Medigap Plans to Rule Out?

[CardsFan]

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.

Not sure this 100% correct. As I understand there are some exceptions. I believe one exception is if you Medicare eligible prior to 2020, but covered on an employer plan, you may still have the ability to enroll in Plan F.

So, if meleana's DH will be 65 before the end of this year, he may be able to enroll in F. If not, then you are correct and Plan F is not an option.

 

[CRLLS]

Not sure this 100% correct. As I understand there are some exceptions. I believe one exception is if you Medicare eligible prior to 2020, but covered on an employer plan, you may still have the ability to enroll in Plan F.

So, if meleana's DH will be 65 before the end of this year, he may be able to enroll in F. If not, then you are correct and Plan F is not an option.

I agree. That is what I tried to say with "That is if he is first eligible for Medicare on that date." You said it better.

 

[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.

Quoting myself because I found the answer.
https://www.cms.gov/Medicare/Health-Plans/Medigap/downloads/Plan_N_Guidance2.pdf

The important part is found on page 2. It's determined by the CPT code and the specific ones are listed.

Office Visit Coinsurance or Copayment

2.Under Plan N, what constitutes an "office visit" for purposes of determining whether the subscriber is subject to the Part B coinsurance or copayment of up to $20?Services coded as office visits or evaluation and management visits and billed on Part B professional claim forms (CMS-1500 or ASC X12N 837 professional) would be considered “office visits” for purposes of determining whether the subscriber is subject to the Plan N Part B coinsurance or copayment of up to $20. These include CPT-4 codes 99201 – 99205 and 99211 – 99215, as well as 92002, 92004, 92012, and 92014 (ophthalmology) and 90805 (psychotherapy). (Note: Consultation CPT-4 codes have been deleted from the 2010 Medicare Physician Fee Schedule and are no longer payable by Medicare as of January 1, 2010.)

3.When applying the Plan N physician office copayment or coinsurance, should the amount be applied only to the office visit charge and not to other charges such as laboratory, x-ray or durable medical equipment (DME)? Yes, the coinsurance or copayment should be applied only to CPT-4 codes 99201 – 99205 and 99211 – 99215, which are codes used to bill an office visit.

4.If the Plan N subscriber presents for multiple Medicare-covered office visits in one day, is the coinsurance or copayment applicable to each office visit?Yes, the coinsurance or copayment is applicable to each Medicare-covered office visit.

5.What are the CPT-4 codes applicable to physician specialty office visits for Plan N?There are no office visit codes used solely for visits to specialists, with the exception of the ophthalmology and psychotherapy codes listed above. CPT-4 codes 99201 – 99205 and 99211 – 99215, which apply to non-specialty office visits, also apply to the Plan N specialty office visit coinsurance or copayment.

 

[lem1955]

You might want to also consider N, especially if you live in one of the states that don't permit excess charges: Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island or Vermont. Plan N does not cover excess charges (F and G do) and therefore has lower premiums.



I don't live in one of those states but the number of health care providers in my area that don't take assignment is very small - I've never run across one. That's why we opted for the lower premium costs of plan N. We're willing to assume the slight risk of having to pay an excess charge, knowing the amount is limited to no more than 15% of the amount Medicare allows.

We live in Vermont and decided on Plan N too. $123.62/mo.

 

[Rocket Man]

We live in Vermont and decided on Plan N too. $123.62/mo.

+1. Plan N.

 

[lonnie]

Have an insurance broker who specializes in these visit and explain the options to you. It really helped us understand and make a decision. Costs nothing to you and heir she can help you sign up too