I have a client who is retired from NC, has lived in South Carolina for a number of years, and has been on the North Carolina state health plan (a 70/30 PPO) for the entire duration. She just turned 65 and was enrolled in Medicare A/B as of 9/1/24. She is being told by someone from the NC state plan that she can remain on that plan (for zero premium) as long as she wants, AND that she can purchase a supplement plan G. She has been told (by multiple people in that office) that this is fairly common with other retirees on the state plan. They say that Medicare will be primary, the 70/30 PPO state plan will be secondary, and the supplement will be tertiary. She wants to keep her state plan, if possible, because it covers all of her (expensive) drugs. She is interested in Plan G specifically because her PPO has co-pays (like $72 physical therapy visits) that she's hoping the supplement will cover. Do any of you NC agents have any experience with this? Is it common for supplement carriers to coordinate with Medicare and state plans like that? Is there any downside, other than premium, to her enrolling in a Plan G?
Medicare Supplement with State Insurance?
- Thread starter Limozine
- Start date
Good grief, what a circlejerk of misinformation. A Med Supp isn't tertiary to anything. By definition, it can't be. She can have the state plan and Medicare A&B or she can have Medicare A&B and a supp. No sharesies.
Tell her to find out if she can 'suspend' her state bennies for Medicare as opposed to terminating them. That tends to make folks feel better. State retiree groups are some of the most opinionated/brainwashed people I have ever had the pleasure of interacting with.
They can have some nice qualified retirement plans to rollover, though.
Tell her to find out if she can 'suspend' her state bennies for Medicare as opposed to terminating them. That tends to make folks feel better. State retiree groups are some of the most opinionated/brainwashed people I have ever had the pleasure of interacting with.
They can have some nice qualified retirement plans to rollover, though.
- 6,928
Caveat, not an agent.
When Medicare becomes primary, the charge liability for physical therapy visits allowed by Medicare will be reduced to the Medicare allowed amount. Perhaps 20% of that allowed charge would be somewhat less than what she is used to paying currently when the retirement plan is primary.
The Medigap plan is kind of a catch situation. If she doesn't get it now, she won't be able to get one later if she can't pass underwriting. If she does get it now, she may not recover the premium cost in benefits.
I would ask representatives of the Medigap plan you are considering whether it would pay before or after the retiree plan in the scenario you are evaluating.
The rules I have seen discussed here say that when you have parts A and B and don't have an MAPD plan, you can buy a Medicare Supplement. Unless there are other rules in play prohibiting a Medicare Supplement, your client should be able to buy one. Whether it is economically wise is another matter.
All the discussions here about future changes in credibility of drug coverage for Part D purposes would suggest that you and client would need to monitor that carefully with the retiree plan in 2025 to see that she doesn't set herself up with possible Part D penalties in the future if she would want to make that switch. (I have no clue how you do that, I have just seen it mentioned several times here as a possible upcoming future issue with employer plans.)
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