COLUMN: Counselor can help explore Medicare options when moving

Volunteer Medicare counselors work with all manner of nice people who have scores of different Medicare-related questions. Seldom, though, do these counselors think of themselves as Medicare relocation agents.

This, however, was one of those times. The couple had made a Senior Health Insurance Benefits Assistance (SHIBA) appointment to ask this question: Where on the Oregon coast could we move and have access to good choices for Medicare insurance? They both had Medicare Advantage plans that they liked.

“We’ve always loved the coast and want to try it out,” she said. “We think we’ll love it and, if not, we’ll come back to Salem,” he said. They said they would engage a manager to rent their Salem house as an Airbnb.

The SHIBA counselor went to the website and began entering ZIP codes for Oregon’s seven coastal counties. For starters, two coastal counties will have no Medicare Advantage plans in 2024. Lincoln County will have only two. Curry and Coos counties will have six and seven such plans, respectively. 

The SHIBA counselor told the couple that they would have the greatest choice of insurance plans in Lane County (27 plans) and Douglas County (10 plans), which offer coastal towns such as Florence, Dunes City, Reedsport and Winchester Bay.

Sensing that the couple didn’t have money worries, however, the SHIBA counselor suggested another option to consider: Medicare supplement (Medigap) insurance, national policies with which one could live anywhere in the U.S. The counselor provided monthly premiums for those plans, as well.

If you would like to make a SHIBA appointment, or to ask a question to be answered here, please see the end of this column.

I hope never to need skilled nursing care, although I guess many people do. In looking at Medicare Advantage plans, I see ones that would charge the patient $190 a day for up to 80 days. I thought these insurance plans had a ceiling on monthly expenses.

They do. But first, let’s clarify that these insurance plans’ coverage is for temporary skilled-nursing-facility (SNF) care following an accident or injury (also following at least three midnights in hospital). You are right: Many Medicare Advantage plans show what appears to be a patient cost of about $15,000 in the unlikely event one remains in skilled-nursing care for 100 days.

As you suggest, though, these insurance plans also have ceilings on how much a Medicare beneficiary could be required to pay annually, and SNF expenses fall under that ceiling. In Marion and Polk counties the annual cost ceiling is never more than $8,850 and usually thousands less even among zero-premium Medicare Advantage insurance plans.

When I retired from the school district, I enrolled in the PERS Medicare supplement insurance. I’m now thinking I’d like to change to a conventional Medigap plan. You’ve written about the birthday rule – can I use it to make the change?

No. Medicare beneficiaries with self-funded employer-sponsored Medigap plans are not eligible to use the Oregon birthday rule to change to plans on the open market. 

Because you no longer have guaranteed issue for Medigap insurance, companies are not required to sell you a policy. In addition, if they do sell you a policy they may levy a premium surcharge if you have a health condition that concerns them. However, it’s very likely that you will find a company to sell you a policy; and if you’re in reasonably good health, you might also avoid a premium surcharge.

But let’s suppose that you are in poor health. If a company agrees to enroll you, you will very likely pay a higher premium as a result. However, you can later shed the surcharge by using the Oregon birthday rule to change companies OR to change Medigap plan type. Read the birthday rule’s two-page fact for details about how to use it and to see restrictions that apply when changing policies from one plan type to another. 

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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