Who can we trust to make the best Medicare decisions?

Editor’s Note: Journalist Philip Moeller, who writes widely on health and retirement, is here to provide the Medicare answers you need in “Ask Phil, the Medicare Maven.” Send your questions to Phil.

Linda – Texas: I will begin Medicare soon and am having a difficult time selecting an insurance company that I feel comfortable with. I am leaning towards Medigap plan G or D. I have contacted the insurance companies on Medicare’s Plan Finder for my ZIP code and have researched them on the Texas Department of Insurance website. I have talked to insurance brokers, but they only push the companies that they represent and get the best commission to sell. What do you suggest?

Phil Moeller: Your question was about Medigap plans, so let’s stick to them. By law, the coverage of all letter D plans must be identical. Ditto with letter G plans. So the main variables are the initial cost of the policy, the quality of the service offered by different insurers and the ratings system they use to price their policies.

In terms of costs, Medicare’s online tool for Medigap plans provides a range of monthly premium costs for the plans offered in your ZIP code. Unfortunately, it does not list premiums for each plan. However, it does list estimated annual costs by plan. And because the plans must cover the same things, their estimated annual costs are a helpful comparison of what you’ll pay for the plan. For starters, I’d pick the three or so plans with the lowest annual costs.

Then, I’d go back to the Texas insurance department website and look for customer complaints on these companies. If you can’t find them, call the department to speak with a consumer representative and ask them about complaints.

The Medicare website also lists the ratings system used by each insurer and has an explanation of these differences. The three ratings are community rated, issue age rated and attained age rated. They can be important to you in terms of projecting future rate increases from the companies. Medicare’s consumer guide to Medigap has a helpful explanation of these ratings systems on page 18.

Changing Medigap policies in the future can be hard. Companies must sell you a Medigap policy on favorable terms during a six-month window when you’re first eligible for coverage. But after this so-called “guaranteed issue” window closes, companies in some states may not choose to sell you a policy or may charge much higher rates for coverage than when you have guarantee issue rights. For this reason, you should be clear that you really want Medigap, that you’re purchasing the most appropriate letter plan and that you’ve selected a high quality insurer with a rating system that works for you.

I suggest you call the Texas office of the State Health Insurance Assistance Program (SHIP). This is a free consumer service staffed with trained counselors who should be familiar with state rules (Medigap policies are regulated by the individual states and not by Medicare).

Good luck!

Michele – Calif.: My parents are 67 and 69 years old. They reside in California. My father worked as a longshoreman for his entire career. He retired with full medical benefits. Now I’m confused. My parents tell me that they can’t use their private health insurance because of Obamacare/Medicare. First, they must see a doctor that accepts Medicare, and whatever costs that Medicare doesn’t pick up their private insurance will pick up. How is this possible that they are being forced to use Medicare when they have private insurance? Most doctors don’t even accept Medicare patients. How is it possible that my parents are being denied medical help when they have private insurance? Can they cancel Medicare and use their private insurance? This is a very scary prospect for their future medical needs. As their daughter I need to find the answers, so I can assist them now and in the future.

Phil Moeller: Michele, nearly all retiree health insurance programs work only in conjunction with Medicare, not in place of it. I’m not aware of the specific details of your parents’ plan, but your description is consistent with a situation where Medicare is the primary health insurer payer, and the retiree plan is the secondary payer. Contrary to what you write, nearly all doctors accept Medicare. If your parents have been denied medical help, this is wrong and should not be the case. I’d like to know the details of any such denials. As for cancelling Medicare, this is not possible, and even if they could, it’s unlikely their retiree plan would provide them primary coverage.

You can follow-up on this on their behalf, but you might need them to give you permission to represent them in health care insurance discussions. If you can, you should speak with their retiree health insurance plan and ask a representative to explain how the plan works and what Medicare’s role is. You also can get free consumer Medicare advice by calling the State Health Insurance Assistance Program (SHIP).

Gary: I am 67, and I have had a health savings account. I did not know that if I was getting Social Security, I could not have a health savings account. I did stop contributions to my health savings account, but now what do I do about what I have put in, since I turned 66 and started getting Social Security? I used the health savings account money to pay the cost of my high deductible insurance through my employer. I do not have a tax person and do my taxes myself. What should I do now? I really need some help.

Phil Moeller: You most likely need to file an amended tax return. The health savings account contributions you made that were not allowed need to be treated as taxable income, so this would boost your taxable income for the period in question. On the flip side, the medical expenses on which you spent these funds are tax deductible. If you had enough health expenses to itemize them on your taxes (more than 10 percent of your taxable income), you can add your health insurance premiums and reduce your added tax liability. The IRS provides links to free tax-return help sites.