Medicare: Plan N now suggested ipo popular Plans F and G

[REWahoo]

I was thinking of going with Plan N since I am in a no-excess-charges-allowed state. But.... since I don't want to pay the $120 per month for it I went with a Medicare Advantage plan with CapBlueCross (which is zero dollars per month premium and large copays for some things). I am testing out the MA plan now. Used it for a dental cleaning and xrays, and also for a blood test. No completed claims to look at yet, still waiting. The grapevine says that the supplements are hassle-free and there is no need for calling up the insurance company for everything, to look for all the gotchas. So, I'm still looking for all the gotchas, but I guess the $120 savings per month makes it worth it.

FWIW, I've not found any gotchas, not during the 6 years when we were on Plan F-HD nor for the past year on Plan N. Medicare, at least for us, has been far better than traditional health insurance when it comes to that side of the equation.

 

[wmc1000]

I have not seen a similar prognostication for what will happen to F-HD premiums. Anyone seen any? I know that the age group will grow older. However since F-HD in my state is age related premiums, I would guess that having no young blood in the system will not have any affect. (?) Maybe I'm ignoring the inevitable. So far F-HD has been a good choice for us including one shoulder surgery.

edit: I really don't understand why F-HD will be closed to new applicants. It has a much higher deductible (almost 10x) than Plan G, which is continuing. Especially if Plan G is changing to guaranteed issue.

Since Plan F is being closed it follows that F-HD will close also. A new G plan, G-HD will open as a replacement, whether the "deductible" will include the regular plan G deductible, currently $185 plus the HD deductible I do not know.

 

[CRLLS]

Since Plan F is being closed it follows that F-HD will close also. A new G plan, G-HD will open as a replacement, whether the "deductible" will include the regular plan G deductible, currently $185 plus the HD deductible I do not know.

I am aware that F-HD will be closed to new applicants in 2020. I am currently on F-HD. I am more interested in what the pundits think about possible future premium increases as mentioned in the article.

Secondarily, F-HD is truly a different plan than F, just like D and G etc. are. It just happens to share the same first letter as Plan F. It requires more out of pocket than G before it starts coverage, the main reported argument for closing C and F. I was curious as to why it will be treated the same as F and closed to new applicants. It simply doesn't make sense to me.

Further, since all but AARP plans in Illinois are age based, I can't see why the lack of incoming young'uns would detrimentally affect older people's premiums as C and F are closed.

 

[wmc1000]

Think of it as just changing letters to avoid confusion. If there is no F why have an F-HD? Since there will be a plan G, G-HD will be the new F-HD but will make sense to more people as a high deductible G plan just like F-HD is a high deductible F plan.

 

[omni550]

I spoke with an agent at seniorsavingsnetwork.org re: Plan N and various options.

The agent said that it is possible to avoid the possible Plan N "excess charges" for a specialist by checking a list of physicians on medicare.gov to see if the specialist accepts Medicare assignment or not beforehand. If they don't, check the list for a specialist who does. (If you have already been admitted to a hospital, this is a non-issue).

She also mentioned a Plan N quasi-loophole. Any visits to an "Urgent Care-type" place do not incur the $20 doctor's office visit co-pay.

---

For details on Plan G and Plan N for my zip code, effective Oct 1, here are the three options under consideration:

A) Keeping the same provider (Aetna) I currently have, and staying on Plan G, my premium will increase by $272/yr.

OR
B) I can keep the same provider (Aetna) and switch to Plan N which will save $689/yr over option A.

OR
C) I can switch to a less-expensive Plan G policy with a different provider that Senior Savings Network considers good (Humana) and thereby save $407/yr over option A.

omni

 

[REWahoo]

The agent said that it is possible to avoid the possible Plan N "excess charges" for a specialist by checking medicare.gov's list to see if the specialist accepts Medicare assignment or not beforehand. If they don't, check the list for a specialist who does. (If you have already been admitted to a hospital, this is a non-issue).

Exactly. That's why I believe the risk of getting hit with an excess charge is extremely small.

As to your A, B or C option, won't you have to go through underwriting to change providers in option C?

She also mentioned a Plan N quasi-loophole. Any visits to an "Urgent Care-type" place do not incur the $20 doctor's office visit co-pay.

Be sure that Urgent Care clinic accepts Medicare assignment. There is a local chain here that does not.

 

[omni550]

REWahoo: As to your A, B or C option, won't you have to go through underwriting to change providers in option C?

We didn't discuss it, but I foresee no issue.

Be sure that Urgent Care clinic accepts Medicare assignment. There is a local chain here that does not.

Good to know. Thanks.

omni

 

[CRLLS]

Think of it as just changing letters to avoid confusion. If there is no F why have an F-HD? Since there will be a plan G, G-HD will be the new F-HD but will make sense to more people as a high deductible G plan just like F-HD is a high deductible F plan.

For this "old geezer" making G-HD the new F-HD with no difference in benefits, premiums or rate increase differences makes it more confusing to me. I have yet to see any mention of benefit description or premiums for Plan G-HD, just mentions of "there will be a Plan G-HD". January is only 4 months away. My Google search for Illinois Medicare "plan g-hd" turned up 6, yes just six hits! One of which was mi post on this site almost 3 years ago.

 

[REWahoo]

Omni, if I did the math right (note my sig ) the savings you would see by going to N (option B) vs going to a new provider and keeping G (option C) would be $282 per year.

What isn't known is how much you'd spend on copays on N and any future reduced rate increase benefit (if any) by choosing N - plus the dead-horse subject of excess charges.

Interested to learn what you decide.

 

[ncbill]

I was thinking of going with Plan N since I am in a no-excess-charges-allowed state. But.... since I don't want to pay the $120 per month for it I went with a Medicare Advantage plan with CapBlueCross (which is zero dollars per month premium and large copays for some things). I am testing out the MA plan now. Used it for a dental cleaning and xrays, and also for a blood test. No completed claims to look at yet, still waiting. The grapevine says that the supplements are hassle-free and there is no need for calling up the insurance company for everything, to look for all the gotchas. So, I'm still looking for all the gotchas, but I guess the $120 savings per month makes it worth it.

Isn't the primary "gotcha" you might not be able to qualify medically if you want to switch from your Advantage to a traditional supplement plan?

 

[ERD50]

I think this is related enough to not start a new thread:

I am in the process of signing up for Medicare. In addition to the Part A, B, & D, I am looking at a Plan G supplemental.

There is a high deductible version for ~ $900 less per year. It says plan deductible is $2,300. Is there anything to consider other than the obvious question of will my expenses exceed the $900 savings on average? And I assume could always change to regular deductible next year if I realize this won't work for me.

Just seems that in general, high deductible makes sense for anyone with average needs and who has the liquidity available. That's what insurance is for.

-ERD50

 

[REWahoo]

We were on a high deductible supplement (F-HD) for the first few years of Medicare. We were (and thankfully still are) both relatively healthy and the choice of a HD plan worked out nicely for us.

When we reached our early 70's we began to have more ailments (thankfully still minor) and could see more medical expenses in our future. We decided to make the change to another letter of the alphabet, one without the HD designation, while we were still healthy enough to get through underwriting.

That's the only issue I see in your HD now, change in the future if it doesn't work for us strategy. Will you have to go through underwriting to make that change, and will you be healthy enough to do so?

 

[John Galt III]

Isn't the primary "gotcha" you might not be able to qualify medically if you want to switch from your Advantage to a traditional supplement plan?

I already know about that, so I won't term it a gotcha. BTW, I have six months from my Medicare start date 7-1-2019 to switch from my MA plan to a supplement with no underwriting (lookback for pre-existing conditions). I am considering doing that, but I will have to talk myself into it. The gotchas I'm talking about are all the things that don't go the way they are supposed to, even though you called the ins co in advance of something, and you end up owing more money than you thought you would. Often it is simply incompetent ins co cs reps telling me bogus info. Sometimes it is a provider coding something wrong or performing some task you didn't ask for, etc, etc ad infinitum. So irritating. All that nonsense goes away when one is on a supplement plan, I hear, and you don't have to spend hours on the phone for every medical event to try to prevent a 'mistake' being made by them.

 

[steelyman]

All that nonsense goes away when one is on a supplement plan, I hear, and you don't have to spend hours on the phone for every medical event to try to prevent a 'mistake' being made by them.

Is this true? Honest question, I just don’t know. It seems errors can occur during processing regardless of insurance through a supplement or Advantage.

 

[John Galt III]

Is this true? Honest question, I just don’t know. It seems errors can occur during processing regardless of insurance through a supplement or Advantage.

The only problem I've heard of with the supplement is having something done that is not covered by Medicare (and there are a few of them, apparently, one being certain blood tests that are deemed 'not medically necessary') so I guess I would have to always ask the supplement insurance co 'Does Medicare cover it?' before I do anything.

 

[REWahoo]

Is this true? Honest question, I just don’t know. It seems errors can occur during processing regardless of insurance through a supplement or Advantage.

I do think errors are less frequent with Medicare/supplement insurance than with private insurance, at least that has been our experience. I'm sure the fact there is no profit motive with Medicare (and supplements simply pay when Medicare pays) while there may be a financial benefit to a private insurer in what they approve, deny, or code incorrectly has nothing to do with it.

Nope, nothing at all.

 

[REWahoo]

The only problem I've heard of with the supplement is having something done that is not covered by Medicare (and there are a few of them, apparently, one being certain blood tests that are deemed 'not medically necessary') so I guess I would have to always ask the supplement insurance co 'Does Medicare cover it?' before I do anything.

Shouldn't you be asking Medicare rather than the supplement insurer?

Get Medicare’s new “What’s covered” app!

 

[CRLLS]

Funny we should be talking about miscoding. Again, we have traditional Medicare and F-HD. I don't pay a bill unless I see Medicare, the supplement provider and the Dr's office all agree. I ran into my first episode of mis-matching. DW had shoulder surgery in early May. I just recently received the bill for part of it. Another part was last billed and paid last month. After trying to make sense of Medicare, BCBS and the Dr's bill, I couldn't find a way to make them match. Called the Dr's office to explain their bill and stumped her. After a while she called back. According to her, in certain instances, Medicare makes errors then makes corrections and then everyone else has to readjust their statements. What caused the error, I don't know. Further, for every other claim the Medicare details tell us how much we may owe. In this case, it was left off the Medicare website. The provider could see it, copied it and emailed it to us. Then they all jived and we paid the provider.

I think neither Traditional Medicare nor an Advantage plan has the upper leg on mistakes.

 

[John Galt III]

Shouldn't you be asking Medicare rather than the supplement insurer?

Get Medicare’s new “What’s covered” app!

I guess you're right, REW. I'm used to thinking that the insurance company rules matter, but with a supplement, it's Medicare rules that matter. And thanks for the link.

 

[steelyman]

I do think errors are less frequent with Medicare/supplement insurance than with private insurance, at least that has been our experience. I'm sure the fact there is no profit motive with Medicare (and supplements simply pay when Medicare pays) while there may be a financial benefit to a private insurer in what they approve, deny, or code incorrectly has nothing to do with it.

Nope, nothing at all.

Thanks (as always). That’s an interesting observation and makes me think I have some more research to do regarding my State retiree health benefits. As of 2019, it’s an Advantage plan administered either by Aetna (HMO) or UHC (PPO).

The “What’s Covered” Medicare app that you posted is new to me and helpful. Not being Medicare-eligible yet, I don’t have personal experience with coverage/costs or processing so that makes it tricky to compare.

 

[CRLLS]

I think this is related enough to not start a new thread:

I am in the process of signing up for Medicare. In addition to the Part A, B, & D, I am looking at a Plan G supplemental.

There is a high deductible version for ~ $900 less per year. It says plan deductible is $2,300. Is there anything to consider other than the obvious question of will my expenses exceed the $900 savings on average? And I assume could always change to regular deductible next year if I realize this won't work for me.

Just seems that in general, high deductible makes sense for anyone with average needs and who has the liquidity available. That's what insurance is for.

-ERD50

Can you tell me where you can see this G-HD details and price quote? I haven't read anything about G-HD. Medicare.gov shows no G-HD listed. Neither does the state's SHIP site. https://www2.illinois.gov/aging/ship/Documents/ChicagoMedSupWeb.pdf

 

[ERD50]

We were on a high deductible supplement (F-HD) for the first few years of Medicare. We were (and thankfully still are) both relatively healthy and the choice of a HD plan worked out nicely for us. ...

That's the only issue I see in your HD now, change in the future if it doesn't work for us strategy. Will you have to go through underwriting to make that change, and will you be healthy enough to do so?

Thanks. I'm so ignorant on all this. I didn't realize the supplemental plans included underwriting. Obviously, (I hope?) Medicare itself doesn't involve underwriting (unless you delayed signing up for Plan B/D or supplemental?).

Since any savings could be wiped out by a few years of hitting the deductible, I think I'll avoid the chances of having higher future rates. Keeps things simpler, I think.

Can you tell me where you can see this G-HD details and price quote? I haven't read anything about G-HD. Medicare.gov shows no G-HD listed. Neither does the state's SHIP site. https://www2.illinois.gov/aging/ship/Documents/ChicagoMedSupWeb.pdf

My Megacorp hires a company to help walk us through out Health Insurance options, and it came up on their site. It was listed as:

United World Life Insurance Company WM36

Which is a Mutual of Omaha company. A quick search did not turn up any other refs to it, not sure why. I'll try to copy the relevant passages, compared to their 'regular' Plan G:

Mutual of Omaha
United World Life Insurance Company WM25
$127.33 Premium (Monthly)

Mutual of Omaha
United World Life Insurance Company WM36
$46.54 Premium (Monthly)


__________________________ WM25 ___ WM36
Plan Deductible (2019) ___ n/a ____ $2,300


-ERD50

 

[CRLLS]

ERD50, thanks for the info.

I had not seen anything as of yet. This looks like it is a done deal.

 

[REWahoo]

Thanks. I'm so ignorant on all this. I didn't realize the supplemental plans included underwriting. Obviously, (I hope?) Medicare itself doesn't involve underwriting (unless you delayed signing up for Plan B/D or supplemental?).

Neither Medicare nor supplemental plans require underwriting during your initial enrollment period at age 65. After that (of course there are exceptions), supplemental plans require you to pass underwriting to change to another plan or to another company.

 

[NoMoreJob]

Originally Posted by REWahoo View Post
Most who don't accept assignment will agree to take the Medicare amount once they learn your insurance will not pay the additional charge.

Last year, my Bronze ACA plan had a $6,550 annual deductible with a monthly premium for a 64 year old nearly $1,400. So far, I'm loving Medicare!

I'm curious if you have any evidence to back that statement up? Relying on the kindness of strangers doesn't give me a warm & fuzzy feeling when it comes to medical bills.

I agree with ncbill. For a modestly higher premium in Plan G, I like the secure knowledge that I'm covered for excess charges. The co-pay avoidance is also nice to have.

Last year, my Bronze ACA plan had a $6,550 annual deductible with a monthly premium for a 64 year old nearly $1,400. So far, I'm loving Medicare!

All I can say is that in my case the provider (a high profile national clinic) did not accept assignment in my state and DID charge the additional allowed amounts to many of my bills. Just FYI, there is 2% of the excess charge amount that the patient is often still responsible for.

I never added up all the charges but my out-of-pocket with Plan F was minimal, maybe a couple of hundred bucks on tens of thousands of dollars of charges and thousands of excess charges.

If nothing else it was a great stress reliever at a time that neither my wife nor I needed any additional stress to know that nearly everything was paid for by Medicare plus my supplement. I think that as we age and our mental capacities decline it will be even more valuable in this respect.