COLUMN: Check the Oregon birthday rule for Medicare changes

What is the value of peace of mind?

Here was a Medicare beneficiary whose Medicare started before age 65 because of a disability. Now that he was about to turn 65 he had a single question: May I keep the Medicare insurance I have?

He made an appointment with a Senior Health Insurance Benefits Assistance (SHIBA) volunteer counselor to ask the question.

He had a Medicare supplement (Medigap) Plan G policy with a major company. Because the insurance shielded him from almost all medical expenses, he loved the policy and wanted to keep it. The answer to his question: Yes, he could keep the policy.

Nevertheless, one could ask whether that was in his best interest. The SHIBA counselor noted these facts about his Plan G policy:

  • He was paying $181.81 a month for the policy, although he could obtain the same coverage from another highly rated company for $142.21 a month.
  • The benefits of all Plan G Medigap policies are identical, so paying a higher premium doesn’t deliver greater benefits.
  • If he wanted to change to the less-expensive policy, he could do so using the Oregon birthday rule.

Nevertheless, the beneficiary was adamant about keeping the policy he had, yielding an answer to the opening question: For him, the value of peace of mind for Medigap insurance was $39.60 a month, the difference between the higher-priced policy and the less expensive policy that offered the same benefits. 

Not that he should be criticized for his decision: Many people make decisions that may appear unwise to others but that help them sleep soundly. (SHIBA counselors are tasked with providing full information to Medicare beneficiaries, as occurred here, but are advised not to make recommendations.)

If you would like to make an appointment with a SHIBA volunteer Medicare counselor, please see the end of this column.

I’m paying a surcharge on my Medigap premium because I had a serious health condition at the time I signed up. I’ve now been free of cancer for several years and would like to know if I can lose that extra charge.

From what you describe, you apparently enrolled in the Medicare supplement (Medigap) policy when you no longer had guaranteed issue. That is why you are paying the premium surcharge.

Your first course would be to call the insurance company, explain your situation (you can document that you are cancer free), and see whether the company will waive the premium surcharge.

If not, you might use the Oregon birthday rule to check premiums from other companies. By using the birthday rule you may enroll with another company without risking a surcharge for a pre-existing condition. The first page of the birthday rule’s two-page fact sheet describes how to use the birthday rule; the second page describes that if you have this kind of Medigap policy, you may change to these. 

A SHIBA counselor or insurance agent who handles Medicare insurance could help you. Or you could compare Medigap premiums yourself using the Medicare website, 

Jim Sellers of Salem is a certified Medicare counselor with the Senior Health Insurance Benefits Assistance (SHIBA) program. To ask a question to be answered in this column, e-mail [email protected]. To schedule a free SHIBA phone, Zoom or in-person appointment with a volunteer Medicare counselor, call 800-722-4134.

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