Medigap Plans to Rule Out?

[Drewskers]

Quote:

Originally Posted by ivinsfan This can vary be state and also how many months exactly was it?

Yes, it varies quite dramatically by state. WA state, for instance, allows Medigap enrollees to switch Medigap plans at any time with guaranteed issue, but this is far from the norm!


Here is a site with some great state-specific Medicare information:


https://www.medicareresources.org/states/

[NoMoreJob]

Quote:

Originally Posted by Momcpa My insurance didn't cover my Annual Wellness exam.........because I had the exam done too soon after the policy was started. I didn't know that there was a time frame to be aware of for the first Annual Wellness. I can't remember exactly, maybe it had to be 12 or 13 months after the policy was in force. Mine wasn't. Found that out the hard way...at least for my specific insurance. FYI

But there is a "welcome to medicare" exam that's covered immediately.

Some practices are very good at navigating the system and coding things properly to make sure they're covered. Fortunately mine is one of those. I've read here and elsewhere that this is no always the case.

[Buckeye]

Quote:

Originally Posted by REWahoo Al, your comparison is hard for me to read, plus it confuses me - nothing new, of course. The difference in plan F-HD and G is this: F-HD pays nothing until you have paid $2,240 out of pocket, then pays the same benefits as plan G. This out of pocket amount will increase each year with inflation. Plan G pays after you have paid your $183 part B deductible. .... Next steps: You sign up for basic Medicare (parts A&B) through the govt. Part D (drug coverage) and Medigap plans are offered by insurance companies so you will need to get quotes and sign up with the insurer of your choice.

I used both the Medicare web page and this website to evaluate drug pland (Part D) when my mother was alive.
https://q1medicare.com/index.php?utm...ign=newsletter

[MBSC]

A reminder from CMS that the Medicare Supplement list on Medicare.gov is not up to date and not all-inclusive.

Quote:

Medigap plans are primarily regulated by State Departments of Insurance and not CMS. As a result, CMS has limited Medigap data available and we cannot support direct online Medigap plan enrollment. The Medigap information that is included in Medicare Plan Finder is intended for general education only. Reference: https://cmsnationaltrainingprogram.c...pdf?download=1

[MBSC]

Medigap plans F-HD and G-HD will have a maximum out-of-pocket of $2340 in 2020, up from $2300 in 2019.

Quote:

Medicare supplemental (Medigap) Plans F and G can be sold with a high deductible option. The high deductible version of Plan F is only available to those who were Medicare eligible before January 1, 2020. Effective January 1, 2020, the annual deductible amount for these plans is $2,340. The deductible amount for the high deductible version represents the annual out-of-pocket expenses (excluding premiums) that a beneficiary must pay before these policies begin paying benefits. Source: https://www.cms.gov/Medicare/Health-...gap/FandJ.html

[audreyh1]

Thanks! Will be shopping for DH early next year.

Probably skip the HD option as we are so tired of dealing with high deductibles, and mainly decide between G and N.

[molly312]

We have Medicare Supplement Plan F (not high deductible). No arguing with insurance carriers/hospitals/doctors. We have had it for 6 years and it has been wonderful. Yes - it might cost a bit more than going the other way, but we can go anyplace in any state and be covered. I am a cancer patient (in remission) and quite healthy. There are extra tests that I have on occasion. - no problem. The relief of not having to worry about "in-network" Mds & hospitals and tracking every little bill is wonderful. Yes, it may cost a bit more, but we consider the extra cost of the billing a retirement luxury.

Part D drug plan is another matter. Every year it is a crapshoot trying to guess if your Rx's might get changed during the year and if so, what the actual cost might be. We spend hours going over formularies, etc. Then when my husband switched last year, S.S kept paying his premium to the old Part D provider for 6 months. He ended up paying the actual Part D from our checking acct. while Medicare and SS tracked down the problem and kept paying the old provider. I can't imagine how this will work when we are much older and our kids will have to figure this out. It was a nightmare for us when my mother got older and we needed to take over.

Plan F = GREAT
Part D = Needs work

[audreyh1]

Didn’t know that SS sent payments to the part D provider. I assumed we pay the provider directly. Any IRMAA excess would be paid via SS of course because that goes to Medicare AFAIK.

[molly312]

If you have Medigap - you pay the premium directly to the insurer. Your Part D can be handled 2 ways..........1) Social Security sends the payment to Medicare who then forwards it to the insurer. 2) You may choose to pay Part D directly.

My recollection (and I can't remember why) but there is some advantage in the "system" to having SS forward the payment from your SS check.

[MBSC]

In states where attained-age Medigap plans dominate, UHC/AARP offers a 36% discount off its community-rated premium for those who enroll at age 65. The discount is cut by 3% per year for 12 years until the person starts paying the full community-rated premium at age 77.

UHC is changing the formula for new enrollees in 2020. Existing enrollees will stay on their current rate schedule. The new formula is a 39% discount for ages 65-68 then 3% cut in discount each year until the person is paying full community-rated premiums at 81. See PDF page 12 in the link below for an example.

https://www.aarpsupplementalhealth.c...ment_Kit_C.pdf

Separate rate adjustments for medical inflation are applied to all ages/all formulas.

[gayl]

I went to a presentation yesterday to try to understand this. Still foggy about what all those letters after Medicare mean. Background: 1st 2 are part of pension pkg.
Have: Medicare + KaiserA @ 105m with $10 visit copays, no deductible, 1500 annual out of pocket, $10 per script

Can select: Medicare + KaiserB @ 15m with $20 visit copays, 500 deductible, 3000 annual out of pocket, $20 per script

Presenters plan was $64 month with same benefits as KaiserB (United HC Canopy)

I see the MD once a year or less GENERALLY except I still am not recovering from my May injury. Take 1 cholesterol pill that I cut in half so 2 scripts a year. MD is aware of this and I'm within the target range with it, really high (?) without it, + Vitamin D3

WWYD? Need to decide by Nov 9

[Another Reader]

Quote:

Originally Posted by gayl I went to a presentation yesterday to try to understand this. Still foggy about what all those letters after Medicare mean. Background: 1st 2 are part of pension pkg. Have: Medicare + KaiserA @ 105m with $10 visit copays, no deductible, 1500 annual out of pocket, $10 per script Can select: Medicare + KaiserB @ 15m with $20 visit copays, 500 deductible, 3000 annual out of pocket, $20 per script Presenters plan was $64 month with same benefits as KaiserB (United HC Canopy) I see the MD once a year or less GENERALLY except I still am not recovering from my May injury. Take 1 cholesterol pill that I cut in half so 2 scripts a year. MD is aware of this and I'm within the target range with it, really high (?) without it, + Vitamin D3 WWYD? Need to decide by Nov 9

Does CoCo County use Via Benefits? Do you get any type of reimbursement as part of your retirement benefits? If so, I would start with the material they provide and talk to one of their benefit people, in house or Via Benefits.

I suspect that these plans are Medicare Advantage plans. Kaiser almost certainly is. You need to understand the differences between traditional Medicare and the Medicare Advantage plans before you decide.

[zaqxsw]

Quote:

Originally Posted by MBSC In states where attained-age Medigap plans dominate, UHC/AARP offers a 36% discount off its community-rated premium for those who enroll at age 65. The discount is cut by 3% per year for 12 years until the person starts paying the full community-rated premium at age 77.

Do you have an example of the current, 2019 discount plan? Effective for anyone who enrolled on 2019, right? Thanks!

I enrolled this year and my wife will enroll in 2020.

I'm a new UHC Plan G enrollee in Ohio effective 11/1/19. They sent me an estimated payment schedule for 12/2019 - 11/2020. In Nov. 2020, my premium goes up 10%. Nothing noteworthy, just some info. It will change by then.

[copyright1997reloaded]

Quote:

Originally Posted by MBSC In states where attained-age Medigap plans dominate, UHC/AARP offers a 36% discount off its community-rated premium for those who enroll at age 65. The discount is cut by 3% per year for 12 years until the person starts paying the full community-rated premium at age 77. UHC is changing the formula for new enrollees in 2020. Existing enrollees will stay on their current rate schedule. The new formula is a 39% discount for ages 65-68 then 3% cut in discount each year until the person is paying full community-rated premiums at 81. See PDF page 12 in the link below for an example. https://www.aarpsupplementalhealth.c...ment_Kit_C.pdf Separate rate adjustments for medical inflation are applied to all ages/all formulas.

Pro-tip: You can get this guide for your state by changing the NM in the URL (New Mexico) to your state code. Well, at least it works for NY, PA, TN, AZ (I stopped trying states after this.)

[MBSC]

Quote:

Originally Posted by zaqxsw Do you have an example of the current, 2019 discount plan?

An example of the 2019 discount is on PDF page 10 with rates starting on page 15. They don't include $2 autopay discount. If your DW also selects a UHC Medigap, both plans receive a 5% household discount.

https://www.aarpsupplementalhealth.c...ment_Kit_B.pdf

Rates for Q1 2020 Ohio applicants: https://www.aarpsupplementalhealth.c...ment_Kit_C.pdf

Quote:

Originally Posted by copyright1997reloaded Pro-tip: You can get this guide for your state by changing the NM in the URL (New Mexico) to your state code. Well, at least it works for NY, PA, TN, AZ (I stopped trying states after this.)

And Kit_C is 2020, Kit_B is 2019.

[meleana]

We are currently looking- through Via Benefits- for a Medigap plan for my husband as he is retiring 12/31. We want either F or G. F is $240 more per year than G. ($230 vs. $210 per month), but G, of course has that Part B $185 annual deductible, so really just a $55 per year difference right now. We also were looking at HDF, but even though the premiums are low, the deductible is $2300, so not crazy about that. It would come in at $475 more than F or G IF you had to pay out that deductible.


So- back to F and G. People say F premiums could skyrocket now that it will no longer be offered next year. But who is to say that once people who normally would have signed up for F now go into G, that the Part B deductible and premium (and Part G premiums) won't skyrocket?



At least with F you know you will not have to pay the B deductible whatever it is.
These are community rated plans in NY.



So we can't decide.


As for Part D- we totally don;t understand them. How can you make a decision other than based on what medicine you are on currently and the pahramcy you use? Who knows what you might need in the future?


On top of everything else, we will be closing on our new home in another state on 12/31 or soon thereafter. NH Medigap rates are less than NY. Part D's are about the same. Then what will we do?

[Sue J]

MBSC, thanks to the link for the AARP Ohio info.

I start Medicare on 2/1/20 and I'm trying to learn all I can while wading through all the mail I get for Advantage plans!

So far, I'm looking at supplements, deciding between Plan G and Plan N. I will most likely go with AARP/UnitedHealthCare.

Here is something that I need more info on. All the Plan N info states "Plan N pays 100% of the Part B coinsurance, except for a co-payment of up to $20 for some office visits and up to a $50 co-payment for emergency room visits that do not result in an inpatient admission." The part I'm wondering about is the $20 for some office visits.

For those of you with Plan N, are you being charged the $20 co-pay by your Primary Care Physician? Is this at every visit or just some visits? Or is this just certain types of visits? How about a specialist? Or is this charged based on the individual provider?

So, I'm looking to find out what "some office visits" means in the real world.

[Likes_to_Lurk]

Meleana, please be careful with the Via Benefits website.

It is not currently showing AARP/UnitedHealthCare options for supplements in my NYC zip code for next year. Part D drug plans are shown, however. I have contacted Via and they are looking into it. Based on previous experience with Via, I don't expect this to be resolved quickly.


This NY state website will give you a list of providers in your zip code and the premiums:
https://myportal.dfs.ny.gov/web/gues...premiums?null=

[MBSC]

Quote:

Originally Posted by meleana We want either F or G. F is $240 more per year than G...

Never choose Plan F if the premium is more than (Plan G + Part B deductible) unless the former employer is picking up the tab. You're just paying someone else's claims in the form of higher F premiums. He can only join F/F-HD in 2020 if he turns 65 before 2020.

Quote:

Originally Posted by meleana We also were looking at HDF, but even though the premiums are low, the deductible is $2300, so not crazy about that. It would come in at $475 more than F or G IF you had to pay out that deductible.

The F-HD (G-HD in 2020) deductible is a little misleading. Medicare still pays 80%. You pay the remaining 20% of the low Medicare approved amount until your 20%, and Part B deductible, totals $2340 (2020). Then, the HD plan starts paying the 20%. Because Medicare reimbursement is so low, it's hard to get to $2340 in any given year unless you have multiple hospital admissions or receiving cancer treatment. There is a work-around if you were not leaving NY.

I can't speak to Via Benefits, but NY has special Medigap rules that allow residents to change Medigaps anytime without underwriting. If a person is healthy, they can start with F-HD/G-HD. If they develop a chronic disease, they can switch to Plan G and it becomes effective the first of the following month. If that episode passes, they can switch back to G-HD.

Quote:

Originally Posted by meleana But who is to say that once people who normally would have signed up for F now go into G, that the Part B deductible and premium (and Part G premiums) won't skyrocket?

The calculation used to set the Part B premium and deductible is based on the cost to run Medicare. Choosing a Medigap impacts your cost, not the government's cost. Actually, in theory it's suppose to lower the government's cost since Plan G enrollees would think twice about making that first doctor's appointment.

Plan G premiums are expected to slowly increase as unhealthy people aging in to Medicare who would have chosen Plan F now choose Plan G. Also, the popularity of MA plans, especially among healthy people, is causing adverse selection for Medigaps (except F-HD/G-HD). Unhealthy people gravitate toward Medigaps.

Quote:

Originally Posted by meleana At least with F you know you will not have to pay the B deductible whatever it is.

This is a common misconception. If the Part B deductible increases $30, the plan F premium increases $30/yr to cover the expense. Either way, the member is paying the Part B deductible. There is no free lunch.

New York Medigap Plans and Rates: https://www.dfs.ny.gov/consumers/hea...nt_plans_rates

[CRLLS]

Quote:

Originally Posted by meleana We are currently looking- through Via Benefits- for a Medigap plan for my husband as he is retiring 12/31. We want either F or G. F is $240 more per year than G. ($230 vs. $210 per month), but G, of course has that Part B $185 annual deductible, so really just a $55 per year difference right now. We also were looking at HDF, but even though the premiums are low, the deductible is $2300, so not crazy about that. It would come in at $475 more than F or G IF you had to pay out that deductible. So- back to F and G. People say F premiums could skyrocket now that it will no longer be offered next year. But who is to say that once people who normally would have signed up for F now go into G, that the Part B deductible and premium (and Part G premiums) won't skyrocket? At least with F you know you will not have to pay the B deductible whatever it is. These are community rated plans in NY. So we can't decide. As for Part D- we totally don;t understand them. How can you make a decision other than based on what medicine you are on currently and the pahramcy you use? Who knows what you might need in the future? On top of everything else, we will be closing on our new home in another state on 12/31 or soon thereafter. NH Medigap rates are less than NY. Part D's are about the same. Then what will we do?

You can no longer enter plan F or F-HD starting 1/1/2020. So if you DH retires on 12/31 and needs insurance beginning the next day, Plan F or F-HD are not any of your choices. That is if he is first eligible for Medicare on that date.

For Part D, you are correct about deciding based on current meds. That is what most here do. Every year you can change plans and companies without requiring underwriting. So if your meds change to one that is not covered under your present Part D, you can change effective the 1st of the new year. In the mean time, there is GoodRx discounts.