Choose Insurance Carefully at 65, Sign-Up Period Is Critical for Coverage

Pre-existing conditions

Choose insurance carefully at 65,
Sign-up period is critical for coverage

Peopleunderage65areprotected(asof2014)frombeingdenied/disqualifiedfromhealthinsurancebecauseofpre-existingconditionsbytheAffordableCareAct (ACA). Thisisoneofthemostpopularaspectsofthecomprehensivehealthcarereformlaw.

However,peopleOVER65canbedenied/disqualifiedbysupplementalhealthinsurancepoliciesforpre-existingconditions.SupplementalhealthpoliciesarealsoknownasMedigappoliciesbecausetheycoverthe“gap”ofMedicare’spaymentof80%ofreasonable/usualcosts.

Confirmation comes via Humboldt County HICAP Program Manager,NancyCloward. She says that pre-existingconditionscanbeexcludedand/orsupplementalinsurancecoveragecan bedeniedbecausetherulesoftheACAdo notapplytothoseover65.

Medicareiscompletelyseparate. Onehas6monthsafterturning65togetasupplementalinsuranceplanwithoutbeing“penalized”forpre-existingconditions. Rightnow,these6monthsaretheonly“guaranteedissue”period.

Birthday Rule

Afterthat,theinsurancecompaniesofferingsupplementalscananddodenycoveragebasedonpre-existingconditions. Californiadoeshavealaw,whichCloward calledtheBirthdayRulethatallowsaperson30daysaftereachbirthdayto“shop”foranewplan.

However,onecanonlygo“down”incoverageorplan,not“up.” Anindividualcannotoptforacheapplanwithminimalcoveragewhenhe/sheturns65,perhapsbecauseheorshefeelshealthy, does not need a better policy,andthenlaterintendstoimprovethesupplementalpolicy.

Ifyouchosenottobuyasupplemental/Medigapplanwhenyouwere65duringtheopenenrollmentperiod,orifyouareinMedicareandwishtochangeyoursupplementalcoverage,orifyouareinMedicareAdvantageHMO(Kaiser,etc.)andwishtochangetooriginalMedicarewithaMedigappolicy,Youcanbedeniedifyouhaveapre-existingmedicalcondition.

Forsomereason,MedicarewasnotpartoftheACA–itwaskeptseparate,andallhealthcaresupplementalpoliciesaresubjecttomedicalunderwriting,astheyareprivateinsurers,notpartofMedicare.

No answers

Someplansmightacceptapersonwithpre-existinghealthissuesbutexcludeaspecificconditionfortheentirecoverageorexcludetheconditionforaspecifictime,i.e.–3or6months. Itisimportanttonotethattheonlytimethataseniorhasaguaranteedissueofaplaniswhenhe/sheturns65.

Whenfolksturning65aremakingtheirdecisionsonsupplementalplans,they must makethemcarefullyaspositivechangelaterisnotpossible–theplanchosencanonlybechangedtooneoflessercoverage. Duringtheopenenrollmentperiod,oneshouldchoosethebestpolicyonecanafford.

WehavenoanswersastowhyMedigappolicieswerenotincludedintheACAreforms. Whatnowexistsisarealexampleofagediscrimination. WeshouldallletourCalRTAleadershipknowhowwefeelandencouragethemtoworkforachange.

NOTE: This material aims only to create awareness, and is not intended as expert or professional advice, nor “endorsed" by CalRTA. Please carefully review with qualified resources and legal advisors prior to acting.

Judy Geppert, CalRTAIIRG

10/16/2018

-- ENDS --

[Words485]