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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 Mar 26, 2020.) 

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:

Basic limitations:
- Original Medicare. "If you don't get Part D or a Medigap policy when you're first eligible, you may have to pay more to get this coverage later. For Part D, this could mean a lifetime premium penalty."
- Medicare Advantage. "In most cases, you'll need to use doctors who are in the plan's network."
https://www.medicare.gov/sign-up-change-plans/get-started-with-medicare

Supplemental (Medigap) plan limitations:
To all find the limitations and traps, start at this page: "How Medicare works with other insurance"
https://www.medicare.gov/supplements-other-insurance/how-medicare-works-with-other-insurance

Work you way -- step-by step -- down the links on the left side of the page:
- "COBRA: 7 important facts"
- "Retiree Insurance" [Includes "4 things to find out about your retiree coverage" ]
- "What's Medicare Supplement Insurance (Medigap)?
- "When can I buy Medigap?" [Key point: "Buy a policy when you're first eligible"]
- "Find a Medigap policy"

Especially note "Guaranteed issue rights" -- situations when insurance companies "...must sell you a Medigap policy, must cover all your pre-existing health conditions, and can't charge you more because of past or present health problems."
https://www.medicare.gov/supplements-other-insurance/when-can-i-buy-medigap/guaranteed-issue-rights

Advantage plan limitations:
To all find the limitations and traps, start at this page: "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

Work you way -- step-by step -- down the links in the lower center of the page:
- How to join a Medicare Advantage Plan
- Who can join a Medicare Advantage Plan?
- When can I join, switch, or drop a Medicare Advantage Plan?
- How do Medicare Advantage Plans work?

Changing plans:
"Medigap & 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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