Medigap Questions

[ncbill]

Isn't Plan F (& F HD) closed to new enrollees?

 

[teej1985]

It is not quite as easy as figuring out what your medical needs are now, in most cases one must bet on on what your medical needs will be in the future. In the name of blow that dough, this seems to me to be a poor place to be gambling on Medigap plans. Go for the best you can afford. Your Plan F was that plan when you entered.





A couple years back, we switched from F-HD under BCBS to G under AARP-UHC. Yes, we had to go thru medical underwriting. Last year I had my gallbladder removed at a rack rate of over $70k. I also had Back problems and 4 months of PT. Boy am I glad that I was on Plan G. Between Medicare's reduced price per procedure and the AARP-UHC I paid the Medicare deductible of $198 and that was it.

One thing to consider is, unlike a traditional insurance we got thru our employer, under Medicare, the deductibles are per person, not per family. When we got our F-HD plan we planned on each of us meeting our deductibles every other year. assuming deductible of ~2k per person per year, the upcharge from F-HD to F in premiums exceeded that amount so it was budgeted into our plans. When Medicare closed Plan F to new applicants, the writing was on the wall. No fresh blood into the plan means much higher annual increases in the future, so we switched while our health was still fairly good.

Repeat, Plan F is no longer open to new applicants. Plan G is today's "Gold Standard" plan.

Why didn't you go to G HD? Most employer insurance has an individual deductible and a family deductible.

 

[CRLLS]

Why didn't you go to G HD? Most employer insurance has an individual deductible and a family deductible.

At the time we started our application for change, for year 2020, G-HD was not even an official Plan yet. They were still working out the kinks. In fact at the time, there was no official mention at all about F-HD being closed or open to new entrants after Jan 2020, just speculation. We also wanted to switch companies at the same time for the future rate protection as we age that AARP/UHC offered, i.e. community rates vs attained age. In addition, I was tired of tracking every transaction between Medicare, the Drs, Supplemental and the back and forth of corrected billing etc all year long. Now with Plan G, I only have to do that until we meet the annual deductibles. After that it is not my problem. Our decision to change at all was also in part, a blow-that-dough decision. I have no regrets in our change at all. And I think we will be well ahead in the coming years as our health invariably will decline. We learned as we went.

Yes, employers typically offer individual and family and some offer spousal plans/deductibles. I was trying to keep the focus on married couples. Few understand that Medicare is an individual coverage regardless of marital status and it is a surprise later on.

 

[audreyh1]

Why didn't you go to G HD? Most employer insurance has an individual deductible and a family deductible.

Ok I can tell you why we didn’t. All these years on ACA, I’m tired of dealing with deductibles. Especially those paid up front. With Medicare this is usually dealt with billing afterwards intead of up front, so it’s a little better. But you still have track and pay all these bills. I’m capable of doing that today, but I really don’t want to deal with it 20 years from now. As a gift to our older selves we decided to “splurge”.

 

[sengsational]

Medicare was a topic like when to take SS, that I ignored on this board for years. Now DW is going to turn 65 and I really appreciate all of these well reasoned posts, even if the solution differs for each. It reminds me of the Roth conversion decision because to do it "right" you need to consider all years, until the plan "sunset", and during that time, there are unknowable variables (tax law and length of the plan in the case of Roth, and rate increases and length of plan in the case of Medigap).

One of the most interesting ideas to me was to get into a plan with the healthiest cohort with the idea that they'll need less care, and so have fewer and smaller rate increases. But I'm not sure that the insurance companies even keep those buckets separate (HD plan vs non).

The other idea I find appealing is the minimal paperwork and tracking with the small deductible; it's not "hard", but it's annoying to do. I'm bad at something like this, but if one knows what the deductible is, I could keep paying without tracking, and just quit paying when the deductible was achieved. Provider A might get too much and provider B might get shorted, and it would be my problem, though.

Given we use almost no services, though, we'd come out way ahead with the HD plan. Of course things could quickly change. If that happened, the 2K would be the least of my worries.

I'm thinking the "advantage" class plans are continuing the headache of what I've been experiencing on the ACA plans. They've got you roped into a network, so if you get a recommendation for a good specialist, they might not accept your plan. That's happened a few times...we take BCBS NC, but not your flavor of BCBS NC. So it creates the top tier of options off the table.

I'm not sure how accurate my understanding is...I haven't done anything but read threads on this board. But I've come to trust what the real people say here more than most sources.

What I'll probably end up with is G HD with a company that's got a reasonable reputation for not jacking up the rates too bad. I bet Consumer Reports has some advice (that I skipped reading), so maybe that's my next assignment.

 

[jollystomper]

Medicare was a topic like when to take SS, that I ignored on this board for years. Now DW is going to turn 65 and I really appreciate all of these well reasoned posts, even if the solution differs for each.

+1

Our Megacorp retiree health insurance expires at 65. DW will be eligible to apply in about a year, and me in early 2023. Threads like these are useful from an education/experience perspective. I also have questions about various tools/calculators/planning resources available beyond Medicare.gov. A couple were entered on this thread, If I cannot find an existing thread with that info consolidated I might create one.

 

[audreyh1]

The other idea I find appealing is the minimal paperwork and tracking with the small deductible; it's not "hard", but it's annoying to do. I'm bad at something like this, but if one knows what the deductible is, I could keep paying without tracking, and just quit paying when the deductible was achieved. Provider A might get too much and provider B might get shorted, and it would be my problem, though.

No, it’s actually a bit simpler than that. You’ll get billed by a provider only after it’s been through the Medicare review and adjustment, and then your Medigap insurer, and Medicare has determined that you have not yet met your deductible. You don’t have to track or worry about who to pay.

 

[REWahoo]

No, it’s actually a bit simpler than that. You’ll get billed by a provider only after it’s been through the Medicare review and adjustment, and then your Medigap insurer, and Medicare has determined that you have not yet met your deductible. You don’t have to track or worry about who to pay.

^ This.

DW and I have been on Medicare/Medigap for almost 10 years. The dozen or so providers we have used do not send us bills until both Medicare and our Medigap insurer have processed our claims. Very straightforward, at least in our experience.

 

[RetMD21]

Some of the brokers say that they will help you with problems such as billing problems. BB says they do, though the only problem I have had in using Medicare I went after myself... Dermatologist has a third-party billing company which seems to be run as a distributed collection of loosely-coupled incompetents. I read them over the phone what Medicare had already paid them, same with what AARP/UHC had paid them. After me hounding the billing company every two weeks over the phone, they finally relented and went with my numbers, which were correct.
Another internet broker is Chris Westfall's Senior Savings Network in South Carolina.

Although I can do it myself, I would rather not. After I understood that the biller's main recourse was a threat to credit ratings I took a little more relaxed approach to my mothers bills. A potential negative mark on a credit rating isn't really going to affect an 89 year old. I had problems with 3 entities out of 15-20. I have noticed that with MIL there have been no issues of this type for her MA account. They do however re-bill rejected charges with a 10 day payment deadline. I have learned to let thing clear insurer's before paying.

 

[joesxm3]

Thank you all for the very informative posts and suggestions.

This month is my Medicare three months before month, so let the fun begin.

My first hurdle is signing up for part A and part B with the government.

After that I am pretty well settled on getting a Medigap Plan G and from the comments am leaning toward ARP/UHC. I took a quick look on their site and got a rough estimate that seems more or less in the range I was expecting.

I am not sure, but suspect that it would be best to be signed up for medicare A and B before I try to sign up for the Medigap. Does the Medigap payer need to have my medicaid number etc?

I will have to get on the stick and get a few more price quotes on the Medigap policies.

August came a lot sooner than I expected. It seemed like I had forever to get ready for the sign-up process.

I guess I will have to also get moving on picking a Part D plan as well.

Thanks gain for all the help on this.

 

[harllee]

joe, when I signed up a few years ago I had to do the Medicare part first and get a Medicare number before I could sign up for the supplement and Part D. The easiest way to do the Part D is on the Medicare.give site, you enter your prescriptions and pharmacy and the website gives you your options. I take no prescription drugs so I always do the cheapest Part D.

 

[audreyh1]

Thank you all for the very informative posts and suggestions.

This month is my Medicare three months before month, so let the fun begin.

My first hurdle is signing up for part A and part B with the government.

After that I am pretty well settled on getting a Medigap Plan G and from the comments am leaning toward ARP/UHC. I took a quick look on their site and got a rough estimate that seems more or less in the range I was expecting.

I am not sure, but suspect that it would be best to be signed up for medicare A and B before I try to sign up for the Medigap. Does the Medigap payer need to have my medicaid number etc?

I will have to get on the stick and get a few more price quotes on the Medigap policies.

August came a lot sooner than I expected. It seemed like I had forever to get ready for the sign-up process.

I guess I will have to also get moving on picking a Part D plan as well.

Thanks gain for all the help on this.

That’s correct. You need your Medicare number before you can proceed with the other parts.

DH signed up online at Medicare.gov for part A and B (but not SS) and got a Medicare number in a few days that he could see in his Medicare account. He then got signed up for Medigap and part D using that number. We got the Medicare card in the mail a week or so later.

We went through Boomer benefits to sign up for those, but we had already made our choices (UHC was one of them). They will quote other insurers to you, but sign up who you want.

 

[teej1985]

Thank you all for the very informative posts and suggestions.

This month is my Medicare three months before month, so let the fun begin.

My first hurdle is signing up for part A and part B with the government.

After that I am pretty well settled on getting a Medigap Plan G and from the comments am leaning toward ARP/UHC. I took a quick look on their site and got a rough estimate that seems more or less in the range I was expecting.

I am not sure, but suspect that it would be best to be signed up for medicare A and B before I try to sign up for the Medigap. Does the Medigap payer need to have my medicaid number etc?

I will have to get on the stick and get a few more price quotes on the Medigap policies.

August came a lot sooner than I expected. It seemed like I had forever to get ready for the sign-up process.

I guess I will have to also get moving on picking a Part D plan as well.

Thanks gain for all the help on this.

You might want to pick UHC if you're in a state that has a one time irrevocable choice, but if you live somewhere like California or Oregon, some others, that lets you change to a different insurer annuially, you should just pick the cheapest plan G you can find.

 

[pb4uski]

No, it’s actually a bit simpler than that. You’ll get billed by a provider only after it’s been through the Medicare review and adjustment, and then your Medigap insurer, and Medicare has determined that you have not yet met your deductible. You don’t have to track or worry about who to pay.

I sometimes wonder about the Part B deductible for $203.... why bother for such a small amount? Why not just get rid of it and simplify things?

Add $5-15 to the monthly Part B premium if you must to offset the cost.

 

[audreyh1]

Because it was important to Congress that Medicare recipients “have some skin in the game”.

I guess the thinking was that if you had to pay even just a little up front, it might make you stop and think about whether that doctor visit was really necessary.

 

[REWahoo]

Because it was important to Congress that Medicare recipients “have some skin in the game”.

I guess the thinking was that if you had to pay even just a little up front, it might make you stop and think about whether that doctor visit was really necessary.

^ This.

That's the same reason medigap Plan F is no longer available to those new to Medicare. It paid the Part B deductible for the insured and now none of the supplements cover it.

 

[sengsational]

No, it’s actually a bit simpler than that. You’ll get billed by a provider only after it’s been through the Medicare review and adjustment, and then your Medigap insurer, and Medicare has determined that you have not yet met your deductible. You don’t have to track or worry about who to pay.

Hmmm! That's a nice surprise to me (my lack of study is showing, though, hehe). It makes the HD plans more tolerable...not having that extended headache. I was thinking I'd be selecting between a short headache ($203+/-) or a long headache (2K+/-). But if they do the book keeping and I won't need to fight the billing department in either case, I'd be pleased with either.

The idea of getting rid of the small deductible seems like a good idea, for simplicity. It makes no difference to medigap people, and so seems regressive (maybe keeping non-medigap people from seeing the doctor?)

Another noob medigap question that I have is about part D. That's just for home-based RX, right? So if you are in the hospital, it's irrelevant?

So can you skip part D, and sign-up during annual open enrollment? Having read here that GoodRx can give you comparable pricing or even better, and we use zero regular Rx right now, I was thinking of skipping it. That is, if I have the opportunity to join once a year.

 

[REWahoo]

So can you skip part D, and sign-up during annual open enrollment? Having read here that GoodRx can give you comparable pricing or even better, and we use zero regular Rx right now, I was thinking of skipping it. That is, if I have the opportunity to join once a year.

If you don't sign up for Part D during your initial enrollment period and delay until later, you will be assessed an ongoing premium penalty for each year you delay. That's why many of us who don't take any maintenance prescription drugs initially enroll in the lowest cost Part D plan available to us.

 

[audreyh1]

Hmmm! That's a nice surprise to me (my lack of study is showing, though, hehe). It makes the HD plans more tolerable...not having that extended headache. I was thinking I'd be selecting between a short headache ($203+/-) or a long headache (2K+/-). But if they do the book keeping and I won't need to fight the billing department in either case, I'd be pleased with either.

Personally I don’t want to deal with higher deductibles. Waiting for bills all year, paying them. Making sure the bill I got from the provider didn’t try to jump ahead of Medicare approval.

I can deal with a small amount up front.

P.S. Why don’t you go do the research you really need to do. If you try to make decisions now you may make some expensive mistakes.

 

[teej1985]

Hmmm! That's a nice surprise to me (my lack of study is showing, though, hehe). It makes the HD plans more tolerable...not having that extended headache. I was thinking I'd be selecting between a short headache ($203+/-) or a long headache (2K+/-). But if they do the book keeping and I won't need to fight the billing department in either case, I'd be pleased with either.

The idea of getting rid of the small deductible seems like a good idea, for simplicity. It makes no difference to medigap people, and so seems regressive (maybe keeping non-medigap people from seeing the doctor?)

Another noob medigap question that I have is about part D. That's just for home-based RX, right? So if you are in the hospital, it's irrelevant?

So can you skip part D, and sign-up during annual open enrollment? Having read here that GoodRx can give you comparable pricing or even better, and we use zero regular Rx right now, I was thinking of skipping it. That is, if I have the opportunity to join once a year.

Here's what John Greaney is doing for Part D:

https://retireearlyhomepage.com/medicare_partD_2021.html

 

[CRLLS]

No, it’s actually a bit simpler than that. You’ll get billed by a provider only after it’s been through the Medicare review and adjustment, and then your Medigap insurer, and Medicare has determined that you have not yet met your deductible. You don’t have to track or worry about who to pay.

If you can trust a 3rd party billing from your Dr's office to be accurate, just go ahead and pay what they ask. It is simple and easy, I agree. I personally am not that trusting. I want to make sure that what they bill me for is for services actually performed and is in agreement with Medicare and my Medigap insurer. That is one of the reasons that I changed from F-HD to G. Now I only have to deal with balancing the 3 statements up to the point of meeting the annual deductible.

I would imagine one would have to track their billing all year long, when a Dr's practice accepts Medicare patients but does not accept Medicare Assignment. They can bill up to 15% more than the Medcare approved amount. If you have a supplement plan that does not cover that overcharging you are on the hook all year long. Sorry I forget which plans don't cover that 15%.

 

[Telly]

Hmmm! That's a nice surprise to me (my lack of study is showing, though, hehe). It makes the HD plans more tolerable...not having that extended headache. I was thinking I'd be selecting between a short headache ($203+/-) or a long headache (2K+/-). But if they do the book keeping and I won't need to fight the billing department in either case, I'd be pleased with either.

The idea of getting rid of the small deductible seems like a good idea, for simplicity. It makes no difference to medigap people, and so seems regressive (maybe keeping non-medigap people from seeing the doctor?)

Another noob medigap question that I have is about part D. That's just for home-based RX, right? So if you are in the hospital, it's irrelevant?

So can you skip part D, and sign-up during annual open enrollment? Having read here that GoodRx can give you comparable pricing or even better, and we use zero regular Rx right now, I was thinking of skipping it. That is, if I have the opportunity to join once a year.

I recommend getting started on research by buying "GET WHAT'S YOURS for MEDICARE" by Philip Moeller. Available on Amazon for $10.89 hardcover. Cheap, and good. He also points out major pitfalls well!

About Medigap -HD plans... The year before I turned 65 I started studying for Medicare. One of the things I did was compare a letter plan with HD, to the same letter plan without HD. I ran a bunch of scenarios, from low medical expenses, to bigger and bigger yearly chunks. Annual cost of premiums were included. I was on a HD insurance plan prior to Medicare, and I thought that was the best choice for that time (and age) period. But in the majority of states, the Medigap plan you choose to start with, may well be the one you have till you die. I did not expect that as I age my excellent health will continue till I suddenly keel over dead without warning (though I'd prefer it!). Adding in some big chunks of medical expense $, particularly if something becomes chronic, made skipping Medicare -HD an easy choice for me.

 

[audreyh1]

If you can trust a 3rd party billing from your Dr's office to be accurate, just go ahead and pay what they ask. It is simple and easy, I agree. I personally am not that trusting. I want to make sure that what they bill me for is for services actually performed and is in agreement with Medicare and my Medigap insurer. That is one of the reasons that I changed from F-HD to G. Now I only have to deal with balancing the 3 statements up to the point of meeting the annual deductible.

I would imagine one would have to track their billing all year long, when a Dr's practice accepts Medicare patients but does not accept Medicare Assignment. They can bill up to 15% more than the Medcare approved amount. If you have a supplement plan that does not cover that overcharging you are on the hook all year long. Sorry I forget which plans don't cover that 15%.

Well that’s where Medicare does a better job IMO. You download the statement from Medicare, and the provider’s bill should agree with that.

But I had heard of people getting billed by providers before Medicare has done their approval and issued a statement. That’s a no no, but some providers try anyway.

Just seemed like more opportunities for this level of headache if you needed a lot of care one year and had an HD Medigap plan.

 

[REWahoo]

But I had heard of people getting billed by providers before Medicare has done their approval and issued a statement. That’s a no no, but some providers try anyway.

I've not experienced it but am sure it happens.

I never pay any medical bill until they have been run through both Medicare and my supplement/medigap insurer. Once the Medicare and supplement EOBs show up online, and their numbers match what I've been billed, then and only then do I pay.

 

[audreyh1]

I've not experienced it but am sure it happens.

I never pay any medical bill until they have been run through both Medicare and my supplement/medigap insurer. Once the Medicare and supplement EOBs show up online, and their numbers match what I've been billed, then and only then do I pay.

I think imoldernu would occasionally warn about it.