Latest news with #Medigap
Yahoo
5 days ago
- Health
- Yahoo
Dialysis Patient Citizens Applauds Texas Legislature for Passing Historic Bill Expanding Affordable Medigap Access for Dialysis and ALS Patients
AUSTIN, Texas, June 23, 2025 /PRNewswire/ -- House Bill 2516 has become public law, a significant victory for Texans living with End-Stage Renal Disease (ESRD), or kidney failure, and Amyotrophic Lateral Sclerosis (ALS). The legislation, championed by Representative Ryan Guillen (R-TX-31), received overwhelming bipartisan support in the Texas State Legislature, passing the House with a 133-4 vote and the Senate unanimously. The law guarantees that ESRD and ALS patients under the age of 65 can access affordable Medigap insurance. Specifically, Medigap Plans A, B, and D will be available at the same premium rate as for those age 65, while the remaining plans will be capped at no more than 200% of the age 65 rate. Now, younger Texans suffering from ESRD and ALS no longer need to worry about Medicare's gaps in coverage. "Today is a landmark moment for dialysis and ALS patients across Texas," said Andrew Conkling, Board President for Dialysis Patient Citizens (DPC). "This law brings long-overdue relief to individuals who, until now, faced Medigap premiums as high as $1,700 per month simply because they were under 65. It restores fairness and makes critical coverage accessible to those who need it most." Previously, under-65 ESRD and ALS patients in Texas were priced out of Medigap plans due to prohibitively high premiums. HB 2516 ensures those patients can finally afford the supplemental insurance they rely on to cover the gaps in Medicare. DPC Patient Ambassador and Texas resident Patricia Benavidez-Patel shared her compelling story in support of the bill, stating: "I've lived with dialysis, and I've lived with the constant fear of bills I can't afford. This law gives patients like me a real chance; it gives me not only a chance to survive, but a chance to live without fear of medical debt." In addition, former DPC board member Natalie Zuniga, who recently passed away, wrote a letter to the editor in defense of Medigap access. Her voice continues to echo during this victory for the dialysis community, which she so fiercely supported. Dialysis Patient Citizens thanks Representative Guillen for his steadfast leadership, Governor Abbott and the Texas Legislature, and all the patient advocates who helped make this victory possible. View original content to download multimedia: SOURCE Dialysis Patient Citizens Error in retrieving data Sign in to access your portfolio Error in retrieving data Error in retrieving data Error in retrieving data Error in retrieving data
Health Line
18-06-2025
- Health
- Health Line
Switching from Medicare Advantage to Medigap: What to Know
Medicare enrollees have the flexibility to change their coverage as their health and financial needs evolve. If you're considering switching from Medicare Advantage (Part C) to a Medicare supplement plan (Medigap), there are various factors to consider. Medicare Advantage and Medigap have some similarities, but they offer different forms of coverage. Both are available from Medicare-approved private insurance companies. But where Medicare Advantage plans are an alternative to Original Medicare, Medigap plans are a supplement to Original Medicare. To switch from Medicare Advantage to Medigap, you'll need to plan ahead, as there are set periods each year to make this sort of change. First, you'll need to return to Original Medicare. In this article, we discuss when to switch coverage, how to switch, why you may want to switch, and more. Medicare Advantage vs. Medigap Medicare consists of four main parts: Part A (hospital insurance) Part B (medical insurance) Part C (Medicare Advantage) Part D (prescription drug coverage) Parts A and B together are called Original Medicare. Original Medicare covers medically necessary inpatient and outpatient services and procedures. If a person with Original Medicare wants prescription drug coverage, they can buy a stand-alone Part D plan. With Original Medicare, beneficiaries have a variety of out-of-pocket costs in the form of premiums, deductibles, copayments, and coinsurance. To help with these costs, people can buy supplemental insurance called Medigap. Medicare Advantage is an alternative to Original Medicare. It includes the same level of coverage as Original Medicare but bundles this coverage with additional benefits, such as drug coverage and dental, vision, and hearing care. When can you switch from Medicare Advantage to Medigap? Since you can't have Medicare Advantage and Medigap at the same time, you'll need to return to Original Medicare before signing up for Medigap. There are set times during the year when a person with a Medicare Advantage plan can change their coverage and return to Original Medicare. These include the following: Medicare open enrollment period (OEP): This runs from October 15 to December 7 each year. Medicare Advantage open enrollment period (MA OEP): This runs from January 1 to March 31 each year. Special enrollment period (SEP): If a person experiences a life event that affects their insurance coverage, they may qualify for an SEP. The timing and duration of the SEP depend on the event itself. Once you have Medicare Part B, you can sign up for Medigap. Unlike Medicare Advantage, which has set enrollment periods, you can enroll in a Medigap plan at any time. However, the best time to enroll in a Medigap plan is during your Medigap open enrollment period (OEP). If you enroll during your Medigap OEP, you can pick from any plan available in your state without being denied coverage due to a preexisting health condition. The Medigap OEP is a one-time, 6-month window that starts at the beginning of the month when you first get Part B coverage and are 65 years or older. If you miss the Medigap OEP, insurance companies aren't federally required to sell you a plan. Why switch from Medicare Advantage to Medigap? There are various reasons why someone may wish to switch to Original Medicare from a Medicare Advantage plan. With Original Medicare, you have greater flexibility to choose healthcare professionals, as you aren't limited to a regional network of providers, as you typically are with Medicare Advantage. If you travel extensively domestically or abroad, you'll have greater coverage with Original Medicare and Medigap. If your health or insurance needs change, you may not require the additional benefits of your Medicare Advantage plan. You don't require prior authorization or referrals for many services with Original Medicare. Ultimately, the decision of whether to switch hinges on personal factors. It's best to compare your options thoroughly and explore the potential effects of changing coverage. If you'd like to speak with someone about your Medicare coverage options and receive unbiased information about what type of Medicare coverage may be best for you, consider speaking with a representative from your local State Health Insurance Assistance Program (SHIP). You can also contact Medicare directly at 800-633-4227 (TTY: 877-486-2048). How to switch from Medicare Advantage to Medigap? Here are some steps to consider as you plan your switch: Research your Medigap plan options and compare benefits versus costs. Confirm that your preferred healthcare professionals accept Original Medicare. Check your timing and determine whether you're eligible for the Medigap OEP. Review your state's Medigap policies so you understand your rights. Contact your Medicare Advantage insurance carrier during a qualifying enrollment period and request to disenroll from your plan. Then, contact Medicare and enroll in Original Medicare. Once you're enrolled in Original Medicare, you can apply for Medigap coverage. However, prepare for possible underwriting if you're outside the Medigap OEP. Frequently asked questions Can I switch from a Medicare Advantage plan to a Medicare supplement plan? Yes, you can switch from a Medicare Advantage plan to a Medicare supplement plan. First, you'll need to return to Original Medicare during an appropriate enrollment period. Then, after researching your plan options, you'll need to apply for Medigap coverage with your chosen insurance carrier. Yes, you can switch from a Medicare Advantage plan to a Medicare supplement plan. First, you'll need to return to Original Medicare during an appropriate enrollment period. Then, after researching your plan options, you'll need to apply for Medigap coverage with your chosen insurance carrier. Is there a penalty for switching from Medicare Advantage to Original Medicare? No, there's no penalty for switching from Medicare Advantage to Original Medicare. While Medicare does have various possible penalties for late enrollment, there's no penalty linked with dropping Medicare Advantage coverage and returning to Original Medicare. To avoid potential penalties, you'll want to make sure you enroll in Part B and Part D prescription drug coverage after leaving your Medicare Advantage plan. No, there's no penalty for switching from Medicare Advantage to Original Medicare. While Medicare does have various possible penalties for late enrollment, there's no penalty linked with dropping Medicare Advantage coverage and returning to Original Medicare. To avoid potential penalties, you'll want to make sure you enroll in Part B and Part D prescription drug coverage after leaving your Medicare Advantage plan. Summary If you're interested in switching from Medicare Advantage to Medigap, you'll first need to return to Original Medicare. You can do so during the Medicare OEP, the Medicare Advantage OEP, or a SEP, if you qualify. This change will likely affect your costs, coverage, and provider access. So it's important to give it ample thought, explore all its potential effects, and compare your options. The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.
Health Line
16-06-2025
- Health
- Health Line
What Is the Medigap Open Enrollment Period?
The Medigap open enrollment period (OEP) is your first opportunity to enroll in a Medigap plan. During the Medigap OEP, you cannot be denied Medigap coverage due to a preexisting health condition. Medicare supplement insurance, or Medigap, is a type of private insurance that helps cover the out-of-pocket costs of Original Medicare. As with other parts of Medicare, Medigap has a set enrollment period for people new to Part B. In this article, we discuss the Medigap open enrollment period, its benefits, and what happens if you miss this window. When is the Medigap open enrollment period? The Medigap OEP is a one-time, 6-month window that begins on the first of the month you are enrolled in Part B and are age 65 years or older. If you sign up for Medigap during the Medigap OEP, you can join any plan in your state. Additionally, insurers cannot deny you coverage or charge you a higher rate due to a preexisting health condition. If you wait until after the Medigap OEP to join a plan, insurers are under no obligation to sell you a plan or charge you the standard rate. Insurers can evaluate factors like your medical history and age when deciding whether to sell you a plan. This process is known as medical underwriting. The Medicare website has a tool you can use to determine when and whether you're eligible to enroll in Medigap. Benefits of the Medigap open enrollment period If you're considering joining a Medigap plan, there are various benefits to doing so during the Medigap OEP instead of waiting. These include the following: You can join any plan in your state regardless of your health status. You'll have access to a wider array of plan options at lower costs. Your coverage will begin immediately (with the exception of expenses related to preexisting conditions, which are subject to a 6-month waiting period before the Medigap policy starts covering them). What happens if I miss the Medigap open enrollment period? As mentioned earlier, if you miss the Medigap OEP, you could be subject to medical underwriting when you try to enroll in a Medigap plan, resulting in fewer options and higher costs. However, there are situations where this may not apply, known as 'guaranteed issue rights.' These rights apply in certain cases where a person loses coverage or experiences a change in coverage. If you have guaranteed issue rights, an insurance company needs to sell you a Medigap policy, regardless of whether you have a preexisting condition, and they can't charge you more due to your health status. Some circumstances where guaranteed issue rights might come into play include: losing Medicare Advantage coverage due to: your plan leaving Medicare your plan leaving your area you moving out of the plan's area losing secondary insurance through an employer while enrolled in Original Medicare losing coverage due to the bankruptcy of your Medigap provider Some states have different Medigap rules. If you have questions about Medigap open enrollment in your specific state, consider reaching out to your local State Health Insurance Assistance Program (SHIP). Frequently asked questions How long is open enrollment for Medigap? Open enrollment for Medigap lasts 6 months. If you're age 65 years or older, the Medigap OEP begins on the first of the month that you have Part B coverage. Open enrollment for Medigap lasts 6 months. If you're age 65 years or older, the Medigap OEP begins on the first of the month that you have Part B coverage. Can I add a Medigap policy at any time? Yes, you can sign up for a Medigap policy at any time. Unlike Medicare Advantage plans, which require waiting for specific enrollment periods to join, switch, or drop coverage, you don't need to wait for a set enrollment period with Medigap. However, if you sign up for a Medigap plan outside of the Medigap OEP, insurance companies are free to deny you coverage or charge you a higher rate based on your health. Yes, you can sign up for a Medigap policy at any time. Unlike Medicare Advantage plans, which require waiting for specific enrollment periods to join, switch, or drop coverage, you don't need to wait for a set enrollment period with Medigap. However, if you sign up for a Medigap plan outside of the Medigap OEP, insurance companies are free to deny you coverage or charge you a higher rate based on your health. Summary The Medigap open enrollment period (OEP) is a 6-month window that starts at the beginning of the month when you're age 65 years or older and first have Part B. During the Medigap OEP, you can buy any Medigap plan offered in your state regardless of whether you have a preexisting health condition.
Health Line
16-06-2025
- Health
- Health Line
Understanding Your Medicare Coverage
There are many Medicare options to consider, so understanding how to navigate them is important. You can begin considering Medicare options before you turn 65, which is when you first become eligible. Medicare is government-funded health insurance available to people ages 65 and older. If you have specific health conditions, including amyotrophic lateral sclerosis (ALS) or end stage renal disease (ESRD), you'll be eligible before turning 65. Medicare is different from Medicaid, which is specifically for people with low incomes and resources. About Medicare Before you turn 65, you may want to consider your current health insurance, when it will end, and whether you may need any new or additional benefits in the future. Original Medicare has two main parts — Part A and Part B. These parts cover most inpatient and outpatient services. Other parts of Medicare include Medicare Advantage (Part C), Part D prescription drug plans, and Medigap supplement insurance. Private insurers administer these plans and offer additional benefits and services. You can choose a plan or combination of plans that will work best for you by considering: budget doctor, hospital, or clinic preferences current and future health conditions medications Once you're eligible for Medicare, you may be automatically enrolled. If not, you can enroll online, by post, or in person at a local Social Security office. Medicare coverage The different Medicare parts include the following coverage: Medicare Part A Part A is for inpatient hospital care. It covers the services you receive when you are admitted to a hospital or other inpatient healthcare facility. It does not cover outpatient care, most hospital room extras, private, custodial care, or long-term care. Medicare Part B Part B covers outpatient services, including diagnostic tests related to your health conditions. It also covers some preventive services and limited prescription drugs. Medicare Part D prescription drug plans If you have Original Medicare, you can enroll in a Part D drug plan. Each Part D drug plan has a formulary, which is a list of covered medications. As private insurers administer these plans, it's important to consider the covered medications when comparing the different options. Medicare Advantage (Part C) Medicare Advantage plans must include the same benefits as Original Medicare Part A and Part B. Plans typically include additional benefits like fitness, vision, dental, and prescription medications. You can use Medicare's plan finder to search for plans in your area. Medigap Medicare supplemental insurance can be added to Original Medicare only. It helps cover some of the associated out-of-pocket costs. There are currently 10 different Medigap plans to choose from, although not all plans are available in all areas. Medicare costs Medicare costs will vary by plan but can include monthly premiums, deductibles, coinsurance, and copayments. Part A In 2025, Medicare Part A costs include: Monthly premium: Most people pay $0 for Part A, but this will depend on your working history. Deductible: It is $1,676 per benefit period. A benefit period begins when you're admitted to a hospital and ends when you haven't received any inpatient care for 60 days in a row. Copayment: This ranges from $0 to the full cost of services, depending on the length of your hospital stay. Part B In 2025, Medicare Part B costs include: Premiums: premiums start at $185 per month but can increase based on your income Deductible: $257 per year Coinsurance: 20% of the Medicare-approved amount for eligible Part B items or services Part C Medicare Advantage plan costs vary but can include: monthly premiums annual deductibles copayments coinsurance According to the Centers for Medicare & Medicaid Services (CMS), the average monthly Part C premium is around $17 in 2025. Part D Premiums and other out-of-pocket costs for Medicare Part D prescription drug plans vary by plan, plan provider, and location. The national 2025 base beneficiary premium is $36.78, and your plan price can increase based on your income. Medigap You'll pay a separate premium for a Medigap plan, which can vary by plan provider and location. Medicare billing Most people will not receive a bill from Medicare, as it generally operates a fee-for-service (FFS) model. This means that healthcare facilities, professionals, doctors, and clinics bill Medicare directly for each item or service. Plan premiums may automatically be deducted from Social Security benefits, but if not, Medicare will bill you. How to pay for Medicare premiums There are various ways to pay your Medicare bills each month, including: through Medicare's website, with a debit or credit card by mail, using a check, money order, or payment form Another way to pay your Medicare bill is through Medicare Easy Pay. This free service allows you to pay your monthly Medicare Part A and Part B premiums through automatic bank withdrawals. You can print and complete the Authorization Agreement for Preauthorized Payments form (SF-5510), which is available in English and Spanish. Takeaway Medicare can be complex, but understanding the basics can help you focus on your coverage needs. Original Medicare covers inpatient and outpatient medical services. Additional plans can be added to cover take-home prescription drugs and some of Original Medicare's out-of-pocket costs. Other bundled plans are also available. Medicare's website can help you browse the different plan options available in your area, and help you make the best choice for your healthcare needs. The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.
Yahoo
14-06-2025
- Health
- Yahoo
Ask Kerry: Readers weigh in on Medicare and more
My recent columns drew thousands of questions and comments, largely centered on rising medical debt and Medicare as well as retirement confusion on Social Security and health savings accounts, known as HSAs. The following is an edited sample of those 6,000-plus comments—good and bad!—and my take on them. As always, if you have a personal finance question, you click here to drop me a note. I'll try and answer in a future column. By subscribing, you are agreeing to Yahoo's Terms and Privacy Policy Here we go. Let's start with someone who wasn't too happy with me: While well intentioned, I was disappointed in your article. You neglected to mention that Medigap policies will cover all or most of what Medicare does not. Also: people you mention could likely be eligible for Medicare Savings Plans that will lower beneficiary costs. A Qualified Medicare Beneficiary or QMB is the most generous plan and covers all copayments and deductibles, the Part B premium, and also provides the extra help you noted. Kerry: Guilty. Regular Medicare does not come with built-in caps on a variety of out-of-pocket costs, so you don't want to be enrolled in it if you don't also have supplemental protection. The bills that lead to medical debt typically include routine healthcare services such as lab fees and diagnostic tests, dental care, and visits to the doctor, and long-term care services not covered by Medicare, according to KFF. And Medicare typically requires patients to pay out of pocket around 20% of their doctor bills. Many retirees can't. Now let's talk about Medigap health insurance. Not everyone has this coverage. These policies are sold by private insurance companies and, as you noted, pay part or all of some leftover costs, such as outstanding deductibles, coinsurance, and co-payments, and may also cover healthcare costs that Medicare does not cover at all like most medical care received when traveling out of the US. In most states, however, the guaranteed right to buy a Medigap is limited to the time when you first sign up for Medicare Part B. That's because Medicare does not permit Medigap plans from rejecting you or charging a higher premium because of a preexisting condition during that period. In most states, your premium, however, will vary depending on factors such as your age, gender, and where you live. The Medigap guarantee policy is also good if you joined an Advantage plan during your first year of Medicare but disenrolled within a year and switched to traditional Medicare. After that, though, Medigap plans in most states can flat-out reject you if you have a preexisting condition, such as diabetes. The exceptions are New York, Connecticut, Maine, and Massachusetts. There is help out there as I noted if you have a limited income, you might be eligible for Medicare's Extra Help, which covers Part D premiums and deductibles and caps drug costs. Free one-on-one counseling is available through state Health Insurance Assistance Programs (SHIP). The Medicare Rights Center offers a free consumer helpline: 800-333-4114. You can also contact Medicare directly at 800-633-4227. QMB, that you mentioned, is a Medicaid program that helps low-income Medicare beneficiaries pay for their Medicare costs, such as premiums, deductibles, and copayments. It's a secondary insurance, meaning it pays for Medicare cost-sharing after Medicare has paid its share. I'm 60 and super worried about future long-term care costs. What might these add up to? Kerry: One factor that plays into the rising healthcare debt for older adults is that traditional Medicare and Medicare Advantage do not cover the cost of long-term care in nursing homes and assisted-living facilities. An apartment in an assisted-living facility had an average rate of $74,148 a year in 2024, according to the National Investment Center for Seniors Housing & Care — and costs go up as residents age and need more care. Units for dementia patients can run more than $94,000. About 80% of those ages 65 and over will require some long-term care, with nearly 20% requiring high-intensity care for more than three years, Anqi Chen, co-author of a brief from the Center for Retirement Research at Boston College, told me Can one use the HSA contributions to pay for Medicare Part B & D costs or any other insurance plans they may have (Advantage, MediGap etc)? Kerry: Yes, you can tap your health savings account to pay for Medicare premiums and other qualified medical expenses, including those covered by Medicare Parts A, B, C (Medicare Advantage), and D (prescription drug coverage). But it's a hard no on using HSA funds to pay for Medicare Supplement (Medigap) plan premiums. Learn more: What is a health savings account (HSA)? My husband and I are retired, in our 70s and living in Mexico. My husband has a HSA he set up through his work probably 15 years ago. Can he use it for medical and similar expenses outside the US? Can we continue to contribute to the existing HSA? Kerry: Yes, you can use your HSA to cover medical costs when you live outside the country as long as the expenses are qualified medical expenses under US law. You, however, might be docked a 1%-3% transaction fee if you are accessing your account with a credit card. As for amping your account up, for now, you can't contribute more money to an HSA at your age. Contributions are kaput once you are eligible for Medicare, typically starting on the first of the month you turn 65. A current bill before the Senate right now might tweak this eligibility if it becomes law. I am about to retire and am planning to live in Canada. If I work and receive a salary of about 50K in Canada, am I bound by the Social Security Income limitations Receipt work limitation? Kerry: This is one to take up with a Social Security officer directly. In general, if you live and work in another country, your Social Security income limits usually remain the same as if you were working in the US. Here's how it works: The earnings test applies only to people who are collecting Social Security between age 62 (the earliest age of eligibility) and their full retirement age, which is between 66 and 67, depending on the year you were born. On the face of it, you're allowed to claim Social Security retirement benefits while working, and the withheld benefits are not lost. Social Security recalculates monthly benefits when you reach full retirement age to credit back the withheld benefits. In general, the way the earnings test works is if you're between age 62 and your full retirement age and earn over $23,400 (the limit is adjusted annually) and collecting Social Security, the administration will withhold $1 for every $2 over that limit. For people hitting their full retirement age in 2025, the annual exempt amount is $62,160. This higher exempt amount applies only to earnings made in months prior to the month you hit your retirement age. The good news is that the earnings test goes away at full retirement age. But nothing is simple here. There is another method called the foreign work test. With this method, your income could impact your current benefit. If you are receiving Social Security benefits and are younger than full retirement age, SSA will withhold your benefits for each month you work more than 45 hours outside the United States and you are not subject to US Social Security taxes. It does not matter how much you earned or how many hours you worked each day. Check out How Work Affects Your Benefits (Publication No. 05-10069). I'm 69 years old and plan to work until at least 72 or 73. My Social Security Income (SSI) benefits will be the bulk of my income upon retirement, and I am currently $40,000 in debt with a repayment plan that will eliminate all or most of the debt before I retire. The caveat is that I will need to claim my SSI benefits to support this payment plan. I turn 70 in September 2025 and would like to know when I can apply for my Social Security Income benefits to maintain the 8% increase until I reach 70 years old. Is it on my birthday in September, or do I need to wait until October 1st? Kerry: To receive the maximum 8% increase in your Social Security benefit, you should apply for your benefits the month before your 70th birthday. This will ensure your benefits start the month of your 70th birthday, and you receive the full 8% increase for each year you delayed taking benefits after your full retirement age. It typically takes at least a month, or 30 days, to receive your first Social Security check after your application is processed. It could be 45 days in some cases. The precise timing of your check delivery relies on processing times at the Social Security Administration. Read more: When will I get my social security check? During a recent operations meeting in April at SSA, an official from the agency reported that the field offices 'are struggling right now to keep pace with the timeliness this year.' The fact that they are aware of this is a good thing, and, if they take action, the SSA will have this under control by the time you apply for your benefit. In general, I recommend applying up to four months before you want to start receiving benefits. Kerry Hannon is a Senior Columnist at Yahoo Finance. She is a career and retirement strategist and the author of 14 books, including the forthcoming "Retirement Bites: A Gen X Guide to Securing Your Financial Future," "In Control at 50+: How to Succeed in the New World of Work" and "Never Too Old to Get Rich." Follow her on Bluesky. Sign up for the Mind Your Money newsletter Sign in to access your portfolio
