Open enrollment for Medicare

[omni550]

I really had no idea that the co-pays on Medicare were so small.

ivinsfan,

It all depends on your Medigap policy as to whether you have any co-pays (some are $20/Dr. office visit & $50 for ER visit, like Plan N) and some are no copays (Plan F) and (Plan G = no copays after $147 Plan B deductible is met at a 20% contribution /'event').

omni

 

[kaneohe]

I checked Florida BCBS F vs C pricing. The difference in premium is $21 x month. So, pay an additional $252 to avoid paying the deductible of $147.

Michael...........this chart suggests that the difference is not the deductible but the coverage of excess charges https://www.medicare.gov/supplement-other-insurance/compare-medigap/compare-medigap.html

 

[ejman]

Michael...........this chart suggests that the difference is not the deductible but the coverage of excess charges https://www.medicare.gov/supplement-other-insurance/compare-medigap/compare-medigap.html

I'm not Michael but the chart you attached shows no difference between F and G for excess charges ?

 

[Bestwifeever]

I'm not Michael either but I believe he compared F with C, not with G?

 

[ivinsfan]

ivinsfan,

It all depends on your Medigap policy as to whether you have any co-pays (some are $20/Dr. office visit & $50 for ER visit, like Plan N) and some are no copays (Plan F) and (Plan G = no copays after $147 Plan B deductible is met at a 20% contribution /'event').

omni

I understand, what I meant to say was I didn't realize that balance left to pay after Medicare payments was so small, such as after a hernia surgery and all bills connected with it, my payments without a supplement would have been only around 450 I just rechecked my bills and BCBS paid 450 not the 500+ I estimated.

 

[MichaelB]

I checked Florida BCBS F vs C pricing. The difference in premium is $21 x month. So, pay an additional $252 to avoid paying the deductible of $147.

Sorry, I meant F vs G. Not sure if that was a typo or a vision problem.

 

[MBSC]

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.

TFL includes prescription drug coverage excluded from Medicare's 80%, so that probably skewed the numbers. The annual billing probably includes the retail prescription price, Medicare paid $0, and TFL paid something close to Part D.

Edit to Add: I also want to thank Michael for splitting the threads.

 

[kaneohe]

Sorry, I meant F vs G. Not sure if that was a typo or a vision problem.

I think you were just trying to see if we were paying attention (or if our vision was as good as yours) Guess we passed.
btw.......nice job on the split.....I would have bet $$ that it wouldn't be split....too much work.

 

[MichaelB]

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.

 

[Bestwifeever]

I checked Florida BCBS F vs [-]C[/-] G pricing. The difference in premium is $21 x month. So, pay an additional $252 to avoid paying the deductible of $147.

DH did the research on this for us and said even if you didn't use Medicare for a year at all that plan G was still better, so I signed up for it as well. The insurance company said it is their most popular plan (and dropped our premiums another 15 percent for being on the same plan with them--I swear it's like we're getting paid to be old). Who knows what the future will hold re premiums, of course.

And another thanks for the most skillful thread split to Michael--I've not looked at the ACA open enrollment thread since the split, so good call.

 

[kaneohe]

DH did the research on this for us and said even if you didn't use Medicare for a year at all that plan G was still better, .....................................

Not sure I understand this.........if you don't have any medical expenses, you won't have to pay a deductible,just premiums and G is cheaper. If you have a lot of medical expenses, F doesn't have to pay deductible but G does so the advantage over F decreases ..........so perhaps you meant the opposite?.....
that even with "heavy" Medicare use, G still was better?

 

[eytonxav]

I have a BCBS Sup F plan and a Humana drug plan. No deductible and a good network of Drs. That decision was a no brainer for me compared to the various medicare advantage plans

 

[ivinsfan]

I have a BCBS Sup F plan and a Humana drug plan. No deductible and a good network of Drs. That decision was a no brainer for me compared to the various medicare advantage plans

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.

 

[Moemg]

My SO has been very happy with his Humana Medicare advantage plan . He was orginally in a HMO but we switched to a PPO last year . He had a total knee last year and Humana paid out $100,000 . He paid $1100. The problem with the HMO is doctors would leave the plan and the coverage would change plus you needed a referral for everything . He was on the HMO when he ended up having a triple bypass and they paid all but a small amount .

 

[Bestwifeever]

Not sure I understand this.........if you don't have any medical expenses, you won't have to pay a deductible,just premiums and G is cheaper. If you have a lot of medical expenses, F doesn't have to pay deductible but G does so the advantage over F decreases ..........so perhaps you meant the opposite?.....
that even with "heavy" Medicare use, G still was better?

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.

 

[ivinsfan]

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.

 

[omni550]

ivinsfan:

Plan F vs Plan G explanation...

omni

 

[kaneohe]

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/article/3-medigap-plan-f-alternatives

 

[MBSC]

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/medicare-supplement-plan-f-vs-plan-g-which-is-best-for-you/

 

[ivinsfan]

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.

 

[omni550]

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.

omni

 

[braumeister]

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.

So you paid no out of pocket?

True. It's a good deal.

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.

 

[kaneohe]

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.

 

[MBSC]

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-Guidance/Guidance/Manuals/Downloads/clm104c04.pdf

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

Your responsibility for ER services: https://www.medicare.gov/coverage/emergency-dept-services.html

 

[braumeister]

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).