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Old 08-28-2018, 07:49 AM   #141
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The part B deductible is $183 per year - one time thing. After that your out of pocket percentage is 20%, which your supplement should then pick up.


We have G, and it doesn't cover the annual $183 deductible, but does cover the 20% out of pocket after we pay the $183.


Clear as mud, huh?
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Old 08-28-2018, 07:56 AM   #142
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Originally Posted by Breedlove View Post
I could go with G but it does not pay any deductibles on part B . So what is the average deductible on part B . Or go with F and a high deductible , might be cheaper.
Part B deductible is currently $183/year. So the Plan G supplement's annual premium savings is greater than $183/year then it's the better deal. Typically (if not always) this is the case.
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Old 08-28-2018, 09:47 AM   #143
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Hmmm...that is interesting. This must be state based. DH has Plan F with AARP/UHC (this is in Texas). Late last year they discontinued their involvement with Silver Sneakers. They said the new benefit would be so much better. The new benefit was 50% reduction in membership cost at some gyms. Of course a 50% reduction is not as good as free....
We're in CA, although we learned about silver sneakers from MIL who lived in MO. We realize they may change or eliminate it at any time but for now it works. I assumed there would be restrictions such as times of use, although we always go during the non-peak times, but there are none.

Amazing that they would think 50% off is a better benefit than free .
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Old 08-31-2018, 02:40 PM   #144
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BoomerBenefits has continued to seem too good to be true. Brad told me that I will never again have to communicate with Anthem Blue Cross directly. Everything can go through him.


Unenrolling from CoveredCA is proving to be difficult, with long phone menus, etc. They also wanted to use Equifax to help me confirm my identity, but that failed because of our freeze. They asked me to upload a scan of my driver's license, but couldn't figure out how to get that done. For example, "You'll have to log out now, because we can't log in to your account when you're logged on."
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Old 08-31-2018, 02:44 PM   #145
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BoomerBenefits has continued to seem too good to be true. Brad told me that I will never again have to communicate with Anthem Blue Cross directly. Everything can go through him.


Unenrolling from CoveredCA is proving to be difficult, with long phone menus, etc. They also wanted to use Equifax to help me confirm my identity, but that failed because of our freeze. They asked me to upload a scan of my driver's license, but couldn't figure out how to get that done. For example, "You'll have to log out now, because we can't log in to your account when you're logged on."

I hope you keep us posted on your experiences with BoomerBenefits. It does sound too good to be true, but I've yet to hear a bad review. I'm going to recommend them to friends who are coming to me since I managed to get DH enrolled in Medicare et all in June, so now they think I'm the expert. I don't wanna be 'that guy'. I'll just send them to BoomerBenefits.
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Old 08-31-2018, 03:02 PM   #146
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just today boomerbenefits.com sent out an email reminding their clients to call them before paying a Medicare Bill they are not expecting .. excerpt of email below …

"Every day our Client Service Team takes dozens of calls from clients like you.
One of the free services that we offer is claim research and resolution.

So if you've got a bill from a Medicare provider that you weren't expecting,
DON'T pay it without calling us first. Let us check first to see if this bill is valid.

Our service team saves our Medicare insurance policyholders thousands of dollars
every year in scenarios just like this one. Could you be the next one to save money?

Reach out for help if you need us!"


Email closed with their client service team phone number if I ever need it.
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Old 08-31-2018, 04:51 PM   #147
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Okay, I got it all done. Just finished talking with someone from CoveredCA who was very good.


I had my first experience with audio fine print. The rep would play a long recorded message and then come back on and I'd say "I do."
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Old 09-19-2018, 01:33 PM   #148
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[QUOTE=nwsteve;2091142]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.[/QUOTE

UPDATE:
Just completed the enrollment process to switch from Premera's Plan F at 216/mon to a Cigna affiliate (Loyal American) Plan G for 147/mon each. Generated a savings of $828/mon each. Cigna also provided an additional discount if both spouses are applying--158/mon reduced to 147. Premera wanted 186/mon as I recall for their plan G and required a new policy to be completed despite being the provider for the last five+ years.

A couple things I learned in the process---WA is a "Guarantee Issue" state which translates that you can move between providers with underwriting as long as the new plan is same or less than the original plan. Other new category was "Community Rating" resulting in all folks with the same age treated the same for underwriting.

To satisfy requirement of existing coverage, agent called Premera with me on the phone. Provided policy # and confirmed with Premera CS agent that the policy was current. Nothing else required to complete beyond providing account for monthly charge.
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Old 12-25-2018, 09:45 AM   #149
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I am very impressed with the level of knowledge demonstrated in this thread.


I understand the general concept of state rules on guarantee issue from this page:

http://https://www.medicarefaq.com/f...edicare-rules/

Besides Washington are there other states where underwriting is limited?
i.e. age based only
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Old 12-26-2018, 05:15 AM   #150
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[QUOTE=nwsteve;2111238]
Quote:
Originally Posted by nwsteve View Post
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.[/QUOTE

UPDATE:
Just completed the enrollment process to switch from Premera's Plan F at 216/mon to a Cigna affiliate (Loyal American) Plan G for 147/mon each. Generated a savings of $828/mon each. Cigna also provided an additional discount if both spouses are applying--158/mon reduced to 147. Premera wanted 186/mon as I recall for their plan G and required a new policy to be completed despite being the provider for the last five+ years.

A couple things I learned in the process---WA is a "Guarantee Issue" state which translates that you can move between providers with underwriting as long as the new plan is same or less than the original plan. Other new category was "Community Rating" resulting in all folks with the same age treated the same for underwriting.

To satisfy requirement of existing coverage, agent called Premera with me on the phone. Provided policy # and confirmed with Premera CS agent that the policy was current. Nothing else required to complete beyond providing account for monthly charge.
You actually wrote with underwriting so that's confusing, is that what meant to type..
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Old 12-26-2018, 10:06 AM   #151
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[QUOTE=ivinsfan;2162837]
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Originally Posted by nwsteve View Post

You actually wrote with underwriting so that's confusing, is that what meant to type..
OP here. My bad! Glad you got the context--NO underwriting is required in WA when switching between Medigap plans that provide equal or less coverage. The Premera agent clearly implied that underwriting would be required. Based on her other remarks, I am guessing she was either new or at least not very knowledgeable about Medigap rules.
I also noticed I mistyped the savings which should be $828/YEAR each not mon--still nice.

Apologies to the Forum for my error--got to bump up my proofing!
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Old 12-28-2018, 03:20 PM   #152
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Here is the language from the Washington Insurance Comissioner:
Quote:
When can I switch plans?
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.
https://www.insurance.wa.gov/when-ca...-medigap-plans
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Old 01-06-2019, 08:02 PM   #153
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Some physicians take Medicare patients but do not accept assignment, and can charge 15% over the Medicare reimbursement rate. Plans F and G cover that as "excess charges).


It sure does.
It's actually not really a straight 15% and not all providers charge that and not for all services. It's very convoluted - I know because unfortunately I've had to deal with it. But suffice it to say that not accepting assignment means they can charge more and, yes, those excess charges are 98% covered by plans F and G. There is a 2% holdback that the patient is still responsible. Look here if you want to be totally befuddled and entertained.....

http://www.rcmanet.org/Portals/17/02...%2003-2013.pdf
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Old 01-15-2019, 01:15 PM   #154
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I'm from the area where Kaiser originated. The original Oakland hospital and clinic was a hellhole in the 60's, 70's and 80's. My mother used to refer to the place as the witch doctors of Kaiser. In her opinion, no real doctor would practice there, only people that graduated in the bottom quartile of their medical school class and couldn't find a better job. Possibly a small step above Highland Hospital, the County cesspool, but she was not totally convinced.

I hear that outside of the Bay Area, Kaiser is pretty good. However, I am of the view that leopards have great difficulty changing their spots, so I will continue to avoid Kaiser.

I have to agree. I am also from Bay Area, and the stories I could tell. They waited 4 months to test to see why my mom was anemic. By that time, the lymphoma was so bad, there was no bone marrow left to test. I won't even talk about some of the forceps births there. I know people who swear by them, but I just can't do it
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Old 04-22-2019, 03:24 PM   #155
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I'm trying to decide on Medigap plans right now. I turn 65 on Dec 31. When I was looking for private insurance I got a spreadsheet from ER entitled "Health Plans - Generic.xls". It had formulas for computing the costs for various plans based on copay, maximum OOP and premiums. With it you could compute which plan would be cheapest depending on how much you predict to spend in the coming year. It also showed the worst case costs if you maxed out everything. I'm looking for a similar spreadsheet or some answers so I can create my own. Here is what I need.



Is there a max OOP for each of the Medigap plans A...N? Add this plus the premiums and you should get the worst case scenario that you would have to pay in any year. The best case is just the costs of the premiums.


I'm doing more research, but I'm asking this because I might be missing something obvious. I'm wondering why no one is discussing Plan L. With the max OOP of $2780 (plus the cost of premiums, in my Utah zip this would be about $720 a year) which brings the grand total OOP worse case to $3,500 a year. For private health insurance in my area this worse case figure is about $21,000. Why isn't Plan L a no-brainer? I can certainly afford $3,500 worst case a year.



So does anyone have a max OOP for each of the plans? What is wrong/right with my thinking on Plan L?



By the by, DW and I buy yearly trip insurance that covers primary medical so that is not an issue.
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Old 04-22-2019, 03:46 PM   #156
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I'm trying to decide on Medigap plans right now. I turn 65 on Dec 31. When I was looking for private insurance I got a spreadsheet from ER entitled "Health Plans - Generic.xls". It had formulas for computing the costs for various plans based on copay, maximum OOP and premiums. With it you could compute which plan would be cheapest depending on how much you predict to spend in the coming year. It also showed the worst case costs if you maxed out everything. I'm looking for a similar spreadsheet or some answers so I can create my own. Here is what I need.



Is there a max OOP for each of the Medigap plans A...N? Add this plus the premiums and you should get the worst case scenario that you would have to pay in any year. The best case is just the costs of the premiums.


I'm doing more research, but I'm asking this because I might be missing something obvious. I'm wondering why no one is discussing Plan L. With the max OOP of $2780 (plus the cost of premiums, in my Utah zip this would be about $720 a year) which brings the grand total OOP worse case to $3,500 a year. For private health insurance in my area this worse case figure is about $21,000. Why isn't Plan L a no-brainer? I can certainly afford $3,500 worst case a year.



So does anyone have a max OOP for each of the plans? What is wrong/right with my thinking on Plan L?



By the by, DW and I buy yearly trip insurance that covers primary medical so that is not an issue.
What's the network, is it good in SL and in Moab..that the first question to ask.
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Old 04-22-2019, 03:56 PM   #157
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Originally Posted by tuffshed View Post
I'm trying to decide on Medigap plans right now. I turn 65 on Dec 31. When I was looking for private insurance I got a spreadsheet from ER entitled "Health Plans - Generic.xls". It had formulas for computing the costs for various plans based on copay, maximum OOP and premiums. With it you could compute which plan would be cheapest depending on how much you predict to spend in the coming year. It also showed the worst case costs if you maxed out everything. I'm looking for a similar spreadsheet or some answers so I can create my own. Here is what I need.



Is there a max OOP for each of the Medigap plans A...N? Add this plus the premiums and you should get the worst case scenario that you would have to pay in any year. The best case is just the costs of the premiums.


I'm doing more research, but I'm asking this because I might be missing something obvious. I'm wondering why no one is discussing Plan L. With the max OOP of $2780 (plus the cost of premiums, in my Utah zip this would be about $720 a year) which brings the grand total OOP worse case to $3,500 a year. For private health insurance in my area this worse case figure is about $21,000. Why isn't Plan L a no-brainer? I can certainly afford $3,500 worst case a year.



So does anyone have a max OOP for each of the plans? What is wrong/right with my thinking on Plan L?



By the by, DW and I buy yearly trip insurance that covers primary medical so that is not an issue.
Medicare, Part B, and Medigap combined are much more comprehensive than traditional insurance. Suggest you consult Boomer Benefits or Senior Savings network, which are nationwide agencies representing most plans. My AARP Medigap Plan F at $128.50, the Part D from Aetna at $19.10, and Medicare Part B, at $135.50, cover almost everything. Less than $300 a month for comprehensive coverage.
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Old 04-22-2019, 04:51 PM   #158
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Suggest you consult Boomer Benefits...
+1

Those folks can help you cut through the fog and provide you with excellent resources and information to educate yourself on Medicare. They will help you understand all your options and likely save you money and potential future headaches. Many of us have used their free services and have been happy with our experience.
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Old 04-22-2019, 04:56 PM   #159
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Is there a max OOP for each of the Medigap plans A...N? Add this plus the premiums and you should get the worst case scenario that you would have to pay in any year. The best case is just the costs of the premiums.
Most people quickly narrow their Medigap choices to G, N and F-HD. The MOOP for G is the annual Part B deductible ($185 in 2019). F-HD has a $2300 (2019) MOOP. Plan N does not have a MOOP. Also, keep in mind that Part D cost sharing is separate and in addition to these amounts. Part D plans do not have a MOOP.

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I'm wondering why no one is discussing Plan L. With the max OOP of $2780 (plus the cost of premiums, in my Utah zip this would be about $720 a year) which brings the grand total OOP worse case to $3,500 a year. Why isn't Plan L a no-brainer?
In my area, Plan L premiums are about the same as premiums for the more comprehensive Plan N.

The MOOP for Plans K and L are not a true MOOP. Part B excess charges (though unlikely) do not count toward the MOOP and the plans do not pay the excess charge once the MOOP is met. So, the true MOOP for Plan L is $2780 + excess charges.

With Plan F-HD (G-HD in 2020), Medicare still pays 80%. You pay 20% of the Medicare approved amount until the 20% totals $2300 (2019). Then F-HD starts paying the 20%. When compared to Plan L, the F-HD premium is lower, the MOOP is lower, excess charges count toward the MOOP and excess charges are paid by the F-HD plan once the $2300 MOOP is met. The $2300 MOOP for F-HD is true.

Worst case for F-HD would be about $2900 ($2300 MOOP + ~$600 annual premium) excluding Part D.
Quote:
Once you reach the annual out-of-pocket limit, K and L pay 100% of the Medicare co-payments, co-insurance, and deductibles for the rest of the calendar year. The out-of-pocket annual limit does not include charges from your provider that exceed Medicare-approved amounts, called excess charges. You are responsible for paying excess charges.

Source #1 (pages 10-11): http://doi.nv.gov/uploadedFiles/doi....ementGuide.pdf

Source #2 (page 14): http://www.ncdoi.com/_Publications/M...P_SSU1_250.pdf
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Old 04-22-2019, 07:19 PM   #160
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As usual, MSBC gives a very good comprehensive answer. If I wanted something with a MOOP and the lowest premiums I would have chosen F-HD when I just went on Medicare. In reality I chose G. Basically I was thinking about the long-term hassle factor.

My mother had Plan G and she had a lot of health problems the last few years of her life. But, basically all she had worry about was paying her annual deductible. That was usually quickly done and then everything was paid the rest of the year. While she was in her 80s and 90s that was really a big deal. She didn't have to worry about co-payments.

Looking ahead, I don't want to deal with them either. Right now, I could easily manage it but I am thinking about what it will be like years from now. So, I am happy to just have one deductible to keep track of.
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