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Old 04-22-2019, 07:35 PM   #161
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Medicare, Part B, and Medigap combined are much more comprehensive than traditional insurance. Suggest you consult Boomer Benefits or Senior Savings network, which are nationwide agencies representing most plans. My AARP Medigap Plan F at $128.50, the Part D from Aetna at $19.10, and Medicare Part B, at $135.50, cover almost everything. Less than $300 a month for comprehensive coverage.

I have a local place that is highly recommended, Senior Benefits, but I'm trying to do my homework upfront. I'm looking forward to the relatively cheap insurance, right now I'm paying $650 month for a high deductible policy. It's that deductible that is the key for me. Literature that I have right now (I'm getting more) says MOOP for every plan but K and L are N/A. Does that mean the skies the limit? I like to know exactly how much is the max and plan accordingly.
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Old 04-22-2019, 07:40 PM   #162
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Most people quickly narrow their Medigap choices to G, N and F-HD. The MOOP for G is the annual Part B deductible ($185 in 2019). F-HD has a $2300 (2019) MOOP. Plan N does not have a MOOP. Also, keep in mind that Part D cost sharing is separate and in addition to these amounts. Part D plans do not have a MOOP.

In my area, Plan L premiums are about the same as premiums for the more comprehensive Plan N.

The MOOP for Plans K and L are not a true MOOP. Part B excess charges (though unlikely) do not count toward the MOOP and the plans do not pay the excess charge once the MOOP is met. So, the true MOOP for Plan L is $2780 + excess charges.

With Plan F-HD (G-HD in 2020), Medicare still pays 80%. You pay 20% of the Medicare approved amount until the 20% totals $2300 (2019). Then F-HD starts paying the 20%. When compared to Plan L, the F-HD premium is lower, the MOOP is lower, excess charges count toward the MOOP and excess charges are paid by the F-HD plan once the $2300 MOOP is met. The $2300 MOOP for F-HD is true.

Worst case for F-HD would be about $2900 ($2300 MOOP + ~$600 annual premium) excluding Part D.

And the MOOP for a regular Plan F or G? Is it as simple as MOOP for Plan F = yearly premium, MOOP for Plan G = yearly premium + $185 part B deductable? Do these plans really pay everything 100% (excluding foreign)?
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Old 04-22-2019, 07:52 PM   #163
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As usual, MSBC gives a very good comprehensive answer. If I wanted something with a MOOP and the lowest premiums I would have chosen F-HD when I just went on Medicare. In reality I chose G. Basically I was thinking about the long-term hassle factor.

My mother had Plan G and she had a lot of health problems the last few years of her life. But, basically all she had worry about was paying her annual deductible. That was usually quickly done and then everything was paid the rest of the year. While she was in her 80s and 90s that was really a big deal. She didn't have to worry about co-payments.

Looking ahead, I don't want to deal with them either. Right now, I could easily manage it but I am thinking about what it will be like years from now. So, I am happy to just have one deductible to keep track of.
Yep, that’s my plan. I really don’t want to have to deal with tracking deductibles like I do now. The worst part is having to pay up front and then try to reconcile later. I guess with Medicare that doesn’t happen, but I really don’t want to deal with it.
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Old 04-22-2019, 08:05 PM   #164
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And the MOOP for a regular Plan F or G? Is it as simple as MOOP for Plan F = yearly premium, MOOP for Plan G = yearly premium + $185 part B deductable? Do these plans really pay everything 100% (excluding foreign)?
I have Plan G. Yes, Medicare + the supplement pays for everything (that is covered by Medicare) except the premium and the part B deductible. My husband has Plan F. Medicare + the supplement pays for everything (covered by Medicare) except his premium. It is really very, very, very simple. Of course, no supplement plan pays for things that are not covered by Medicare.

Also, bear in mind as MSBC pointed out that the part D premium and deductible/co-pays, etc. is separate and apart from Medicare Parts A and B.
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Old 04-22-2019, 08:47 PM   #165
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I have Plan G. Yes, Medicare + the supplement pays for everything (that is covered by Medicare) except the premium and the part B deductible. My husband has Plan F. Medicare + the supplement pays for everything (covered by Medicare) except his premium. It is really very, very, very simple. Of course, no supplement plan pays for things that are not covered by Medicare.

Also, bear in mind as MSBC pointed out that the part D premium and deductible/co-pays, etc. is separate and apart from Medicare Parts A and B.

Unbelievable! I can get a Medigap F for about $129 a month, plus a Part D that covers everything I take now for $28 month plus the $135 for the Part A/B costs for a grand total of a little more than $3,500 a YEAR and it that's covers everything!


Worse case scenario is that I get prescribed lots of expensive drugs and end up with another $5,100 in part D costs?



Total damage if all hell breaks loose is $8,600 a year, this is too good to be true. Am I missing anything else?



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Old 04-22-2019, 09:11 PM   #166
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There are some things that Medicare won't cover or will limit. If Medicare doesn't cover something, Medigap won't cover it either. Some physical exams are excluded IIRC. I have not run into this yet, but other posters have. Perhaps MBSC could provide some examples of things that are not covered.
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Old 04-22-2019, 10:24 PM   #167
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There are some things that Medicare won't cover or will limit. If Medicare doesn't cover something, Medigap won't cover it either. Some physical exams are excluded IIRC. I have not run into this yet, but other posters have. Perhaps MBSC could provide some examples of things that are not covered.

Not MBSC but Medicare does have limits. Regular preventative physical exams are not covered. Medicare does cover certain preventative services at specified intervals.

Medicare doesn't cover long term care, eye exams, hearing aids and exams and a few other things:

https://www.medicare.gov/what-medica...-part-a-part-b

That said - DH has been on Medicare for 6 years and about the only thing he has had come up that hasn't been covered are eye exams.
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Old 04-24-2019, 11:55 AM   #168
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Not MBSC but Medicare does have limits. Regular preventative physical exams are not covered. Medicare does cover certain preventative services at specified intervals.
.
No annual exam but an annual wellness visit


Covered services

During your first Annual Wellness Visit, your PCP will develop your personalized prevention plan. Your PCP may also:

Check your height, weight, blood pressure, and other routine measurements
Give you a health risk assessment
This may include a questionnaire that you complete before or during the visit. The questionnaire asks about your health status, injury risks, behavioral risks, and urgent health needs.
Review your functional ability and level of safety
This includes screening for hearing impairments and your risk of falling.
Your doctor must also assess your ability to perform activities of daily living (such as bathing and dressing), and your level of safety at home.
Learn about your medical and family history
Make a list of your current providers, durable medical equipment (DME) suppliers, and medications
Medications include prescription medications, as well as vitamins and supplements you may take
Create a written 5-10 year screening schedule or check-list
Your PCP should keep in mind your health status, screening history, and eligibility for age-appropriate, Medicare-covered preventive services
Screen for cognitive impairment, including diseases such as Alzheimer’s and other forms of dementia
Medicare does not require that doctors use a test to screen you. Instead, doctors are asked to rely on their observations and/or on reports by you and others.
Screen for depression
Provide health advice and referrals to health education and/or preventive counseling services aimed at reducing identified risk factors and promoting wellness
Health education and preventive counseling may relate to weight loss, physical activity, smoking cessation, fall prevention, nutrition, and more.
AWVs after your first visit may be different. At subsequent AWVs, your doctor should:

Check your weight and blood pressure
Update the health risk assessment you completed
Update your medical and family history
Update your list of current medical providers and suppliers
Update your written screening schedule
Screen for cognitive issues
Provide health advice and referrals to health education and/or preventive counseling services
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Old 04-24-2019, 12:34 PM   #169
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Unbelievable! I can get a Medigap F for about $129 a month, plus a Part D that covers everything I take now for $28 month plus the $135 for the Part A/B costs for a grand total of a little more than $3,500 a YEAR and it that's covers everything!


Worse case scenario is that I get prescribed lots of expensive drugs and end up with another $5,100 in part D costs?



Total damage if all hell breaks loose is $8,600 a year, this is too good to be true. Am I missing anything else?
Yes. Actually, there is no OPM with Part D. Once you have paid out-of pocket the amount ($5,100 in 2019) to qualify for catastrophic coverage you still have a 5% copay for the rest of the year.
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Old 04-24-2019, 07:36 PM   #170
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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
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Old 04-25-2019, 05:15 AM   #171
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Not MBSC but Medicare does have limits. Regular preventative physical exams are not covered. Medicare does cover certain preventative services at specified intervals.

Medicare doesn't cover long term care, eye exams, hearing aids and exams and a few other things:

https://www.medicare.gov/what-medica...-part-a-part-b

That said - DH has been on Medicare for 6 years and about the only thing he has had come up that hasn't been covered are eye exams.
So all those old folks at the optometrist's office are paying full price for their annual dilation and check for glaucoma, cataracts, astigmatism, etc?
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Old 04-25-2019, 07:35 AM   #172
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So all those old folks at the optometrist's office are paying full price for their annual dilation and check for glaucoma, cataracts, astigmatism, etc?
Maybe. If they have a medical condition like diabetes or are at high risk for glaucoma (or in my case a posterior vitreous detachment which is pretty common) then an annual exam is covered by Medicare. They could also have vision insurance through a previous employer, a Medicare advantage plan or private pay. If you put all these things together I'd guess that the majority have at least some insurance coverage.
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Old 04-25-2019, 01:19 PM   #173
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So all those old folks at the optometrist's office are paying full price for their annual dilation and check for glaucoma, cataracts, astigmatism, etc?
In this area of the country that test runs around $70. Doesn't seem it would be worth having insurance for that.
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Old 04-25-2019, 04:03 PM   #174
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Unbelievable! I can get a Medigap F for about $129 a month, plus a Part D that covers everything I take now for $28 month plus the $135 for the Part A/B costs for a grand total of a little more than $3,500 a YEAR and it that's covers everything!


Worse case scenario is that I get prescribed lots of expensive drugs and end up with another $5,100 in part D costs?



Total damage if all hell breaks loose is $8,600 a year, this is too good to be true. Am I missing anything else?

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All the money you paid in while working?
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Old 04-25-2019, 08:05 PM   #175
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So all those old folks at the optometrist's office are paying full price for their annual dilation and check for glaucoma, cataracts, astigmatism, etc?
They are usually paying for the refraction just like most people with private (pre-Medicare) insurance. For certain medical things it is covered by Medicare. When DH had his done last year I think $60 of it was not covered and the rest was covered.

At the time I had regular insurance (not on Medicare yet) and my refraction wasn't covered either (most regular insurance does not cover a refraction) but because I have a mild cataract part of the exam was covered and paid by insurance.

DH's Medicare supplement plan would have also given him a discount at some optometrists and for some glasses. He didn't want to go there, though, so he didn't take advantage of that.
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Old 04-26-2019, 08:34 AM   #176
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I batted around F-hd, G and N. They all have their merits but I'm going with G. F-hd is tempting but more dr visits kicked in last year and more of the same so far this year. G, B and D totals close to half of what I'm paying now with my HD Bcbs plan so I'm pleased with new rates. Just wish they were all effective now.
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Old 05-26-2019, 05:34 AM   #177
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Thank you for this sticky topic. I read it all and almost understand LOL.

Read this on boomerbenefits.com:

Post-note: Because Medicare terminology uses the words Parts and Plans, you will sometimes hear people refer to Part G, or Medicare Part G plans. For example, people ask us: “What is Medicare Part G?” or “What does Part G cover?”

Insurance agents will usually know what you mean when you ask about Part G, but Plan G is the correct terminology. Here’s an easy way to remember how to use the right terms. Only Original Medicare itself has Parts and there are only four parts – A, B, C and D. So there is no such thing as Medicare Part G! All Supplement insurances, on the other hand, are called Plans. So instead of saying Medicare Part G say Plan G, and you’ll be using the correct wording. Hope that helps you!
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Old 08-15-2019, 09:19 AM   #178
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Several posts have mentioned that F is to be discontinued. I thought only the regular (low deductible) F was going away, and that the F High Deductible was sticking around.
Is it easy to switch from Plan F to Plan G? Or does one need to medically qualify? I am currently on Plan F and so far so good. But, it's always nice to have options.
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Old 08-15-2019, 09:36 AM   #179
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Is it easy to switch from Plan F to Plan G? Or does one need to medically qualify? I am currently on Plan F and so far so good. But, it's always nice to have options.

I called my broker 6+ months after initial enrollment, and told him we wanted to switch from Plan F to Plan G. A few minutes later he called me back and told me it was done, so apparently it's not a big deal.
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Old 08-15-2019, 09:49 AM   #180
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I called my broker 6+ months after initial enrollment, and told him we wanted to switch from Plan F to Plan G. A few minutes later he called me back and told me it was done, so apparently it's not a big deal.
This can vary be state and also how many months exactly was it?
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