aja8888
Moderator Emeritus
Plan F is one of the Medigap insurance plans that covers what Medicare does not cover. Here is an explanation:
https://www.medicare.gov/supplement-other-insurance/compare-medigap/compare-medigap.html
Budgeting for Medicare costs
- Thread starter simple girl
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Plan F is one of the Medigap insurance plans that covers what Medicare does not cover. Here is an explanation:
https://www.medicare.gov/supplement-other-insurance/compare-medigap/compare-medigap.html
Ian S
Thinks s/he gets paid by the post
With Plan F closing to new enrollees in a few years, I'd venture to guess that folks ought to avoid it now. Without fresh recruits, the existing members will get older and sicker and premiums will likely increase dramatically.
REWahoo
Give me a museum and I'll fill it. (Picasso) Give
I've seen similar comments to yours and other comments saying concerns about big increases are overblown. What I have NOT seen is any information on whether or not the 'closed to new enrollees in 2020" also applies to the high deductible (HD) version of Plan F. Since the purpose of the change was to stop "first dollar coverage" provided by Plan F, and since the HD version requires you to pay $2,180 out of pocket before it kicks in, it would appear the change would not apply to the HD version. But I can find no information to confirm this.
meierlde
Thinks s/he gets paid by the post
Comparing plan f with plan g the difference is covering the part B deductible of $166. As various articles point out if the cost difference exceeds $13.90 or so then go with G as you are effectively just paying the deductible to the medigap plan. If the cost difference between f and g is less than 13.90 then you do need to think a bit more about it.
Another point worth bringing up is that depending on your personal medical conditions, Medicare may pay more than you think.
I'm looking at the last three years (2013 through 2015) of medical bills for two of us, and I see the following:
Billed (by doctors, hospitals, etc.): $32,044
Approved by Medicare: $13,617
My responsibility (ignoring supplemental coverage): $3,216
I'm fortunate in that my supplemental coverage picked up virtually all of that, but still my share would only have been about 10% of the original billed amount (plus the cost of Part B, of course).
I'm looking at the last three years (2013 through 2015) of medical bills for two of us, and I see the following:
Billed (by doctors, hospitals, etc.): $32,044
Approved by Medicare: $13,617
My responsibility (ignoring supplemental coverage): $3,216
I'm fortunate in that my supplemental coverage picked up virtually all of that, but still my share would only have been about 10% of the original billed amount (plus the cost of Part B, of course).
meierlde
Thinks s/he gets paid by the post
The hospital bill for someone on medicare will show an itemized bill and then the total zero it out and replace it with the reimbursement for the diagnosis related charge that medicare uses I was surprised when I say it on my mothers hospital bills, but that is the way it is done (mostly part A here). Then for part B if not on medicare advantage there is a max charge they can charge as well.
Ian S
Thinks s/he gets paid by the post
I've also see claims (e.g. in the video below) that annual rate increases for Plan G tend to be far lower than for Plan F so that's perhaps another consideration.
I'm curious, does anyone here use Medicare Advantage plans (Part C, I believe)? How do those compare cost-wise (premiums + OOP) to Medigap/Part F policies?
We're currently with Kaiser in SoCal and my parents are nearing Medicare age.
We're currently with Kaiser in SoCal and my parents are nearing Medicare age.
meierlde
Thinks s/he gets paid by the post
The problem of narrow networks affects medicare advantage plans. However in the case of traditional medicare almost all hospitals take it (because folks over 65 are their biggest customers). In addition the question of physicians and taking medicare is much clearer and more easy to frame than the problems folks have with networks.
The bill failed to address HD-F. CMS is working on a resolution but it appears the more likely outcome will create HD-G. If so, the $2180 OOP is expected to provide a buffer and insulate HD-F from most of the premium increases experienced after Plans E, H, I, and J closed in 2010.
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I would think so. I can tell you that physical therapy visits are only covered 80% by Medicare part B. These charges can really add up when visits are 2 to 3 times a week for 2 or 3 months, typically. And as you get older, your need for rehab services can go up markedly, so it is imporant to plan for that. There always seems to be some kind of musculoskeletal injury or balance issue that crops up. I always felt bad for my patients who didn't have a Medigap plan. Many times they would refuse therapy or cut their therapy short due to the out of pocket costs they would incur.
According to this reference, there is no maximum OOP for original Medicare Part A and Part B:
What else do I need to know about Original Medicare?
You generally pay a set amount for your health care (deductible) before Medicare pays its share. Then, Medicare pays its share, and you pay your share (coinsurance / copayment) for covered services and supplies. There's no yearly limit for what you pay out-of-pocket.
I do recall that some of my patients had a "managed Medicare" type of plan - I believe it costs less than original Medicare, but what I saw with these plans were (1) needing to get referrals from a primary gatekeeper doc and (2) more limits on what was covered and who you could see for your care. For example, some of them would be limited to a 60 day time period to receive "x" number of PT visits per diagnosis per year. Typically that would be sufficient, but not always (aka extensive rotator cuff repairs, etc.) I don't know what these plans are like now, this is based upon treating patients under these plans several years ago.
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I'm also going to use Fidelity's RIP to see how my projections look with it, but I have a question about FIRE calc. Under the spending models tab I see that the default uses CPI for inflation adjustments. Does that work out to be more than the 3% option for inflation?
I'm asking because I am trying to figure out how much extra our total healthcare costs will be than basic Medicare inflated by the CPI over our total projected retirement years.
Rustic23
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From what I can find these amounts are not indexed. With a 4% inflation rate, our RMD will force us over the $170K limit in about 15 to 20 years. As we are in our 70's this is not much of a worry for us, but if I was younger and looking at 25-35 years of retirement it would be something I would look at planning around, if possible.
Is there a website that compares coverage to all the options? I understand policy coverage is the same for the same type of policy, but how do we learn about a supplement vs medigap for example. We are a still a few years out, but it seems the learning curve on this to get educated for choices is huge!
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According to this article:
Starting in 2020, the high income premium brackets will be adjusted for inflation, so that promises to keep some out of reach of the income surcharges. But don’t count on it.
So, I guess we will see! I'm hoping me planning for a 7% increase in Medicare costs yearly will be enough. Too hard to plan for everything...but this is good to know. Thanks!
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I've been looking at the actual Medicare site, which has been surprisingly helpful and organized! It is indeed a huge task to educate yourself on...hard to make myself do it this far out (age 48), but, I am really trying to be as sure as I can that our projections for our portfolio to survive are as accurate as possible.
https://www.medicare.gov/sign-up-ch...-medicare-coverage-choices.html#collapse-5313
True but I think one benefit to Kaiser's closed network is you clearly know if you're in-network or out of network. If you go anywhere outside Kaiser, it's automatically out of network. Kaiser covers emergency services (even international) at in-network rates. All others, you're on your own.
CRLLS
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My state's "dept of aging" has a great service which describes the differences in plans very well. In addition, it lists all the companies approved for their Medicare plans and their individual costs at ages under 64, 65 and every 5 year increment thereafter up to age 85. Many are fairly competitive at age 65 but digress as ages increase.
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Alan, I was surfing for other Medicare stuff, and ended up finding this page, which I think may prove helpful to you. Sounds like it could be tricky to lose coverage and then try to pick it up again.
https://www.medicare.gov/find-a-plan/staticpages/learn/rights-and-protections.aspx
And, on a different note, I found this information about how Medigap policies price their rates and how to shop for them quite interesting. Sharing for anyone who may find it helpful.
https://www.medicare.gov/find-a-plan/staticpages/learn/how-insurance-companies-price-policies.aspx
Thanks for the links, and your earlier replies. It looks like I'll have to budget for Medigap or other supplemental insurance even for years when we are not even in the country.
Does anyone here actually have a Part G plan? How stringent are the criteria for getting onto it? Do they require an actual medical exam?
I was planning on a Part F plan (turn 65 in October) but if I could get onto G it might solve the problem of F being closed.
For the OP: I would advise against a Medicare Advantage plan because 1) it's basically an HMO with narrow provider and hospital panels and 2) several insurers have stopped offering them due to lack of profits.
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I was planning on a Part F plan (turn 65 in October) but if I could get onto G it might solve the problem of F being closed.
For the OP: I would advise against a Medicare Advantage plan because 1) it's basically an HMO with narrow provider and hospital panels and 2) several insurers have stopped offering them due to lack of profits.
Sent from my iPhone using Early Retirement Forum
All Medigap plans are guaranteed issue during your Medigap initial enrollment period. The initial enrollment period is when you first become eligible to enroll, usually when you turn 65.
It is after the initial enrollment period has expired and you qualify for a SEP that Plan F is guaranteed issue and G is not.
The medical underwriting comes when your initial enrollment period has expired, you don't qualify for a SEP, and you want to change Medigap plans. An independent health insurance agent specializing in Medigap can let you know the ones which are more lenient, but they usually ask if you are on dialysis, have any upcoming surgeries, or had any major surgery during the past few years.
Some states, like NY, are year round guaranteed issue. Other states, like CA, allow you to downgrade or move to a different insurer with the same plan letter around your birthday.
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What does SEP stand for?
Sounds like one needs to research Medigap plans very closely and choose wisely at age 65 as changing plans later on could be difficult, if not impossible depending on your health status and state you live in...correct?
Special Enrollment Period.
Certain situations, such as your Medigap plan no longer being offered, create a Special Enrollment Period where you have guaranteed issue rights to some, but not all, of the Medigap Plan letters. In this situation, you can apply for Plan G but they do not have to accept you since G does not carry guaranteed issue rights. G will replace F on the guaranteed issue list in 2020.
List of SEP situations that create guaranteed issue rights to Medigap: https://www.medicare.gov/supplement...edigap/guaranteed-issue-rights-scenarios.htmlhttps://www.medicare.gov/supplement...eed-issue-rights-scenarios.html#collapse-4690
There is no annual open enrollment for Medigap at the federal level like there is for Medicare Advantage and Part D. So, in most states, it is important to choose a Medigap that not only offers low rates at age 65 but still has competitive rates at age 80 in case medical issues arise which prevent you from switching in the future.
