Medicare Choices

[kaneohe]

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Originally Posted by REWahoo You and T-Al seem to live in the Medigap Black Hole area of the US...

but the black hole seems to be that private company's . Medicare.gov lists Medigaps including AARP which I have.

[kaneohe]

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Originally Posted by TromboneAl Okay, my zip is 95570 (Trinidad, CA), but when I put in 95501 (McKinleyville), there are some to choose from. Medigap Policy A, Medigap Policy B, etc. Are those standard policy types? That is, do all Policy Bs have the same benefits, etc?? Are independent agents a good idea, or should I view them as I do financial planners? Thanks, guys.

I stuck in 95570 in the medicare.gov site and got stuff.......31 companies offer Plan F.......doubt that this link is specific to that zip but try anyway
https://www.medicare.gov/find-a-plan...y.aspx?ref=det

[kaneohe]

which came from this page which shows the zip
https://www.medicare.gov/find-a-plan...-policies.aspx

The following Medigap Policies are available in ZIP Code 95570: you will find this at the top of the table.

[audreyh1]

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Originally Posted by REWahoo Not sure whether to post this here or on the "What did you do today?" thread... I mentioned in an earlier post that after checking out the Medigap policy prices on https://www.bestmedicaresupplement.com/ (thanks wmc1000) I discovered our Medigap provider (BC/BS) was priced substantially higher than many of their competitors. DW and I both have Plan F-HD, and I've seen a lot of conjecture about the potential for higher future rate increases after the plan is closed to new applicants in 2020. I had been thinking about looking at alternative plans but let inertia have the upper hand until learning our current rates were almost 50% higher than some other insurers. That got me motivated! Looks like we have a very good chance to make it through underwriting to change to another plan, and I had always thought Plan G would be our best option. But after some additional research and assistance from the folks at https://boomerbenefits.com/ (another thanks wmc1000), we ended up applying for Plan N. The cost/benefit ratio of N fits our needs better than the higher costs/higher benefits of Plan G. So now we wait to hear from our applications, hopefully early next week.

According to that https://www.bestmedicaresupplement.com/ website, Plan G provides no international medical coverage whereas Plan F does. I thought Plan G was simply Plan F with a small deductible, but apparently there are other potentially significant differences.

[Another Reader]

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Originally Posted by REWahoo You and T-Al seem to live in the Medigap Black Hole area of the US...

#metoo...

[REWahoo]

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Originally Posted by audreyh1 According to that https://www.bestmedicaresupplement.com/ website, Plan G provides no international medical coverage whereas Plan F does. I thought Plan G was simply Plan F with a small deductible, but apparently there are other potentially significant differences.

I think there is an error in whatever you saw there. I agree with your understanding of the two plans and every reliable source I've seen says the deductible is the only difference:

https://www.medicare.gov/supplement-...e-medigap.html

[audreyh1]

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Originally Posted by REWahoo I think there is an error in whatever you saw there. I agree with your understanding of the two plans and every reliable source I'v seen says the deductible is the only difference: https://www.medicare.gov/supplement-...e-medigap.html

Thanks, I was wondering if there was an error because that was news to me!

Makes me a bit nervous about the site then!

If you click on the “details” link of a plan G you get an explanation of the coverages and in the footnotes it says

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Plans C, D, F, HDF, M & N cover foreign travel emergencies. There is a $250 deductible and then the Medicare supplement will pay 80% of the cost of the care. The emergency must be within the first 60 days of your stay outside the USA. Lifetime benefits are $50,000. Plans A, B, G & K do not cover foreign travel emergencies.

[MBSC]

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Originally Posted by audreyh1 According to that https://www.bestmedicaresupplement.com/ website, Plan G provides no international medical coverage whereas Plan F does. I thought Plan G was simply Plan F with a small deductible, but apparently there are other potentially significant differences.

Consider your source (a broker who receives higher commissions on higher priced plans).

"Medigap coverage outside the U.S.

If you have Medigap Plan C, D, E, F, G, H, I, J, M or N, your plan:

* Covers foreign travel emergency care if it begins during the first 60 days of your trip, and if Medicare doesn't otherwise cover the care.

* Pays 80% of the billed charges for certain medically necessary emergency care outside the U.S. after you meet a $250 deductible for the year.

Foreign travel emergency coverage with Medigap policies has a lifetime limit of $50,000."

Source: https://www.medicare.gov/supplement-...nd-travel.html

[REWahoo]

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Originally Posted by audreyh1 Thanks, I was wondering if there was an error because that was news to me! Makes me a bit nervous about the site then! If you click on the “details” link of a plan G you get an explanation of the coverages and in the footnotes it says

I found this (apparently correct) chart on the site here: https://www.bestmedicaresupplement.com/benefit

[audreyh1]

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Originally Posted by MBSC Consider your source (a broker who receives higher commissions on higher priced plans). "Medigap coverage outside the U.S. If you have Medigap Plan C, D, E, F, G, H, I, J, M or N, your plan: * Covers foreign travel emergency care if it begins during the first 60 days of your trip, and if Medicare doesn't otherwise cover the care. * Pays 80% of the billed charges for certain medically necessary emergency care outside the U.S. after you meet a $250 deductible for the year. Foreign travel emergency coverage with Medigap policies has a lifetime limit of $50,000." Source: https://www.medicare.gov/supplement-...nd-travel.html

Thanks agan for your clear information.

I edited my later post to quote the specific language and the only error seems to be G? Not sure what to think. I guess you have to be careful.

Lifetime limit of $50K? Not so high if you do a lot of international travel. I guess you have to supplement the supplemental insurance then!

[meierlde]

On the issue of future plan f I would be surprised if the run a different pool for f&g since for all practical purposes you can regard the deductible as something that will be paid, so you just add the deductible and overhead to G to get F. The various price differentials mean that essentially the insurance company must be assuming everyone pays the medicare deductible. It should be noted that eyeglass exams also do some tests that medicare pays for.

[audreyh1]

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Originally Posted by meierlde On the issue of future plan f I would be surprised if the run a different pool for f&g since for all practical purposes you can regard the deductible as something that will be paid, so you just add the deductible and overhead to G to get F. The various price differentials mean that essentially the insurance company must be assuming everyone pays the medicare deductible. It should be noted that eyeglass exams also do some tests that medicare pays for.

Yeah - I've wondered the same thing and wondered if G&F wouldn't be the same pool.

[REWahoo]

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Originally Posted by audreyh1 Yeah - I've wondered the same thing and wondered if G&F wouldn't be the same pool.

I don't think insurers can mix or combine risk pools - at least nothing I've seen regarding the closing of F to new applicants indicates this is an option. This is the typical information I keep seeing:

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The existing Plan F policies will be a “closed risk pool” meaning no new members can participate. New members in good health are what help offset claims of those who are not in good health. No new members means increased premiums for the remaining members.

[Running_Man]

One thing that is a big favorable for Plan F & Plan G is they cover the 15% extra that insurers are allowed to charge over medicare rates that you would otherwise be responsible for, you will find doctors are more receptive and attentive when they know you can pay 15% more easily.

[REWahoo]

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Originally Posted by Running_Man One thing that is a big favorable for Plan F & Plan G is they cover the 15% extra that insurers are allowed to charge over medicare rates that you would otherwise be responsible for, you will find doctors are more receptive and attentive when they know you can pay 15% more easily.

Doctors who do not agree to accept Medicare assignment may charge up to 15% in "excess charges" above what Medicare will pay and the insured is responsible for that amount. Plans F & G are the only two Medigap plans that pay for these Part B excess charges, and that is reflected in their higher premium costs.

So if your primary doctors don't accept Medicare assignment, F or G may be the way to go but I don't know that having F or G vs another plan will necessarily make your doctors more "receptive and attentive".

EDIT: A number of states (Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont) prohibit charging any more that the Medicare allowed amount. No need to pay for F or G in those states unless there are other provisions of those plans you want and are willing to pay higher premiums to obtain.

[MBSC]

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Originally Posted by Running_Man One thing that is a big favorable for Plan F & Plan G is they cover the 15% extra that insurers are allowed to charge over medicare rates that you would otherwise be responsible for, you will find doctors are more receptive and attentive when they know you can pay 15% more easily.

A non-participating provider receives 9.25% more because their approved amount is set at 95% (0.95*1.15).

Medicare and the supplement send payment to the patient on non-assigned claims. But, the patient usually has to pay the non-participating provider in full up front. A participating provider is out 20% when the patient's check bounces. A non-participating provider is out 100%.

99% of physician claim volume is assigned.

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In recent years, physicians nationwide have accepted assignment on nearly 99 percent of their claims. When providers do not accept assignment, they can bill the patient for more than the Medicare approved amount and ask for full payment at the time they give the service. Medicare then pays the patient, not the provider. Source (page 52): https://www.kdads.ks.gov/docs/defaul...k-handbook.pdf

While Plans F/G pay the Part B excess charge, Medicare does not 'crossover' non-assigned claims. This means Medicare does not forward the claim and MSN (EOB) to the Medigap. A few non-participating providers will submit the information to the Medigap but most leave it up to the patient.

[REWahoo]

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In recent years, physicians nationwide have accepted assignment on nearly 99 percent of their claims.

This was the deciding factor in my decision to select Plan N rather than the more expensive Plan G. I can afford to self-insure for the 1% chance I'll have to pay out of pocket for the 15% above the Medicare approved rate a non-participating provider may charge.

[TrvlBug]

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Originally Posted by audreyh1 Thanks, I was wondering if there was an error because that was news to me! Makes me a bit nervous about the site then! If you click on the “details” link of a plan G you get an explanation of the coverages and in the footnotes it says

There is another error on the site. I plugged in my area code as I will be going on Medicare next year and it states that UHC/AARP does not offer G in my area. DH just signed up with them and they do offer G.

[REWahoo]

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Originally Posted by TrvlBug There is another error on the site.

It is obvious the site ( https://www.bestmedicaresupplement.com/benefit ) has some issues. I'd suggest it may be a good source to get an idea of the relative difference in prices insurers charge in your location but to look elsewhere for confirmation and more reliable details.

[TrvlBug]

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Originally Posted by REWahoo It is obvious the site ( https://www.bestmedicaresupplement.com/benefit ) has some issues. I'd suggest it may be a good source to get an idea of the relative difference in prices insurers charge in your location but to look elsewhere for confirmation and more reliable details.

Definitely. I made the mistake last year of using another site where email and phone # were required. Stupidly, I input our real ones and was hounded for about 6 months.