Medigap and Part D Questions
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CRLLS
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Wellcare is a provider of Medicare part D plans as well as Medicare Advantage Plans. I'm not sure if you think a drug plan provider should also be a Medigap provider. These are two separate parts of the Medicare options. One does not need to have a Medigap and Part D from the same company. And none of the Part D providers that I know of have their own pharmacies you need to go to,. Well, possibly for the mail-order prescriptions. We use AARP Humana for Medigap, Wellcare for Part D (CVS and other local pharmacies) and Wellcare uses CVS Caremark for mail-order prescriptions.
AARP Medigap is United HealthCare, not Humana.
ncbill
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just understand the birthday rule in most states means you may only switch to a plan of "equal or lesser benefit" w/o passing medical underwriting
so it won't help if you currently have Medicare Advantage but want to switch to a Medigap plan w/o passing medical underwriting.
so it won't help if you currently have Medicare Advantage but want to switch to a Medigap plan w/o passing medical underwriting.
CRLLS
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OOps. You are right. Too many references in this thread with Humana and my brain went with it. Sorry.
That's why you need to pick Medigap initially, or at least before you develop issues that wouldn't pass underwriting.
isisdave
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Two things about Medigap I wanted to invite you to consider:
1. Some are age-rated, and these start out cheaper but go up every year or two based on your age. Others are community rated; everyone pays the same (they still go up, but not because you get older). The AARP/UHC was the only one of the latter in Riverside County when I applied.
2. I was going to invite you to consider Plan N instead of G. Here's an article. With G, you have no deductible nor copay; with N, you pay the $226 deductible and up to $20 copay for doctor visits (but not procedures or any tests). When I joined, the annual price difference was about $700, and I only visited a doctor a few times a year. The premium difference may be different now. Do the math. (I have never seen a "Part B excess charge.")
1. Some are age-rated, and these start out cheaper but go up every year or two based on your age. Others are community rated; everyone pays the same (they still go up, but not because you get older). The AARP/UHC was the only one of the latter in Riverside County when I applied.
2. I was going to invite you to consider Plan N instead of G. Here's an article. With G, you have no deductible nor copay; with N, you pay the $226 deductible and up to $20 copay for doctor visits (but not procedures or any tests). When I joined, the annual price difference was about $700, and I only visited a doctor a few times a year. The premium difference may be different now. Do the math. (I have never seen a "Part B excess charge.")
Plan G has the deductible of $226, but no copay. Plan N has the deductible of $226 and up to the $20 copay. It's Plan F that had no deductible. Plan F is no longer offered unless you are eligible before a certain date that I don't remember. Someone else can post that.
MacsNMore
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Getting back to the OP’s original question regarding the Lockheed Martin HRA for retirees: Use their services!
VIA Benefits cannot/does not lock you into any specific plan or company. That annual $900 is for you to use for any approved medical services which are not otherwise covered by your existing Medicare G or D or Medigap plans (ie: optometrist exams, prescription eyeglasses, dentist, health insurance premiums, etc.). If you don’t use all of the $900 in any calendar year(s), the remaining balance in your account rolls over for future use. It’s one of the best benefits LMT retirees receive!
That's all well and good, but it's important to remember that there are some companies that you can't get through Boomer Benefits.
For example, USAA in many states is very cost effective, and it can only be bought through USAA. You don't need a military affiliation to buy Medigap from USAA. They sell it to anybody.
Camas Lilly
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We go through Senior Healthcare Direct as our broker. It pays to have them shop pricing every couple of years or so. It is my understanding you are locked into the pricing for the first year, but then providers will start increasing on an annual basis. We started with Plan N at $136/month and in a handfull of years, it reached $208. Broker shopped pricing and switched us to AARP/UNH and we are back to $135/month. You have to play the game, so I let them do the work.
On Part D, yes be sure to check your medications, tiers and preferred pharmacy. The latter was important to us because we are 35 miles out from the closest place to fill prescriptions, although you can always get mail order. You can compare the plans and it should break down your drug costs annually and then add in your premium to see your total annual cost. We are using Cigna Saver RX at $12.30/month since most of our drugs are tier 1 or $0. We have one tier 3, so I use RX Saver on that one. A couple of years ago, I was filling a prescription (different prescription plan) and 90 day supply was $126. The cashier asked if I ever checked RX Saver and she put in the info and the cost went down to $26 for 90 days. Now I combine both plans.
On Part D, yes be sure to check your medications, tiers and preferred pharmacy. The latter was important to us because we are 35 miles out from the closest place to fill prescriptions, although you can always get mail order. You can compare the plans and it should break down your drug costs annually and then add in your premium to see your total annual cost. We are using Cigna Saver RX at $12.30/month since most of our drugs are tier 1 or $0. We have one tier 3, so I use RX Saver on that one. A couple of years ago, I was filling a prescription (different prescription plan) and 90 day supply was $126. The cashier asked if I ever checked RX Saver and she put in the info and the cost went down to $26 for 90 days. Now I combine both plans.
ncbill
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Plan G-HD is even cheaper on premiums for those to whom that is more important than the possibility of hitting the higher annual "deductible" (maximum OOP)
I wouldn't get Plan N unless I lived in a state that prohibited excess charges altogether.
Community rating is so much less important in Riverside County CA where you can change plans as desired with the birthday rule. When I searched the Medicare site, it seemed like UHC/AARP became the most cost effective around age 85 or so, until then it was either State Farm or USAA for most ages sub-85
Dash man
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If you research excess charges, you’ll find they’re pretty rare, mostly with psychiatrists and not that high an expense.
REWahoo
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^ This.
Camas Lilly
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We have never had a problem with excess charges.
Midpack
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+1. That’s been my experience for 4 years. I am amazed at how rare out of pocket expenses have been. Of course YMMV
REWahoo
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+1
I've come to believe Medigap insurers use the possibility of excess charges as the Bogeyan to scare folks into opting for more expensive/profitable coverage than Plan N. No proof of course, just my opinion.
DW and I have been on Plan N for almost 7 years. In that time we've been to more than a dozen different doctors and specialists, had all sorts of tests (bone marrow biopsy, anyone?), and she's had two TKR surgeries. We've never been billed for excess charges or any other out-of-pocket expenses other than the standard Medicare annual deductible and the Plan N $20 co-pay for dr visits.
I was amazed that both her TKR surgeries and hospital stays were totally covered, not even a $20 co-pay.
CRLLS
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That is what I also found. Since our financial plan goes out to age 100, I figured that our medical plan should do the same. We live in a state where we cannot easily change Medigap plans or providers without going to a lower plan, going thru underwriting or some other gotcha rule. For all intents and purposes, we are stuck with what we have until the laws here change. That is why we went with AARP/UHC. If we die earlier, we won't die broke. If we die later, then we are ahead.
With certain Medigap plans as a supplement, is the best way to avoid "excess charges" for Part B to go to the Medicare.gov site and make sure the provider only charges the Medicare approved rate? The site appears to tell if a provider does so or not. Would this then avoid the "excess charge" risk of some Medigap plans?
I have Medicare+FEHB combo and the FEHB brochures seem to say--I think--that providers which do not accept Medicare's approved rate can then charge up to 115% of that amount (perhaps similar to Medigap "excess charge").
This is why I always go to Medicare.gov when planning to see any provider to find out ahead of time whether there could be the additional charge. Also, it could be a good idea to call the provider billing office to see what their latest position is on this.
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REWahoo
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Yes, it is my understanding that this is correct. I will admit I've only done so on a couple of occasions and instead have only confirmed on the provider's website or via phone that they "accept Medicare assignment". So far I have never encountered one that does not.
Camas Lilly
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EastWest Gal
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I am starting to research Medigap plans since both of us will go on Medicare in 2024. We're looking at Plan G and Plan N, so this discussion is very helpful. Looking at the Plan N companies available in our area, most have this description:
"Premiums are low for younger buyers, but go up as you get older and can eventually become the most expensive."
But the UHC AARP plans (there are two and I cannot tell the difference), state the following:
"Premiums are the same no matter how old you are. Premiums may go up because of inflation and other factors."
Give me a reason to choose anything but one of these two plans. If I live to be 100, I don't want to pay lots of money for insurance I will not use. At age 100, I'm likely to decline most care except comfort care.
Those of you on Medicare, did this factor into your decision about a particular plan?
"Premiums are low for younger buyers, but go up as you get older and can eventually become the most expensive."
But the UHC AARP plans (there are two and I cannot tell the difference), state the following:
"Premiums are the same no matter how old you are. Premiums may go up because of inflation and other factors."
Give me a reason to choose anything but one of these two plans. If I live to be 100, I don't want to pay lots of money for insurance I will not use. At age 100, I'm likely to decline most care except comfort care.
Those of you on Medicare, did this factor into your decision about a particular plan?
