Medicare / disability coverage with gap insurance

[jrm105]

I am going to be eligible for Disability Medicare in next few months and am fairly confused over gap insurance vs Advantage plans. I currently live in NJ and this state has some wonderful rules that help folks with pre-existing conditions get insurance without any extra fees or being turned down. But I want to move out of state.....

I currently have an individual HMO plan that is getting very costly since I turned 50. I am anxious to get on Medicare but it seems getting a gap policy is not an automatic when you are under 65.

From what I can understand gap insurance still has pre-existing conditions when under 65. Advantage plans I am not sure what their rules are, they seem to vary state to state.

Are you guaranteed coverage to an Advantage Plan in any state? I don't exactly know what state I am moving to but it most likely will be NC, SC, NV or AZ. Is there any chart that shows state by state what the rules are for gap insurance?

Also do Advantage plans have limits on procedures? For example my current plan has a total of 60 days of physical therapy for lifetime per condition.

My reply is also very late and perhaps you have your answers. I hope my response will help you and others who might find themselves with the same questions.

If you are moving onto Medicare through Disability and moving to SC (pretty much any state actually) you will be given an opportunity by Medicare to enroll in any plan you want that is in the SERVICE AREA you move to. Generally service area means the county you live in. You can go to the official web site called: www.Medicare.gov and there you will find plenty of information including the ability to go to a particular zip code and see what Medicare Advantage Plans, Drug plans and Medicare supplements are available.

You indicated you are in your 50's. You will find in SC that your age will limit the Medicare supplement available to you. HOWEVER. the good news is that you will be allowed to enroll in ANY Medicare Advantage Plan in your service area, so long as you do not have End stage renal disease. In SC there are a number of good plans but not all are available in every county. (once you are enrolled it is good all over the United States) You simply have to live in a service county to enroll in it. An MAPD plan offers drug coverage inside the plan itself so that you don't have to spend extra money getting a drug plan and the really good news is that most MAPD plans are very reasonable, including some with a zero premium and yes, they are full plans offering everything the law requires them to do and more. Med supp plans when under 65 are not the best deal in town but a Medicare Advantage Plan has NO pre-existing conditions other than ERSD and that one will keep you off most plans. Once you enroll you have full coverage no pre-existing conditions allowed. As you may have surmised I am an insurance agent and so have a greater than average knowledge of these plans.

So, if you want to move to SC come on down! We will be glad to have you join us.

I thought once you were enrolled in a Medicare Supplement plan it would carry forward to any state. It's the Medicare Advantage plans that I understood you need to reapply depending on where you move.


Not quite. Fore instance, if you are what we call a snowbird - that is someone who comes South for the winter but who stays no longer than that and does NOT make SC your legal residence then you can keep the Medicare Supp or Medicare Advantage or part D that you purchased in your home state. However, if you leave one state and take up permanent residence in another state then you must call your health plan and inform them that you have moved. If it is a Medicare Supp and that plan writes the plan you have - say plan F then you can most generally keep it but with a premium adjustment up or down depending on health costs in the state you have moved to. If it is a Medicare Advantage Plan you must call the plan to ask if they service that area and if they do you can either keep the plan you have if it is available or enroll in ANY plan in that service area through a Medicare special enrollment period (SEP). Premiums can go up or down depending on what the cost is for that area. Basic difference is that if you have to change companies or plans on a med supp you have to go through underwriting and may be turned down while, for a Med. Advantage you can enroll in any plan available in the service area or keep the one you have it is available - though the cost could change.
Hope this helps

 

[flyfoam]

I am going to be eligible for Disability Medicare in next few months and am fairly confused over gap insurance vs Advantage plans. I currently live in NJ and this state has some wonderful rules that help folks with pre-existing conditions get insurance without any extra fees or being turned down. But I want to move out of state.....

I currently have an individual HMO plan that is getting very costly since I turned 50. I am anxious to get on Medicare but it seems getting a gap policy is not an automatic when you are under 65.

From what I can understand gap insurance still has pre-existing conditions when under 65. Advantage plans I am not sure what their rules are, they seem to vary state to state.

Are you guaranteed coverage to an Advantage Plan in any state? I don't exactly know what state I am moving to but it most likely will be NC, SC, NV or AZ. Is there any chart that shows state by state what the rules are for gap insurance?

Also do Advantage plans have limits on procedures? For example my current plan has a total of 60 days of physical therapy for lifetime per condition.

My reply is also very late and perhaps you have your answers. I hope my response will help you and others who might find themselves with the same questions.

If you are moving onto Medicare through Disability and moving to SC (pretty much any state actually) you will be given an opportunity by Medicare to enroll in any plan you want that is in the SERVICE AREA you move to. Generally service area means the county you live in. You can go to the official web site called: www.Medicare.gov and there you will find plenty of information including the ability to go to a particular zip code and see what Medicare Advantage Plans, Drug plans and Medicare supplements are available.

You indicated you are in your 50's. You will find in SC that your age will limit the Medicare supplement available to you. HOWEVER. the good news is that you will be allowed to enroll in ANY Medicare Advantage Plan in your service area, so long as you do not have End stage renal disease. In SC there are a number of good plans but not all are available in every county. (once you are enrolled it is good all over the United States) You simply have to live in a service county to enroll in it. An MAPD plan offers drug coverage inside the plan itself so that you don't have to spend extra money getting a drug plan and the really good news is that most MAPD plans are very reasonable, including some with a zero premium and yes, they are full plans offering everything the law requires them to do and more. Med supp plans when under 65 are not the best deal in town but a Medicare Advantage Plan has NO pre-existing conditions other than ERSD and that one will keep you off most plans. Once you enroll you have full coverage no pre-existing conditions allowed. As you may have surmised I am an insurance agent and so have a greater than average knowledge of these plans.

So, if you want to move to SC come on down! We will be glad to have you join us.

I thought once you were enrolled in a Medicare Supplement plan it would carry forward to any state. It's the Medicare Advantage plans that I understood you need to reapply depending on where you move.


Not quite. Fore instance, if you are what we call a snowbird - that is someone who comes South for the winter but who stays no longer than that and does NOT make SC your legal residence then you can keep the Medicare Supp or Medicare Advantage or part D that you purchased in your home state. However, if you leave one state and take up permanent residence in another state then you must call your health plan and inform them that you have moved. If it is a Medicare Supp and that plan writes the plan you have - say plan F then you can most generally keep it but with a premium adjustment up or down depending on health costs in the state you have moved to. If it is a Medicare Advantage Plan you must call the plan to ask if they service that area and if they do you can either keep the plan you have if it is available or enroll in ANY plan in that service area through a Medicare special enrollment period (SEP). Premiums can go up or down depending on what the cost is for that area. Basic difference is that if you have to change companies or plans on a med supp you have to go through underwriting and may be turned down while, for a Med. Advantage you can enroll in any plan available in the service area or keep the one you have it is available - though the cost could change.
Hope this helps

In my case I am looking to sell my home in NJ and move to SC. I have an AARP United Health Care Plan C. I understand the rate would change but otherwise there should be no other issues?

 

[jrm105]

I am going to be eligible for Disability Medicare in next few months and am fairly confused over gap insurance vs Advantage plans. I currently live in NJ and this state has some wonderful rules that help folks with pre-existing conditions get insurance without any extra fees or being turned down. But I want to move out of state.....

I currently have an individual HMO plan that is getting very costly since I turned 50. I am anxious to get on Medicare but it seems getting a gap policy is not an automatic when you are under 65.

From what I can understand gap insurance still has pre-existing conditions when under 65. Advantage plans I am not sure what their rules are, they seem to vary state to state.

Are you guaranteed coverage to an Advantage Plan in any state? I don't exactly know what state I am moving to but it most likely will be NC, SC, NV or AZ. Is there any chart that shows state by state what the rules are for gap insurance?

Also do Advantage plans have limits on procedures? For example my current plan has a total of 60 days of physical therapy for lifetime per condition.

My reply is also very late and perhaps you have your answers. I hope my response will help you and others who might find themselves with the same questions.

If you are moving onto Medicare through Disability and moving to SC (pretty much any state actually) you will be given an opportunity by Medicare to enroll in any plan you want that is in the SERVICE AREA you move to. Generally service area means the county you live in. You can go to the official web site called: www.Medicare.gov and there you will find plenty of information including the ability to go to a particular zip code and see what Medicare Advantage Plans, Drug plans and Medicare supplements are available.

You indicated you are in your 50's. You will find in SC that your age will limit the Medicare supplement available to you. HOWEVER. the good news is that you will be allowed to enroll in ANY Medicare Advantage Plan in your service area, so long as you do not have End stage renal disease. In SC there are a number of good plans but not all are available in every county. (once you are enrolled it is good all over the United States) You simply have to live in a service county to enroll in it. An MAPD plan offers drug coverage inside the plan itself so that you don't have to spend extra money getting a drug plan and the really good news is that most MAPD plans are very reasonable, including some with a zero premium and yes, they are full plans offering everything the law requires them to do and more. Med supp plans when under 65 are not the best deal in town but a Medicare Advantage Plan has NO pre-existing conditions other than ERSD and that one will keep you off most plans. Once you enroll you have full coverage no pre-existing conditions allowed. As you may have surmised I am an insurance agent and so have a greater than average knowledge of these plans.

So, if you want to move to SC come on down! We will be glad to have you join us.

I thought once you were enrolled in a Medicare Supplement plan it would carry forward to any state. It's the Medicare Advantage plans that I understood you need to reapply depending on where you move.


Not quite. Fore instance, if you are what we call a snowbird - that is someone who comes South for the winter but who stays no longer than that and does NOT make SC your legal residence then you can keep the Medicare Supp or Medicare Advantage or part D that you purchased in your home state. However, if you leave one state and take up permanent residence in another state then you must call your health plan and inform them that you have moved. If it is a Medicare Supp and that plan writes the plan you have - say plan F then you can most generally keep it but with a premium adjustment up or down depending on health costs in the state you have moved to. If it is a Medicare Advantage Plan you must call the plan to ask if they service that area and if they do you can either keep the plan you have if it is available or enroll in ANY plan in that service area through a Medicare special enrollment period (SEP). Premiums can go up or down depending on what the cost is for that area. Basic difference is that if you have to change companies or plans on a med supp you have to go through underwriting and may be turned down while, for a Med. Advantage you can enroll in any plan available in the service area or keep the one you have it is available - though the cost could change.
Hope this helps

In my case I am looking to sell my home in NJ and move to SC. I have an AARP United Health Care Plan C. I understand the rate would change but otherwise there should be no other issues?


Had to do some checking before I opened my mouth so to speak. SC does offer a Plan C BUT not for people under 65. So, yes you would have to change and that might not be possible depending on your health

 

[flyfoam]

I thought once you were enrolled in a Medicare Supplement plan it would carry forward to any state. It's the Medicare Advantage plans that I understood you need to reapply depending on where you move.


Not quite. Fore instance, if you are what we call a snowbird - that is someone who comes South for the winter but who stays no longer than that and does NOT make SC your legal residence then you can keep the Medicare Supp or Medicare Advantage or part D that you purchased in your home state. However, if you leave one state and take up permanent residence in another state then you must call your health plan and inform them that you have moved. If it is a Medicare Supp and that plan writes the plan you have - say plan F then you can most generally keep it but with a premium adjustment up or down depending on health costs in the state you have moved to. If it is a Medicare Advantage Plan you must call the plan to ask if they service that area and if they do you can either keep the plan you have if it is available or enroll in ANY plan in that service area through a Medicare special enrollment period (SEP). Premiums can go up or down depending on what the cost is for that area. Basic difference is that if you have to change companies or plans on a med supp you have to go through underwriting and may be turned down while, for a Med. Advantage you can enroll in any plan available in the service area or keep the one you have it is available - though the cost could change.
Hope this helps

In my case I am looking to sell my home in NJ and move to SC. I have an AARP United Health Care Plan C. I understand the rate would change but otherwise there should be no other issues?


Had to do some checking before I opened my mouth so to speak. SC does offer a Plan C BUT not for people under 65. So, yes you would have to change and that might not be possible depending on your health

Are you sure that's not for new people applying? I was told once you are in a Medicare Plan C it carries with you anywhere you go in the USA.

 

[jrm105]

I thought once you were enrolled in a Medicare Supplement plan it would carry forward to any state. It's the Medicare Advantage plans that I understood you need to reapply depending on where you move.


Not quite. Fore instance, if you are what we call a snowbird - that is someone who comes South for the winter but who stays no longer than that and does NOT make SC your legal residence then you can keep the Medicare Supp or Medicare Advantage or part D that you purchased in your home state. However, if you leave one state and take up permanent residence in another state then you must call your health plan and inform them that you have moved. If it is a Medicare Supp and that plan writes the plan you have - say plan F then you can most generally keep it but with a premium adjustment up or down depending on health costs in the state you have moved to. If it is a Medicare Advantage Plan you must call the plan to ask if they service that area and if they do you can either keep the plan you have if it is available or enroll in ANY plan in that service area through a Medicare special enrollment period (SEP). Premiums can go up or down depending on what the cost is for that area. Basic difference is that if you have to change companies or plans on a med supp you have to go through underwriting and may be turned down while, for a Med. Advantage you can enroll in any plan available in the service area or keep the one you have it is available - though the cost could change.
Hope this helps

In my case I am looking to sell my home in NJ and move to SC. I have an AARP United Health Care Plan C. I understand the rate would change but otherwise there should be no other issues?


Had to do some checking before I opened my mouth so to speak. SC does offer a Plan C BUT not for people under 65. So, yes you would have to change and that might not be possible depending on your health

Are you sure that's not for new people applying? I was told once you are in a Medicare Plan C it carries with you anywhere you go in the USA.

Sorry, there is no Plan c with AARP United Health for people under 65 in SC. If you move here you will not be allowed to keep that plan and will have to choose a different means of getting your benefits . We do have some really good MAPD plans. I have verified this three different ways and I have been doing this for almost 30 years and so I am pretty confident of my answer.

 

[flyfoam]

In my case I am looking to sell my home in NJ and move to SC. I have an AARP United Health Care Plan C. I understand the rate would change but otherwise there should be no other issues?


Had to do some checking before I opened my mouth so to speak. SC does offer a Plan C BUT not for people under 65. So, yes you would have to change and that might not be possible depending on your health

Are you sure that's not for new people applying? I was told once you are in a Medicare Plan C it carries with you anywhere you go in the USA.

Sorry, there is no Plan c with AARP United Health for people under 65 in SC. If you move here you will not be allowed to keep that plan and will have to choose a different means of getting your benefits . We do have some really good MAPD plans. I have verified this three different ways and I have been doing this for almost 30 years and so I am pretty confident of my answer.

I moved to SC and was able to keep my Plan C with AARP United. As the guide points out you can keep your plan when you move.

 

[mattspits]

Thanks for updating this and confirming that you were able to keep your med supp. I had never heard of anyone moving and having to Change med supp plans!

 

[bobbybrock]

I am going to be eligible for Disability Medicare in next few months and am fairly confused over gap insurance vs Advantage plans. I currently live in NJ and this state has some wonderful rules that help folks with pre-existing conditions get insurance without any extra fees or being turned down. But I want to move out of state.....

I currently have an individual HMO plan that is getting very costly since I turned 50. I am anxious to get on Medicare but it seems getting a gap policy is not an automatic when you are under 65.

From what I can understand gap insurance still has pre-existing conditions when under 65. Advantage plans I am not sure what their rules are, they seem to vary state to state.

Are you guaranteed coverage to an Advantage Plan in any state? I don't exactly know what state I am moving to but it most likely will be NC, SC, NV or AZ. Is there any chart that shows state by state what the rules are for gap insurance?

Also do Advantage plans have limits on procedures? For example my current plan has a total of 60 days of physical therapy for lifetime per condition.

Hello Flyfoam. If you are confused you are not alone. Many people are confused about the difference in medigap and medicare advantage. Here is the difference.

Medicare Advantage is another way for you to receive your Part A and B benefits.

You have a choice: Original Medicare or Medicare Advantage. Both contain Part A & B benefits. The difference is in the gaps: The gaps are deductibles, copays and coinsurance.

Example:

Original Medicare Part A (in-patient): The benefit period is a 60 day benefit period. The deductible of $1184.00 is charged on the first day of your hospital stay. That's all of the Medicare approved charges you are responsible for during the first 60 days. The $1184 is the gap. (The 20% does not apply to the in-patient hospital bill. 20% coinsurance is only applies to Part B: outpatient services.)

There are many different Medicare advantage plans and they all have their own copays or "gaps". The Part A (inpatient) benefit period is still 60 days but the deductible is broken down into copays over a few days. Like $265 per day for the first 7 days. This gap is different and so a Medigap policy is not designed to pay it.

Medicare Advantage and Original Medicare are both the primary coverage of Medicare.

Medicare supplement or Medigap insurance is "optional" coverage that is specifically designed to pay the gaps of Original Medicare. The gaps are the copays, deductibles, and the 20%.

Only people who have Original Medicare are eligible to buy a Medigap policy. Gap insurance will not work for Medicare Advantage because Medigap policies were specifically designed to fill the gaps of Original Medicare. As the previous example illustrates the gaps on Medicare Advantage are different.

People with gap coverage pay an additional premium every month so they don't have to be overwhelmed with out of pocket expenses. People who choose Medicare Advantage choose to cover the out of pocket expenses as they occur and usually do not pay as much premium every month.

There are some other major differences you should be aware of. Medicare Advantage plans are not portable and you may not be able to use the doctor and hospital of your choice. When you decide where you want to move you can check to see the plans available in that county. Some plans are much better than others.

Original Medicare combined with Medigap insurance is portable and any doctor that accepts Medicare will accept Medigap.

But now the catch: Since you are under 65 Medigap may not be available to you. It depends on the state. For instance, South Carolina's insurance department does not require insurance companies to offer Medigap to people under 65. Insurance companies do not like to offer it to people with disability because it is very hard for them to predict the claims. North Carolina does offer it but it will be more expensive than for people age 65 and you may only be able to get the coverage if you are in your original open enrollment period or entitled to a guaranteed issue.

I know it's a lot of info but I hope it helps some.

Bobby

 

[Maxtor]

I think really some nice and helpful information for a lot of concerned people as,
To fill this Medicare coverage gap, seniors can choose from private supplemental insurance that range from basic to more high-end plans that cover all expenses. To make it easier for seniors to choose, these plans are categorized from A to P.

 

[bobbybrock]

I think really some nice and helpful information for a lot of concerned people as,
To fill this Medicare coverage gap, seniors can choose from private supplemental insurance that range from basic to more high-end plans that cover all expenses. To make it easier for seniors to choose, these plans are categorized from A to P.

When you get to SC look me up on lowcountrymedicare.com. I'll help you shop for the best plan. That's what I do.

Bobby