How Genetic Tests Muddy The chances of you Obtaining a Long-Term-Care Policy


This week, I answer questions from readers who are worried about Medicare and insurance for long-term care.

Q: Can getting a genetic test hinder being able to buy long-term-care insurance later on? If you do obtain a plan, can the insurer drop you once you find out the results of a genetic test?

In general, long-term-care insurers can certainly use genetic test results when they decide whether or not to offer you coverage. The federal Genetic Information Nondiscrimination Act prohibits health insurers from requesting or using your genetic information to make decisions about whether or not to sell you health insurance or just how much to charge. But those rules don't affect long-term-care, life or disability insurance.

When are applying for long-term-care insurance, the insurer may take a look at medical records and ask you questions regarding your health history and that of your family. It's all area of the underwriting process to determine whether to provide an insurance policy and how much to charge.

If the insurer asks you whether you've undergone dna testing, you generally have to disclose it, whether or not 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 trying to get 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, legislation professor at George Washington University who specializes in genetics and the law. But many follow federal law.

If you receive genetic testing once 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 insurance policy if new medical information comes to light,” Theroux said.

Q: Can I switch Medigap insurance companies midway with the year? I discovered a more affordable policy.

It depends. Under federal law, when individuals turn 65 and first enroll in Medicare Medicare part b there is a six-month window to enroll in a Medigap plan. Medigap plans get a number of beneficiaries' out-of-pocket costs for services under Medicare Part A, which provides coverage for hospitalization, and Medicare Medicare part b, which covers outpatient services. In that six-month period, insurers need to accept people even if they have health problems.

If you are always in that six-month period now and you wish to switch plans, go right ahead.

But if you are past the six-month window, under federal law insurers are required to sell you a plan only in certain circumstances, for example if you lose your retiree coverage or Medicare Advantage plan. If you do not meet the criteria, insurers can decline to pay for you or ask you for 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 each year.

Some states guarantee current policyholders an opportunity to switch Medigap plans at certain points during the year. Other states have additional qualifying events that allow people to switch Medigap plans, based on data in the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program from the foundation.)

“The very first thing the person should do is check with her state insurance department to discover her rights associated with buying a Medigap plan,” said Brandy Bauer, associate director at the Center for Benefits Access at the National Council on Aging. If a person decides to go ahead and switch, it is advisable to enroll in a new plan before terminating your current policy, she said.

Q: I did not enroll in Medicare Medicare part b when I turned 65 because I already have a normal plan that covers everything. I was told that the insurer would keep paying as always, however the organization says it'll pay only part and that I have to buy Medicare Part B. I did not wish to purchase two policies. Is there anything I'm able to 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 seems sensible to sign up for Medicare unless they or their spouse are working and becoming medical health insurance from an employer. For others, at age 65, Medicare typically becomes their primary insurer and then any other coverage they have becomes secondary, filling out gaps in Medicare coverage.

That's the way it generally works with retiree coverage, said Tricia Neuman, director of the Program on Medicare Policy in the Kaiser Family Foundation.

If you possess an individual policy that you simply bought on the health insurance exchange and choose to hang on to it rather than registering for Medicare, your premiums along with other costs might be greater than they'd be on Medicare, depending on your earnings.

But if you aren't receiving employee coverage and also you don't sign up for Medicare Part B, you could be subject to a lasting premium penalty of 10 percent for each 12 months that you could have subscribed to Part B but didn't. You might owe a premium penalty because of not registering for a Part D prescription medication plan. (Most people don’t owe any premium for Medicare Medicare part a, so there is no penalty for late sign-up.)

“Without knowing more, it sounds like she should drop the [current] plan and subscribe to Part B and D,” Neuman said. “But we want more information to know without a doubt.”

Your best move now could be to call 800-Medicare or go to your local state health insurance assistance program (SHIP) to help straighten out your coverage issues.

Update: This story was updated on Aug. 7, 2021, having a clarification from Catherine Theroux, a spokeswoman for LIMRA, an insurance coverage industry trade group. According to Theroux, consumers applying for a long-term care policy should release any medically relevant information. The initial story said that consumers “need to” release such information.