Medicare-Medigap Preparation Question

[Murph]

I'm going with either Aetna or Cigna Plan N in Ohio this July. For those of you with Plan N experience, how exactly does the whole process work once I have the coverage? Assume a scenario where I use a doctor or lab and I've exceeded the deductible amount on the first visit; I also assume that the doctor's office may request the $20 co-pay up front.

1. Do they bill Medicare directly for their 80%?
2. Do they bill the Medigap company directly for their share?
3. Do I pay them everything and then have to file claims with Medicare and/or the Medigap company?

4. (side question): Are the monthly premiums really billed separately by Medicare, the Medigap company, and Part D company? Seems like a lot of bother.

Thanks in advance!

 

[zl55lz]

I'm going with either Aetna or Cigna Plan N in Ohio this July. For those of you with Plan N experience, how exactly does the whole process work once I have the coverage? Assume a scenario where I use a doctor or lab and I've exceeded the deductible amount on the first visit; I also assume that the doctor's office may request the $20 co-pay up front.

1. Do they bill Medicare directly for their 80%?
2. Do they bill the Medigap company directly for their share?
3. Do I pay them everything and then have to file claims with Medicare and/or the Medigap company?

4. (side question): Are the monthly premiums really billed separately by Medicare, the Medigap company, and Part D company? Seems like a lot of bother.

Thanks in advance!

No experience with Plan N, but in general:

1. Yes
2. I believe it is sent directly to Medicare first, which then forwards to Medigap.
3. No, should not have to do so.
4. Yes

 

[teej1985]

Why did you choose Aetna or Cigna?

 

[Murph]

Why did you choose Aetna or Cigna?

Price, mainly.

 

[Texas Proud]

I have paid the $20 upfront before but also have had them bill me....

The interesting thing is sometimes when billed it is $18 somethinig... not $20..

Other questions have been answered...

 

[teej1985]

Price, mainly.

They are both as notorious as Mutual of Omaha for the close the book game...so it might not continue to be a good price in the long run.

 

[Murph]

So do you have any recommendations?

 

[Texas Proud]

Mine is UHC/AARP.... it was only a few dollars more and they do not close the books...

 

[teej1985]

So do you have any recommendations?

USAA, Statefarm, UHC/AARP...

 

[Dash man]

I have Plan N and never have been asked to pay the $20 up front. It can be slightly less, especially if seeing a CRNP or PA.
I recommend AARP/UHC. USAA is probably good too. I’ve no experience with State Farm.
Note that you can change your choice of plan or provider for the six month period beginning with your birth month.

 

[Midpack]

Mine is UHC/AARP.... it was only a few dollars more and they do not close the books...

They’re basically the only provider that doesn’t close the books, and when I last checked they were way more expensive —- though maybe it all evens out in the long run? We just had a great thread showing firm after firms record on closing the books. Medigap Shopping: Closing the Book & Rate Increases

 

[sengsational]

1. Do they bill Medicare directly for their 80%?
2. Do they bill the Medigap company directly for their share?
3. Do I pay them everything and then have to file claims with Medicare and/or the Medigap company?

Everything happens automatically...you don't do anything but pay the bills when they come. You get statements telling you what happened, so you can validate it is working as prescribed, but basically you're just validating that you did get the service from the provider and they accept Medicare assignment. Then, you pay what they calculate.

4. (side question): Are the monthly premiums really billed separately by Medicare, the Medigap company, and Part D company? Seems like a lot of bother.

If you are getting SS payments, it's a little simpler (they deduct Medicare premiums), but yes, there's a lot of separate premiums to pay.

 

[CRLLS]

Medicare knows your supplement provider and your Plan D provider. You can setup Medicare to withhold and pay the Part D insurer. I do not think that a Supplement can be paid from the SS benefit. I might be wrong on that point. I do have my Part D paid by MC. This year, with our Wellcare Part D being zero cost, it is a moot point. But MC still shows the relationship should there be a charge next year.

 

[a60dan]

1. Do they bill Medicare directly for their 80%?
2. Do they bill the Medigap company directly for their share?
3. Do I pay them everything and then have to file claims with Medicare and/or the Medigap company?

Everything happens automatically...you don't do anything but pay the bills when they come. You get statements telling you what happened, so you can validate it is working as prescribed, but basically you're just validating that you did get the service from the provider and they accept Medicare assignment. Then, you pay what they calculate.

4. (side question): Are the monthly premiums really billed separately by Medicare, the Medigap company, and Part D company? Seems like a lot of bother.

If you are getting SS payments, it's a little simpler (they deduct Medicare premiums), but yes, there's a lot of separate premiums to pay.

Is there an option to receive statements electronically?

 

[pb4uski]

I'm going with either Aetna or Cigna Plan N in Ohio this July. For those of you with Plan N experience, how exactly does the whole process work once I have the coverage? Assume a scenario where I use a doctor or lab and I've exceeded the deductible amount on the first visit; I also assume that the doctor's office may request the $20 co-pay up front.

1. Do they bill Medicare directly for their 80%?
2. Do they bill the Medigap company directly for their share?
3. Do I pay them everything and then have to file claims with Medicare and/or the Medigap company?

4. (side question): Are the monthly premiums really billed separately by Medicare, the Medigap company, and Part D company? Seems like a lot of bother.

Thanks in advance!

Not Plan N here either, but I don't think the process differs between plans.

My providers bill Medicare directly and Medigap as well. Other than giving the provider my Medicare and Medigap cards I don't need to do anything.

No, you should only pay off of Explanation of Benefits from your Medigap provider which may only be available a couple months after the service is provided.

Since I'm not collecting SS yet, I get a bill for Medicare Part B and have it on EasyPay. DD is collecting SS and her Medicare Part B premiums are deducted from her SS benefits. Our Medigap premiums are on autopay directly with the insurer. Part D works similarly, for DW it was withheld from her SS benefit and mine was on autopay.

 

[Murf2]

I have a somewhat related idea. When it’s time to buy your supplemental plan, can you buy it through the Medicare website? Like it is done on the ACA marketplace or do you have to contact the insurers / agents or use a broker?
The Marketplace place system is so easy. I suppose that would be too much to ask.
I think I did see where you can buy the Part D insurance on MediCare. gov. but didn’t see supplemental health coverage you could sign up for. It is three months until turning 65 still.

Thanks!

 

[MichaelB]

I have a somewhat related idea. When it’s time to buy your supplemental plan, can you buy it through the Medicare website? Like it is done on the ACA marketplace or do you have to contact the insurers / agents or use a broker?
The Marketplace place system is so easy. I suppose that would be too much to ask.
I think I did see where you can buy the Part D insurance on MediCare. gov. but didn’t see supplemental health coverage you could sign up for. It is three months until turning 65 still.

Thanks!

My understanding is you cannot enroll in a MediGap policy on the Medicare website. You can see what plans are available, choose one, and click on a link to go to that insurer’s web page for that policy.

 

[pb4uski]

I would recommend using Boomer Benefits to help guide you through the Medicare process, including Medigap or Medicare Advantage. No cost to you. They get paid by the insurer.

 

[audreyh1]

I would recommend using Boomer Benefits to help guide you through the Medicare process, including Medigap or Medicare Advantage. No cost to you. They get paid by the insurer.

Perhaps, but before talking to them be aware that they will probably push you towards one of the many Mutual of Omaha companies which has a history of closing the books and then raising prices faster.

This thread discusses the overall issue as do several others here. Medigap Shopping: Closing the Book & Rate Increases

 

[teej1985]

I would recommend using Boomer Benefits to help guide you through the Medicare process, including Medigap or Medicare Advantage. No cost to you. They get paid by the insurer.

If you're in a state with the birthday rule, better to just use the Medicare.gov search tool and sort by rates. That way you know which insurers to target for year 1.

 

[a60dan]

Not Plan N here either, but I don't think the process differs between plans.

My providers bill Medicare directly and Medigap as well. Other than giving the provider my Medicare and Medigap cards I don't need to do anything.

No, you should only pay off of Explanation of Benefits from your Medigap provider which may only be available a couple months after the service is provided.

Since I'm not collecting SS yet, I get a bill for Medicare Part B and have it on EasyPay. DD is collecting SS and her Medicare Part B premiums are deducted from her SS benefits. Our Medigap premiums are on autopay directly with the insurer. Part D works similarly, for DW it was withheld from her SS benefit and mine was on autopay.

I recently confirmed that my Part B premium can be paid from my HSA too. Will be helpful until I start social security.