m in,” said Thompson, who depends on dialysis instead of his kidneys to cleanse his blood. “My plan is to get a transplant so I can go back to work.”

Almost one in four Medicare beneficiaries has such a policy, known as Medigap, which is sold by private insurance companies. It can help pay for costs Medicare doesn’t cover, including the 20 percent coinsurance required for medical expenses, including certain drugs, plus deductibles and co-payments. Those expenses have no out-of-pocket limit for beneficiaries.

Money cover

This KHN story also ran on Money.

Federal law requires companies to sell Medigap plans to any Medicare beneficiary aged 65 or older within six months of signing up for Part B, which covers doctor visits and other outpatient services. If they sign up during this guaranteed open enrollment, they cannot be charged higher premiums due to their medical conditions.

But Congress left it to states to determine whether Medigap plans are sold to the more than 9 million people younger than 65 years old who qualify for Medicare because of a disability. [Continued in Kaiser Health News or Money magazine.]…

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Insurance Commissioners Reject Calls To Limit Seniors’ Medigap Policies

By Susan Jaffe  KAISER HEALTH NEWS in collaboration with      Dec. 6, 2012

The nation’s insurance commissioners have some stern advice about proposals to shrink Medicare spending by asking seniors with supplemental Medigap policies to pay more out of pocket for their health care: Don’t do it.

The health law requires the National Association of Insurance Commissioners to advise the administration about whether seniors would use fewer Medicare services — and therefore, cost the government less money — if the most popular Medigap plans were less generous.

“Everything we’ve looked at has shown that increasing cost-sharing does stop people from seeking medical care,” said Bonnie Burns, a training and policy specialist at California Health Advocates who serves on an NAIC committee that has studied the issue for more than a year. “The problem is they stop using both necessary and unnecessary care.” [More in The Washington Post] or longer version from Kaiser Health News]

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Officials Looking To Cut Federal Spending Eye Medigap Policies

By Susan Jaffe  KAISER HEALTH NEWS in collaboration with      Nov. 21, 2011

Margaret Fisher is among the millions of seniors with private, supplemental health insurance that takes care of most of the medical bills Medicare doesn’t cover. If she has a health crisis, she reasons, it won’t become a financial crisis, too.

But officials looking for ways to cut the federal deficit are suggesting that these Medigap policies help explain why the government’s Medicare bill is rising so fast. If these private policies were less generous, they figure, seniors might reduce their trips to the doctor or find cheaper care, which in turn would save the government money.Fisher, 86, a cancer survivor   from Gaithersburg who has had two hip replacements, says that strategy could backfire… [Continued on Kaiser Health News and in The Washington Post]

Younger, Disabled Medicare Beneficiaries Have Trouble Getting Supplementary Insurance

By Susan Jaffe   KAISER HEALTH NEWS  | March 7, 2011   This story was produced in collaboration with  

Joe Hobson, 63, crosses the street in front of his Arlington apartment. (Jessica Marcy / Kaiser Health News).

One night three years ago, Joe Hobson finished reading a book, went to sleep and woke up blind. The problem,a rare hereditary disease, forced him to give up his 20-year communications job, along withits generous health insurance. Now 63, the Arlington man is covered by Medicare, the federal program for elderly and disabled Americans.

Like many people with Medicare, Hobson would like to buy supplemental, or Medigap, insurance to help cover his out-of-pocket costs, such as co-payments and deductibles. But Medigap prices can be prohibitive for disabled beneficiaries younger than 65. The cheapest plan for such people in Northern Virginia is $338 a month, according to Brad Rothermel,an Annandale insurance agent who has helped Hobson look for a policy. That’s three times the premium of a plan with much better benefits that is available to a 65-year-old. And the private insurers that offer Medigap policies are free to reject Hobson or charge him extra because of his preexisting health conditions.[Continued in KHN]  andin The Washington Post]

 

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