Still holding back seeing doctors with Medigap Plan G?

[fh2000]

I always had high deductible health plan before retirement. I rarely used the health insurance partly because I am quite healthy. Now that I am retired with a Medigap plan G for 2 years now, somehow my mindset hasn't changed from that old habit.

I understand that, you are free to see any specialists without concerns of much cost incurred as long as small deductible is paid. So, do you actually start booking appointments with specialists with minor ailments? Are there any restrictions or limitations of what you can/should do?

 

[Midpack]

We moved to a new state, so we’ve used our GP for referrals mostly, and we’ve been pleased with her recommendations. But if we were still near Chicago, we’d have no qualms about going to specialists we knew of there after 26 years. We’re also generally healthy, but we’ve had a few minor issues - and we’ve been very pleased with our Medicare plus Plan G supplement.

 

[Rianne]

fh2000, thanks for that question. I just started Medigap plan G and have wondered the same thing. So what if I decided to go to Mayo Clinic or Cleveland Clinic for specialized treatment (kidney disease)? Can I just make an appointment and go? Those hospitals are in different states. I guess I'd have to check if the specialist takes medicare first.

 

[Trooper]

So what if I decided to go to Mayo Clinic or Cleveland Clinic for specialized treatment (kidney disease)?

I just learned that, while Mayo accepts Medigap, it does not accept assignment. So if you have Plan N you may be subject to up to 15% excess charges.

 

[Rianne]

I just learned that, while Mayo accepts Medigap, it does not accept assignment. So if you have Plan N you may be subject to up to 15% excess charges.

What about plan G? I don't know what "assignment" means in terms of Medigap coverage.

 

[Midpack]

fh2000, thanks for that question. I just started Medigap plan G and have wondered the same thing. So what if I decided to go to Mayo Clinic or Cleveland Clinic for specialized treatment (kidney disease)? Can I just make an appointment and go? Those hospitals are in different states. I guess I'd have to check if the specialist takes medicare first.

AFAIK you could. As for coverage, every doctors appointment I've ever made asks about insurance/Medicare, and I would think the doctor would warn you if your coverage might not cover as much as you might be expecting. Doctors don't want angry patients or bad reviews (these days).

Why wouldn't you proactively ask the provider anyway? If you get an unexpected charge and you didn't ask any questions up front, whose fault is that? Nothing wrong with asking here first, but I'd sure double check with the provider myself.

 

[MRG]

I haven't changed anything after going on Medicare/medigap. I have had two surgeries and a colonosopy this year but I would have done the same with my old ACA plan.

 

[Rianne]

ask the provider[/U] anyway? If you get an unexpected charge and you didn't ask any questions up front, whose fault is that? Nothing wrong with asking here first, but I'd sure double check with the provider myself.

Yes, I plan to ask lots of questions. I just remember my MIL was DX with colon cancer within a year after going on Medigap. She had several chemo treatments, and surgeries, over 7 or 8 years. DH said she paid nothing. That seems so unbelievable to me.

 

[MBSC]

I just learned that, while Mayo accepts Medigap, it does not accept assignment. So if you have Plan N you may be subject to up to 15% excess charges.

Your source may be outdated or unofficial. The Mayo locations in AZ and FL became Medicare participating providers in 2021. The MN location has been participating longer.

Does Mayo Clinic accept Medicare?

Yes, Mayo Clinic is a participating Medicare facility in Arizona, in Florida, in Rochester, Minn. and at all Mayo Clinic Health System locations.

Reference: https://www.mayoclinic.org/patient-visitor-guide/billing-insurance/insurance/faq

You can also use the "find providers" function on Medicare.gov to see that Mayo Clinic in AZ "charges the Medicare approved amount". When you hover the cursor over that statement for Mayo on the website below, a bubble appears stating "When a doctor accepts the Medicare approved amount as payment, you won't be billed for more than the Medicare deductible and coinsurance."

https://www.medicare.gov/care-compa...a-8bdaf23f39f8&city=Phoenix&state=AZ&zipcode=

 

[REWahoo]

Your source may be outdated or unofficial. The Mayo locations in AZ and FL became Medicare participating providers in 2021. The MN location has been participating longer.

Thanks for correcting this.

 

[REWahoo]

I don't know what "assignment" means in terms of Medigap coverage.

Here ya go: https://www.medicare.gov/basics/costs/medicare-costs/provider-accept-Medicare

 

[Ian S]

Yes, I plan to ask lots of questions. I just remember my MIL was DX with colon cancer within a year after going on Medigap. She had several chemo treatments, and surgeries, over 7 or 8 years. DH said she paid nothing. That seems so unbelievable to me.

Welcome to the joys of Medigap! Your MIL possibly had plan F for which everything would be free. I have plan G so have the Part B deductible to pay which I've done every year on Medicare. Usually it happens in the first quarter of the year.

I'm not one to rush to the doctor for every minor ailment but I do have to be seen regularly by a dermatologist as I get precursors to cancer that have to be frozen. A couple of weeks ago, the dermatologist also did two biopsies for suspicious spots. I won't take any chances with skin cancer. I've also had various surgical procedures over the last few years for non life threatening problems. Virtually any specialist visit eats up your Part B deductible immediately.

 

[Bamaman]

Sometimes specialists require that you be referred by another physician and sometimes they'll allow you to come to them directly. You want to find the best quality doctors possible as you age.

My wife has terrible arthritis and we anticipated she'd need extensive surgeries and joint replacements in the future. She required an electric wheelchair ($2500) and my very expensive insulin pump needed replacing at the same time. Instead of getting hit with 20% co-pay for durable goods, I switched to Plan F in the middle of the year and everything was covered. But getting on Plan F or G now requires going thru underwriting initially.

My wife has suffered with painful ailments for the last 40 years--since she was young. We don't see the bills on Plan F, but I would think her recent medical bills (3 hospitals, 2 surgeries and 2 rehabs) exceeded $500K. Her neurostimulator implanted last year was $65K and a heart ablation for AFIB was another $100K. We'd be dead ducks for deductibles and co-pays had we not been on Plan F.

 

[Teacher Terry]

Plan F is being discontinued and neither F or G require underwriting if you are new to Medicare. Different states have different requirements about whether you can change plans without underwriting being required.

 

[Car-Guy]

I have in the past generally avoided doctors unless I had a very specific need. Now that I'm getting older, I tend to see more doctors but still "opt out" of some of the tests, drugs, procedures or follow-ups they sometimes suggest. I pay them for their advice but I still believe in applying my common sense. If they get too pushy, I'll move on to someone else.

 

[Texas Proud]

I am new to N myself... and I plan on using it...


Starting to have knee pain and shoulder pain... I would not go in on my old insurance as I KNOW I would be paying over $7000 for whatever treatment I got...



Now I know that my max is the $233 or so.. it is a benefit that I plan on using...


I will tell you that you do NOT need a PCP... my sister is in her 80s and had not have a PCP for 15 or so years... but she is on a advantage plan... but N does not require one...

 

[Trooper]

Your source may be outdated or unofficial. The Mayo locations in AZ and FL became Medicare participating providers in 2021. The MN location has been participating longer.

Thanks MBSC and sorry for posting bad info.

 

[Trooper]

I am new to N myself... and I plan on using it...

Now I know that my max is the $233 or so.. it is a benefit that I plan on using...

With Plan N you also have $20 copays on top of the $233 annual deductible. So if you intend to have lots of office visits, Plan G may be more cost effective.

 

[Sunset]

I have my old habits, so I generally don't see a doc unless there is an issue, and even then I delay a lot.

 

[Dash man]

With Plan N you also have $20 copays on top of the $233 annual deductible. So if you intend to have lots of office visits, Plan G may be more cost effective.

Plan N is likely to have lesser price increases over time, since Plan G is the “Guaranteed Issue” plan for later enrollees. Between my regular twice per year office visits to my PCP, cardiologist, nephrologist, pain intervention specialist, and occasional visits to a dermatologist and gastroenterologist, the copays still are less than the price difference for the plans.

 

[Texas Proud]

With Plan N you also have $20 copays on top of the $233 annual deductible. So if you intend to have lots of office visits, Plan G may be more cost effective.

Nope, will not come close to the cost difference between the two plans...

 

[Trooper]

Plan N is likely to have lesser price increases over time, since Plan G is the “Guaranteed Issue” plan for later enrollees. Between my regular twice per year office visits to my PCP, cardiologist, nephrologist, pain intervention specialist, and occasional visits to a dermatologist and gastroenterologist, the copays still are less than the price difference for the plans.

Good to know as I am considering a Plan N for my first year. I guess the big question is how easily will I be able to switch later in life if/when Plan G becomes more cost effective?

 

[Sunset]

Good to know as I am considering a Plan N for my first year. I guess the big question is how easily will I be able to switch later in life if/when Plan G becomes more cost effective?

Probably impossible as you won't pass the health screening (which is why you would want to switch).

 

[anethum]

Plan N is likely to have lesser price increases over time, since Plan G is the “Guaranteed Issue” plan for later enrollees. Between my regular twice per year office visits to my PCP, cardiologist, nephrologist, pain intervention specialist, and occasional visits to a dermatologist and gastroenterologist, the copays still are less than the price difference for the plans.

You keep posting this in multiple threads but you haven't offered any evidence why later enrollees using Guaranteed Issue rules are likely to be more expensive to insure than existing Medicare enrollees in the same age cohort. In most states, Medigap premiums differ by age cohort. Even AARP/UHC Medigap essentially does, too, since their discounts decrease with age. Guarantee Issue typically applies when someone's current health insurance plan ends for a variety of reasons, or someone moves to an area where their Medicare Advantage plan doesn't exist. I don't see why anyone in those circumstances is likely to be more expensive to insure than anyone of the same age who is already enrolled in a Medigap plan.

You also haven't offered any evidence that "Guaranteed Issue" is available to, and used by a large number of people each year. You simply said in another thread that I "might be surprised". I wouldn't call that data. And regardless of how many people it may apply to, that still isn't evidence that those people are more expensive to insure than existing Medigap plan G holders of the same age.

I've been wary of this argument since watching one of the Chris Westfall videos where it appeared to me that he was simply trying to drum up business & new commissions by getting people to switch from their Medigap G plan to Medigap N due to the Guarantee Issue bogeyman. I watched one of his previous videos where he was recommending Medigap G plans.

 

[Katsmeow]

I understand that, you are free to see any specialists without concerns of much cost incurred as long as small deductible is paid. So, do you actually start booking appointments with specialists with minor ailments? Are there any restrictions or limitations of what you can/should do?

I have Plan G so only the deductible to pay. I don't have any hesitancy about seeing a doctor, specialist or otherwise when I need to. That said, I don't have high medical needs yet so don't really see anyone that often.

fh2000, thanks for that question. I just started Medigap plan G and have wondered the same thing. So what if I decided to go to Mayo Clinic or Cleveland Clinic for specialized treatment (kidney disease)? Can I just make an appointment and go?

Last year I had I needed to have a biopsy after a mammogram. The radiologist at the place that did the routine mammogram kept talking about how the location was difficult and he might or might not be able to do it through ultrasound.

Anyway, I decided to drive about 5 hours to go to MD Anderson. I knew that they do this kind of thing a lot. I used to live close to them and many years ago had had a biopsy there (no cancer).

So, I simply called them on the phone and explained what I needed. They told me what records they needed. I made the trip and everything went well. (The radiologist there had no hesitancy about doing the biopsy and thought it strange the other doctor had been hesitant).

Total cost was a small amount left on my annual Medicare deductible. I would do it again. One reason I like traditional Medicare is that I have no networks.