Insurance Denial due to prednisone

Posted by virginiaj @virginiaj, Jan 6 8:01pm

I am wondering if anyone else has had an insurance denial because of prednisone. I wanted to change from one Medigap company to another to save about $100 a month on premium costs. You need “medical approval” to change. This consisted of a phone interview by a non-medical person. They sent me a letter saying I was denied because I am on prednisone. I talked to my agent who said after I was off for 6 months, I could try again. When I had my first bout of PMR at age 57, I was denied long-term care insurance because I was on prednisone. Has this happened to anyone else? I take no other prescription meds.

Hi Virginia @virginiaj, Unfortunately I think it's due to Medigap policies having their own set of rules. I've had a Medicare Advantage plan since being on Medicare and have been prescribed prednisone for my PMR which I've had 2 occurrences (now in remission). Here's a recent article that discusses the problem you found with a Medigap policy.

If your Medicare coverage changes include Medigap, beware of snags
https://www.cnbc.com/2019/10/26/if-your-medicare-coverage-changes-include-medigap-beware-of-snags.html

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Hi Virginia @virginiaj, I want to thank you for the private message. I thought I would answer it here in this discussion because I do think that it's OK to discuss medical insurance problems in a patient to patient forum which is what Connect is all about. I'm sure a lot of the aging population (hey that's me too!) has medicare questions and issues and can learn what other members have experienced.

The main reason I chose a Medicare Advantage plan over the Medigap is I would rather have an HMO like policy with low copay and good coverage so that catastrophic type stuff is covered better (I hope!). I have had a Minnesota UCare Advantage policy since I went on Medicare and really like it. It was really great for me this past year when I had a knee replacement. It is a real bummer that the Medigap policies don't play by the same rules as the Advantage policies. It is hard to understand why they would deny coverage in a Medigap plan due to being on prednisone and prevent you from changing Medigap plans. I did read about a change to Medigap at the end of 2019 which may have something to do with your situation.

"At the end of 2019, the doors will close on Plan F, which is considered the Cadillac plan of supplemental insurance policies known as Medigap. Designed for people who do not like healthcare cost surprises, it is the most popular of supplemental plans used to pay for services that Medicare does not cover.Sep 19, 2018".
Medicare supplement plans are changing: What you need to know:
https://www.reuters.com/article/us-column-marksjarvis-medigap/medicare-supplement-plans-are-changing-what-you-need-to-know-idUSKCN1LZ18F

I've heard the argument that the advantage plans have about 20% administrative costs versus about 2 or 3 % for traditional Medicare but I'm not sure it's that easy to compare. I did find an article that provides some thoughts by Kip Sullivan, Physicians for a National Health Program, Minnesota Chapter:
How to Think Clearly about Medicare Administrative Costs: Data Sources and Measurement (PDF)
https://pnhp.org/system/assets/drupal/Medicare_admin_costs_JHPPL.pdf

I hope you are able to find a Medicare coverage that works for you

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