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2. Medicare traps and limitations

(Whether or not receiving benefits from HP or HPE)

Advice and reference info from members. (Updated Apr 24, 2019.)  Page updated often -- use browser refresh button to display latest version.

Questions or comments to: info@hpalumni.org

Dependent coverage coordination. Unlike group plans for employees and retirees, which cover dependents, a Medicare plan covers one individual. There is no family coverage under Medicare. This complicates the transition from a group employee or retiree plan to Medicare since you and your spouse/partner probably don't have the same age and birthdate. See Coordinating with dependent coverage

There are limitations and traps related to pre-existing conditions, and when changing between employer-provided, retiree, Advantage, and Supplemental (Medigap) coverage.

There are several expensive traps in Medicare -- one of which could cost you for years.

- Lifetime costs for missing deadlines.

- Premium depends on the last tax return available to Medicare, which may be a lot higher than your actual income.

- In-network vs. out-of-network.

- Physically in a hospital but not technically "admitted" -- a potentially very expensive trap.

- The deductible, coinsurance, and drug coverage differences between the various alternatives.

For background and discussion of these traps, watch HPAA's 2014 Medicare Webinar.

Key pages on the official Medicare website covering limitations and traps:

- Supplemental (Medigap) plans:
"Choosing a Medigap Policy" Especially note the section on Guaranteed Issue -- pages 21-24.
https://www.medicare.gov/pubs/pdf/02110-Medicare-Medigap.guide.pdf
"8 things to know about Medigap policies"
https://www.medicare.gov/supplement-other-insurance/medigap/whats-medigap.html
"Guaranteed issue rights. Rights you have in certain situations when insurance companies are required by law to sell or offer you a Medigap policy even if you have health problems (called 'pre-existing conditions.')"
https://www.medicare.gov/find-a-plan/staticpages/learn/rights-and-protections.aspx

- Advantage plans:
"13 things to know about Medicare Advantage Plans"
https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-plans/things-to-know-about-medicare-advantage-plans

- Changing plans:
"Medigap [Supplemental] & Medicare Advantage Plans"
https://www.medicare.gov/supplements-other-insurance/whats-medicare-supplement-insurance-medigap/medigap-medicare-advantage-plans

- Comparing open-market plans:
You can compare quality and performance of Medicare plans on the official Medicare website: 
https://www.medicare.gov/find-a-plan/

If you have found an especially helpful page on the official Medicare site, please pass the word via an email to info@hpalumni.org

Next step: 3. Compare plans


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