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Old 11-02-2015, 11:09 AM   #41
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Originally Posted by Bestwifeever View Post
m

Both plans are exactly the same except F pays the deductible, G doesn't. The G premiums are $200+ less than the F premiums over the year. Pay the $147 (this year) deductible on G, you are still ahead $50+ on G. Don't go to the doc at all, ahead by the $200+. I'm not very good at explaining things, but I meant we end up ahead in either scenario.
How can this be possible, I'm thinking of changing my DH from F to G and am afraid I'm missing something? That doesn't seem like something that would get by a regulator.
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Old 11-02-2015, 11:25 AM   #42
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ivinsfan:

Plan F vs Plan G explanation...



omni
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Old 11-02-2015, 11:32 AM   #43
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If you're switching plans, something to keep in mind. Don't know if it's true but a bit scary.........
"Medicare states, "Don't cancel your first Medigap policy until you've decided to keep the second Medigap policy". We suggest keeping your current policy until you are approved for G. However, remember that even if they accept his new application, there can be a 6 month waiting period for preexisting conditions -

https://www.senior65.com/medicare/ar...f-alternatives
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Old 11-02-2015, 11:34 AM   #44
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How can this be possible, I'm thinking of changing my DH from F to G and am afraid I'm missing something? That doesn't seem like something that would get by a regulator.
In a competitive market, the members enrolled in G are healthier than those in F, allowing the rates to be lower even counting the deductible. Plan G is offered by fewer companies so this scenario does not apply to all markets. More companies should start offering G in the near future.

More detailed explanation: http://www.seniorsavingsservices.com...-best-for-you/
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Old 11-02-2015, 11:38 AM   #45
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ivinsfan:

Plan F vs Plan G explanation...



omni
thanks for that link, I'm talking to my agent of 20+ year this afternoon and between these 2 I should understand more. I have to change 2 plans for next year so I am pretty stressed out.
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Old 11-02-2015, 11:52 AM   #46
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thanks for that link, I'm talking to my agent of 20+ year this afternoon and between these 2 I should understand more. I have to change 2 plans for next year so I am pretty stressed out.
ivinsfan,

I was getting stressed out and quite confused just trying to figure out which Medigap plan I should I sign for when it was my Initial Open Enrollment Period. I stumbled across Chris Westfall's videos on YouTube which I found very helpful. I called and scheduled an appointment with him to go over my remaining list of questions. I was favorably impressed by his willingness and patience to discuss my concerns and seeming interest in finding the least expensive plan for me. I double-checked his quote for Plan G which was better than anything I found on my own, so I called back and signed up thru his company.

Best of luck in your selection.

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Old 11-02-2015, 11:56 AM   #47
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braumeister..........I don't understand the math for your numbers. If Medicare pays 80% and supplement pays the other 20%, then (ignoring the deductible), Medicare payments should be 4x the supplement.
Medicare pays 80% of the amount they allow, which is far less than the billed amount.

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So you paid no out of pocket?
True. It's a good deal.

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TFL includes prescription drug coverage excluded from Medicare's 80%, so that probably skewed the numbers.
My numbers didn't include prescription drugs, just medical care.
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Old 11-02-2015, 12:55 PM   #48
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Medicare pays 80% of the amount they allow, which is far less than the billed amount.
I'm just using your Medicare paid & supplement paid #s and ignoring the Retail Price. Still don't get that 80:20 split.
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Old 11-02-2015, 02:18 PM   #49
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I'm just using your Medicare paid & supplement paid #s and ignoring the Retail Price. Still don't get that 80:20 split.
Same here, but the 80% Part B reimbursement is a general rule and rules have exceptions. In my previous response, I chose a reason specific to TFL (drugs) and missed. There are exceptions not specific to TFL, including but not limited to:

Part A services
Preventive services
Outpatient Hospital services reimbursed by OPPS. For details on this one, see Section 30.2 in this link: http://www.cms.gov/Regulations-and-G.../clm104c04.pdf

Less detailed version of your responsibility for OP hospital services: https://www.medicare.gov/coverage/ou...-services.html

Your responsibility for ER services: https://www.medicare.gov/coverage/em...-services.html
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Old 11-02-2015, 02:26 PM   #50
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I'm just using your Medicare paid & supplement paid #s and ignoring the Retail Price. Still don't get that 80:20 split.
Oh, I see what you're saying.
I think it's because in some cases the billing office is happy with what they get from Medicare and they never bother to bill TFL. In other cases, the amounts allowed are different, and TFL may pay more or less than expected.

Confusing at best, but I can't complain as long as the bottom line is that TFL pays whatever Medicare doesn't pay (including my Medicare deductible).
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Old 11-02-2015, 02:33 PM   #51
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How can this be possible, I'm thinking of changing my DH from F to G and am afraid I'm missing something? That doesn't seem like something that would get by a regulator.
Regulators have nothing to do with this, as long as the policy itself complies with all coverage standards. The insurer is free to charge more or less, and in this case they charge an additional $200 for something at is worth, maximum value, $147.
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Old 11-03-2015, 12:25 PM   #52
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Would you mind explaining a little why it was a no brainer..I now realize my spouse in on a BCBS F plan and was thinking of going cheaper. But from what I have been reading, he would have to be underwritten to go back to F if we decided to switch back at some point.He went on the F with no problem the month he turned 65, but he does have an underlying health that we need to watch forever.
For me it was no deductible or copays, significantly lower monthly rate, excellent Dr coverage in my area. Once you get on a plan like this when you first sign up for medicare, its important to stay on the plan, otherwise you will have to re-qualify for other plans that could result in even higher rates due to pre-existing conditions.

I do not understand why medicare plans can ding those with pre-existing conditions when one changes plans, unlike Obamacare.
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Old 11-03-2015, 01:04 PM   #53
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It was a good idea to separate the threads. The process of choosing Medicare coverage is not at all similar to getting coverage for us youngsters.
Yes, you folks need to be sure your personal pediatricians are in the network........ The rest of us are looking for docs that specialize in treating geezers!
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Old 11-03-2015, 02:58 PM   #54
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.........................

I do not understand why medicare plans can ding those with pre-existing conditions when one changes plans, unlike Obamacare.
Good point! Can we cry age discrimination to our reps? If we do nothing,
nothing will change.........
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Old 11-04-2015, 01:27 PM   #55
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I do not understand why medicare plans can ding those with pre-existing conditions when one changes plans, unlike Obamacare.
Because Medicare Supplement plans are not health care plans, they are supplements to health care plans. Your health care plan is traditional Medicare. The impact on the ACA to traditional Medicare is that you get an annual physical for free. All the other stuff in the ACA has always been a part of traditional Medicare. Medicare Supplements are different:
* They must issue policies that meet standard wording and coverage in the various flavors (plan a, c, f, g etc.) - this is controlled/approved by CMS.
* But they can underwrite the applicant for health issues and deny them coverage, just as if one was buying coverage before ACA was implemented.
* They file their rates with the state insurance commissioner, who approves the rates based on what they show as their experience with the population.

Don't want to get 'dinged'? Switch to a Medicare Advantage Plan. They cannot underwrite and must provide all the same coverage as traditional Medicare, plus pick up most of the deductibles and co-pays of traditional Medicare. But - most are HMOs, so you lose the ability to select any doctor who accepts Medicare. You can however change plans yearly with no medical underwriting.

- Rita
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Old 11-04-2015, 01:37 PM   #56
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Don't want to get 'dinged'? Switch to a Medicare Advantage Plan. They cannot underwrite and must provide all the same coverage as traditional Medicare, plus pick up most of the deductibles and co-pays of traditional Medicare. But - most are HMOs, so you lose the ability to select any doctor who accepts Medicare. You can however change plans yearly with no medical underwriting.

- Rita
I did not know that you could change from Medicare Advantage Plans without getting dinged, but nevertheless, these plans are very expensive vs gap coverage. I just think that once you are in a gap plan, it should be switchable to some other carriers gap plan without having to re-qualify. You do not get dinged when you first sign up for medicare, so like Obamacare, it would be nice to be able to change sup carriers based on their coverage.
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Old 11-04-2015, 01:42 PM   #57
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The impact on the ACA to traditional Medicare is that you get an annual physical for free.
I don't view Medicare's Annual Wellness Visit as a physical. It is nowhere near as comprehensive as the physical exams I had under previous insurance - nothing more than blood pressure, weight, and questions to determine if I'm ready yet for assisted living.

Scroll down on this attachment for the list of items to be checked at an AWV:

https://www.cms.gov/Outreach-and-Edu..._ICN905706.pdf
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Old 11-04-2015, 04:08 PM   #58
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ivinsfan:

Plan F vs Plan G explanation...



omni
And here's a guy touting the advantages of Plan N:

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Old 11-04-2015, 06:46 PM   #59
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I don't view Medicare's Annual Wellness Visit as a physical. It is nowhere near as comprehensive as the physical exams I had under previous insurance - nothing more than blood pressure, weight, and questions to determine if I'm ready yet for assisted living.

Scroll down on this attachment for the list of items to be checked at an AWV:

https://www.cms.gov/Outreach-and-Edu..._ICN905706.pdf
That's the same thing you get under ACA. Mostly questions.
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Old 11-05-2015, 04:25 PM   #60
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I don't view Medicare's Annual Wellness Visit as a physical. It is nowhere near as comprehensive as the physical exams I had under previous insurance - nothing more than blood pressure, weight, and questions to determine if I'm ready yet for assisted living.

Scroll down on this attachment for the list of items to be checked at an AWV:

https://www.cms.gov/Outreach-and-Edu..._ICN905706.pdf
I didn't say Wellness Visit - which is just a discussion. I said Annual Physical - which is the poking and prodding. Covered by ACA and Medicare.
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