A few years back I didn’t read the fine print. A medication I was on was cheaper under MA and I made the switch. After a couple of years of hearing horror stories, I wanted back in to traditional Medicare. THEY WOULDN’T TAKE ME! Why not? Seems my medical history had some mention of “arthritis”. OMG! I am not seriously arthritic. I ride m…
A few years back I didn’t read the fine print. A medication I was on was cheaper under MA and I made the switch. After a couple of years of hearing horror stories, I wanted back in to traditional Medicare. THEY WOULDN’T TAKE ME! Why not? Seems my medical history had some mention of “arthritis”. OMG! I am not seriously arthritic. I ride my bike 70 miles a week. But “arthritis” was a magic word that let them deny coverage.
What people, particularly those nearing retirement age, need to know is that it’s only when you first go on Medicare that the insurance companies can’t consider “preexisting conditions”. If you go onto Medicare Advantage and then try to get back in to traditional Medicare they can reject for preexisting conditions.
I got lucky though. There is a loophole. If you move to a different state, which, as it happened, I did, then they can’t reject for preexisting conditions. The same company that initially rejected me now accepted me once a broker pointed this out.
Steve thanks for sharing. Can you clarify a bit, because what you wrote makes it sound like our government Medicare rejected you. It's likely it was your private insurance gap-policy where they could then reject your purchase of a policy to cover what Medicare doesn't pay.
Many people don't understand that Medicare (from the government) only pays 80%, so people purchase (from private insurers) a "gap" policy to cover the rest. This is where the problem is when you try to go back and forth from Advantage to regular Medicare. Those PRIVATE insurers are allowed to use pre-existing conditions to reject or charge more.
And thanks for the hot tip about how moving made a difference!
Perfect explanation. And it's perfectly awful that they do this. Just like Thom says, if profit is involved, it becomes all about rejecting people or care for their medical conditions. We need a law. We need single payer for everyone.
Steve please clarify your situtation I am confused
First you switeched from Medicare to MA because of a cheaper medication under MA.
Then when you discovered that MA was a rip off, Medicare wouldn't take you back because of a pre existing condition (arthritis) . First question: How did they know that if it isn't in your medical records?
Lastly: How did moving to a different state,exempt you from Medicare rules?Medicare is Federal, not state, nor is it regulated by any state. It is simply a single payor program.
Thus not subject to state Insurance regulators.
It sounds to me like you were denied by Medicare Advantage for a pre existing condition, and to my knowledge Medicare doesn't deny for pre existing conditions (I will research that, trust me) My initial search reveals that Medicare will cover pre existing conditions.
Your experience reads to me as though you
1. Left Medicare for MA
2. Tried perhaps to leave your MA advantage program for another MA advantage program
3. Were denied, until you moved to another state.
I don't know rules for private insurance including so called medi-gap. I have such, a Group plan through CalPers, and everything is covered I haven't paid one cent, though I have been treated for cancer, in fact I had a CT Scan yesterday and an MRI on Saturday, and get the same ever six months, including a visit with my oncologist, and I have been in remission for four years. I am pre diabetic and get blood tests and a follow up with my PCP every six months as well, and haven't paid a cent, nor had a procedure denied.
I really don't understand your situation, especially since a state insurance regulator has no jurisdiction or say over Medicare, only private insurance companies.
You have correctly understood what I said. I joined MA in '21, got out in '23 after moving in late '22.
They knew about my arthritis from my medical records.
Your 3 point summary is incorrect on point 2. I never tried to or wanted to enroll in another MA program.
How did moving to a different state exempt me from that rule? I don't know what to tell you except that it DID! I was working with a broker, who said my condition didn't seem so bad and that she'd try to get me in a traditional Medicare plan. And then, I just happened to mention that I'd recently moved from Illinois to Arizona, and she said "Oh! That changes everything." And she got me into the plan I originally chose (actually, it was slightly more expensive, since I no longer had "guaranteed-issue" rights, but with the same company).
That is what happened. I am neither a lawyer nor an insurance administrator and I was surprised as hell that it happened, but it did!
Your question got me to research exactly what happened because I don't quite understand it myself.
"Please note that if you have Medicare Part C and there aren’t any Medicare Advantage plans available in the new service area that you’re moving to (or you don’t want to enroll in one), you can also choose to return to Original Medicare. You can then sign up for a stand-alone Medicare Part D prescription drug plan, and you might be able to buy a Medicare Supplement insurance plan."
Note the "(or don't want to enroll in one)". Weird, I know, but we live in weird times.
A few years back I didn’t read the fine print. A medication I was on was cheaper under MA and I made the switch. After a couple of years of hearing horror stories, I wanted back in to traditional Medicare. THEY WOULDN’T TAKE ME! Why not? Seems my medical history had some mention of “arthritis”. OMG! I am not seriously arthritic. I ride my bike 70 miles a week. But “arthritis” was a magic word that let them deny coverage.
What people, particularly those nearing retirement age, need to know is that it’s only when you first go on Medicare that the insurance companies can’t consider “preexisting conditions”. If you go onto Medicare Advantage and then try to get back in to traditional Medicare they can reject for preexisting conditions.
I got lucky though. There is a loophole. If you move to a different state, which, as it happened, I did, then they can’t reject for preexisting conditions. The same company that initially rejected me now accepted me once a broker pointed this out.
Steve thanks for sharing. Can you clarify a bit, because what you wrote makes it sound like our government Medicare rejected you. It's likely it was your private insurance gap-policy where they could then reject your purchase of a policy to cover what Medicare doesn't pay.
Many people don't understand that Medicare (from the government) only pays 80%, so people purchase (from private insurers) a "gap" policy to cover the rest. This is where the problem is when you try to go back and forth from Advantage to regular Medicare. Those PRIVATE insurers are allowed to use pre-existing conditions to reject or charge more.
And thanks for the hot tip about how moving made a difference!
You're right! MEDICARE didn't reject me. The private Part B Medicare Supplement plans (aka "traditional Medicare") rejected me.
Perfect explanation. And it's perfectly awful that they do this. Just like Thom says, if profit is involved, it becomes all about rejecting people or care for their medical conditions. We need a law. We need single payer for everyone.
Happy Bike-Trails Steve!
Steve please clarify your situtation I am confused
First you switeched from Medicare to MA because of a cheaper medication under MA.
Then when you discovered that MA was a rip off, Medicare wouldn't take you back because of a pre existing condition (arthritis) . First question: How did they know that if it isn't in your medical records?
Lastly: How did moving to a different state,exempt you from Medicare rules?Medicare is Federal, not state, nor is it regulated by any state. It is simply a single payor program.
Thus not subject to state Insurance regulators.
It sounds to me like you were denied by Medicare Advantage for a pre existing condition, and to my knowledge Medicare doesn't deny for pre existing conditions (I will research that, trust me) My initial search reveals that Medicare will cover pre existing conditions.
Your experience reads to me as though you
1. Left Medicare for MA
2. Tried perhaps to leave your MA advantage program for another MA advantage program
3. Were denied, until you moved to another state.
I don't know rules for private insurance including so called medi-gap. I have such, a Group plan through CalPers, and everything is covered I haven't paid one cent, though I have been treated for cancer, in fact I had a CT Scan yesterday and an MRI on Saturday, and get the same ever six months, including a visit with my oncologist, and I have been in remission for four years. I am pre diabetic and get blood tests and a follow up with my PCP every six months as well, and haven't paid a cent, nor had a procedure denied.
I really don't understand your situation, especially since a state insurance regulator has no jurisdiction or say over Medicare, only private insurance companies.
You have correctly understood what I said. I joined MA in '21, got out in '23 after moving in late '22.
They knew about my arthritis from my medical records.
Your 3 point summary is incorrect on point 2. I never tried to or wanted to enroll in another MA program.
How did moving to a different state exempt me from that rule? I don't know what to tell you except that it DID! I was working with a broker, who said my condition didn't seem so bad and that she'd try to get me in a traditional Medicare plan. And then, I just happened to mention that I'd recently moved from Illinois to Arizona, and she said "Oh! That changes everything." And she got me into the plan I originally chose (actually, it was slightly more expensive, since I no longer had "guaranteed-issue" rights, but with the same company).
That is what happened. I am neither a lawyer nor an insurance administrator and I was surprised as hell that it happened, but it did!
Your question got me to research exactly what happened because I don't quite understand it myself.
I found this: https://www.ehealthinsurance.com/medicare/states/moving-another-state/, which says:
"Please note that if you have Medicare Part C and there aren’t any Medicare Advantage plans available in the new service area that you’re moving to (or you don’t want to enroll in one), you can also choose to return to Original Medicare. You can then sign up for a stand-alone Medicare Part D prescription drug plan, and you might be able to buy a Medicare Supplement insurance plan."
Note the "(or don't want to enroll in one)". Weird, I know, but we live in weird times.
Sorry Steve I am still confused
Let me go point by point, tell me where I am wrong
1 You enrolled in MA in '21. you moved in late '22 and in'23 you dropped your MA plan.
Is that correct?
2. After dropping your MA advantage plan you tried to re enroll in Medicare.
Is that correct?
3. When you tried to re enroll in Medicare they denied you because of a pre existing condition
Is that correct?
This is true. Glad you brought up this point!