Next week, The Oregonian/Oregonlive publishes its anniversary adviser to accessible accepting for Medicare Advantage plans. From Oct. 15 to Dec. 7, some 320,000 Oregonians can about-face affairs afterwards annoying about actuality alone based on their medical history.
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But for readers abutting age 65 and new to Medicare, it's important to apperceive that Medicare Advantage isn't your alone option. Depending on your health, breadth you alive and whether your accepted plan still wants you, it ability not be your best option.
For years, Medicare Advantage has bedeviled the bazaar in Oregon, decidedly about Portland, breadth almost 60 percent of Medicare beneficiaries acquire in one.
But back 2014, the cardinal of Medigap enrollees in Oregon has jumped by 14 percent, from 129,000 to added than 147,000, according to Oregon Allowance Division records. The fasten coincides with Medicare Advantage amount increases in some of the added rural counties and the actualization of a new, lower-cost plan in Oregon from Stonebridge Life Allowance Co., accompaniment allowance admiral said.
Medigap ability be abnormally adorable in 2016 to 5,000 Oregonians whose Medicare Advantage affairs are abeyance their coverage. That includes added than 3,000 bodies in Hood, Clatsop, Tillamook and Lincoln counties, breadth Cambia Bloom Solutions is abandoning its Regence Blue Cross Blue Shield Medicare Advantage plans.
A agent for Cambia said Regence would acquire had to decidedly admission premiums and accession added costs to abide alms its affairs in those areas.
"Unfortunately, ascent costs acquire fabricated Medicare Advantage affairs financially unsustainable in some areas," said Cambia agent Jared Ishkanian.
Medicare 101
Before we go any further, let's analysis some of the basics about Medicare insurance.
Original Medicare covers hospitalizations (Part A) and medical visits (Part B), mostly for seniors age 65 and over. But its advantage is limited. You pay a deductible ($1,260 in 2015) for hospitalizations,, for instance, and 20 percent of the amount of seeing a doctor. Continued stays in a hospital or nursing home can advance to aerial abroad costs.
Medigap, additionally accepted as Medicare Supplement Insurance, fills in some or all of those advantage gaps. There are 10 types of Medigap plans, alignment from belletrist A through N. Anniversary offers a altered akin of coverage.
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Most Medigap enrollees acquire Blazon F, which covers all abroad costs. That agency their alone medical cost, abreast from decree drugs, is their account premium.
Medicare Advantage plans, by contrast, can accommodate somewhat broader advantage than basal Medicare with Medigap supplements. Some Medicare Advantage plans, for instance, awning decree drugs, dental and eyecare, usually aural a assigned arrangement of providers. Premiums can be lower, too.
But Medicare Advantage affairs appoint added costs, too -- deductibles, coinsurance and copays -- back associates seek care. Those costs can add up bound if you acquire a lot of bloom issues.
"The advantage plan is acceptable if you're advantageous but it break bottomward if you aren't," said Richard Reynolds, a advance with Oregon Senior Bloom Allowance Benefit Assistance (SHIBA) program in Newport.
So which is appropriate for you? Consider these advantages and disadvantages:
Medigap Pros
They're standardized. Advantage varies by plan blazon (see the blueprint below), but aural anniversary type, the allowances are the same. Insurers can't action account or barrier coverage. This makes comparing ante a lot easier. Alike so, premiums alter absolutely a bit.
They're portable. You charge not stick to a bloom aliment alignment or physician arrangement to acquisition affliction as you would with best Medicare Advantage plans.
John Melvin, diagnosed with prostate cancer, sought a targeted radiation analysis that wasn't accessible in Portland, his wife said. He concluded up traveling to Swedish Medical Center in Seattle. Medicare and his Medigap Blazon F plan acquire paid all of his bills totalling added than $50,000, she said.
"We haven't paid a penny - aloof as advertised," Susan Melvin said. "On an Advantage Plan we would acquire had to pay the exceptional added apparently the max out of pocket." And it's not bright any Medicare Advantage plan would acquire accustomed him to go to Seattle to seek treatment, she said.
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For retirees who biking a lot, Medigap ability be added suitable. Six types of Medigap affairs accommodate up to 80% advantage for emergency affliction alfresco the country.
There may be beneath announcement disputes. Providers abide claims to Medicare for reimbursement. Then the Medigap action pays the rest. As continued as Medicare covers the care, you shouldn't acquire to argue with the allowance aggregation to awning the claim.
"The allowance aggregation isn't authoritative any decisions," said Reynolds. "Claims to go Medicare and they actuate what's allowable.
Plan F covers all gaps. One account exceptional takes affliction of all copays, coinsurance and deductibles. Policyholders apperceive their medical and hospital costs up front, admitting decree biologic costs will be extra.
By contrast, medical bills beneath some Advantage affairs could ability $6,700 a year, possibly more, on top of premiums.
Birthday rule. Anniversary year, Oregon allows Medigap policyholders to about-face carriers aural 30 canicule of their birthday. They can alone about-face to the aforementioned blazon of Medigap plan or a blazon with beneath allowances (from Blazon F to Blazon C, for instance).
This appropriate open-enrollment aeon gives consumers an out if premiums abide to admission or they appetite a beneath big-ticket plan. Without the rule, insurers could analyze about a senior's bloom history and use it to abjure coverage.
Lyn Weber switched on her altogether in May from Omaha Allowance Co. Plan F to USAA Life Allowance Co. Plan F. The move adored added than $300 a year in premiums, her bedmate said.
"No academician anaplasty required," Walt Weber said of the switch. "There's no discernable aberration in service. All bills are actuality paid and handled the same."
Medigap Cons
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They don't awning prescriptions. If you appetite biologic insurance, you'll acquire to buy a stand-alone Allotment D biologic plan. This can admission your account costs abutting year in Oregon by amid $18 and $154 a month. Such affairs ability acquire their own deductibles, and seniors with ample biologic bills will pay alike added in the Allotment D advantage gap. Many Medicare Advantage plans, by contrast, accommodate decree biologic advantage as allotment of one account premium.
And if you adjournment to get a Allotment D plan afterwards you're aboriginal acceptable for Medicare, you'll pay a account amends that increases for anniversary ages you delay. Added on that online at bit.ly/PartDpenalty
They don't awning eyeglasses, hearings aids or dental care. Some Medicare Advantage affairs do, for an added premium.
Premiums are about college and admission with age. Aftermost year, for instance, added than 40 insurers offered Blazon F affairs for amid $128 and $267 a ages for a 70-year-old, according to Oregon SHIBA. That's afterwards any biologic coverage.
In 2016, Medicare Advantage premiums in Oregon will ambit from $0 to $242 a month. Some of those awning decree drugs and added care. But remember, Medicare Advantage affairs additionally appoint added costs in the anatomy of co-pays, co-insurance and deductibles.
Some doctors won't see you. Several ample doctors' practices in the Portland and Salem areas -- including The Portland Clinic and Cascade Physicians -- acquire chock-full demography new Medicare patients with Medigap plans, acute Advantage affairs instead. This could accomplish award a primary affliction provider added time consuming, experts say.
Volunteers in Oregon's rural counties, breadth beneath Medicare Advantage affairs are available, do not see this trend, however. "For the best part, bodies are able to admission the physicians that they need," said Cheryl Webb, a SHIBA volunteer in Baker City.
Guaranteed accepting is limited. If you buy a Medigap action aural 6 months of starting basal Medicare Allotment B, an insurer charge acquire you, behindhand of your medical history. But if you wait, insurers can abjure advantage based on your health.
There are exceptions. There's the altogether aphorism mentioned above. If your accepted Medicare Advantage or Medigap plan drops coverage, you get affirmed accepting into addition plan. That's additionally accurate if you move out of your Advantage plan's advantage breadth or if you enrolled in an Advantage plan and appetite out in beneath than 12 months.
Bottom line
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What's appropriate for the Melvins and Webers ability not be best for Mr. Weed or you. If you're new to Medicare, analysis your options with an Oregon SHIBA volunteer or a bloom allowance agent who sells a array of plans. Read aftermost year's Oregon Adviser to Medicare Allowance Affairs from SHIBA. And chase for Medigap behavior and prices at Medicare's online chase engine: bit.ly/MedigapFinder.
-- Brent Hunsberger is an Investment Adviser Representative and CERTIFIED FINANCIAL PLANNERcertificant in Portland. For important disclosures and advice about Brent, appointment ORne.ws/aboutbrent. Ability him by email or leave a bulletin about his columns at 503-683-3098.
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