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Old 08-09-2018, 05:19 PM   #81
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Only states can regulate insurers. Congress passed a law standardizing MediGap policies, and CMS oversees that. The pricing and general compliance is a state responsibility.

Pricing is done like any other insurance product. The insurer submits pricing requests to the state insurance commission, which then acts to approve, reject or modify. Insurers are free to price as they wish, within state guidelines.
That's what I thought. They are co-regulated.

Got my first call from the Via Benefits sales group today. From the voicemail transcript:

"Hello this is a recorded line for (my first name) I'm calling with a courtesy call from (my last employer) just seeing how things are going and to get you scheduled for your appointment for your upcoming enrollment into Medicare. So if you could please give us a call back as earliest convenience so we could tell you about and it's ready about two plans available to you as your agent and Medicare. We appreciate that. You can call us at our toll free phone number 888. That's 888-427-8730 CV hours of 8:00 AM to 9:00 PM Eastern Standard Time Monday through Friday. TTY users can call 711. Thanks and have a great day."

The transcript was not totally accurate, the guy spoke poor English, and it took 15 minutes to get to someone that sort of knew what she was talking about when I called back. That person said she could not discuss any plans until the beginning of September and until I had my Medicare card. At least I found out my reimbursement is around $260 a month and it can only be applied to supplement and drug plans plus medical expenses such as co-pays. They do offer the AARP plans but they don't show up on the website until you are eligible to enroll. Guess it's time to join AARP.

No reimbursement for Part B. There is zero incentive to buy anything other than the top of the line Mercedes supplement and drug plans, as they are less than $260 a month. Considering I will pay through the nose for Part B, I will take whatever relief is offered.

I was planning on buying the drug plan with the most inclusive formulary and the least resistance to allowing you to ditch second tier drugs on your doctor's recommendation and to paying for those expensive cancer drugs. Anyone have experiences with Part D drug plans they want to share?
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Old 08-09-2018, 05:29 PM   #82
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I was planning on buying the drug plan with the most inclusive formulary and the least resistance to allowing you to ditch second tier drugs on your doctor's recommendation and to paying for those expensive cancer drugs. Anyone have experiences with Part D drug plans they want to share?
Plan D is different. There is an annual open enrollment and you can change plans each January. I plan to follow the lead of others here. Use the Medicare Plan D finder (here) to identify the plan with the lowest total annual cost (premiums + cost sharing) this year based on teh prescriptions I currently use. The revisit each November to see if there is a less costly option.
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Old 08-09-2018, 05:47 PM   #83
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You will need to apply since you do not live in the states.
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Old 08-09-2018, 05:48 PM   #84
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Plan D is different. There is an annual open enrollment and you can change plans each January. I plan to follow the lead of others here. Use the Medicare Plan D finder (here) to identify the plan with the lowest total annual cost (premiums + cost sharing) this year based on teh prescriptions I currently use. The revisit each November to see if there is a less costly option.
Cost is not one of my important criteria in selecting health insurance products. Coverage is the most important of my criteria. My one prescription today I can get very inexpensively with no insurance. It's the future prescriptions that are my main concern. I did look at the site you mentioned, but my guess is the actual experience of people with these plans will be more helpful to me.
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Old 08-09-2018, 05:52 PM   #85
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Actually, the quality of Kaiser health care providers is excellent and data shows that the care provided is top notch. We have Kaiser here, I have used them except when out of their service area. I don't think they have enough dermatologists or physical therapists but that is a small whine in the grand scheme of things.

Keep in mind the fact that some Medicare Advantage Plans decline patients with severe illnesses.
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Old 08-09-2018, 06:26 PM   #86
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I live overseas so I will only be getting Plan A&B at this time. I am on SS and am turning 65 this year, do I have to apply or is it automatic?

NYEP -- If I recall correctly, you're planning on moving to the States in a few years. You may also wish to consider signing up for a cheap Part D (drug) plan on turning 65, even if you are not on any Rxs. If you do not sign up, and later wish to get Part D you will then have to pay a monthly surcharge for the remaining years you would be getting a Part D.

omni

EDIT: I stand corrected. See MBSC's post #87, below. (Thanks, MBSC!)
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Old 08-09-2018, 06:34 PM   #87
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NYEP -- If I recall correctly, you're planning on moving to the States in a few years. You may also wish to consider signing up for a cheap Part D (drug) plan on turning 65, even if you are not on any Rxs. If you do not sign up, and later wish to get Part D you will then have to pay a monthly surcharge for the remaining years you would be getting a Part D.
There is a Special Enrollment Period (SEP) for those returning to the U.S. to enroll in Part D plans and MA plans without a late penalty.

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When you return to the United States after living abroad.

You cannot receive Medicare drug coverage when you’re living abroad, but you can join Part D when you return to live in this country permanently. If you turned 65 when you were living abroad, you get a seven month initial enrollment period to join a Part D plan without penalty, starting three months before the month of your return and ending three months after it. Or, if you turned 65 before leaving the United States to live abroad, you get a special Part D enrollment period on your return, and will not pay a late penalty provided that you begin receiving Medicare drug coverage within 63 days of the date of your return.

Reference: https://www.aarp.org/health/medicare...re_Part_D.html
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Old 08-09-2018, 06:35 PM   #88
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I originally called my Supplement provider, Premera, a Blue , to understand the process for changing our plan from F to G. Pretty much got danced around on the question if the change would require an underwriting but I would have to fill out a new application.
As REWahoo so succinctly pointed out, no point for "messin with the high priced boys from the Blues" when the same is available for a lot less. Got the list of plans approved in our state and found a G plan from a Cigna affiliate for 147/mon if we both move versus the 185/mon for G and 216 for F from Premera.
The Cigna rep, unlike his counterpart at Premera, quickly advised there is no underwriting in WA as long as you go to a comparable or less plans. State uses a "community rated" model and not individual pricing system.
We will make the move as soon as my DW gets her semi-annual Prolia shot ($900-covered by Supplemental but not by D for some reason) later this month so we do not have to pay the 183 Medicare deductible.
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Old 08-09-2018, 09:38 PM   #89
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WA does a good job with health insurance underwriting. You (actually we as I lived in WA when I turned 65) are blessed.
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Old 08-09-2018, 11:07 PM   #90
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............The Cigna rep, unlike his counterpart at Premera, quickly advised there is no underwriting in WA as long as you go to a comparable or less plans. State uses a "community rated" model and not individual pricing system.
............
Is the no underwriting rule between companies or just between plans, within the same company (in WA)?
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Old 08-10-2018, 05:47 AM   #91
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Is the no underwriting rule between companies or just between plans, within the same company (in WA)?
You can switch between companies anytime in WA.

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WA Medigap rates can be found here: https://www.insurance.wa.gov/media/1807
Quote:
WA Residents: If you're already enrolled in a Medigap plan B through N, you can switch at any time to another Medigap plan B through N. If you have a Medigap plan A, you can switch to any other Medigap plan A. In either of these situations, you do not have to take a written health screening questionnaire.

Source: https://www.insurance.wa.gov/when-ca...-medigap-plans
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Old 08-15-2018, 02:39 AM   #92
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I have N, which is the same as G except it doesn't cover "excess charges," and "may" permit a $20 copay for doctor visits and a $50 ER charge if not admitted.

I've never been charged an "excess charge" that is, something the plan didn't pay. I think these are more common in urban areas, which is not where I live. I've also never been charged the $20 copay. I've never been to the ER under Medicare, but wouldn't mind paying $50 if I did go.

I have Blue Shield of CA and pay $136 for N. They don't offer G. F would be $215, so I could pay a lot of copays, and the deductible, for the almost $1000 savings per year.
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Old 08-15-2018, 08:17 AM   #93
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Got, coincidentally, the Via Benefits and the Medicare envelopes in the mail on Monday. Phone rep was wrong, we get $200 a month, down from the $270 we get as pre-Medicare retirees. Once I can see the plans offered (i.e. when these people stop playing hide the ball with the AARP plans), I can decide if AARP is the best option.

Based on my limited interactions with Via Benefits, it looks like they are not well organized or helpful. The licensed person got the subsidy wrong. I really don't want to reward these people by giving them a commission if I can avoid it. Someone up thread or possibly in another thread said it was more expensive to buy the AARP plan through them than by buying it through AARP. I'm going to verify through the pension system that I have to buy through them to get the reimbursement.

They sent me a survey... Could not find anything positive to say.
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Old 08-15-2018, 04:20 PM   #94
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Got, coincidentally, the Via Benefits and the Medicare envelopes in the mail on Monday. Phone rep was wrong, we get $200 a month, down from the $270 we get as pre-Medicare retirees. Once I can see the plans offered (i.e. when these people stop playing hide the ball with the AARP plans), I can decide if AARP is the best option.

Based on my limited interactions with Via Benefits, it looks like they are not well organized or helpful. The licensed person got the subsidy wrong. I really don't want to reward these people by giving them a commission if I can avoid it. Someone up thread or possibly in another thread said it was more expensive to buy the AARP plan through them than by buying it through AARP. I'm going to verify through the pension system that I have to buy through them to get the reimbursement.

They sent me a survey... Could not find anything positive to say.
I have dealt with ViaBenefits (previously OneExchange) for a couple of years on DH's retiree medical plan. I have found when I call there that there are 3 separate groups of people. Each is fine within their own lane but not so much if they go beyond it. There is a licensed representative who does the placement. In my experience they know a lot about the plans but not so much about the reimbursement issues. On the other hand if you talk to the people who handle the reimbursements they understand those issues pretty well but not much about the actual policies. Then there is the customer service people who know more about nuts and bolts but not so much about the specific policies or the reimbursements.
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Old 08-16-2018, 02:04 PM   #95
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This has simplified my research, many thanks.


Now that I got the kid married off, I'm going to get this thing done.
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Old 08-16-2018, 02:56 PM   #96
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Okay, I'm leaning toward Medigap G.

Am I correct in that the only differences between F-HD and G are these:


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Old 08-16-2018, 03:15 PM   #97
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Let's say I go with a Medigap G plan. The next steps are to:


1. Choose a provider.
2. Go to SSA.gov and sign up for A, B, and D, and G?
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Old 08-16-2018, 03:20 PM   #98
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Al, your comparison is hard for me to read, plus it confuses me - nothing new, of course.

The difference in plan F-HD and G is this:

F-HD pays nothing until you have paid $2,240 out of pocket, then pays the same benefits as plan G. This out of pocket amount will increase each year with inflation.

Plan G pays after you have paid your $183 part B deductible.

....

Next steps:

You sign up for basic Medicare (parts A&B) through the govt.

Part D (drug coverage) and Medigap plans are offered by insurance companies so you will need to get quotes and sign up with the insurer of your choice.
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Old 08-16-2018, 03:30 PM   #99
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Al you can go through an independent agency such as www.boomerbenefits.com for the Medigap and part D drug plans. They will explain the differences to you and the costs for the various companies plans.
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Old 08-16-2018, 04:45 PM   #100
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Al you can go through an independent agency such as www.boomerbenefits.com for the Medigap and part D drug plans. They will explain the differences to you and the costs for the various companies plans.
Deciding on a Part D (Drug) plan is different than choosing your Medicare Supplement for a few reasons. First, a good decision is very much based on what medications you take. Different carriers' plans can have very different coverages for different medications. Second, you can sign-up for a different plan each year with no possibility of underwriting. Third, if you were to skip purchasing a plan altogether, once you do choose one you will pay an annual penalty that will increase with each year you chose not to buy a plan.

In my case I take no regular medications so I just purchase the cheapest plan available to me which turns out to be a Humana Wal-Mart Plan for about $7/month. If started taking a maintenance med tomorrow I would look for the plan that covered my required meds at the lowest cost come next open enrollment. I can review and change plans every year as needed.
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