@CarolynBI
Just a few corrections in what you said
MEDICAID:
You wrote: . . . .there is no medicaid for adults under 62 even if they are working, etc.
Of course people less than 62 can get Medicaid. In Federal law they can get Medicaid IF THEY ARE LOW income disabled people or elderly or blind with few assets.
The ACA only widened the scope of MEDICAID to childless, abled bodied adults that meet the (MAGI) low income threshold.
Even then most states have increased their Medicaid coverage to children under the CHIPS program and to pregnant women, some even cover the woman and the child after birth for an extended period like 12 months.
MEDIGAP plans rating options
You wrote: I have no clue what you are talking about with respect to how gap plans are rated.
Premiums for a Medigap plan can be rated in one of three ways to set the initial premiums and then as part of the increases in premiums going forward.
1. Community Rated
2. Issue Age
3. Attained Age
You wrote: I don't know how this works for the disabled under 65 either other than they eventually get medicare.
People who have been declared disabled who are less than 65 get access to Medicare after receiving a SSDI (Social Security Disability Insurance) payment for 24 months or have a diagnosis of ESRD (End Stage Renal Disease) or ALS (Lou Garrett Disease or ) for which they get immediate access to Medicare.
Federal law does NOT give people less than 65 years old access to any Medigap or Medicare Supplemental policy. So these folks are either forced into a Medicare Advantage plan to protect themselves financially OR the state where they live passes a state law giving them access to SOME Medigap plans usually Plan A and/or Plan B - which are both less than the lucrative benefits in Plan G or the others. Even when they, as disabled folks, are given access to certain Medigap plans by a state because of the high utilization they have of health care, their premiums are pretty astronomical in some states. I am talking $500 - $ 1000 a month just for a Medigap plan over and above the Medicare Part B premium.
So in many states, these disabled folks opt for a Medicare
Advantage plan to save in premium, and medical cost.
When they turn 65 years old, they get a “do-over” with Medicare and can re-enter the program under their 65 year old guaranteed issue period and enroll in a Medigap plan without underwriting under their initial Enrollment Period (IEP).
Yes, having Traditional Medicare with a lucrative Medigap plan, at present, gives a beneficiary access to a lot of providers that accept assignment or even some that have signed up as “non-participating). “Non-participating” providers can charge a beneficiary up to 15% more and some Medigap plans cover this too. Those providers who have “opted out” have to do so for a minimum of 2-years and the only way they will work with you as a Medicare beneficiary is under a contract basis - Providers who have opted out, do not bill Medicare and neither do they get any reimbursement from Medicare either. Opt-out providers are on your nickel and under contract which usually has their cost outlined.
Yes, MOST AARP/UHC Supplemental plans are community rated. However, in those states that have expand their guaranteed issue rights in some way - all of their premiums are much higher than in other states because the insurers in those states have to contend with a much higher risk.
There are (4) states where a beneficiary can pretty much sign up for a Medigap plan at any time, at any age and without underwriting - these are the states with the highest Medigap premiums - and they are all, I believe, community rated.
CT, MA, ME and NY.
Then the other states that have expanded GI rights let the beneficiary CHANGE plans without underwriting during some set time of the year. (i.e. around ones’ birthday so some of them are known as birthday rule states). Premiums are still high in these states too - CA, MO are a few of them but there are others. In these states, if one wants to switch a Medigap plan it’s has to be to an equal or lesser (in benefits) plan.
I hope I have just added to your knowledge of the program of Medicare. I do know that an Independent Medicare Plan broker in your state and area will know better than anybody else which insurers are likely to rate you during underwriting more or less leniently based on your health.
Sometimes BCBS (and perhaps others) might open up their Medigap coverage with no underwriting if they are wanting to build their Medigap business. Again, an independent Medicare plan insurance broker will be aware of these types of offerings.
Also know, you might already know this, that a Medigap insurer can refused coverage to a beneficiary outside of IEP and the surrounding period, they can also charge a beneficiary more out side of that IEP and the surrounding period, or they can not cover any preexisting condition for around 6-months.
If there is anything different in your state about Medigap plans, your state’s SHIP office or the state Dept of Insurance should know about it and they usually have it somewhere on the states website all the particulars.
Goo Luck in finding and getting the coverage that you need and want.
