Protections for life

It’s time for Medicare open enrollment. For those new to Medicare, if you can afford it, you’ll want to find a separate supplemental insurance policy (i.e. Medigap) to complement Medicare. These policies are offered by private insurance companies in alignment with state regulations and federal laws. Supplements cover Medicare’s significant deductibles and copayments and fill in coverage gaps.

When seniors first enroll in Medicare they can purchase any supplemental Medigap policy regardless of their health history. This occurs only during your initial (one-time only), six-month open enrollment period.

Unlike the protections in the Affordable Care Act (ACA), which don’t allow insurers to deny coverage for pre-existing conditions, Medigap supplemental policies may do just that after the initial six-month enrollment period. After the enrollment period expires, if you choose to change policies due to an increase in premiums, deductibles or an unforeseen limitation, a pre-existing medical condition may make you unable to purchase a Medigap policy or change your supplemental coverage. If you have a pre-existing medical condition or a disease you can be denied a Medigap policy. 

States do have the flexibility to institute consumer protections for Medigap policies that go beyond the minimum federal standards. For example, 28 states require Medigap insurers to issue policies to eligible Medicare beneficiaries whose employer has changed their retiree health coverage benefits.

Only four states, Connecticut, Massachusetts, Maine and New York, require either continuous or annual guaranteed protections for Medigap policies for all beneficiaries on traditional Medicare, regardless of medical history. Guaranteed protections prohibit insurers from denying a Medigap policy to eligible applicants in these four states. This includes people with pre-existing conditions, such as diabetes and heart disease.

As a result of these issues, when you transition to Medicare, you’ll want to consider which type of plan would be the best choice for you over your lifetime, not just at the time when you transition to Medicare.

The normal business model for health care uses “underwriting” (risk analysis), which undermines the whole purpose of health insurance. Health insurers don’t necessarily make more money when they have more customers. They make more money when they have more customers whose health care they don’t have to pay for. Making a profit is antithetical to good health care.  

I’m calling on all seniors to push your state legislators to join ME, CT, MA and NY and provide seniors with stronger and continuous guaranteed protections “annually” regardless of medical history. We’ve earned and paid for Medicare through a lifetime of work and deserve continuous guaranteed protections for life.

– Jan Phillips,  Durango