Written by: Bijan Noori

Many individuals sign up for or are sold Medicare Advantage plans as soon as they are eligible for Medicare.  Newly eligible individuals have what’s called “guaranteed issue.”  This means an enrollee can apply for any private Medicare plan without going through underwriting or answering medical related questions.  Great news for those with pre-existing issues since they can get onto more robust Medicare Supplement options also known as Medigap.

Medicare Supplement plans typically offer more freedom than Medicare Advantage plans when it comes to provider selection and self-referring while avoiding the Medicare Advantage managed care system hamster wheel.  The freedom of Medicare Supplement plans usually comes at the cost of a monthly premium which depends on the zip code, plan availability, plan letter, and age of the enrollee.  Medicare Supplement plan enrollees also need to enroll in a separate prescription drug plan (PDP).  This has a separate cost from their Medicare Supplement plan.

Medicare Advantage plans do not offer the same freedoms that Medicare Supplement plans offer but usually have a handful of perks, includes a drug plan and, best of all usually, cost $0 in additional monthly premium to add to your Medicare Parts A and B.

This sounds like a great option for those who seldom see their providers for anything other than normal checkups.  The younger the enrollee is, the more likely they are to be in this category.  Note: Typically, the youngest you can enroll into Original Medicare is the same month you turn age 65.  Many with little health concerns that want to save in costs will choose Medicare Advantage over a Medicare Supplement plan because of the extra cost. 

As enrollees age, they may come across more and more health issues that require the freedom that the Medicare Supplement plan would have offered them.  Medicare Supplement plans will allow anyone to apply for a plan even if they are currently on a Medicare Advantage plan, but this will not be “guaranteed issue.”  Meaning, the applicant will need to go through underwriting unlike when moving from a Medicare Supplement plan to a Medicare Advantage plan during the Annual Enrollment Period or AEP which is automatic acceptance.

For those on Medicare Advantage plans that want to hop over to a Medicare Supplement plan, underwriting can be a major issue.  Especially since you are more likely to switch when you need better access to providers via Medicare Supplements.

This is where many get stuck with keeping their Medicare Advantage plans when they have a need for a Medicare Supplement plan.  How can one get “unstuck?”

Usually within the year, one or more carriers will have a window or time period where anyone eligible person can enroll into a Medicare Supplement plan without having to answer underwriting questions.   This is called an “underwriting holiday.”  In California, these are most often offered by Blue Shield of CA.  When compared apples-to-apples with supplements of other carriers, Blue Shield of CA tends to increase their rates a bit faster each and every year as an enrollee ages.  However, the cost difference is not significant enough to deter someone from seeking this unique opportunity to switch to a Medicare Supplement from Medicare Advantage plan or to switch from a lower tier Medicare Supplement “Plan Letter” to a higher tier Medicare Supplement “Plan Letter.”  Like from Plan N to Plan G.

This change is very simple to do with an experienced broker.  You will also want to make sure that the broker is adding your necessary standalone Prescription Drug Plan when leaving your Medicare Advantage plan or MAPD plan that includes drugs.  Keep in mind the drug plan can be switched during AEP, which will offer an effective date of 1/1.  This is why many “underwriting holiday” enrollments will also have effective dates of 1/1.

For more information or a no-obligation consultation to review personalized plan option, send me an email bijan@baypointins.com

Written By:

Bijan Noori

CA Lic. 0G24279

bijan@baypointins.com

The information provided in this blog post is for general informational purposes only. It is not intended as legal, financial, or medical advice. Medicare plans and regulations can vary by location and individual circumstances. Always consult with a qualified professional for personalized advice and to ensure you have the most current information. This blog does not represent the views or policies of any government agency or private company.