Many questions have come in wondering what this means, who does it affect, and why. The answer to all of these is it depends on your circumstances.
Medicare Plan F
The Medicare Plan F is the health insurance equivalent of “Total Coverage” in car insurance. It’s a Medicare supplement plan that covers all of your Medicare Part A and Part B out of pocket cost as well as often providing coverage for worldwide emergencies. So why is the plan with the most coverage money can buy going away? The long explanation is MACRA, which is a big legislative bill that was passed a few years back. This is the same bill that removes everyone’s social from their Medicare card and gave them the new one. The short answer is that Medicare has a huge budgeting issue going on. Even with your supplement plan Medicare (the feds) are still on the hook for 80% of your bills, generally. They believe that if everyone has to pay their part B deductible then this would help lower waste and unnecessary spending through over use. This means that the less popular Medicare Plan C will be leaving as well since it also covers the Part B deductible. This is the old belief that if you have some skin in the game you’ll be more cautious in spending. Whether it’s right or wrong it’s happening and that’s the reason behind it.
Will my Plan F be cancelled?
No. Think of what’s happening more as a phasing out instead of a termination of the Plan F. Starting on January 1, 2020 no newly eligible Medicare members may sign up for the Medicare Plan F and Plan C. So, everyone who first signs up for Medicare Part A and Part B after January will not be able to enroll into these plans. Those who have been enrolled into Medicare before January will still be able to keep their plan. Those who have had Medicare before January can still enroll into the Medicare Plan F or Plan C if they would like. Unless you are generally healthy you may need a guaranteed acceptance reason to get enrolled. These plans can chose to deny enrollment for medical history. To learn more about guarantee acceptance click here (link).
What are my options?
Let’s start with those who are grandfathered in.
If you already have the Plan F or Plan C then it’s probably neat to leave things alone and keep it. Once you leave these plans it can be difficult to get back on. They can get pricey as you get older but the coverage will be hard to beat. If the price does become too much bear then you may want to see if a Medicare Advantage plan is a good fit for you. These plans generally have no monthly premium but instead have small copays and coinsurances instead. Financially they’re extremely affordable but you have to do your homework or work with a broker who does due to networks. These plans are mostly HMO products which mean you will need to ensure that all of the doctors you see are “in network” so that you can continue to see them. If they are then you will likely be just fine once you adjust to the process of getting referrals. A referral is when you must get approval from your Primary care doctor to see a specialist.
Now sometimes patients don’t adjust well to this process or find out that one or more of their doctors aren’t in network. There is a guaranteed acceptance rule that allows for someone who left a Medicare Supplement plan for a Medicare Advantage plan to return to their same plan as long as they do so within one calendar year. After 365 days you will have to reapply as if you never had it. Since a Medicare Supplement can deny enrollment based on health history you may have difficulty getting accepted if you decide too late.
Now let’s look at those who are not grandfathered in.
This means you are enrolling into Medicare after January 1, 2020. As far as Medicare Supplement plans, the Plan G will be the plan with the most coverage available to you.