I read your column pretty much every week as my husband and I are set to retire and enroll in Medicare Part B in 2025. I believe you mentioned in a prior column that you could provide a list of health conditions that prevent individuals from moving back to a Supplement once they’re insured by an Advantage Plan. I have osteoporosis and would like to know if this limits my future options. Initially, my husband and I plan to purchase a Supplement policy once we leave our employer provided coverage but realize they may become unaffordable down the road. I’m 72 and my husband is 77.

Also, can you clarify what the customer is charged to use your services? Thanks for all the good information you provide. I feel like advocates are needed for seniors regarding Medicare. The government does not seem to care if we can fully understand their polices.

Right off the bat, let me address some important facts that pertain to Mary Jo’s question and concerns. It DOES NOT matter that she has osteoporosis or any other diagnosis or condition when she goes on Medicare Part B for the first time. Per regulation, all Supplement companies must accept anyone in this situation up to three months prior to one’s Part B effective date and up to six months after. This is known as the Initial Election Period (IEP) and is generally the only time when those with current or past health issues can’t be discriminated against by Supplement companies and acceptance into any letter plan they offer is guaranteed. Even if Mary Jo or her husband were going through cancer and getting treatments upon enrolling in Part B, neither can be denied acceptance and the Supplement company would have to pay all Medicare approved claims as soon as the policy goes into effect.

As Mary Jo eluded, this is not the case for those who start with an Advantage Plan or want to move from one Supplement company or plan to another. Once the IEP has ended, Supplement insurers can pick and choose who they accept and decline. Osteoporosis with fractures would result in a denial. Examples of other conditions that would keep someone from ever getting approved for a Supplement outside of IEP are congestive heart failure, lymphoma, melanoma, Alzheimer’s or dementia, organ transplant, among a few others.

This is why it’s so important to understand all the differences, pros and cons of Advantage Plans and Supplements when going on Medicare Part B for the first time. Those who start with a Supplement can always move back to an Advantage Plan without any concerns of pre-existing medical conditions. Companies offering HMOs and PPOs must accept anyone who has both Medicare Parts A and B during any valid enrollment period. But the opposite doesn’t hold true. We’ve met thousands of people who didn’t have both types of plans explained properly by another agent or insurance company, enrolled in an Advantage Plan without being told about the risks, and had a medical condition that would NEVER allow them to get a Supplement policy the rest of their lives. Many then went on to spend much more money on co-pays and coinsurance for medical services than Supplement premiums and small out of pocket costs would have been with Plan N.

Please keep in mind you WILL NOT be automatically denied for a Supplement if you’ve had other cancers, a heart attack, stroke, diabetes, joint replacement, among many other health issues. If it has been between two to five years since the incident, surgery, or release from care, you can still get approved if you want to leave a Medicare Advantage Plan for a Supplement or move from one letter plan or company to another. Anyone who is interested in getting a full list of medical questions and a quote can simply call us or email me personally. We will gladly send them to you.

Those on Advantage Plans have until March 31^st to move to a Supplement, and those already on Supplements can change anytime during the year. As I keep writing over and over, I recommend that everyone who has Supplement Plans C, F, or G and can pass underwriting, move to Plan N immediately.

I’m not bad-mouthing Advantage Plans. I can’t begin to explain what an important role they play as a choice for seniors. We have 30% or more of our Medicare clients, over 4,000 total, enrolled in HMOs and PPOs. We often do exactly what Mary Jo talked about, moving older clients over to them once premiums get to a point where they’re uncomfortable or unaffordable. The problem with Advantage Plans is there has yet to be any regulations put on agents to ensure the Supplement option is always given to everyone and the disclosure that a choice of enrolling in an HMO or PPO when one first goes on Part B comes with the risk of never being able to get approved for a Supplement again. That rarely happens and I blame it on Advantage Plan commissions being so much higher than Supplements. Unfortunately, this can cloud the judgement of agents, and from my experience the majority don’t ever mention Supplements or even discourage people from considering them.

We don’t charge any fees for our services. And unlike other agents and agencies who only care about their paycheck, we always give advice based on what’s best for the person sitting in front of us or at the other end of the phone or internet connection! That often means recommending a plan we get paid no commission on such as an employer or retiree option.

Don’t count on the government giving good advice, help, or easy to understand information regarding Medicare. In fact, they seem to make it more confusing with every passing year. However, the staff at The Health Insurance Store are advocates for those on Medicare and have been since 2008! Not only will we make sure every client makes the best possible choice for their personal needs, once enrolled in a plan, we will get involved anytime a billing error occurs, a claim is denied or delayed, prescription costs are unexpectedly high, or anything else even remotely related to their policies goes awry or is in question. My goal has always been to provide our clients with the best customer service experience they’ve ever had in their lives!

If you would like to make an appointment or have any questions about this column or any other Medicare related topic, give us a call or email me personally at aaron@getyourbestplan.com.