FAQs about Medicare: Filling the gaps

SocialTwist Tell-a-Friend
Kimberly Lankford

Every day, my in-box is filled with questions from readers about the nuances of Medicare. The following frequently asked questions concerning signing up or changing your coverage will help you navigate the system and deal with tricky issues.

Q: Why do I need Medigap insurance?

A: Even with Medicare, you still have to pay deductibles and co-payments. Most people buy a Medicare supplement (Medigap) policy to pay those costs, plus Part D prescription-drug coverage because Medicare generally doesn’t cover drugs. Or you can sign up for a private Medicare Advantage plan, which provides both medical and drug coverage.

Medigap policies are sold by private insurers and come in 10 standardized versions (A through D; F; G; and K through N). With the coverage, you can use any doctor or facility that accepts Medicare.

Every Medigap plan with the same letter designation must provide the same coverage, even though different insurers may, and often do, charge varying prices for the same coverage. Many state insurance departments have Medigap price lists by insurer (go to www.naic.org and click “map” for links).

Part D prescription-drug plans are sold by private insurers, and have average premiums of $34 per month. You can compare premiums and out-of-pocket costs for your drugs under each Part D plan available in your area at www.medicare.gov/find-a-plan.

Medicare Advantage plans combine medical and drug coverage, and may also provide coverage that isn’t available through Medicare, such as for some dental and vision care. Premiums for Advantage plans average $38 per month, which tends to be lower than for Medigap plus Part D, but you may have more out-of-pocket costs.

Also, the plans usually have a limited network of doctors and hospitals, and you may have higher costs (or no coverage) if you choose to go out of network. You may also need a referral to see a specialist.

You can shop for a Medicare Advantage plan at www.medicare.gov/find-a-plan. For an analysis of the best values based on typical costs for people in good, fair and poor health, go to www.medicarenewswatch.com.

Q: I’ve been paying high premiums for my Medigap Plan F. Can I switch to another policy to save money?

A: Maybe. There’s a huge price range for Medigap policies, and you may be able to save by switching. But depending on your health and the state where you live, your options may be limited.

Insurers cannot reject you or charge more because of preexisting conditions if you buy a Medigap policy within six months of signing up for Medicare Part B. But after that, your health can affect your costs and coverage options. If you’re still healthy, you may qualify for a better deal with another insurer.

Some insurers will let you switch to a less-comprehensive policy without medical underwriting — for example, your current insurer may let you switch to a high-deductible Plan F, for which you pay a $2,200 deductible in 2017 before Medigap coverage kicks in. Median premiums are $610 per year for a 65-year-old man, compared with $2,184 for the standard Plan F, according to Weiss Ratings.

Plan N has coverage similar to that of standard Plan F, but you pay the Part B deductible ($183 in 2017) and a $20 co-payment for each physician visit, as well as $50 for emergency-room visits. Median premiums are $1,448 per year.

Your state may offer special opportunities to switch, regardless of preexisting conditions. However, Maryland, Virginia and the District of Columbia do not have additional switching rules.

(Learn more from your state health insurance assistance program at www.shiptacenter.org, or call 1-800-633-4227 for contacts.)

Q: The doctor I want to use isn’t covered by my Medicare Advantage plan. When can I switch to a different plan?

A: You generally can’t switch to another Medicare Advantage plan until open enrollment in the fall, which runs from Oct. 15 to Dec. 7, 2017, for 2018 coverage. There are a few exceptions: You can switch plans if you qualify for a special enrollment period, such as if you move to an address that isn’t in your plan’s service area.

You can also switch to a Medicare Advantage plan with a five-star quality rating anytime during the year. But there are only 17 five-star plans in the U.S. in 2017. Locally, these include Kaiser Permanente Medicare Plus and Erickson Advantage Freedom (available only to residents of Erickson retirement communities). You can look up “Medicare health plans” by zip code at www.medicare.gov/find-a-plan. 

If you join a Medicare Advantage plan when you are first eligible for Medicare and switch back to traditional Medicare within 12 months, you can buy a Medigap policy and a Part D plan within 63 days of the change.

Each year from Jan. 1 to Feb. 14, you can switch from Medicare Advantage back to traditional Medicare and get a Part D drug plan. But you could be rejected or charged more for Medigap because of a preexisting condition. For more about the rules, see Medicare Interactive at www.medicareinteractive.org.

© 2017, Kiplinger. All Rights Reserved. Distributed By Tribune Content Agency, LLC.