Is there a wrong pick for a medicare [medigap] provider?

[Steve s]

Thought for sure I was going BCBS, here is Iowa, but started looking at premiums in IOWA SHIP book and they are the highest in the state.
Colonial Penn, Humana and Aetna come in lower. There is a company Globe that comes in 100% lower!
I have read some comments that individuals just picked the lowest because they are all the same plans. Is there a wrong pick in this logic. Example customer service or a company going default.
Lets say a company goes belly up mid year who is responsible for medical balance. I will assume it will be me.
I am tempted to stay with a big name company. They all have some bad reviews but those reviews are with there life, health and long term care and not so much with their supplements plans.
Not asking who should I pick, although I will listen! Just wondering what would be a wrong pick other then price.
Thanks

 

[Dr Dave]

I am a retired physician, and I have no idea what is the best thing to do about health insurance when you are retired. I would think that my work in the health care industry would give me the inside track on how best to decide about health insurance, but such is not the case.

Health insurance is about risk management, and if you get it wrong, it could wipe out all of your savings in a twinkling of an eye. I just retired two days ago, and I am going to get the best policy that I can afford. If I stay healthy, I will be paying too much for my health insurance. If I get sick, then I win the health insurance lottery.

It's pretty sad in my professional opinion. When I lived in New Zealand, I rolled my car, broke two legs, five ribs, punctured one lung, and broke my scapula. I was in the ICU nine days, I had three surgeries, and was in the hospital for two months. Total cost was exactly Zero Dollars! In America, the same accident would have probably cost over a million dollars.

I am discouraged with the state of health care in the U.S. It should be as easy as it was in New Zealand, but instead the politicians, hospitals, and insurance companies have turned it into a meat grinder and you are the meat.

 

[Ian S]

You have to be careful. Sometimes there's what amounts to a teaser starting rate (usually indicated by a gradually diminishing "discount.") Customer service may not be the best with some of the lesser names from what I've heard. I went with the AARP United Healthcare plan as it included free gym membership via Silver Sneakers which is a significant savings for me.

 

[Texas Proud]

I am a retired physician, and I have no idea what is the best thing to do about health insurance when you are retired. I would think that my work in the health care industry would give me the inside track on how best to decide about health insurance, but such is not the case.

Health insurance is about risk management, and if you get it wrong, it could wipe out all of your savings in a twinkling of an eye. I just retired two days ago, and I am going to get the best policy that I can afford. If I stay healthy, I will be paying too much for my health insurance. If I get sick, then I win the health insurance lottery.

It's pretty sad in my professional opinion. When I lived in New Zealand, I rolled my car, broke two legs, five ribs, punctured one lung, and broke my scapula. I was in the ICU nine days, I had three surgeries, and was in the hospital for two months. Total cost was exactly Zero Dollars! In America, the same accident would have probably cost over a million dollars.

I am discouraged with the state of health care in the U.S. It should be as easy as it was in New Zealand, but instead the politicians, hospitals, and insurance companies have turned it into a meat grinder and you are the meat.

First, congrats on coming on board... looks like your second post (could be first!!)....


BUT, your stmt was a bit off... total cost to YOU was zero dollars... total cost was at least half of what it cost in America.... maybe even closer...

That is one of the problems when talking about health care... the actual cost of care and who is actually paying for it... people confuse the two...

 

[Texas Proud]

I am not there yet, but have helped my mom and oldest sister with their decisions....


There IS a big difference in what plan you choose... not just the company, but the plan!!!

Each plan has groups of docs who will accept that plan... each has some extra benefits that others do not... drugs, care outside the service area... care outside of the country!!!

You need to make a list of what is the most important to you from your insurance and see which company and plan matches the best at the lowest overall cost...


For my mother, she has Human HMO and is happy with that... my sister had regular Medicare and her teacher health plan and was happy with that.... mom paid nothing and sister paid over $100 per month... that is over and above what they take out of your SS check...

 

[kimcdougc]

Not there yet, but very interested in this thread, as choosing is coming up shortly.

 

[OldShooter]

Our experience was that plan benefits vary quite a bit. We went with a plan that provides fairly generous coverage if we need care while we are traveling outside the US, but not the most expensive plan from that provider because it added bells and whistles we did not need. Fortunately we had an excellent insurance agent to guide us through the process.

 

[Dave J]

To the OP, are you talking about supplements or advantage plans?

 

[meierlde]

Are we talking medicare advantage or medigap here? If medigap the benefits are standardized and designated by letters a,b,c... All plans have the same benefits. This of course requires traditional medicare. Medicare advantage benefits vary all over the map. Be aware that Medicare only provides insurance in the US and on a direct drive between the lower 48 and Alaska. For drug plans you need to look at what drugs you take and go from there.
For medigap look at the AARP plans also.

 

[CRLLS]

I helped DW sign up for Medicare last winter and I will be signing up later this year. If you are going with traditional Medicare and choose a Medicare Supplement (aka Madigan) plan look at which plan has the coverage you want, then look for a provider of that plan in your state. Not all providers carry all plans. AARP didn't offer a Plan F-HD in my state. Choosing between Traditional Medicare and an Advantage plan is more difficult decision, as is choosing between a Medigap and a "Select" (limited Drs and Hospitals I think) Medigap plan.

As has been stated, every provider of any given letter Medigap plan are, by law, the same coverage as the others. If medicare covers a procedure, so will the provider. The only things that matter between providers are cost and service. Then there is attained age, issue age and community plans which have to do with current costs and future costs. Then you get to choose a Part D drug plan. They don't make it easy.

 

[Steve s]

Thanks for the replies!! I know I am getting F hi ded. When I look at the Iowa SHIP price comparison the price goes from $360 to $835 for the year for the same plan. Leaning toward Aetna or Humana possible colonial penn, they are lower BCBS is the highest. When comparing i am also comparing the different age brackets. So I would.think the one that averages the lowest to the age of 80 would be a reasonable pick. Cannot predict future increases so have to go on info i have. I know advantage plans have more customer service issues but I believe the medigap plans are more straight forward. Was curious what happens when a company leaves medigap plans do they fulfill their obligation until you get a new provider? What happens if they fold up? Thanks again.

 

[Sarah S]

A question you might want to ask- can they/ do they require prior authorizations for services like MRIs CTs etc? These companies certainly do in their HMO forms. I don't remember ever doing a PA for someone with primary medicare for these things though, so I am guessing not?

If they do require one though I found a big difference between my regional plans and Blue Cross MA on one hand and the more national plans on the other. The latter would not give a same day PA for a request from a doctor's office which meant in a couple of situations like suspected appendicitis the patient had to go through the ED to get the scan done in a timely manner

I plan to ask this question when I get to Medicare age

 

[MichaelB]

Insurance companies can price three different ways; community rated, age attained, or issue age. Community rated will be more expensive today compared with age attained, but age attained will increase much more.

Once you enroll in the Medigap policy it's yours for life. If the insurer leaves the marketplace, you are guaranteed enrollment in another MediGap policy for the next 63 days.

 

[MBSC]

Was curious what happens when a company leaves medigap plans do they fulfill their obligation until you get a new provider? What happens if they fold up? Thanks again.

CMS calls this "Guaranteed issue rights." As long as you pay your premium you will not be stuck with unpaid medical bills if you lose your plan. If you are still healthy and can pass underwriting, you can apply for any Medigap plan letter. If you cannot pass underwriting, you are guaranteed acceptance into any Medigap Plan A, B, C, F (includes F-HD), K, or L sold in your state at their preferred rate. You would need to apply within 63 days of losing coverage.

Avoid Mutual of Omaha. In some markets, they close their books to new business every few years and open new ones under a slightly different Omaha name. The members left behind in the old risk pool get older and sicker so their rates rise faster.

Your Medigap insurance company goes bankrupt and you lose your coverage, or your Medigap policy coverage otherwise ends through no fault of your own.

You have the right to buy Medigap Plan A, B, C, F (includes F-HD), K, or L that’s sold by any insurance company in your state.

You can/must apply for a Medigap policy no later than 63 calendar days from the date your coverage ends.

Reference: https://www.medicare.gov/supplement...eed-issue-rights-scenarios.html#collapse-4696

 

[grasshopper]

You should also look at a medigap plan to see if it is community or age rated. Community rated plans tend to only increase with inflation. YMMV.

MichaelB, beat me to it.

 

[Steve s]

MichaelB and MBSC you can get a new insurer within 63 days but who is responsible for the bills prior to the change over to a new provider if the old provider no longer exists? Does your new provider go back and pick up those bill also? Did a lot of web searching "who do you use as a medicare supplement provider?" and get little results. It leans toward particular plans where I am looking at the company. I did find out a company rates vary greatly state to state. A poll of what insurance company do you use for your medigap plan would be interesting. Thanks for all the information....steve

 

[REWahoo]

...who is responsible for the bills prior to the change over to a new provider if the old provider no longer exists?

I don't know the answer to your question but the solvency of my Medicare supplement provider is way down near the bottom of the things I waste time worrying about.

(If anyone is curious, The Asteroid is #1)

 

[MichaelB]

MichaelB and MBSC you can get a new insurer within 63 days but who is responsible for the bills prior to the change over to a new provider if the old provider no longer exists? e

Health insurers are heavily regulated. Withdrawing from a market for any reason will include advance notice to the regulator and all policyholders. This notice will allow you a 63 day window to apply for a MediGap policy with another insurer. As long as you do not lose coverage, you are insured.

I don't know the answer to your question but the solvency of my Medicare supplement provider is way down near the bottom of the things I waste time worrying about.

(If anyone is curious, The Asteroid is #1)

Do not underestimate the Zombie apocalypse. After reading the book "Seveneves" (well, to be honest, about 2/3 of the book) I'm not sure I want to survive an asteroid hit.

 

[MBSC]

MichaelB and MBSC you can get a new insurer within 63 days but who is responsible for the bills prior to the change over to a new insurer if the old insurer no longer exists? Does your new insurer go back and pick up those bill also?

Initially, the courts and state DOI will attempt to find another insurer to take over and maintain the current policy. If this fails, generally the company's assets will be liquidated and placed in a trust to cover the medical bills. If there is remaining debt because the assets in the trust do not cover all the liabilities, the state Guaranty Association (nolhga.com :: welcome) may cover the remaining liability up to the state limit (typically $100k per individual). If there is remaining liability after the $100k, the medical provider has to absorb the loss. The contract to pay the medical claim was between the insurer and medical provider. The members of the plan have no liability.

Remember, we are discussing Medicare Supplements which typically cover the remaining 20% not covered by traditional Medicare. So $100K in GA coverage translates into ~$500k in Medicare allowed amounts or $1M+ in billed charges.

Iowa Health Insurance Guaranty Association: Iowa Life & Health Insurance Guaranty Association - Frequently Asked Questions

 

[Steve s]

What if a company goes belly up is more a what if question knowing it is a stretch. Just curious.
But more to my question on picking a provider. In Iowa I only have AARP United Health that is community rated but they don't offer F HD in my area. There is only one company Bankers Fidelity that offers Issue age. So if I decide to go the attained-age way for my F HD would it be logical to take the lowest rate of that category or is there something else I should also be looking at since F HD is the same for all insurers? BCBS attained-age $835 Colonial Penn attained-age $432 Globe life attained age $360.
The logical pick Globe Life
What else should I look at? I just am confused why there is such a big gap in prices for the same plan and why anyone would pick the $835 vs $432 or $360 all being attained age.
Appreciate the input. Until today I never did research the different rate categories. I see the majority of Iowa companies are attained-age.
Thanks

 

[Steve s]

MBS Great information and a good job in explaining.
Sarah S does that preapproval also include Medigap plans or more toward advantage plans? I though if medicare approves the plan approves.

 

[Sarah S]

I think you are right Steve S but I was not sure. As I said I never did a PA for medigap so think it would be ok. What you say makes sense and I think is correct The PA obstructionist attitude made a big difference to the patients I saw with those HMOs so I raised it as a doublecheck it won't apply. The choice of medigap is such an important issue

 

[explanade]

I'm trying to help my mother enroll for a new plan.

She is on Kaiser Medicare Advantage plan, which is rated very highly on the Medicare.gov site.

Friends of hers advised her to look at an AARP plan from UHC.

When I checked on the AARP site, they offered their own Medicare Advantage plan and a Supplement Plan F plan.

The latter is more than double the premiums of the Medicare Advantage plan, which has copays but no deductibles, so similar to Kaiser.

I guess the expensive Plan F covers all the copays?

Main difference that I can tell is that Medicare Advantage plans are HMOs so you're limited to which doctors you can see while the Supplement plans let you go see any doctor who takes Medicare?

 

[MichaelB]

I'm trying to help my mother enroll for a new plan.

She is on Kaiser Medicare Advantage plan, which is rated very highly on the Medicare.gov site.

Friends of hers advised her to look at an AARP plan from UHC.

When I checked on the AARP site, they offered their own Medicare Advantage plan and a Supplement Plan F plan.

The latter is more than double the premiums of the Medicare Advantage plan, which has copays but no deductibles, so similar to Kaiser.

I guess the expensive Plan F covers all the copays?

Main difference that I can tell is that Medicare Advantage plans are HMOs so you're limited to which doctors you can see while the Supplement plans let you go see any doctor who takes Medicare?

A couple of things. MediGap is only guaranteed enrollment when you are initially eligible. After that the insurance company can underwrite and reject. In addition, with traditional Medicare, you also need a separate pharmaceutical plan (Plan D). MediGap F covers all cost sharing, but is being phased out. It will continue but not take new members, and this may lead to premium increases that are greater than other options.

Medicare Advantage is Medicare coverage but provided by a private insurer, like Kaiser or UHC. Some are HMO, others are PPOs. There may be differences in cost-sharing (deductibles, co-pays) and some Advantage plans include drug coverage.

 

[explanade]

Thanks, in her zip code, all the Medicare Advantage plans seem to be HMOs but the network includes hospitals and medical groups which are well regarded.

They do continue to show all the Medigap options, including several Plan Fs.

One thing I understand is that Plan F includes Part B premiums? I think they were already deducting Part B premiums in her Social Security checks. Does that mean if she enrolled in Plan F, they'd stop deducting from her Social Security checks? That might offset the higher premiums of Plan F compared to the Medicare Advantage plans.