Medigap Questions

[teej1985]

Well that’s where Medicare does a better job IMO. You download the statement from Medicare, and the provider’s bill should agree with that.

But I had heard of people getting billed by providers before Medicare has done their approval and issued a statement. That’s a no no, but some providers try anyway.

Just seemed like more opportunities for this level of headache if you needed a lot of care one year and had an HD Medigap plan.

I don't understand where the headache would come form, Medicare pays the same thing whether you have G or G HD. You have to wait for Medicare to process it either way, beyond the $203 or whatever.

 

[audreyh1]

I don’t want to deal with paying a bunch of providers in my 80s assuming I have to deal with a major medical issue. I can’t avoid the up front $203 or whatever, but I really don’t want to have to deal with a bunch of it when I’m quite elderly.

Already had my fill on ACA.

 

[pb4uski]

Because it was important to Congress that Medicare recipients “have some skin in the game”.

I guess the thinking was that if you had to pay even just a little up front, it might make you stop and think about whether that doctor visit was really necessary.

If Congress thinks that $203 is going to dissuade Medicare recipients from seeing a doctor, then Congress is more stupid than I thought they were.

It seems to me that the benefit of simplification far outweighs the lack of $203 of skin in the game.

 

[pb4uski]

I've not experienced it but am sure it happens.

I never pay any medical bill until they have been run through both Medicare and my supplement/medigap insurer. Once the Medicare and supplement EOBs show up online, and their numbers match what I've been billed, then and only then do I pay.

+1. No EOB, no payment.

 

[harllee]

Medicare and supplements are not always as smooth as one would hope. I have had several doctor bills coded wrong and Medicare rejected and then I had to contact the doctors office to correct it. I have doctor's offices simply fail to bill Medicare. I have had problems where Medicare did not forward the bill to my supplement. One year Medicare made me pay the deductible amount twice, it took months to straighten it out. I have found you still need to be diligent and review your bills.

 

[sengsational]

P.S. Why don’t you go do the research you really need to do. If you try to make decisions now you may make some expensive mistakes.

Ok, this might not be fair to the patient people here, but I'm afraid that this dialog IS the research I need to do. Smart people have laid out their reasons for why they took various paths. That's pretty valuable research to me. But see below...

I recommend getting started on research by buying "GET WHAT'S YOURS for MEDICARE" by Philip Moeller. Available on Amazon for $10.89 hardcover. Cheap, and good. He also points out major pitfalls well!

Got this book at the library and will study it soon (in the context of what I've learned from the folks here, making it more valuable).

Here's what John Greaney is doing for Part D:

https://retireearlyhomepage.com/medicare_partD_2021.html

Yeah, just what I thought. You need to know what specific medications you'll be buying (we buy none). As a future drug is needed, it's random as to if the plan will benefit, or cheaper on GoodRx. So then it becomes unknowable what the best plan is. So this one seems easy: buy the cheapest plan for the day that (maybe) you'll need an expensive drug that actually can be had cheaper through the plan. Then re-evaluate and switch plans (presuming one can do that). Part D seems a bit like "dental insurance", which really isn't insurance...more like a discount plan. The more diligent you are shopping for stuff like this, the more value you can get, but if you just buy never re-evaluate, you might be getting gypped.

 

[harllee]

We shop for Plan D every year and change our plan most years based on current prescriptions and plan costs. There is an open enrollment every year for Plan D, I think it is 11/1 to 12/15 every year. It is easy to shop for Plan D on Medicare.org every year.

 

[REWahoo]

So this one seems easy: buy the cheapest plan for the day that (maybe) you'll need an expensive drug that actually can be had cheaper through the plan. Then re-evaluate and switch plans (presuming one can do that).

Bingo.

Yes, you can change your Part D plan each year during the annual open enrollment period, which runs from mid-October through the first week in December.

 

[audreyh1]

Ok, this might not be fair to the patient people here, but I'm afraid that this dialog IS the research I need to do. Smart people have laid out their reasons for why they took various paths. That's pretty valuable research to me. But see below...

OK, I was complaining a bit because you were asking some very basic questions and asking people to correct some (often not correct) basic assumptions when an hour or two of reading (including numerous threads on thus forum) will get you up to speed. I’ll shut up now.

 

[RetMD21]

I applied for my Medicare card at 65 - 3 months and got the approval and number in a few days and the card in 2 weeks. The mailing from AARP/UHC is showing a that plan N would only save $20/month over G and L is a savings of about $30. I don't live in a state that allows no switches without underwriting so it makes sense to me to just get G now. There is no cost savings to avoiding a broker and some will help with claims so I am planning to call Boomer Benefits. I watched a lot of their Youtube videos and found them informative. I think I'll just toss the rest of the pre-Medicare junk mail.

 

[scottyp]

After seeing some discussions about NOT signing up for Medicare Part D since "you" are not currently taking any prescription medications, I would like to share what my parents are dealing with. When Dad retired both were in excellent health so did not signup for Part D. Well, Dad is 91 and Mom just turned 90. For the past 10 years their health has changed (no surprise there), and they have both had to start taking meds. Both Mom and Dad have medication for some kidney failure problems (not unheard of later in life), blood thinners due to paroxysmal AF for Mom and TIA's for Dad (even post bilateral Carotid artery surgery). There are a couple of other medications Dad is on as well. Due to the out of pocket cost for the blood thinners, they are taking one that requires blood checks monthly to monitor how "thin" their blood is and then balanced with adjustment of their medication dose. (Coumadin). They have fewer choices of medications (in the same class of medication) due to their out of pocket costs. If they could afford a different blood thinner that would mean not having to drive and get stuck monthly checks (sometime twice a month depending on test results) which would be priceless. They are very independent, live in the same house they built 50+ years ago and still drive. They do not have smart phones so using Good Rx is not very doable for them (they are not technically inclined/interested and live in another state from me). Their medication costs are very high and the Part D premium savings certainly has not saved them in the long run. I've tried many times to help with their medication costs, but they refuse since they are "fine" financially (that's your money for retirement not ours). Sure, it made sense to them at the time Dad retired since they both were health and not taken any medications at all up to that point, but you just don't know what tomorrow has in store for you. Financially it is not killing them, but who know what medication prices anyone could be facing in the future.

 

[RetMD21]

After seeing some discussions about NOT signing up for Medicare Part D since "you" are not currently taking any prescription medications, I would like to share what my parents are dealing with.

One of the Boomer Benefits videos I watched said that the catastrophic coverage benefit of the part D might be worth it alone. Oral chemotherapy, for example, can cost thousands. Unfortunately delaying the purchase of part D results in higher premiums.

 

[Sue J]

They do not have smart phones so using Good Rx is not very doable for them (they are not technically inclined/interested and live in another state from me).

Do they have a computer? I just print out my GoodRx coupons and take them to the pharmacy.

So they have never signed up for a Part D plan? How bad is the penalty after all these years?

I remember trying to learn about Medicare before I turned 65. Our medications were all cheap generics and it seems silly to pay for a plan although I knew we'd need a Part D. Someone here referred to it as a "placeholder" because we all realize our future medications could be very expensive.

BTW, we both enrolled the the Aetna SilverScript SmartRx for $7.30/mo each. It was the cheapest Plan D and so far it's been fine for all but one of DHs Rxs and we use a GoodRx coupon for that one. I hope this plan is still available for 2022 even if the price goes up a little.

 

[audreyh1]

BTW, we both enrolled the the Aetna SilverScript SmartRx for $7.30/mo each. It was the cheapest Plan D and so far it's been fine for all but one of DHs Rxs and we use a GoodRx coupon for that one. I hope this plan is still available for 2022 even if the price goes up a little.

DH ended up getting two one time prescriptions this year, first time he’d used Plan D. And they were both not expensive so he was really happy with his cheap $7.30 a month Aetna Part D plan.

 

[scottyp]

It is too late for my parents to enroll in any part D program due to the late enrollment penalty.

From the CMS Website:

“ How’s the late enrollment penalty calculated?

Medicare, not the plan, calculates the late enrollment penalty when a person subject to the penalty first joins a Medicare drug plan. The late enrollment penalty amount typically is 1% of the national base beneficiary premium (also called “base beneficiary premium”) for each full, uncovered month that the person didn’t have Part D or other creditable coverage. The national base beneficiary premium for 2020 is $32.74. The monthly penalty is rounded to the nearest $0.10 and added to the monthly Part D premium.”

“Here’s the math: (numbers modified to fi my parents) 312 months since Dad turned 65 back in 1995.
3.12 (312% penalty) x $32.74 (2020 base beneficiary premium) = $102.15. $102.15 rounded to the nearest $0.10 = $102.20
$102.20 = my Dad’s monthly late enrollment penalty for 2020 (on top of the monthly premium for any part D plan he would choose)”

“In general, once Medicare determines a person’s penalty amount, the person will continue to owe a penalty for as long as he or she is enrolled in a Medicare drug plan. This means that even if the person decides to join another Medicare drug plan, he or she will still have to pay the penalty once enrolled in a new plan. This also means that if a person joins a plan that has a $0 monthly premium, he or she will still owe a penalty”. https://www.cms.gov/Outreach-and-Education/Outreach/Partnerships/downloads/11222-P.pdf

So enrolling my parents now would not be an option or fiscally doable. Until I did some research I didn’t realize how cumulative the penalty is (1% per month).

Scottyp

 

[Telly]

I applied for my Medicare card at 65 - 3 months and got the approval and number in a few days and the card in 2 weeks. The mailing from AARP/UHC is showing a that plan N would only save $20/month over G and L is a savings of about $30. I don't live in a state that allows no switches without underwriting so it makes sense to me to just get G now. .

I started with Plan G, but switched to Plan N when I dumped MoO. I passed underwriting to do so. MoO was hitting G with a 15% increase, N with 6% in my geographical area. I saw similar differences in rate increases G vs. N in some other states with them. In general, it is expected that increases in N will be less than G. And the difference may increase in time, as "G is the new F" as far as those who are coming into Medicare at ages greater than 65, who have the guaranteed issue right. For example, someone well over 65 who is retiring from their employer, and had qualifying health insurance through their employer, so they were not on Medicare when they were employed and age 65 or greater. The idea is that they tend to have higher medical expenses being older. Some in the industry point to that effect when Plan F was the guaranteed entry for those. Now it's Plan G. Besides being employed at or over age 65, I think there were other scenarios that had the same effect, I don't remember what they were.

I don't live in a state that allows no switches without underwriting so it makes sense to me to just get G now.

A triple-negative sentence! I'm lost... can you please reword it? I'm not trying to be funny, I just can't figure it out, and I would like to know.

 

[travelover]

DH ended up getting two one time prescriptions this year, first time he’d used Plan D. And they were both not expensive so he was really happy with his cheap $7.30 a month Aetna Part D plan.

I switched to that plan and it provides a free prescription that I was paying cash for that cost about $7 a month, so the insurance is essentially free.

 

[audreyh1]

“Here’s the math: (numbers modified to fi my parents) 312 months since Dad turned 65 back in 1995.
3.12 (312% penalty) x $32.74 (2020 base beneficiary premium) = $102.15. $102.15 rounded to the nearest $0.10 = $102.20
$102.20 = my Dad’s monthly late enrollment penalty for 2020 (on top of the monthly premium for any part D plan he would choose)”

Scottyp

Part D wasn’t available in 1995. Coverage started in 2006, so late 2005 must have been the earliest anyone could have signed up.

 

[RetMD21]

I started with Plan G, but switched to Plan N when I dumped MoO. I passed underwriting to do so.

My issues with N are

1. No excess charge coverage for nonparticipating providers (I haven't found any detailed explanation of what is included in this and I suspect that it isn't a big deal financially)

2. No max OOP (K and L have this)

3. The copays would be a nuisance.

I'm not sure that I'll be able to meet medical underwriting in the future so I am inclined to favor G understanding that premium increases could be higher and the cost would be higher at least in the early years.

On the other matter is seems crazy to me that there isn't an upper limit to the late penalty for part D.

 

[CRLLS]

My issues with N are

1. No excess charge coverage for nonparticipating providers (I haven't found any detailed explanation of what is included in this and I suspect that it isn't a big deal financially)

2. No max OOP (K and L have this)

3. The copays would be a nuisance.

I'm not sure that I'll be able to meet medical underwriting in the future so I am inclined to favor G understanding that premium increases could be higher and the cost would be higher at least in the early years.

On the other matter is seems crazy to me that there isn't an upper limit to the late penalty for part D.

Regarding no.1: nonparticipating providers are those who will accept Medicare patients and insurance, but do not participate in "Medicare Assignment". Medicare assignment is where the Dr. agrees to the payment that Medicare says it should be. If not accepting Medicare Assignment, the Dr can bill up to 15% above Medicare's amount.

 

[Telly]

My issues with N are

1. No excess charge coverage for nonparticipating providers (I haven't found any detailed explanation of what is included in this and I suspect that it isn't a big deal financially)

2. No max OOP (K and L have this)

3. The copays would be a nuisance.

CRLLS has covered your 1. I'll add that providers that accept Medicare patients, but do not accept Medicare Assignment are rare. Using the Medicare.gov finder tool, one would have to search very hard to find one in my area!

2. Max OOP is not applicable to Plan N, nor F, nor G. I have no idea why someone would even consider Plans K or L! Those two have major issues! The simple table of Benefits vs. Plan letters shows it quite clearly. I respectfully suggest that our members here at E-R.org not even consider K or L. Plans K or L would be better than going barefoot, without a Medigap Plan at all if going the Original Medicare route. My personal opinion is one would have to be in dire straights to consider K or L, seems that the concept of an E-R and those two plans don't go together.

3. It depends. I'm willing to accept small copays (if indeed I have to pay them, so far only one Dr. office charges it to me), in trade for lower initial premium cost and lower future rate increases. Rate increases over the years, like raises to base salary, quickly build upon each other. It is something that one may consider in choosing what plan.

 

[REWahoo]

^ Adding to Telly's comments:

1. I've seen several sources saying providers who accept Medicare but not assignment (i.e., who may bill a Part B excess charge) number less than 4%. Barring an emergency situation it isn't difficult to determine in advance if a provider doesn't accept assignment and is one of the few who may charge the extra 15%.

3. I've been on N for three years and haven't found the $20 copay ($50 for an emergency room visit) to be a nuisance. Heck, several times a provider has apparently determined billing me for $20 isn't cost effective so I never get invoiced. YMMV of course.

 

[sengsational]

3. It depends. I'm willing to accept small copays (if indeed I have to pay them, so far only one Dr. office charges it to me), in trade for lower initial premium cost and lower future rate increases. Rate increases over the years, like raises to base salary, quickly build upon each other. It is something that one may consider in choosing what plan.

How much faith should one put in the proposition that the rate increases over time will be lower with plan type N? I guess the people that are the highest utilizers of services gravitate towards G, but isn't the Medigap provider only on the hook for a fixed maximum in both cases?

 

[teej1985]

How much faith should one put in the proposition that the rate increases over time will be lower with plan type N? I guess the people that are the highest utilizers of services gravitate towards G, but isn't the Medigap provider only on the hook for a fixed maximum in both cases?

Fixed maximum? Not really. It covers everything that Medicare approves but does not cover. There is no cap.

 

[RetMD21]

I don't know what services the excess charges apply to. Office visits and an occasional surgery are no big deal financially. What about chemotherapy administration or radiation treatments?