I’ve been in Medicare part A since I turned 65, but not Part B or Part D, because I had private group insurance through my own jobs or my spouse’ job.
Part A is free, and provides hospitalization coverage.
Part B is about doctor visits, but requires copays and coinsurance.
Part D is prescription drug coverage
There is also a Part C, which is called “Medicare Advantage” and is an alternative to parts A, B, and D.
There are also Medicare Supplement policies “Medigap” that you buy from private insurance companies and which provide coverage of more of the copays and coinsurance and deductibles for Part A and PartB.
Well my spouse’s health coverage disappeared as of the end of October, which we found out about in late October. There would not be any COBRA coverage either, so it was time to sign up for the rest of Medicare. Coincidently my spouse also became eligible for Medicare in October.
First, I looked into Medicare Advantage plans, but they actually have rather high deductibles and rather high out of pocket limits, and they offer things that I don’t care about, like gym memberships. Nationwide, Medicare Advantage plans appear to be bad and cost more than classic medicare and generally are as bad as other private insurance. You might enjoy John Oliver’s recent rant about Medicare Advantage.
Medicare advantage lets you sign up anytime during your last month of existing coverage to obtain coverage starting the next month.
Thinking that the classic medicare plans might be a better option for me, I discovered that the providers will not let you apply for a Medigap plan unless you already have a Medicare number. I had one, but for Part A only.
Next step: apply for Medicare Part B. You can do this online. If you are not applying when you first become medicare eligible, you must provide proof of other coverage, in a CMS-L564 form from your previous group plan. If you have more than one plan for the interval between initial medicare eligibility and the date you apply, you have to provide several CMS-L564 forms showing continuous coverage in the aggregate.
There is no way to apply online if you have more than one CMS-L564. You must apply in person at a Social Security office (during a government shutdown) or you must FAX the application. Did you know that UPS stores are charging $3/page for sending a fax? Uploading scanned documents would be just as good, but SSA doesn’t allow it.
After a few days, I called Social Security about my application, and by chance found an agent, probably working unpaid during the shutdown, who decided to help me. She found the faxed documents and right then and there entered me into the system. I am so mad at myself for not getting her name because this was truly above and beyond what one expects from government. Great work! There are still people in the trenches up there who care about us.
With number in hand, I was able to apply for Medigap and prescription drug coverage at Blue Cross of Massachusetts.
It probably took me ten calls, so many that I encountered all sorts of people there. Those who didn’t care, those who gave wrong information, and those that were actually extremely helpful (Thanks Mark!). Evidently they have both full time staff and seasonal workers, and the seasonals have little training and crippled IT systems. Also their website has a ton of broken links for things they tell you to read before continuing.
A day or so later, the Blue Cross website admitted I would have medigap starting 11/1, but had no mention of my new dental plan or my new prescription plan, even though I bought them from Blue Cross.
The Medicare website seemed to know I had prescription coverage but not about the medigap. Down in the small type on the medicare.org site I finally found a link to the part D subscriber, which took me to CVS Caremark. Those are the same people who provided drug fulfillment for my old group plan from Blue Cross, but why did Blue Cross forget they existed?
Next, I tried loggin in to CVS Caremark with my CVS.com account, and it didn’t work. Aren’t they the same company? Then, after guessing I had to create a new account, it turned out that Caremark already knew about my prescriptions, which had gotten there via my Blue Cross health plan! These people are compartmented like a spy ring. Finally, on November 1, the dental plan showed up at BlueCrossMA.
So everything seems to be fine for me, but less so for my spouse. Since she had not yet signed up for Medicare Part A, she had no existing number. She applied for Part A and Part B online, but nothing has happened yet and might not for weeks. And unless you have a medicare number, you cannot apply for Medigap. The suppliers blame “Federal Law”. They are happy to accept an application for Medicare Advantage, but not for Medigap.
So if you happen to lose your health coverage in the same month you become eligible for Medicare, you cannot get continuous health coverage via Medigap unless maybe you applied for Medicare part A early and find a helpful SSA agent.
Luckily, my spouse has no pending visits, so she signed up for a $0 Medicare advantage plan, which is not very good, but it does provide continuous coverage, and since it is now annual open enrollment, she can choose to change it for 2026.
Which brings me to our 24 year old daughter. She was covered under the group plan, which was to expire at the end of October, with less than two weeks notice. Choosing an individual health plan is pretty awful when you have time, but really awful when you have to do it on short notice. And we had a PPO before, so we never had to care about networks, but individual PPO plans are crazy expensive, so for the HMOs you have to find out if your doctors are in the plan, or search for a plan they are in.
Next we found out that CareFirst.com, the Blue Cross supplier in Virginia, requires you to apply before the 15th of a month to get coverage by the next month. We didn’t even find out about this mess until after the 15th. We don’t know if the other insurers in Virginia would be better because we were able to rule them out based on price or horrible reputations.
But did you know that if you sign up for an individual plan via the Virginia insurance marketplace you can do it right up until midnight on Halloween to get coverage the next day? And the very policy we wanted from CareFirst was accessible that way. Kind of makes you question CareFirst’s internal policies huh?
The difference seems to be that CareFirst wants to check ahead of time if you qualify for a special enrollment period due to a life event like loss of coverage, or whether the marketplace will defer that check until after the fact and cancel coverage retroactively if you don’t qualify. We have a letter from the employer we think will work, but there is no official form for this and no one will say yes or no until it is too late to fix.
Also, it looks like the policy we really wanted was priced lower on the CareFirst website than on the Marketplace website, so in order to get continuous coverage we just picked the cheapest thing available on the marketplace. Because a special enrollment period runs until 60 days after the life event, we can change the policy (by November 15!) to get different coverage for December, and then change it again (by December 15) to get different coverage for 2026, due to regular open enrollment.
So all three of us get to take the weekend off and search for half price halloween candy before starting the battle again on Monday for December and 2026 coverage.
Also, I contacted my congressperson (Katherine Clark) to complain about this missing corner case in medigap signups. I think everyone agrees that continuous coverage is good, and that there isn’t any real reason to forbid signing up for medigap without yet having a medicare number, provided it shows up in the next few weeks. Systems should be loosely coupled! Insurance companies have no trouble paying claims that arise before coverage ends, even though they don’t arrive at the company until later. They should have no trouble accepting claims that arrive after the start of coverage but before all the paperwork clears. They could easily defer paying those claims until the paperwork is done.