Medicare-Medigap Preparation Question

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Murph

Recycles dryer sheets
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I'm going with either Aetna or Cigna Plan N in Ohio this July. For those of you with Plan N experience, how exactly does the whole process work once I have the coverage? Assume a scenario where I use a doctor or lab and I've exceeded the deductible amount on the first visit; I also assume that the doctor's office may request the $20 co-pay up front.

1. Do they bill Medicare directly for their 80%?
2. Do they bill the Medigap company directly for their share?
3. Do I pay them everything and then have to file claims with Medicare and/or the Medigap company?

4. (side question): Are the monthly premiums really billed separately by Medicare, the Medigap company, and Part D company? Seems like a lot of bother.

Thanks in advance!
 
Murph said:
I'm going with either Aetna or Cigna Plan N in Ohio this July. For those of you with Plan N experience, how exactly does the whole process work once I have the coverage? Assume a scenario where I use a doctor or lab and I've exceeded the deductible amount on the first visit; I also assume that the doctor's office may request the $20 co-pay up front.

1. Do they bill Medicare directly for their 80%?
2. Do they bill the Medigap company directly for their share?
3. Do I pay them everything and then have to file claims with Medicare and/or the Medigap company?

4. (side question): Are the monthly premiums really billed separately by Medicare, the Medigap company, and Part D company? Seems like a lot of bother.

Thanks in advance!
Click to expand...
No experience with Plan N, but in general:

1. Yes
2. I believe it is sent directly to Medicare first, which then forwards to Medigap.
3. No, should not have to do so.
4. Yes
 
I have paid the $20 upfront before but also have had them bill me....

The interesting thing is sometimes when billed it is $18 somethinig... not $20..

Other questions have been answered...
 
Mine is UHC/AARP.... it was only a few dollars more and they do not close the books...
 
I have Plan N and never have been asked to pay the $20 up front. It can be slightly less, especially if seeing a CRNP or PA.
I recommend AARP/UHC. USAA is probably good too. I’ve no experience with State Farm.
Note that you can change your choice of plan or provider for the six month period beginning with your birth month.
 
Texas Proud said:
Mine is UHC/AARP.... it was only a few dollars more and they do not close the books...
Click to expand...
They’re basically the only provider that doesn’t close the books, and when I last checked they were way more expensive —- though maybe it all evens out in the long run? We just had a great thread showing firm after firms record on closing the books. Medigap Shopping: Closing the Book & Rate Increases
 
1. Do they bill Medicare directly for their 80%?
2. Do they bill the Medigap company directly for their share?
3. Do I pay them everything and then have to file claims with Medicare and/or the Medigap company?

Everything happens automatically...you don't do anything but pay the bills when they come. You get statements telling you what happened, so you can validate it is working as prescribed, but basically you're just validating that you did get the service from the provider and they accept Medicare assignment. Then, you pay what they calculate.

4. (side question): Are the monthly premiums really billed separately by Medicare, the Medigap company, and Part D company? Seems like a lot of bother.

If you are getting SS payments, it's a little simpler (they deduct Medicare premiums), but yes, there's a lot of separate premiums to pay.
 
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