MediCare plan acceptance?

[Murf2]

I tried searching but I had no luck. I’m sure it’s been asked before.

If a physician / hospital accepts MediCare, do they have to accept coverage from all carriers?

I’m trying to plan my switch to MediCare. This is the only thing I can see being an issue. We plan to travel in retirement. I was wondering if the size of the carrier would make any difference. We have BCBS Kansas and have had great service from them but I know UHC is a much bigger company.

If this isn’t an issue, should a person just shop price? All plan G insurance has the same coverage, don’t they?

Thanks
Murf

 

[PaunchyPirate]

I tried searching but I had no luck. I’m sure it’s been asked before.

If a physician / hospital accepts MediCare, do they have to accept coverage from all carriers?

I’m trying to plan my switch to MediCare. This is the only thing I can see being an issue. We plan to travel in retirement. I was wondering if the size of the carrier would make any difference. We have BCBS Kansas and have had great service from them but I know UHC is a much bigger company.

If this isn’t an issue, should a person just shop price? All plan G insurance has the same coverage, don’t they?

Thanks
Murf

If I understand you correctly, you are asking about standard Medicare + BCBS or UHC Plan G supplemental (Medigap) coverage. And not asking about BCBS or UHC Medicare Advantage plans? Correct?

 

[Rianne]

If this isn’t an issue, should a person just shop price? All plan G insurance has the same coverage, don’t they?

Thanks
Murf

I was told by a broker, that all G plans are Govt. regulated and must have the same coverage regardless of the company. I guess the difference might be future premium costs. How do they pool their clients?

 

[PaunchyPirate]

I was told by a broker, that all G plans are Govt. regulated and must have the same coverage regardless of the company. I guess the difference might be future premium costs. How do they pool their clients?

Right. With Medicare Supplements like Plan G, all companies provide the same coverage. If the claim is an approved Medicare claim, the Supplement must pay their portion.

When comparing different providers of the same Plan Type since they all cover the same things at the same levels, you should look at price history, customer support reviews, company viability and history (have they dropped market areas in the past), etc.

To the OP’s question, I’m pretty certain that if a doctor accepts Medicare, they are also accepting payment from the Plan G insurance company. And the Plan G is obligated to pay them.

 

[Murf2]

Sorry, yes I’m asking about medigap Plan G policies. I realize they all have the same coverage.

If a hospital takes MediCare must they accept any / all companies Plan G coverage?

It seems insurance costs and how they rate you for premiums is the only difference, correct?

I guess I’m concerned if it will be harder to find services with one carrier compared to another.

Thanks again!
Murf

 

[PaunchyPirate]

Sorry, yes I’m asking about medigap Plan G policies. I realize they all have the same coverage.

If a hospital takes MediCare must they accept any / all companies Plan G coverage?

It seems insurance costs and how they rate you for premiums is the only difference, correct?

I guess I’m concerned if it will be harder to find services with one carrier compared to another.

Thanks again!
Murf

Yes. If they accept Medicare, they must accept your Supplemental coverage.

https://65medicare.org/do-all-doctors-accept-medigap-plans/

“Medigap plans "follow" Medicare. If a doctor accepts regular Medicare, he or she is required to accept your Medigap plan, regardless of which company or plan you have.”

 

[MichaelB]

If a hospital takes MediCare must they accept any / all companies Plan G coverage?

Yes.

It seems insurance costs and how they rate you for premiums is the only difference, correct?

There’s no individual rating, so it’s how they rate the group. There have been some discussion here about that. Some insurers have acted poorly in that respect. Once you’re in the group you are mostly captive, and can only change Medigap policies with underwriting.

Here’s a thread discussing this https://www.early-retirement.org/fo...-provider-selection-for-my-plan-g-100099.html. Mutual of Omaha has been mentioned in a couple of threads for closing groups and hiking prices.

 

[CardsFan]

Yes.

There’s no individual rating, so it’s how they rate the group. There have been some discussion here about that. Some insurers have acted poorly in that respect. Once you’re in the group you are mostly captive, and can only change Medigap policies with underwriting.

Here’s a thread discussing this https://www.early-retirement.org/fo...-provider-selection-for-my-plan-g-100099.html. Mutual of Omaha has been mentioned in a couple of threads for closing groups and hiking prices.

Referring to the bold above:

There are a few states that allow change of carriers without underwriting. My state (MO) is one. OP should check their own state laws on this one.

 

[Bamaman]

When comparing policies, Medigap Plan G policies should all have the same terms. But that doesn't mean you'll always be accepted under the plan--if you have prior conditions like end stage renal failure. (I remember being asked that question.)

Hospitals that take Medicare should accept all companies' Plan G coverage. But not all hospitals accept Medicare Advantage insurance plans that act like a PPO with the primary care doctor being paid $X monthly for visits--no matter how many times he has to see the patient.

I've read recently about some Medigap insurance companies dragging out payments for Medicare services--possible cash flow problems after the Pandemic. I wonder how hospitals react to insurance companies that owe them a small fortune being past due?

My wife is having a number of ongoing medical procedures. We had Plan G a year ago, but switched to Plan F when we were going to have a number of durable goods (Plan B) like an electric wheelchair and my insulin pump. Plan F covers all Plan B--no 20% deductibles. We've received virtually no bill from any doctor or hospital. And we've had not the first complaint with AARP's United Healthcare administration.

 

[CRLLS]

I tried searching but I had no luck. I’m sure it’s been asked before.

If a physician / hospital accepts MediCare, do they have to accept coverage from all carriers?

I’m trying to plan my switch to MediCare. This is the only thing I can see being an issue. We plan to travel in retirement. I was wondering if the size of the carrier would make any difference. We have BCBS Kansas and have had great service from them but I know UHC is a much bigger company.

If this isn’t an issue, should a person just shop price? All plan G insurance has the same coverage, don’t they?

Thanks
Murf

Most definitely they have to accept the Supplement insurer.

If a provider accepts Medicare "assignment", they agree to some dollar amount for the procedure as agreed to by Medicare. the Supplement covers your 20% coinsurance after the deductible and in agreement to the terms of your plan. If a provider accepts Medicare, but not "Medicare assignment", then you may be on the hook for up to a maximum of 15% over the Medicare allowed "rate" . Depending on the supplement plan you choose, that 15% may be covered by the supplement. Medicare plans do not make it simple.

So far, I have not seen where my drs accepted Medicare but not "Medicare assignment" YMMV.

 

[MichaelB]

Referring to the bold above:

There are a few states that allow change of carriers without underwriting. My state (MO) is one. OP should check their own state laws on this one.

Yes, you are right and it’s an important point.

 

[Dash man]

I believe after Medicare processes the claim, they send the claim to your insurer, not the providers. The providers do send your supplement information to Medicare when they file the claim. The insurer is required to pay if Medicare pays.

 

[RetMD21]

When comparing policies, Medigap Plan G policies should all have the same terms. But that doesn't mean you'll always be accepted under the plan--if you have prior conditions like end stage renal failure. (I remember being asked that question) l

You'll be accepted if you are in a guaranteed enrollment period (including initial enrollment at 65) dialysis patients have another arrangement

 

[Murf2]

Yes.

There’s no individual rating, so it’s how they rate the group. There have been some discussion here about that. Some insurers have acted poorly in that respect. Once you’re in the group you are mostly captive, and can only change Medigap policies with underwriting.

Here’s a thread discussing this https://www.early-retirement.org/fo...-provider-selection-for-my-plan-g-100099.html. Mutual of Omaha has been mentioned in a couple of threads for closing groups and hiking prices.

Yes.

There’s no individual rating, so it’s how they rate the group. There have been some discussion here about that. Some insurers have acted poorly in that respect. Once you’re in the group you are mostly captive, and can only change Medigap policies with underwriting.

Here’s a thread discussing this https://www.early-retirement.org/fo...-provider-selection-for-my-plan-g-100099.html. Mutual of Omaha has been mentioned in a couple of threads for closing groups and hiking prices.

Are you not able to change providers every year without underwriting during open enrollment or is that just Plan D coverage?

Thanks
Murf

 

[Sunset]

Are you not able to change providers every year without underwriting during open enrollment or is that just Plan D coverage?

Thanks
Murf

Need underwriting to change medical providers, like plan G for example. In most States.

Can change plan D (drug plans) every year , and it's easy on the medicare.gov site to do it.
I recommend looking each year to check. I saved some old people hundreds to a few thousand per year each by changing Drug plan as they had just stuck with their plans for many years without looking.