Open enrollment for Medicare

[MichaelB]

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.

 

[eytonxav]

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.

 

[youbet]

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!

 

[kaneohe]

.........................

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.........

 

[Gotadimple]

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

 

[eytonxav]

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.

 

[REWahoo]

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-Ed...MLNProducts/downloads/AWV_chart_ICN905706.pdf

 

[Ian S]

ivinsfan:

Plan F vs Plan G explanation...

omni

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

 

[audreyh1]

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-Ed...MLNProducts/downloads/AWV_chart_ICN905706.pdf

That's the same thing you get under ACA. Mostly questions.

 

[Gotadimple]

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-Ed...MLNProducts/downloads/AWV_chart_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.

 

[molly312]

In Missouri - if you have a GAP plan - you also have GI on your enrollment date. For example: If you have BCBS Medigap N and you think you want to switch to AARP N, you have a 60 day window every year on your enrollment date. I don't think you can switch to a different letter without underwriting unless the company has its own rule about that.

 

[REWahoo]

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.

I don't believe that is accurate:

Will Medicare pay for a routine yearly physical examination? (Reviewed 10/23/14)

No. However, Medicare does cover an annual wellness visit (AWV). An AWV is not a physical, but it does include a review of the beneficiary's basic health measurements (e.g., height, weight, blood pressure, etc.) and his or her medical history. The doctor also reviews the beneficiary's risk factors for certain other diseases and conditions, and develops a personalized plan for prevention services.

General Medicare Frequently Asked Questions (FAQs)

 

[Gotadimple]

I don't believe that is accurate:



General Medicare Frequently Asked Questions (FAQs)

True for traditional Medicare and Medicare Supplement plans. Not true for Medicare Advantage.

Medicare Supplements (Medigap) cover the deductibles and co-pays of traditional Medicare.

Medicare Advantage plans must cover all the services provided by traditional Medicare, plus add other services. Annual Physical Exam seems to be an add-on for most every MA plan in Washington state. May be true in your state as well.

Rita

 

[iac1003]

There is no annual physical coverage on traditional Medicare Part B. DH thinks the Wellness visit is a joke. A bunch of generic questions, vital signs and routine bloods. No laying on of hands and no MD in sight.

I hope I will get a Medicare Part F plan next year - 10/2016. I have only 1 pre-existing condition which has needed no treatment since 2007 and I haven't seen an MD about it since 2010.

DH just realized how much he was paying for AARP Medicare Part D when he takes no regular prescriptions. It is going up to $66 a month. He is switching to a Humana plan with a deductible. Even if he meets the deductible and pays all the premiums it is still much less expensive by over $200 a year and the copays are only $1-2 more for each tier.


Sent from my iPhone using Early Retirement Forum

 

[audreyh1]

Are there Medigap plans that aren't limited to a regional network? If you sign up for a Medigap plan when you start Medicare, and then move to another state, are there plans that have national networks?

 

[kaneohe]

Are there Medigap plans that aren't limited to a regional network? If you sign up for a Medigap plan when you start Medicare, and then move to another state, are there plans that have national networks?

Medicare covers you if the doctor accepts Medicare and the expense is covered by Medicare. Medigap covers you if the expense is covered by Medicare. There aren't really any networks......regional or national.......although you should check whether the doctor accepts Medicare . Apparently the % of docs who accept Medicare can vary depending on location.

In some sense, there is a national network of docs who accept Medicare but that network would be the same for all Medigap plans.

 

[youbet]

Medicare covers you if the doctor accepts Medicare and the expense is covered by Medicare. Medigap covers you if the expense is covered by Medicare. There aren't really any networks......regional or national.......although you should check whether the doctor accepts Medicare . Apparently the % of docs who accept Medicare can vary depending on location.

Actually Medicare supplemental plans can include networks and can be regional. My BCBS F Select plan is both.

 

[MBSC]

Are there Medigap plans that aren't limited to a regional network? If you sign up for a Medigap plan when you start Medicare, and then move to another state, are there plans that have national networks?

Actually Medicare supplemental plans can include networks and can be regional. My BCBS F Select plan is both.

There are two types of Medigap plans, 'plain' Medigap and Medicare SELECT. The SELECT plans are more like HMOs or may only limit hospital choice, depending on the plan (link). With a 'plain' Medigap you can see any provider who accepts Medicare (and is accepting new patients if you move). The plain Medigap follows you when you move.

I'm moving out of state:
You can keep your current Medigap policy regardless of where you live as long as you still have Original Medicare. If you want to switch to a different Medigap policy, you'll have to check with your current or the new insurance company to see if they will offer you a different Medigap policy.
If you decide to switch, you may have to pay more for your new Medigap policy and answer some medical questions if you're buying a Medigap policy outside of your Medigap initial open enrollment period.

Source: https://www.medicare.gov/supplement...hing-plans/switch-medigap-.html#collapse-2514

But be aware that if you’re moving to an area where medical care is more expensive, your health insurance company may have the right to charge higher monthly Medigap premiums, in line with how much medical care costs in your new state of residence.

Source: https://medicare.com/resources/changes-medicare-moving-another-state/

Please note that "accepts Medicare" has two sub-categories, Participates and Non-Participating. The Non-Participating can choose not to accept assignment and balance bill an extra 15% called Part B Excess Charges. Some Medigaps, like Plan N, do not cover this.
More info: http://www.producersweb.com/r/pwebmc/d/contentFocus/?pcID=e3a36489ba8ff3d529317d76de9b2fa3&pn=1

 

[kaneohe]

There are two types of Medigap plans, 'plain' Medigap and Medicare SELECT. The SELECT plans are like HMOs. With a 'plain' Medigap you can see any provider who accepts Medicare (and is accepting new patients if you move). The plain Medigap follows you when you move.

Had never heard of the SELECT plans..............thanks for the education!

 

[W2R]

Although I am not medicare elgible yet I would be interested in hearing what people are opting for and why ? I realize there are many variables but for someone who is just six months out from medicare the options seem many and the products confusing in their different offerings. Thank you in advance.

Somehow I never posted on this thread but better late than never, I guess.

Frayne, I don't blame you for being confused! I still don't understand all the Medicare supplementary plans and options. Luckily, I don't need to in my case.

I still have the same federal employee/retiree BCBS that I always have had and I pay as much for it as employees do. It converts into some sort of Medicare supplementary coverage when you get to Medicare age. They recommend not getting Part D coverage because their prescription drug plan is the same or better. But they do recommend Part B, so I got that too, adding $104.90/month to my monthly insurance costs.

Since I have Part B, federal BCBS gives me a wonderful additional perk that we don't normally get - - $0 deductible and $0 co-pay.

So, since I went on Medicare over two years ago, I have not paid one cent for anything except my prescription meds. To me this is fun even though I am probably paying more overall.

My recent cataract surgery bills were staggering. I know because I got the paperwork from BCBS, all of it marked "You Owe $0.00". Medicare paid most of the costs, and BCBS paid the rest, so all I had to pay was $142 for the prescription eyedrops. To me this is really really cool.

 

[kaneohe]

A couple of links on the medigap vs medicare advantage choice:

Medigap vs Medicare Advantage - Consumer Reports News

Medigap vs. Medicare Advantage Plan - Which is Best Medicare Supplemen... - AARP

Some of the considerations: advantage plans typically have networks like HMOs; your doctor could be in the network one yr and not next yr; you can more easily change plans each yr at open enrollment (than w/ Medigap); often come w/ built-in drug plans;
plans may be harder to compare since they are not standard (as for medigap); check out of pocket max

medigap plans: typically (but not for SELECT) plans do not have a network like Advantage plans so you can go to any dr who accepts Medicare; may not be easy to change plans once enrolled so at least in the beginning may want to consider carefully what you want or start w/ the "best" plan since it may be easier to migrate downstream to lower plans than the reverse; need a separate drug plan; easier to compare plans because there are a finite number of standard plans; https://www.medicare.gov/supplement-other-insurance/compare-medigap/compare-medigap.html

Sounds like W2R in the post above has something similar to medigap F..........and as she relates, if you ever have a major incident, you will be very happy you have a top-of-the-line plan..........of course you pay more for that kind of plan so it kind of depends on whether you are betting on the best or worst (or the middle) to happen.

 

[W2R]

Sounds like W2R in the post above has something similar to medigap F..........and as she relates, if you ever have a major incident, you will be very happy you have a top-of-the-line plan..........of course you pay more for that kind of plan so it kind of depends on whether you are betting on the best or worst (or the middle) to happen.

Oh, thanks! They never told me, AFAIK, and I always wondered what the heck it was. They just act like it's the same insurance as before Medicare, and this is how they interact with Medicare.

You are SO right that it is great to have a plan like this, even for a basically healthy person like me. The charges submitted from my cataract surgery already add up to $20,664 so far, with probably more to come, and every last penny of the lower negotiated cost has been paid.

"You owe the provider $0.00" is a wonderful thing to see in print.

If, heaven forbid, I should end up with a terrible condition like cancer, I'll be so thankful that I have this coverage (even though I had to work two very long and miserable years past FI in order to qualify for it).

 

[youbet]

There are two types of Medigap plans, 'plain' Medigap and Medicare SELECT. The SELECT plans are like HMOs. With a 'plain' Medigap you can see any provider who accepts Medicare (and is accepting new patients if you move). The plain Medigap follows you when you move.
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Saying "The SELECT plans are like HMOs" isn't completely inaccurate but is somewhat misleading. HMO's usually restrict the member to a predetermined list of providers, down to the individual doc level and often require pre-approvals to see specialists, etc. My BCBS "Select" Medigap plan only limits hospitals. I chose the BCBS "Select" plan because (1)it's hospital network contained all the local hospitals I'd be interested in using for elective admittance. Only a few specialty, boutique hospitals were omitted. (2) Emergency admittance to a non-network hospital is covered. (3) I can change to a non-Select plan at any time, with a phone call, even on short notice. If I did want to be admitted to one of the local botique/specialty hospitals for an elective procedure, I'd change to the non-select plan during the hospitalization planning stage. (4) The premiums are lower than the non-Select plans.

So, yes, the Select plan does have a hospital network. But unlike HMO's which generally restrict your doc choices, lab choices, specialist choices, etc., the BCBS Select only restricts hospital choices and here in the Chicago area their in-network hospital list is very comprehensive and they're flexible about letting you change to a non-Select plan on short notice.

Maybe instead of saying they'e like an HMO, we could say they have some HMO-like restrictions regarding hospitals but still allow broad access and can be changed to a non-Select plan on short notice at any time. At least that's how BCBS of Illinois works.

I can see where in a rural area with reasonable proximity to, say, only 2 hosptials and the one your prefer is not on the list, then the Select plan would not be your choice. You'd pay the higher premium for the non-Select plan. Here, there seems to be little reason to pay the higher premium.

Like all purchases, it pays to shop and understand what you're getting and what you're paying. The additional cost for the non-Select plan is fairly modest and I will look at changing and absorbing that when we're older and the possibility that the extra steps involved with keeping an eye on the Select plan hospital network becomes more burden than the savings is worth.

 

[audreyh1]

I see that starting in 2020, Medigap plan F will no longer be available for new enrollees.

 

[nvestysly]

Although I am not medicare elgible yet I would be interested in hearing what people are opting for and why ? I realize there are many variables but for someone who is just six months out from medicare the options seem many and the products confusing in their different offerings. Thank you in advance.

I'm nine years aware from Medicare eligibility but I've been frustrated by Medicare issues for several years with older siblings and friends who have seemingly ongoing issues with coverage/plans/networks/doctors/billing/etc. related to Medicare.

I've learned several things about Medicare by reading this thread. I'm sure coverage will change in the nine years before I'm required to sign-up for Medicare but it's never too soon to obtain a better understanding of the system.

I see that starting in 2020, Medigap plan F will no longer be available for new enrollees.

Oh jeez! Just when I thought I understood which plan I wanted!