Oregonians have found myriad ways to spend their stimulus checks, but this might be a new one.
With her Medicare about to start, the woman said she wanted to use the check for medical insurance.
She made an appointment with a Senior Health Insurance Benefits Assistance counselor to ask about insurance options.
She said she wanted to use the $1,400 stimulus check to pay for higher-priced insurance for a year. She expressed special concern about the cost of lab tests.
She was thinking of going with a costlier Medigap supplemental insurance instead of Medicare Advantage, available in some circumstances at no cost.
The counselor told her that lab tests under Medicare Advantage might be less expensive than she expected. The counselor provided premium and benefit details for both types of insurance so she could make an informed decision.
If you would like to make a phone appointment with a SHIBA counselor, or to ask a question to be answered here, please see the end of this column.
Q: I understand that if I want to buy Medigap supplemental insurance, I would have to answer questions about my health. What sorts of questions do insurance companies ask?
This is called medical underwriting. If the person wishing to purchase a Medigap supplemental policy doesn’t is guaranteed a policy, then companies may ask health-related questions. Depending on the answers, they may refuse to sell a policy or they may sell it at a higher premium.
One company asks: “Within the past three years, have you been diagnosed with or received treatment for internal cancer, leukemia, malignant melanoma, Hodgkin’s Disease, Parkinson’s Disease, Alzheimer’s Disease, Myasthenia Gravis, Lupus, Multiple Sclerosis, Lou Gehrig’s Disease (ALS), paralysis, cirrhosis of the liver, alcohol or drug abuse, Acquired Immune Deficiency Syndrome (AIDS) or AIDS-Related Complex (ARC)?”
This company also asks if within five years the individual had a heart attack, stroke, heart valve surgery, angioplasty, heart bypass surgery or an episode of angina. It also asks whether in the past three years the individual had been advised to have surgery for cataracts, joint replacement, a heart condition or any other in-patient surgery. Note: This reflects the questions of only one company; others may differ.
It is important to remember that most health-related questions may not be asked if a Medicare beneficiary has guaranteed issue. The exception: Companies may always ask if the applicant is a tobacco user.
Guaranteed issue applies in instances such as when the individual first has Medicare Part B, when a person loses insurance because of a move or, for people who are enrolled in Medicare after receiving Social Security disability benefits, also when they turn 65.
Q: I was looking at Medicare Advantage plans on the Medicare website. Some of them have no premium. Are these substandard plans? Are they restricted to people with lower incomes?
These plans are available to anyone who has Part A and Part B of Medicare. The benefits of these plans can be surprisingly good, although that is for the Medicare beneficiary to assess. Compared with conventional insurance, Medicare Advantage plans are relatively inexpensive because Medicare subsidizes the premium by more than $800 a month. Medicare does this because if you have Medicare Advantage insurance, Medicare receives no bills for your health care.
Q: I was a public employee. When I retired, I enrolled in the PERS Medigap insurance. If I want to enroll in a Medigap policy outside of PERS, could I use the “birthday rule” to switch to another policy with a guarantee I wouldn’t be charged a higher premium? (I have a cancer diagnosis.)
First, let’s explain Oregon’s birthday rule.
If you have Medigap insurance, on your birthday and for 30 days after you may change type of Medigap policy or change companies without incurring a rate increase because of a pre-existing condition.
To your question: Unfortunately, no. Oregon’s birthday rule applies only to conventional Medigap policies. PERS Medigap insurance doesn’t qualify.
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 appointment with a volunteer Medicare counselor, call 800-722-4134.
