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My husband and I are investigating making a switch from an Advantage plan to a Supplement, if we qualify, and have several questions which we’ve not yet seen addressed in your columns:
A little different format today since we have multiple questions related to the same topic. I will answer one at a time.
1) What conditions would generally make one ineligible for a supplemental plan? More serious issues and conditions such as cancer, heart disease, stroke or heart attack, insulin dependent diabetes, auto immune disorders, neuropathy, blood disorders, kidney disease, COPD or emphysema, rheumatoid arthritis, and A-Fib, among a couple others can trigger a denial.
2) Is recency of a condition considered, and if so, what are the “look-back” periods? Do all supplements have the same underwriting “rules,” or can one shop around? We absolutely shop around to ensure the highest approval rate. Look back periods can range from 1 to 5 years depending on company/condition, and underwriting can be much different from company to company as well. For example, one of our most popular Supplement companies only looks back 1 year on heart attacks while another 5 years. Those same two companies look at COPD differently too. One will not take anyone with COPD while another will if the applicant isn’t using oxygen or taking three or more medications for the condition. Our third most popular company will accept those who have insulin dependent diabetes.
3) What kind of information/evidence does one need to submit for considerations? Do any carriers require actual physicals, or is it only a matter of their accessing medical records? There are no physicals required. There are a series of medical questions that need to be answered. Generally, any “yes” answer will result in the application being denied. Also, the Supplement companies look at what’s called a Medical Information Bureau (MIB). It’s the equivalent of a credit report and most insurance companies participate by sending out codes to the MIB for claims they paid. The Supplement companies use this information to verify medical questions were answered honestly/accurately and it can be used to deny an application.
4) Once you submit the required information, how long does it usually take to get a decision? Not long at all. This time of year, the turnaround time is just a few days. One of our favorite companies is actually approving some applications immediately upon electronic submittal.
5) When you’re on original Medicare and a Supplement Plan, where do your medical records reside and how do you access them? Is there coordination across carriers and health care providers? Medicare or a Supplement company do not keep medical records. Those would be kept by the doctors and hospitals you use. Medicare and insurance companies would only keep your claim history. The MIB also does not gather or keep medical records.
6) More generally, what happens to one’s access to existing electronic records kept by an Advantage Plan when one switches insurance carriers? Again, it isn’t an insurance company’s job to keep your medical records, only your claim history of what was paid, who it was paid to, the dates of the services, and codes that were used would be kept on file. You could still call your prior company if you had questions regarding those.
I want to make sure readers understand that those going on Medicare Part B for the first time are not subject to medical underwriting to get a Supplement within six months of their effective date. This is called Open Enrollment and all companies must approve the application for any plan they offer at their preferred, non- tobacco rate. Anyone who’s been on Part B for over six months will have to go through medical underwriting. Those who want to change from and Advantage Plan to a Supplement, one Supplement company to another, and even those who want to change plan letter within the same Supplement company will have their medical history considered.
Also, please be advised there is never medical underwriting to switch from one Medicare Advantage Plan HMO or PPO to another, and there are no waiting periods or pre- existing condition clauses.
Unfortunately, there is no Annual Election Period for Supplements where underwriting is waived, and pre-existing conditions not considered. In addition, Supplement plans can be changed at any time during the year. You don’t have to wait until 2021. This is important because as I’ve written on several occasions, it’s my professional opinion that no one should have Plans F or C. I’m also advising almost all clients to move from Plan G to N if possible. The difference in coverage is extremely minimal and I’m predicting the savings on Plan N over the next ten years will amount to thousands of dollars.
Another important information of note. Almost everyone who can pass medical underwriting can change from an Advantage Plan to a Supplement now. If you’re interested, consultations to discuss and go over the pros and cons of doing so are always free of charge.
If you have any questions regarding this or any other column, or would like to submit a question for future columns, please email me directly at firstname.lastname@example.org. If you would like to speak to a licensed agent or set up an appointment, give one of our offices a call.
Don’t forget to catch my live radio show, every first and third Monday of the month on WMBS Uniontown 590am. You can listen on their website wmbs590.com from 1:15 to 3 or find the replay on our website, GetYourBestPlan.com
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