By Tom Swanson
Chair, TVARA Health Committee
Health Care Insurance – Are you ready for the crazy season?…..uh, open season?…..uh, open enrollment?
For retirees not covered by the TVA group plan (primarily those covered by Medicare) the time is here when your mailbox becomes packed with advertisements from insurance companies and brokers wanting to SAVE YOU MONEY on your health insurance! How can you refuse such deals?
Well, for most of you it’s easy. You already went through a fairly rigorous process to determine the insurance that would best meet your health care needs considering the amount of the premium for the coverage offered. So, with the exception of prescription drug insurance that we will cover later, unless you have had a change in your health situation that would require another look at health providers (doctors or medical facilities) you probably don’t need to do anything.
For those of you who are nearing age 65 and have not gone through the process of selecting a Medicare supplemental health insurance plan from a private insurer, we encourage you to review this article: Supplemental Health Insurance – What To Do When You Hit 65.
Regardless of the reason for selecting a Medicare supplemental insurance plan (new to Medicare coverage or wanting to make a change), there are several resources available to you to help in making that decision:
- Consultation with an insurance advisor at OneExchange which is the Towers Watson service to TVA retirees that provides access to the policies posted on their private insurance exchange.
- State Health Insurance Assistance Program (SHIP) which is familiar with ALL health insurance available in a state. For Tennessee it is 1-877-801-0044 but the number for the appropriate state is on the back of the Medicare & You white book and is also available online at https://www.medicare.gov/contacts/ by selecting state and “SHIP”. SHIP provides the same consultation service as does OneExchange and its also free.
- Online with Medicare at https://www.medicare.gov/sign-up-change-plans/decide-how-to-get-medicare/your-medicare-coverage-choices.html Be sure to enter the same information that you provided the consultants so that you can review comparable results. Medicare’s free publication “Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare” has much more detailed information on Medigap Plans. https://www.medicare.gov/Pubs/pdf/02110-Medicare-Medigap.guide.pdf
- Independent insurance brokers. There are a considerable number of health insurance brokerage sources online providing information about Medicare supplemental insurance (medigap) plans such as https://www.medigap.com and https://www.gomedigap.com. Some retirees have reported good results in obtaining a Medicare supplemental plan through them.Health insurance company websites along with information sessions hosted by insurance company agents and independent brokers in motels, community centers, senior centers, etc. are good sources of information while munching on cookies and juice.
The point of the discussion above is that you should expect to spend some time getting educated on this topic but there are plenty of sources of information and free consultation services to help you.
Before leaving the discussion of medical insurance we need to remind retirees that if you have chosen a Medigap Plan F as your supplement to Medicare, that plan is to close January 1, 2020 to new participants which will pretty much guarantee an aging insurance pool for that plan with a resulting negative impact from increasing claim costs over time. Medigap Plan G provides the same extensive coverage as Plan F but not does not cover the Medicare Part B deductible. However, the Plan G premium is usually priced sufficiently lower than the Plan F premium making up for the missing Medicare Part B deductible on an annual basis and if you are lucky enough to incur little expense that is subject to the deductible in any year, it makes Plan G an even better buy than Plan F.
You are also reminded that OneExchange must be used for the purchase of your medical health insurance (not prescription drug coverage insurance) if 1) you want to continue to collect the TVA Health Care Credit (this is NOT the TVARS supplemental payment) or 2) you want to keep your TVA group health insurance coverage for a non-Medicare family member.
Finally, as mentioned earlier, there is the matter of Prescription Drug Coverage.
As most of you know, Medigap plans don’t cover prescription drugs so a standalone Part D prescription drug plan is required if you purchased or will purchase a Medigap plan. Once again, start with the advisors at OneExchange, move on to the advisors at SHIP, check out the Medicare & You white book and look at https://www.medicare.gov/part-d/index.html. Be absolutely certain that your prescriptions are covered by the plan you are considering and focus on the estimated annual cost to you. Some retirees noted that not everyone is reporting the annual cost of drugs correctly if you have tier 2 and 3 drugs. Be sure to check out any quote received by a consultant or other website with the estimate from the Medicare website and compare the annual cost of drugs and not just the premium. The annual cost takes into consideration out of pocket costs such as the operation of the deductible and the premium.
The drugs (formulary) covered by any prescription drug insurance plan can change, and usually do change, every year. In addition, your prescription drug requirements may change within a year. The government provides the opportunity to re-shop for medical and prescription drug insurance each year (the open enrollment period) from October 15 to December 7. Even if you are perfectly satisfied with your current medical insurance, you are encouraged to look for new drug coverage every year, especially if you have changed your prescriptions in any way such as changed to a time-release formula…..it makes a difference in cost and coverage.
Remember, if you do not choose a prescription drug plan now because you have no or few prescriptions for example, but later in life you do want to pick up prescription drug insurance there will be a penalty that you will pay every month for your late enrollment. For more information see https://www.medicare.gov/part-d/costs/penalty/part-d-late-enrollment-penalty.html Shopping around is not just encouraged but is a necessity for this type of insurance coverage.
Finally, before you lose your TVA group health insurance plan due to age (before the month that you turn 65), you should take advantage of your vision benefit, your hearing benefit (audiology screening – especially if it turns out that you need hearing aids) and your preventive care benefit. These either do not exist or are different under Medicare.
An ongoing discussion of discoveries concerning Medicare supplemental insurance can be viewed on Facebook at Tennessee Valley Authority Retirees Association (do not abbreviate) and TVA Friends Past & Present (requires an invite).