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Old 10-27-2015, 05:45 PM   #21
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I also do not understand why one would pick any offer other than the cheapest one? It's not obvious to me what the extra value is for additional premium paid.
Possibly the lack of International coverage might be an issue.

Or, what about coverage of care not covered by Medicare?

I am as confused as anybody.
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Old 10-27-2015, 06:06 PM   #22
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Possibly the lack of International coverage might be an issue.

Or, what about coverage of care not covered by Medicare?

I am as confused as anybody.
No, Both G and F cover exactly the same ( International and care not covered by Medicare seem to be identical) The only difference I can see is that F covers the $147 deductible and G does not. Amen to being in the confusion department.
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Old 10-27-2015, 07:40 PM   #23
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Asking members to respect this request and get back on topic, which is why a MediGap F policy would increase price by 17%.
Medigap 'F' pays the Part B deductible which is increasing from $147 to $223 in 2016, so $6.33 of the monthly increase is to cover that. The Part B fee schedule (allowable amount) is changing, generally resulting in slightly higher payments. Since Part B only pays 80%, the remaining 20% left for the supplements to pay is increasing.

'F' is generally more expensive than 'G'+deductible because it's on the 'guaranteed issue' list after initial enrollment. This means 'F' has to accept high users of medical services. 'G' can pick and choose healthy members after initial enrollment.
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Old 10-27-2015, 08:04 PM   #24
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Medigap 'F' pays the Part B deductible which is increasing from $147 to $223 in 2016, so $6.33 of the monthly increase is to cover that. The Part B fee schedule (allowable amount) is changing, generally resulting in slightly higher payments. Since Part B only pays 80%, the remaining 20% left for the supplements to pay is increasing.

'F' is generally more expensive than 'G'+deductible because it's on the 'guaranteed issue' list after initial enrollment. This means 'F' has to accept high users of medical services. 'G' can pick and choose healthy members after initial enrollment.
Thank you. Now we are getting some place. Does this mean that if we sign up for the G coverage, next year at renewal time the insurance company can deny our application based on "high use of medical services"?
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Old 10-27-2015, 10:55 PM   #25
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Does this mean that if we sign up for the G coverage, next year at renewal time the insurance company can deny our application based on "high use of medical services"?
No, it only means if you initially enrolled in something other than 'G' (such as 'F' or Medicare Advantage and had high use there), the 'G' can deny your application request because it's subject to medical underwriting. But once accepted into 'G' or any other Medigap plan, it is guaranteed renewable regardless of health issues as long as premiums are paid on time.

If you live in a guaranteed issue state, such as NY or CT, you cannot be denied at any point.
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Old 10-28-2015, 12:55 AM   #26
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Some folks here are talking about ACA premiums, but I think the original 'What is going on' was related to the jump in Medicare premiums for some folks. Here's some info on the reason for the jump, why it only hit some folks, and a possible fix now in the works.
Nope. That isn't what this thread is about. This thread is about a jump in premium on a Medicare supplement policy.
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Old 10-28-2015, 05:36 AM   #27
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Whoever said "what comes up must come down" obviously never considered US health care costs.
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Old 10-28-2015, 06:23 AM   #28
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I didn't notice if anyone else noted that the budget deal will fix this year's Part B increase problem. Instead, all Part B participants will get smaller, gradual raises over several years to make up the difference.
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Old 10-28-2015, 07:50 AM   #29
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Whoever said "what comes up must come down" obviously never considered US health care costs.
But then as Buffett says, trees don't grow to the sky. I believe in equilibrium, but sometimes it takes awhile.
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Old 10-28-2015, 08:15 AM   #30
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Whoever said "what comes up must come down" obviously never considered US health care costs.

Although they do try to balance out the ups and downs. While cost are going up, the things a policy covers tend to go down at the same time. Example my monthly premiums are going up next year but I'm finding a number of services that are either gone or more restrictive. You need to read the details of coverage to pick them out.

It appears to me that the drug coverage is the worse.
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Old 10-28-2015, 08:29 AM   #31
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No, it only means if you initially enrolled in something other than 'G' (such as 'F' or Medicare Advantage and had high use there), the 'G' can deny your application request because it's subject to medical underwriting. But once accepted into 'G' or any other Medigap plan, it is guaranteed renewable regardless of health issues as long as premiums are paid on time.

If you live in a guaranteed issue state, such as NY or CT, you cannot be denied at any point.
So this distinction that you are trying make between F & G only applies to certain states?
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Old 10-28-2015, 09:24 AM   #32
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Although they do try to balance out the ups and downs. While cost are going up, the things a policy covers tend to go down at the same time. Example my monthly premiums are going up next year but I'm finding a number of services that are either gone or more restrictive. You need to read the details of coverage to pick them out.
Well, it usually seems like a multiple whammy: premiums, deductibles and OOP maximums rise MUCH faster than inflation, let alone wage growth, and at the same time it seems like networks are becoming more restrictive and more and more folks are being forced into HMOs where insurance bureaucrats dictate your care far more than you and your doctor.
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Old 10-28-2015, 09:35 AM   #33
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Well, it usually seems like a multiple whammy: premiums, deductibles and OOP maximums rise MUCH faster than inflation, let alone wage growth, and at the same time it seems like networks are becoming more restrictive and more and more folks are being forced into HMOs where insurance bureaucrats dictate your care far more than you and your doctor.
That is a true general statement, but this thread relates to Medigap policies, which means no set network of doctors, only that they accept Medicare. The wide pricing differences for the exact same policy in the same location illustrates that these companies are setting prices based on what they can get and not on what the actual cost is. One must be careful in shopping for these plans.
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Old 10-28-2015, 09:38 AM   #34
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That is a true general statement, but this thread relates to Medigap policies, which means no set network of doctors, only that they accept Medicare. The wide pricing differences for the exact same policy in the same location illustrates that these companies are setting prices based on what they can get and not on what the actual cost is. One must be careful in shopping for these plans.
Agreed -- that said, it seems like more and more providers are either not accepting Medicare, or at the very least not accepting new Medicare patients. So even for those in Medicare, especially those new to Medicare, it amounts to a "shrinking network".
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Old 10-28-2015, 09:53 AM   #35
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I will do my best to keep this "non-political", but I wonder what will happen now since there appears to be an agreement between the Prez and Congress on the budget. A budget that includes yet more cuts to doctor reimbursements? I already can't believe how little the doctors are getting NOW from the insurance companies! I mentioned to my new primary care doc (who spent a FULL 45 minutes with me!) that she will get less money from the insurance company than what I pay to get an oil change...and that just isn't right.
I went to the doctor and spent less than 20 minutes with him. He got $137 for that time which is less than the $174 he wanted to charge. Even if he only sees 2 people an hour for 8 hours a day that's $2192 per day. I realize he and his partners have a lot of overhead but there's no way they are not profiting six-figures a year each. They are getting paid plenty for non-emergency physicians or surgeons.
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Old 10-28-2015, 11:36 AM   #36
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I went to the doctor and spent less than 20 minutes with him. He got $137 for that time which is less than the $174 he wanted to charge. Even if he only sees 2 people an hour for 8 hours a day that's $2192 per day. I realize he and his partners have a lot of overhead but there's no way they are not profiting six-figures a year each. They are getting paid plenty for non-emergency physicians or surgeons.
I might spend 20 minutes or more in the examination room waiting on the doc, but I get less than 5 minutes with mine. Of course he's a Doc in a Box type of physician.
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Old 10-28-2015, 11:53 AM   #37
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No, it only means if you initially enrolled in something other than 'G' (such as 'F' or Medicare Advantage and had high use there), the 'G' can deny your application request because it's subject to medical underwriting. But once accepted into 'G' or any other Medigap plan, it is guaranteed renewable regardless of health issues as long as premiums are paid on time.
+1
Here are some links to the Medicare page explaining guaranteed issue.
https://www.medicare.gov/supplement-...scenarios.html
https://www.medicare.gov/find-a-plan...otections.aspx

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The pricing for these policies is really bizarre with wide variations from one insurer to another. Since Medicare supplement policy coverage is not a question of being in network or not (unlike Medicare Advantage plans) I do not understand why there is such a variation in policy pricing. I also do not understand why one would pick any offer other than the cheapest one? It's not obvious to me what the extra value is for additional premium paid.
A very good question, not easy to answer. These are still insurance policies, the issuers must process and pay claims. When an insurer fails to pay a claim the medical service provider often looks to the customer to make up the difference. I would looks for a low price, but also an insurer with higher satisfaction ratings.
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Old 10-28-2015, 11:59 AM   #38
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Just me, but I don't think the 'high' salaries of doctors is responsible for the increase!
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Old 10-28-2015, 12:34 PM   #39
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+1
Here are some links to the Medicare page explaining guaranteed issue.
https://www.medicare.gov/supplement-...scenarios.html
https://www.medicare.gov/find-a-plan...otections.aspx


A very good question, not easy to answer. These are still insurance policies, the issuers must process and pay claims. When an insurer fails to pay a claim the medical service provider often looks to the customer to make up the difference. I would looks for a low price, but also an insurer with higher satisfaction ratings.
Thank you for the links. I don't see the situation my wife is in i.e. voluntarily looking for a cheaper medigap plan with the same or lesser coverage during the open enrollment period. Now I wonder is that particular situation under a guaranteed coverage provision or does the Insurance company have the right of refusal during this particular period?

Is there a reliable source for satisfaction ratings for insurance companies in the medigap business?
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Old 10-28-2015, 12:34 PM   #40
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That is a true general statement, but this thread relates to Medigap policies, which means no set network of doctors, only that they accept Medicare. The wide pricing differences for the exact same policy in the same location illustrates that these companies are setting prices based on what they can get and not on what the actual cost is. One must be careful in shopping for these plans.
Medigap policies are controlled by state insurance commissioners in terms of price, and by CMS (the same friendly folks who bring you Medicare, Medicare Advantage, and the supplement plans) controls the content of each plan.

So all Plan F's contain the same coverage limits, coinsurance, etc. But they differ in price based on the pricing method used and the experience of the plan (claims paid out).

From Medicare.gov
The cost of Medigap policies can vary widely. There can be big differences in premiums that insurance companies charge for exactly the same coverage. . .
Each insurance company sets its own premiums. It is important to ask how an insurance company prices Medigap policies. How they set the price affects how much you pay now and in the future. Medigap policies can be priced or "rated" in three ways.
https://www.medicare.gov/find-a-plan...-policies.aspx

The above link describes the rating methods. You will need to ask the insurer what method they use to determine the rates.

- Rita
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