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Managing Medicare's Costs

Finding ways to save money on Medigap policies (2 of 2)

Medigap policies are the easiest-to-understand type of Medicare supplemental coverage. That’s because they almost never change their benefits. Six of the ten Medigap plans have the same benefit designs that they had 25 years ago — other than for a few tweaks that resulted from changes in Medicare’s benefits. And the coverage of the other four Medigap plans has not changed since they first came on the market in 2010.

While their coverage is easy to understand, Medigap policies’ pricing is confusing. Here’s an example: ff you are a 65-year-old San Francisco resident enrolling in Medigap Plan N, for instance, you may pay as little as $1,117 a year or as much as $1,807 a year, according to quotes from CSG Actuarial.

Thus if you buy your policy from the most expensive insurer, you’ll pay 62% more than if you choose the least expensive company – even though the coverage is identical.

Why do premiums vary so much? One answer is that insurance companies know that some retirees do not shop around before buying a policy. A handful of insurers may intentionally overprice their Medigap policies because they are willing to sell fewer policies so long as the ones they do sell have hefty profit margins.

Another reason is that smaller, less well-known companies may have to offer larger commissions to entice insurance agents to sell their policies, and that added cost is reflected in steeper premiums. Still another reason is that when insurance companies are losing money on their Medigap policies, perhaps because of past underwriting errors, they have no choice but to hike premiums.

Companies use one of three different rating methods when they set premiums. The most common one is the attained-age rating, which raises your premiums by about 3% for each additional year of age in addition to an annual increase to account for for health care inflation. Attained-age policies are usually the best deals for young retirees but can be pricey for older people.

The issue-age rating method, on the other hand, raises premiums to stay even with medical inflation but does not adjust them for age except when the policy is initially sold. Issue-age policies usually have higher premiums for younger retirees since future age increases have already been priced in. But issue age-policies should be less expensive for older retirees who purchased their policies years earlier. Six states require insurance companies to use issue-age ratings – Arizona, Florida, Georgia, and Idaho. Missouri, and New Hampshire.

The third method uses a community rating approach in which everyone pays the same premiums regardless of age or health. Like the issue-age approach, community ratings result in premiums that are expensive for younger retirees but relatively affordable for older people. The popular UnitedHealthcare (UHC) policies endorsed by AARP use a modified community rating in most states, although they will sometimes set their premiums higher or deny coverage to people who want to acquire a Medigap policy after their initial enrollment period has passed.

So that their premiums will be competitively priced for younger retirees, UHC modifies its community rating by offering discounts of 3% a year for each year that the policyholder is younger than 75. This results in a 65-year-old getting a 30% discount, a 66-year-old a 27% discount, and so on until at age 75 the discount has vanished. Eight states require Medigap policies to be community-rated – Arkansas, Connecticut, Maine, Massachusetts, Minnesota, New York, Vermont, and Washington.

In trying to protect yourself from sharp increases in premiums, it can helpful to know which ratings method an insurer uses. As an example, if you find an issue-rated policy that has lower premiums than an attained-age policy, it is expected to have lower premium increases over the long term than will the attained-age policy.

But there are other factors which also play key roles in future premium increases. Companies that have conservative underwriting rules and low sales costs will have lower premium increases regardless of which ratings method they use. And state insurance regulators also play a role. The Florida Office of Insurance Regulation, for example, places caps on Medigap policies’ yearly premium increases.

Here are suggestions about ways you may be able to save money when you are buying a Medigap policy:

Compare premiums from at least three insurance companies. But which three companies do you call, since in many states 30 or more insurance companies sell Medigap policies? As a start, you can look at your state insurance department’s online premium comparisons for Medigap policies, which can be found at the bottom of this page.

Most states list each company’s premiums for individuals of various ages (age 65, age 70, etc.) as well as its toll-free number. Even though some states do not regularly update their premium comparisons, they will give you an idea of the companies most likely to have lower premiums.

The objective is not necessarily to buy your policy from the company that has the lowest premiums, but to buy from a company that has reasonably low premiums and that meets your other criteria, e.g., it is a large, well-known insurer.

If you live in one of the few states that do not have the online comparisons, you can go to the Medicare web site to find a list of companies selling Medigap policies in your state. you might use the Medicare web site’s list of companies here. The Medicare web site does not show insurance companies’ premiums but it does list their toll-free numbers.

Buy from an insurance company that sells a large number of Medigap policies. A government study several years ago found that in the three-year period immediately after people acquired Medigap policies, the largest premium increases came from companies with fewer enrollees. If you want to improve your chances of having only modest increases in your future premiums, your best bet may be to purchase your policy from a large, stable company.

Larger firms not only have lower administrative costs, but they are more capable of withstanding a high claims year without having their premiums spike. According to a a report last year from the National Association of Insurance Companies, the country’s three largest Medigap insurers are 1) United Healthcare, whose policies are endorsed by AARP, 2) Health Care Services Corporation, a Midwestern company, and 3) United of Omaha.

Look for discounts. Several companies offer early enrollment discounts to younger retirees, although these discounts last for only a few years. Also, some companies offer household discounts if both spouses purchase a policy, and those discounts will likely last throughout retirement. Household discounts are typically in the 5% range.

Consider a Medicare Select policy. This type of Medigap policy requires that you use a network provider in exchange for a 10% or greater reduction in premiums. With many Select policies, the only network restriction is that you agree to go to a specific hospital unless it’s an emergency. In almost all cases, the Select policy’s benefits are the same as those of Plan F or perhaps Plan C, except for the network restrictions.

Medicare Select policies are sometimes described as being a combination of a Medigap policy and a PPO. If you go outside the network, you will still have your underlying Medicare coverage but will likely be responsible for those costs that Medicare does not cover.

If you later want to upgrade from a Medicare Select policy to a standard Medigap policy, you may be asked questions about your health before you get a quote. In some cases your request to upgrade to a standard Medigap policy could be denied, although you can also apply to other insurance companies. ◊◊

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