By Michelle Andrews
AUGUST 7, 2018
This
week, I answer questions from readers who are concerned about Medicare and
insurance for long-term care.
Q: Can
getting a genetic test interfere with being able to buy long-term-care
insurance in the future? If you do get a plan, can the insurer drop you after
you find out the results of a genetic test?
In
general, long-term-care insurers can indeed use genetic test results when they
decide whether to offer you coverage. The federal Genetic Information
Nondiscrimination Act prohibits health insurers from asking for or using your
genetic information to make decisions about whether to sell you health insurance or
how much to charge. But those rules don’t apply to long-term-care, life or
disability insurance.
When
you apply for long-term-care insurance, the insurer may review your medical
records and ask you questions about your health history and that of your
family. It’s all part of the underwriting process to determine whether to offer
you a policy and how much to charge.
If the
insurer asks you whether you’ve undergone genetic testing, you generally have
to disclose it, even if the testing was performed through a direct-to-consumer
site like 23andMe, said Catherine Theroux, a spokeswoman for LIMRA, an
insurance industry trade group.
Consumers
applying for a long-term care policy should release any medically relevant
information, she said.
Some
states provide extra consumer protections related to genetic testing and
long-term-care insurance, said Sonia Mateu Suter, a law professor at George
Washington University who specializes in genetics and the law. But most follow
federal law.
If you
get genetic testing after you have a policy, the results can’t affect your
coverage.
“Once
the policy has been underwritten and issued, the insurer doesn’t revoke the
policy if new medical information comes to light,” Theroux said.
Q: Can
I switch Medigap insurance companies midway through the year? I found a less
expensive policy.
It
depends. Under federal law, when people turn 65 and first enroll in Medicare
Part B they have a six-month window to
sign up for a Medigap plan. Medigap plans pick
up some of beneficiaries’ out-of-pocket costs for services under Medicare Part A, which
covers hospitalization, and Medicare Part B, which
covers outpatient services. During that six-month period, insurers have to
accept people even if they have health problems.
If
you’re still in that six-month period now and you want to switch plans, go
right ahead.
But if
you’re past the six-month window, under federal law insurers are required to
sell you a plan only in certain circumstances, such as if you lose your retiree
coverage or Medicare Advantage plan. If you don’t meet the criteria, insurers
can decline to cover you or charge you more for preexisting medical conditions.
Many
states have provided more robust protections, however. Three states —
Connecticut, Massachusetts and New York — have year-round open enrollment and
require insurers to offer coverage. And Maine requires a one-month “guaranteed
issue” open-enrollment period every year.
Some
states guarantee current policyholders a chance to switch Medigap plans at
certain points during the year. Other states have additional qualifying events
that allow people to switch Medigap plans, according to data from
the Kaiser Family Foundation. (Kaiser Health News is an editorially
independent program of the foundation.)
“The
first thing the person should do is check with her state insurance department
to find out her rights related to buying a Medigap plan,” said Brandy Bauer,
associate director at the Center for Benefits Access at the National Council on
Aging. If someone decides to go ahead and switch, it is wise to sign up for a
new plan before terminating your current policy, she said.
Q: I
did not enroll in Medicare Part B when I turned 65 because I already have a
regular plan that covers everything. I was told that the insurer would keep
paying as usual, but now the company says it will pay only part and that I have
to buy Medicare Part B. I didn’t want to pay for two policies. Is there
anything I can do to avoid that?
From
your description, it’s hard to know exactly what’s going on, but we can make
educated guesses. Typically, when people turn 65, it makes sense to sign up for
Medicare unless they or their spouse are working and getting health insurance
from an employer. For others, at age 65, Medicare typically becomes their
primary insurer and any other coverage they have becomes secondary, filling in
gaps in Medicare coverage.
That’s
how it generally works with retiree coverage, said Tricia Neuman, director of
the Program on Medicare Policy at the Kaiser Family Foundation.
If you
have an individual policy that you bought on the health insurance exchange and
decide to hang on to it instead of signing up for Medicare, your premiums and
other costs could be higher than they would be on Medicare, depending on your
income.
But if
you’re not receiving employee coverage and you don’t enroll in Medicare Part B,
you could be subject to a permanent premium penalty of
10 percent for every 12 months that you could have signed up for Part B but
didn’t. You could also owe a premium penalty for not signing up for a Part
D prescription drug plan. (Most people don’t owe any premium for Medicare Part
A, so there’s no penalty for late sign-up.)
“Without
knowing more, it sounds like she should drop the [current] plan and sign up for
Part B and D,” Neuman said. “But we need more information to know for sure.”
Your
best move now may be to call 800-Medicare or visit your local state health insurance assistance program (SHIP) to
help sort out your coverage issues.
Update:
This story was updated on Aug. 7, 2018, with a clarification from Catherine
Theroux, a spokeswoman for LIMRA, an insurance industry trade group. According
to Theroux, consumers applying for a long-term care policy should release any
medically relevant information. The original story said that consumers “need
to” release such information.
Michelle
Andrews: @mandrews110
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