Medigap Plans to Rule Out?

[nwsteve]

You actually wrote with underwriting so that's confusing, is that what meant to type..

OP here. My bad! Glad you got the context--NO underwriting is required in WA when switching between Medigap plans that provide equal or less coverage. The Premera agent clearly implied that underwriting would be required. Based on her other remarks, I am guessing she was either new or at least not very knowledgeable about Medigap rules.
I also noticed I mistyped the savings which should be $828/YEAR each not mon--still nice.

Apologies to the Forum for my error--got to bump up my proofing!

 

[RetMD21]

Here is the language from the Washington Insurance Comissioner:

When can I switch plans?
If you're already enrolled in a Medigap plan B through N, you can switch at any time to another Medigap plan B through N. If you have a Medigap plan A, you can switch to any other Medigap plan A. In either of these situations, you do not have to take a written health screening questionnaire.

https://www.insurance.wa.gov/when-can-i-sign-or-switch-medigap-plans

 

[NoMoreJob]

Some physicians take Medicare patients but do not accept assignment, and can charge 15% over the Medicare reimbursement rate. Plans F and G cover that as "excess charges).


It sure does.

It's actually not really a straight 15% and not all providers charge that and not for all services. It's very convoluted - I know because unfortunately I've had to deal with it. But suffice it to say that not accepting assignment means they can charge more and, yes, those excess charges are 98% covered by plans F and G. There is a 2% holdback that the patient is still responsible. Look here if you want to be totally befuddled and entertained.....

http://www.rcmanet.org/Portals/17/0...on-frequently-asked-questions AMA 03-2013.pdf

 

[CrysMos]

I'm from the area where Kaiser originated. The original Oakland hospital and clinic was a hellhole in the 60's, 70's and 80's. My mother used to refer to the place as the witch doctors of Kaiser. In her opinion, no real doctor would practice there, only people that graduated in the bottom quartile of their medical school class and couldn't find a better job. Possibly a small step above Highland Hospital, the County cesspool, but she was not totally convinced.

I hear that outside of the Bay Area, Kaiser is pretty good. However, I am of the view that leopards have great difficulty changing their spots, so I will continue to avoid Kaiser.

I have to agree. I am also from Bay Area, and the stories I could tell. They waited 4 months to test to see why my mom was anemic. By that time, the lymphoma was so bad, there was no bone marrow left to test. I won't even talk about some of the forceps births there. I know people who swear by them, but I just can't do it

 

[tuffshed]

I'm trying to decide on Medigap plans right now. I turn 65 on Dec 31. When I was looking for private insurance I got a spreadsheet from ER entitled "Health Plans - Generic.xls". It had formulas for computing the costs for various plans based on copay, maximum OOP and premiums. With it you could compute which plan would be cheapest depending on how much you predict to spend in the coming year. It also showed the worst case costs if you maxed out everything. I'm looking for a similar spreadsheet or some answers so I can create my own. Here is what I need.



Is there a max OOP for each of the Medigap plans A...N? Add this plus the premiums and you should get the worst case scenario that you would have to pay in any year. The best case is just the costs of the premiums.


I'm doing more research, but I'm asking this because I might be missing something obvious. I'm wondering why no one is discussing Plan L. With the max OOP of $2780 (plus the cost of premiums, in my Utah zip this would be about $720 a year) which brings the grand total OOP worse case to $3,500 a year. For private health insurance in my area this worse case figure is about $21,000. Why isn't Plan L a no-brainer? I can certainly afford $3,500 worst case a year.



So does anyone have a max OOP for each of the plans? What is wrong/right with my thinking on Plan L?



By the by, DW and I buy yearly trip insurance that covers primary medical so that is not an issue.

 

[ivinsfan]

I'm trying to decide on Medigap plans right now. I turn 65 on Dec 31. When I was looking for private insurance I got a spreadsheet from ER entitled "Health Plans - Generic.xls". It had formulas for computing the costs for various plans based on copay, maximum OOP and premiums. With it you could compute which plan would be cheapest depending on how much you predict to spend in the coming year. It also showed the worst case costs if you maxed out everything. I'm looking for a similar spreadsheet or some answers so I can create my own. Here is what I need.



Is there a max OOP for each of the Medigap plans A...N? Add this plus the premiums and you should get the worst case scenario that you would have to pay in any year. The best case is just the costs of the premiums.


I'm doing more research, but I'm asking this because I might be missing something obvious. I'm wondering why no one is discussing Plan L. With the max OOP of $2780 (plus the cost of premiums, in my Utah zip this would be about $720 a year) which brings the grand total OOP worse case to $3,500 a year. For private health insurance in my area this worse case figure is about $21,000. Why isn't Plan L a no-brainer? I can certainly afford $3,500 worst case a year.



So does anyone have a max OOP for each of the plans? What is wrong/right with my thinking on Plan L?



By the by, DW and I buy yearly trip insurance that covers primary medical so that is not an issue.

What's the network, is it good in SL and in Moab..that the first question to ask.

 

[Another Reader]

I'm trying to decide on Medigap plans right now. I turn 65 on Dec 31. When I was looking for private insurance I got a spreadsheet from ER entitled "Health Plans - Generic.xls". It had formulas for computing the costs for various plans based on copay, maximum OOP and premiums. With it you could compute which plan would be cheapest depending on how much you predict to spend in the coming year. It also showed the worst case costs if you maxed out everything. I'm looking for a similar spreadsheet or some answers so I can create my own. Here is what I need.



Is there a max OOP for each of the Medigap plans A...N? Add this plus the premiums and you should get the worst case scenario that you would have to pay in any year. The best case is just the costs of the premiums.


I'm doing more research, but I'm asking this because I might be missing something obvious. I'm wondering why no one is discussing Plan L. With the max OOP of $2780 (plus the cost of premiums, in my Utah zip this would be about $720 a year) which brings the grand total OOP worse case to $3,500 a year. For private health insurance in my area this worse case figure is about $21,000. Why isn't Plan L a no-brainer? I can certainly afford $3,500 worst case a year.



So does anyone have a max OOP for each of the plans? What is wrong/right with my thinking on Plan L?



By the by, DW and I buy yearly trip insurance that covers primary medical so that is not an issue.

Medicare, Part B, and Medigap combined are much more comprehensive than traditional insurance. Suggest you consult Boomer Benefits or Senior Savings network, which are nationwide agencies representing most plans. My AARP Medigap Plan F at $128.50, the Part D from Aetna at $19.10, and Medicare Part B, at $135.50, cover almost everything. Less than $300 a month for comprehensive coverage.

 

[REWahoo]

Suggest you consult Boomer Benefits...

+1

Those folks can help you cut through the fog and provide you with excellent resources and information to educate yourself on Medicare. They will help you understand all your options and likely save you money and potential future headaches. Many of us have used their free services and have been happy with our experience.

 

[MBSC]

Is there a max OOP for each of the Medigap plans A...N? Add this plus the premiums and you should get the worst case scenario that you would have to pay in any year. The best case is just the costs of the premiums.

Most people quickly narrow their Medigap choices to G, N and F-HD. The MOOP for G is the annual Part B deductible ($185 in 2019). F-HD has a $2300 (2019) MOOP. Plan N does not have a MOOP. Also, keep in mind that Part D cost sharing is separate and in addition to these amounts. Part D plans do not have a MOOP.

I'm wondering why no one is discussing Plan L. With the max OOP of $2780 (plus the cost of premiums, in my Utah zip this would be about $720 a year) which brings the grand total OOP worse case to $3,500 a year. Why isn't Plan L a no-brainer?

In my area, Plan L premiums are about the same as premiums for the more comprehensive Plan N.

The MOOP for Plans K and L are not a true MOOP. Part B excess charges (though unlikely) do not count toward the MOOP and the plans do not pay the excess charge once the MOOP is met. So, the true MOOP for Plan L is $2780 + excess charges.

With Plan F-HD (G-HD in 2020), Medicare still pays 80%. You pay 20% of the Medicare approved amount until the 20% totals $2300 (2019). Then F-HD starts paying the 20%. When compared to Plan L, the F-HD premium is lower, the MOOP is lower, excess charges count toward the MOOP and excess charges are paid by the F-HD plan once the $2300 MOOP is met. The $2300 MOOP for F-HD is true.

Worst case for F-HD would be about $2900 ($2300 MOOP + ~$600 annual premium) excluding Part D.

Once you reach the annual out-of-pocket limit, K and L pay 100% of the Medicare co-payments, co-insurance, and deductibles for the rest of the calendar year. The out-of-pocket annual limit does not include charges from your provider that exceed Medicare-approved amounts, called excess charges. You are responsible for paying excess charges.

Source #1 (pages 10-11): http://doi.nv.gov/uploadedFiles/doi...ccident_Insurance/MedicareSupplementGuide.pdf

Source #2 (page 14): http://www.ncdoi.com/_Publications/Medicare Supplement Comparison Guide_SVCP_SSU1_250.pdf

 

[Katsmeow]

As usual, MSBC gives a very good comprehensive answer. If I wanted something with a MOOP and the lowest premiums I would have chosen F-HD when I just went on Medicare. In reality I chose G. Basically I was thinking about the long-term hassle factor.

My mother had Plan G and she had a lot of health problems the last few years of her life. But, basically all she had worry about was paying her annual deductible. That was usually quickly done and then everything was paid the rest of the year. While she was in her 80s and 90s that was really a big deal. She didn't have to worry about co-payments.

Looking ahead, I don't want to deal with them either. Right now, I could easily manage it but I am thinking about what it will be like years from now. So, I am happy to just have one deductible to keep track of.

 

[tuffshed]

Medicare, Part B, and Medigap combined are much more comprehensive than traditional insurance. Suggest you consult Boomer Benefits or Senior Savings network, which are nationwide agencies representing most plans. My AARP Medigap Plan F at $128.50, the Part D from Aetna at $19.10, and Medicare Part B, at $135.50, cover almost everything. Less than $300 a month for comprehensive coverage.

I have a local place that is highly recommended, Senior Benefits, but I'm trying to do my homework upfront. I'm looking forward to the relatively cheap insurance, right now I'm paying $650 month for a high deductible policy. It's that deductible that is the key for me. Literature that I have right now (I'm getting more) says MOOP for every plan but K and L are N/A. Does that mean the skies the limit? I like to know exactly how much is the max and plan accordingly.

 

[tuffshed]

Most people quickly narrow their Medigap choices to G, N and F-HD. The MOOP for G is the annual Part B deductible ($185 in 2019). F-HD has a $2300 (2019) MOOP. Plan N does not have a MOOP. Also, keep in mind that Part D cost sharing is separate and in addition to these amounts. Part D plans do not have a MOOP.

In my area, Plan L premiums are about the same as premiums for the more comprehensive Plan N.

The MOOP for Plans K and L are not a true MOOP. Part B excess charges (though unlikely) do not count toward the MOOP and the plans do not pay the excess charge once the MOOP is met. So, the true MOOP for Plan L is $2780 + excess charges.

With Plan F-HD (G-HD in 2020), Medicare still pays 80%. You pay 20% of the Medicare approved amount until the 20% totals $2300 (2019). Then F-HD starts paying the 20%. When compared to Plan L, the F-HD premium is lower, the MOOP is lower, excess charges count toward the MOOP and excess charges are paid by the F-HD plan once the $2300 MOOP is met. The $2300 MOOP for F-HD is true.

Worst case for F-HD would be about $2900 ($2300 MOOP + ~$600 annual premium) excluding Part D.

And the MOOP for a regular Plan F or G? Is it as simple as MOOP for Plan F = yearly premium, MOOP for Plan G = yearly premium + $185 part B deductable? Do these plans really pay everything 100% (excluding foreign)?

 

[audreyh1]

As usual, MSBC gives a very good comprehensive answer. If I wanted something with a MOOP and the lowest premiums I would have chosen F-HD when I just went on Medicare. In reality I chose G. Basically I was thinking about the long-term hassle factor.

My mother had Plan G and she had a lot of health problems the last few years of her life. But, basically all she had worry about was paying her annual deductible. That was usually quickly done and then everything was paid the rest of the year. While she was in her 80s and 90s that was really a big deal. She didn't have to worry about co-payments.

Looking ahead, I don't want to deal with them either. Right now, I could easily manage it but I am thinking about what it will be like years from now. So, I am happy to just have one deductible to keep track of.

Yep, that’s my plan. I really don’t want to have to deal with tracking deductibles like I do now. The worst part is having to pay up front and then try to reconcile later. I guess with Medicare that doesn’t happen, but I really don’t want to deal with it.

 

[Katsmeow]

And the MOOP for a regular Plan F or G? Is it as simple as MOOP for Plan F = yearly premium, MOOP for Plan G = yearly premium + $185 part B deductable? Do these plans really pay everything 100% (excluding foreign)?

I have Plan G. Yes, Medicare + the supplement pays for everything (that is covered by Medicare) except the premium and the part B deductible. My husband has Plan F. Medicare + the supplement pays for everything (covered by Medicare) except his premium. It is really very, very, very simple. Of course, no supplement plan pays for things that are not covered by Medicare.

Also, bear in mind as MSBC pointed out that the part D premium and deductible/co-pays, etc. is separate and apart from Medicare Parts A and B.

 

[tuffshed]

I have Plan G. Yes, Medicare + the supplement pays for everything (that is covered by Medicare) except the premium and the part B deductible. My husband has Plan F. Medicare + the supplement pays for everything (covered by Medicare) except his premium. It is really very, very, very simple. Of course, no supplement plan pays for things that are not covered by Medicare.

Also, bear in mind as MSBC pointed out that the part D premium and deductible/co-pays, etc. is separate and apart from Medicare Parts A and B.

Unbelievable! I can get a Medigap F for about $129 a month, plus a Part D that covers everything I take now for $28 month plus the $135 for the Part A/B costs for a grand total of a little more than $3,500 a YEAR and it that's covers everything!


Worse case scenario is that I get prescribed lots of expensive drugs and end up with another $5,100 in part D costs?



Total damage if all hell breaks loose is $8,600 a year, this is too good to be true. Am I missing anything else?



What part of Socialism do people hate?

 

[Another Reader]

There are some things that Medicare won't cover or will limit. If Medicare doesn't cover something, Medigap won't cover it either. Some physical exams are excluded IIRC. I have not run into this yet, but other posters have. Perhaps MBSC could provide some examples of things that are not covered.

 

[Katsmeow]

There are some things that Medicare won't cover or will limit. If Medicare doesn't cover something, Medigap won't cover it either. Some physical exams are excluded IIRC. I have not run into this yet, but other posters have. Perhaps MBSC could provide some examples of things that are not covered.

Not MBSC but Medicare does have limits. Regular preventative physical exams are not covered. Medicare does cover certain preventative services at specified intervals.

Medicare doesn't cover long term care, eye exams, hearing aids and exams and a few other things:

https://www.medicare.gov/what-medicare-covers/whats-not-covered-by-part-a-part-b

That said - DH has been on Medicare for 6 years and about the only thing he has had come up that hasn't been covered are eye exams.

 

[RetMD21]

Not MBSC but Medicare does have limits. Regular preventative physical exams are not covered. Medicare does cover certain preventative services at specified intervals.
.

No annual exam but an annual wellness visit


Covered services

During your first Annual Wellness Visit, your PCP will develop your personalized prevention plan. Your PCP may also:

Check your height, weight, blood pressure, and other routine measurements
Give you a health risk assessment
This may include a questionnaire that you complete before or during the visit. The questionnaire asks about your health status, injury risks, behavioral risks, and urgent health needs.
Review your functional ability and level of safety
This includes screening for hearing impairments and your risk of falling.
Your doctor must also assess your ability to perform activities of daily living (such as bathing and dressing), and your level of safety at home.
Learn about your medical and family history
Make a list of your current providers, durable medical equipment (DME) suppliers, and medications
Medications include prescription medications, as well as vitamins and supplements you may take
Create a written 5-10 year screening schedule or check-list
Your PCP should keep in mind your health status, screening history, and eligibility for age-appropriate, Medicare-covered preventive services
Screen for cognitive impairment, including diseases such as Alzheimer’s and other forms of dementia
Medicare does not require that doctors use a test to screen you. Instead, doctors are asked to rely on their observations and/or on reports by you and others.
Screen for depression
Provide health advice and referrals to health education and/or preventive counseling services aimed at reducing identified risk factors and promoting wellness
Health education and preventive counseling may relate to weight loss, physical activity, smoking cessation, fall prevention, nutrition, and more.
AWVs after your first visit may be different. At subsequent AWVs, your doctor should:

Check your weight and blood pressure
Update the health risk assessment you completed
Update your medical and family history
Update your list of current medical providers and suppliers
Update your written screening schedule
Screen for cognitive issues
Provide health advice and referrals to health education and/or preventive counseling services

 

[FIRE'd@51]

Unbelievable! I can get a Medigap F for about $129 a month, plus a Part D that covers everything I take now for $28 month plus the $135 for the Part A/B costs for a grand total of a little more than $3,500 a YEAR and it that's covers everything!


Worse case scenario is that I get prescribed lots of expensive drugs and end up with another $5,100 in part D costs?



Total damage if all hell breaks loose is $8,600 a year, this is too good to be true. Am I missing anything else?

Yes. Actually, there is no OPM with Part D. Once you have paid out-of pocket the amount ($5,100 in 2019) to qualify for catastrophic coverage you still have a 5% copay for the rest of the year.

 

[Momcpa]

My insurance didn't cover my Annual Wellness exam.........because I had the exam done too soon after the policy was started. I didn't know that there was a time frame to be aware of for the first Annual Wellness. I can't remember exactly, maybe it had to be 12 or 13 months after the policy was in force. Mine wasn't. Found that out the hard way...at least for my specific insurance. FYI

 

[John Galt III]

Not MBSC but Medicare does have limits. Regular preventative physical exams are not covered. Medicare does cover certain preventative services at specified intervals.

Medicare doesn't cover long term care, eye exams, hearing aids and exams and a few other things:

https://www.medicare.gov/what-medicare-covers/whats-not-covered-by-part-a-part-b

That said - DH has been on Medicare for 6 years and about the only thing he has had come up that hasn't been covered are eye exams.

So all those old folks at the optometrist's office are paying full price for their annual dilation and check for glaucoma, cataracts, astigmatism, etc?

 

[NoMoreJob]

So all those old folks at the optometrist's office are paying full price for their annual dilation and check for glaucoma, cataracts, astigmatism, etc?

Maybe. If they have a medical condition like diabetes or are at high risk for glaucoma (or in my case a posterior vitreous detachment which is pretty common) then an annual exam is covered by Medicare. They could also have vision insurance through a previous employer, a Medicare advantage plan or private pay. If you put all these things together I'd guess that the majority have at least some insurance coverage.

 

[wmc1000]

So all those old folks at the optometrist's office are paying full price for their annual dilation and check for glaucoma, cataracts, astigmatism, etc?

In this area of the country that test runs around $70. Doesn't seem it would be worth having insurance for that.

 

[Animorph]

Unbelievable! I can get a Medigap F for about $129 a month, plus a Part D that covers everything I take now for $28 month plus the $135 for the Part A/B costs for a grand total of a little more than $3,500 a YEAR and it that's covers everything!


Worse case scenario is that I get prescribed lots of expensive drugs and end up with another $5,100 in part D costs?



Total damage if all hell breaks loose is $8,600 a year, this is too good to be true. Am I missing anything else?

What part of Socialism do people hate?

All the money you paid in while working?

 

[Katsmeow]

So all those old folks at the optometrist's office are paying full price for their annual dilation and check for glaucoma, cataracts, astigmatism, etc?

They are usually paying for the refraction just like most people with private (pre-Medicare) insurance. For certain medical things it is covered by Medicare. When DH had his done last year I think $60 of it was not covered and the rest was covered.

At the time I had regular insurance (not on Medicare yet) and my refraction wasn't covered either (most regular insurance does not cover a refraction) but because I have a mild cataract part of the exam was covered and paid by insurance.

DH's Medicare supplement plan would have also given him a discount at some optometrists and for some glasses. He didn't want to go there, though, so he didn't take advantage of that.