Help on medicare

[audreyh1]

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Originally Posted by Another Reader They are standard plans, at least in California. The other person there had heard of them, but they did not have any information about them. https://www.blueshieldca.com/sites/m...plan-extras.sp

If Medicare.gov does not list or explain these plans, then how can they be standard?

[MichaelB]

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Originally Posted by audreyh1 I wouldn’t expect a SHIP counselor to know anything about non-standard Medigap plans.

I would expect a SHIP counselor to be familiar with all Medicare options, including non-standard state specific offerings, Medicare Select, Plan D, and Medicaid for Medicare options.

[winger]

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Originally Posted by MBSC You need to read your policy again. You can go to any provider in an emergency. For non-emergencies, PPO members can go to any provider that hasn't opted out of Medicare AND takes the MA PPO (aka accepts the plan's terms). MD Anderson Cancer Center in Houston: Mayo Clinic - Arizona campus:

Perhaps YOU need to read my policy.

[audreyh1]

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Originally Posted by MichaelB I would expect a SHIP counselor to be familiar with all Medicare options, including non-standard state specific offerings, Medicare Select, Plan D, and Medicaid for Medicare options.

What obligations does an insurance company have to stand behind any non standard Medigap offering? I would be very concerned about a bait and switch, as well as constant stream of new non-standard plans to confuse the customer. So I guess it’s hard to see how someone would keep abreast of nonstandardized offerings if they aren’t guaranteed like the standard ones are.

[MBSC]

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Originally Posted by winger Perhaps YOU need to read my policy.

It would be my pleasure.

[ivinsfan]

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Originally Posted by winger Not in all cases. We have a United Advantage plan through a former employer. While they do recommend their nationwide network, we can go to any provider that hasn't opted out of Medicare. United pays the same to either. There are many thousands of us.

That they pay the same to either isn't the point, if you go out of network the payment might cover the charge of the out of network provider. The very definition of an Advantage plan means they pay differently then Medicare pays. Medicare will never see the bill from the out of network provider.

[Another Reader]

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Originally Posted by MichaelB I would expect a SHIP counselor to be familiar with all Medicare options, including non-standard state specific offerings, Medicare Select, Plan D, and Medicaid for Medicare options.

The people that most need help from SHIP are the ones being shortchanged. From what I could glean, the counselors get some basic training on how to do the Part D cost comparison and some education on Medicare, Part B, Part D, and Medicare Advantage. They have a nice booklet to refer to, but it is outdated and does not have much detail. Apparently they can enroll you in a Part D plan, based on the experience of a friend in another county that was trying to set up two different plans for her husband and herself. For the letter plans and Advantage, you are on your own.

[MichaelB]

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Originally Posted by audreyh1 What obligations does an insurance company have to stand behind any non standard Medigap offering? I would be very concerned about a bait and switch, as well as constant stream of new non-standard plans to confuse the customer. So I guess it’s hard to see how someone would keep abreast of nonstandardized offerings if they aren’t guaranteed like the standard ones are.

It's likely we mean different things by "nonstandard". All Medicare plans are subject to pretty tight regulation. The "Medicare Select" is the same MediGap coverage with restricted networks. The State Medicare Supplemental Plans are state mandated but still must meet Federal standards, and there's no stream of new plans, just a similar approach (a standardized set of coverage options) to supplemental coverage, with fewer alternatives.

This is definitely not like the pre-ACA insurance world where insurers could offer minimum coverage options that looked good,

[Texas Proud]

Got some interesting info from one of my sisters....


She has a place down here and one in Wisconsin..... she was up there when she had a big pain in one of her eyes... she went to the emergency room to get treatment, but they do not have an ophthalmologist in the ER.... there is one that is attached to the hospital, but not part of the ER...


She calls the insurance help line and is told they will ONLY pay for the ER room... the Drs said they cannot treat her in the ER as the equipment is NOT there... much back and forth, some faxing going on etc... the Drs finally treat her (heck, I do not remember what it was)... but, my sis does not know if the medicare advantage plan will pay for the visit since it was refused and not done in an ER...


One of the downsides of an advantage plan with only a local network...

[Another Reader]

The key point about Advantage plans is that you are no longer directly enrolled in Medicare. You have been offloaded to the insurance company, who contracts with Medicare to cover you. Medicare pays some amount to the insurance company, and you are the insurance company's customer. You have no further contact with Medicare.

[audreyh1]

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Originally Posted by MichaelB It's likely we mean different things by "nonstandard". All Medicare plans are subject to pretty tight regulation. The "Medicare Select" is the same MediGap coverage with restricted networks. The State Medicare Supplemental Plans are state mandated but still must meet Federal standards, and there's no stream of new plans, just a similar approach (a standardized set of coverage options) to supplemental coverage, with fewer alternatives. This is definitely not like the pre-ACA insurance world where insurers could offer minimum coverage options that looked good,

So do these alternative CA Medigap plans like "Plan F Extra" and "Innovative Plan F" that Another Reader is referring to fall under the Federal standards?

[winger]

At one time, I looked forward to Medicare. It seemed simple after dealing with Insurance Companies for 45+ years.

And then I started looking at it. Pre-existing conditions matter there. Changing plans will be difficult after the first year of eligibility. Few people over 65 don't have some medical issues.

It's a complicated pile of steaming doggie doo.

[winger]

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Originally Posted by audreyh1 So do these alternative CA Medigap plans like "Plan F Extra" and "Innovative Plan F" that Another Reader is referring to fall under the Federal standards?

Medicare plans have to meet minimum guidelines. But, an insurance company (or Employer) can sweeten the plan, and still meet the minimum.

Probably higher premiums, too.

[Another Reader]

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Originally Posted by audreyh1 So do these alternative CA Medigap plans like "Plan F Extra" and "Innovative Plan F" that Another Reader is referring to fall under the Federal standards?

Yes, or they would not be approved as Medicare supplement plans.

ETA: That's why I initially asked in another thread if it was possible to move to a regular F plan if Plan F Extra and Innovative Plan F were eliminated.

[MichaelB]

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Originally Posted by audreyh1 So do these alternative CA Medigap plans like "Plan F Extra" and "Innovative Plan F" that Another Reader is referring to fall under the Federal standards?

One of the things that really irritates me about Medicare and Medicaid is the difficulty finding simple answers to straightforward questions, like the one you ask. Looking for plain-talk information and actionable responses is like looking for the needle in the haystack. The websites are not built for typical users and the information is presented for professionals and policy people, not actual users.

Rant over, back on topic. Those California MediGap F Extra includes things such as hearing, vision and emergency call button. These look like areas of limited value for most consumers.

[Another Reader]

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Originally Posted by MichaelB One of the things that really irritates me about Medicare and Medicaid is the difficulty finding simple answers to straightforward questions, like the one you ask. Looking for plain-talk information and actionable responses is like looking for the needle in the haystack. The websites are not built for typical users and the information is presented for professionals and policy people, not actual users. Rant over, back on topic. Those California MediGap F Extra includes things such as hearing, vision and emergency call button. These look like areas of limited value for most consumers.

Hearing aid coverage could be valuable at some point. I already have vision coverage through the pension system. The intriguing aspect is that the Blue Shield policy is less expensive than the AARP plan after the $25 discount for 12 months. And they have Silver Sneakers, although the only local participant is 24 hour Fitness. I was thinking of trying it out and switching to the AARP plan after a year if I did not like it under the California birthday rule. Hence, my earlier question in another thread about switching in 2020, after Plan F is closed.

[ShokWaveRider]

I think it is terrible how all these Ads on TV for Medicare Advantage plans for $0 are being plugged as the best. I think they are misleading medicare recipients. I checked a few of them in our area and Yes the Premiums are all $0...… BUT the deductibles Copays and Coinsurance are virtually never ending. If one got sick or had to see a specialist a few times, they would be broke. Far better to get a Medigap part G, at least in my case. Just my opinion, I could be wrong.

[DeborahB]

I looked at my Medicare options for a couple of hours today. It’s my fifth year of coverage so it’s less confusing. Sort of. Anyhow, I’m staying with the plans I have. I am on regular Medicare, plan F supplement. Also have a drug and dental plan but that’s not the point. I like plan F because it’s simple. I’ve never had a doctor refuse it - I get the impression they’re relieved. Other than premiums and a deductible, I basically walk into the doctor’s office for whatever and pay nothing. This includes frequent visits to a retina specialist and cataract surgery, MRIs, epidurals for lower back stenosis... nada. It’s a lot simpler for me not to change.

The problem with the Advantage plans is co-pays and finding an in-network provider. They throw in a lot of shiny toys like health club memberships as a distraction, and much lower premiums. But if I am horribly ill and the best surgeon by far is thousands of miles away, I can go to him or her. There may be other things about Advantage plans- I’m not expert in them. But I can afford the higher premiums of original Medicare and I’m staying with it. Also, as someone said, it simplifies my life.

[ShokWaveRider]

I would like to take F too, but every agent I have spoken to recommends G instead. Same but you pay the small Medicare Deductible ($185). They say that in 2020 when it goes away, existing grandfathered (Grandmothered) policy holders will see their premiums rise as the pool diminishes, and they may/will be liable to underwriting in order to change over. They also say virtually everyone they signup is taking G.

[DeborahB]

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Originally Posted by ShokWaveRider I would like to take F too, but every agent I have spoken to recommends G instead. Same but you pay the small Medicare Deductible ($185). They say that in 2020 when it goes away, existing grandfathered (Grandmothered) policy holders will see their premiums rise as the pool diminishes, and they may/will be liable to underwriting in order to change over. They also say virtually everyone they signup is taking G.

I haven’t committed yet, thanks for the info.