It’s always nice to see family members helping one another through difficult circumstances. In this instance, Medicare insurance was the challenge. A Salem-area woman was helping her brother who lives in a neighboring state make decisions about both insurance and living arrangements.
She made an appointment with a Senior Health Insurance Benefits Assistance (SHIBA) volunteer counselor to get her insurance questions answered. These were her questions.
If my brother were to move to Oregon, would he be able to enroll in new insurance here?
Yes, if the move would result in losing his current insurance he would have a special enrollment period to enroll in new Medicare insurance in Oregon. He would have a deadline of 60 or 63 days, depending on the insurance type, so he should enroll promptly.
My brother’s health has taken a turn for the worse. If he moves to Oregon, could he enroll in Medigap insurance?
Yes. If he loses his current insurance in the move to Oregon he would have guaranteed issue for Medicare supplement (Medigap) insurance. Guaranteed issue means that the insurance company cannot legally levy a premium surcharge because of a pre-existing health condition. Although costly compared with most Medicare Advantage insurance plans, Medigap is especially good insurance for people with expensive medical conditions. The other type of Medicare insurance, Medicare Advantage, does not take health status into account.
But what if he decides not to move to Oregon. In the state where he lives now, would he pay a premium surcharge because of serious medical issues?
Almost certainly. However, in reviewing companies whose Medigap premiums seem reasonable, check with more than one. This is because companies’ health-related questions differ. Ask the state where you brother lives whether it has a law similar to Oregon’s Medigap birthday rule that would permit him later to shed the surcharge by changing insurance company or changing Medigap plan type.
Or, consider this scenario: Your brother enrolls in a Medigap policy in the state where he lives now, and must pay a premium surcharge because of poor health. If he later moves to Oregon, he could use the state’s Medigap birthday rule to change insurance companies or Medigap plan type to eliminate the premium surcharge.
If you would like to make an appointment with a SHIBA volunteer Medicare counselor, or to ask a question to be answered here, please see the end of this column.
My parent in another Oregon county wants to compare her Medicare Advantage insurance with all plans available to her in 2024. What are her options?’
She can make a SHIBA appointment (see how at end of this column). If she’s comfortable with computers, she can go on the Medicare.gov website to review plans on her own. She could meet with a state-certified insurance broker who handles Medicare insurance. She could call 800-MEDICARE (800-633-4227); this is a 24/7 service, so calling at an odd hour may reduce wait time.
For an excellent state-specific booklet about Medicare, see the Oregon Guide to Medicare Insurance Plans. The Guide is also available in multiple languages on the shiba.oregon.gov website.
I have Medicare Advantage insurance. I’m happy with it, but wonder if plans will make many changes for 2024.
Even though you’re happy with your insurance – two words not always found in the same sentence – it’s always good to keep track of premiums and benefits. That starts with reviewing the information that the company sent to you in September, which outlines any changes that will be made in your insurance for 2024.
As for other differences in 2024, here are three: For Marion and Polk county residents, insurance companies will offer 12 zero-premium Medicare Advantage (MA) plans compared with nine this year. Although Medicare beneficiaries with zero-premium MA plans most often pay $90 or $95 for a hospital emergency room visit this year, many plans have bumped up the copay to $120 in 2024. One MA plan with a monthly premium in excess of $100 had no patient copay this year for temporary skilled nursing care; in 2024, the daily copay will be $196 beginning on the 21st day of care.
Those are only examples, of course, albeit each suggesting it’s a good idea to keep abreast of the market to ensure your Medicare insurance is best at meeting your needs. Annual open enrollment for Medicare Advantage and prescription drug plans began on Oct. 15 and runs through Dec. 7.
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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