Medigap Shopping: Closing the Book & Rate Increases

[FIREchief]

This can't be said for HD policies, because you're going to have some big bills to pay, and you don't know if it's the 20% or the chargemaster.

Can't I just download the EOBs from the Medigap insurer website? I do that anyways for HSA reimbursements. Every HD plan I've ever had clearly shows progress towards the deductible on their website.

What's a "chargemaster?"

 

[teej1985]

This can't be said for HD policies, because you're going to have some big bills to pay, and you don't know if it's the 20% or the chargemaster.

Are you joking? I never pay a medical bill until i see an EOB. Thats normal procedure when you have a plan that doesn't have copays.

 

[audreyh1]

Right, until you receive the EOB from Medicare.gov, you then have what you really owe the providers.

 

[FIREchief]

Right, until you receive the EOB from Medicare.gov, you then have what you really owe the providers.

Won't I also then get an EOB from my Medigap insurer after they process it?

 

[teej1985]

Won't I also then get an EOB from my Medigap insurer after they process it?

I would assume so.

 

[sengsational]

Are you joking? I never pay a medical bill until i see an EOB. Thats normal procedure when you have a plan that doesn't have copays.

That's Standard Operating Procedure: Ignore all bills until you get the EOB. True whether you have high or low deductible or some or no copays.

What I was saying was that with a low deductible policy, one can recognize something is amiss without adding up the EOB's. This can't be said for HD policies.

Say you add up all of the "you might owe" from Medicare, and subtract out the amount that your supplemental policy paid and the net was $500. And the provider says you owe $700. What do you do?

If you pay the $500, they send the $200 to collections, and it's your problem.

I wouldn't pay a dime until the bill agrees with Medicare, but I'm not sure how responsive the hospital billing department is going to be if you just come in with "I should only owe $500 according to Medicare". They'll probably just keep sending the $700 bill. And according to my state DOI rep, pretty much everyone just gives up and pays the extra if it isn't "too much."

 

[FIREchief]

That's Standard Operating Procedure: Ignore all bills until you get the EOB. True whether you have high or low deductible or some or no copays.

What I was saying was that with a low deductible policy, one can recognize something is amiss without adding up the EOB's. This can't be said for HD policies.

Say you add up all of the "you might owe" from Medicare, and subtract out the amount that your supplemental policy paid and the net was $500. And the provider says you owe $700. What do you do?

If you pay the $500, they send the $200 to collections, and it's your problem.

I wouldn't pay a dime until the bill agrees with Medicare, but I'm not sure how responsive the hospital billing department is going to be if you just come in with "I should only owe $500 according to Medicare". They'll probably just keep sending the $700 bill. And according to my state DOI rep, pretty much everyone just gives up and pays the extra if it isn't "too much."

I don't know where you get this stuff. If I suspect a discrepancy, I call the billing department and they call up the EOB and it's resolved. I've been paying copays and deductibles for decades, and never had the type of problem you describe. Why would any of that change just because my form of insurance changes?

 

[sengsational]

I get this stuff from experience. You are fortunate to have never had to deal with the kind of billing departments I've run into.

At risk of boring those who got it the first two times, the type of insurance just makes it easier or harder to recognize a problem. I never said it alters the resolution process.

 

[Buckeye]

Providers often demand payment upfront and charge more than the amount the policyholder is liable for. Providers also send invoices before the EOB has been processed and charge amounts greater than the price Medicare allows. They are reluctant to reimburse incorrect charges and drag that process out.

The high deductible plans give them room and opportunity to do this. Like many other members here, I am the one who handles these matters and I would rather leave DW in a situation where this is minimized and she doesn’t have to face it. Once the deductible is met, the likelihood of an overcharge is substantially reduced.

That is why many members prefer lower deductible options.

I haven't ever had any provider require an up-front payment on our Plan G-HD plans. Also, I go online on the Medicare website and make of list of who we will owe and how much.

 

[CRLLS]

I haven't ever had any provider require an up-front payment on our Plan G-HD plans. Also, I go online on the Medicare website and make of list of who we will owe and how much.

I have on, Plan G. I have mentioned this before. I went to a local walk-in medical facility to get a pre-op physical. They wanted payment up front. They said "This is our policy". They would return any excess if paid by M/C and/or my supplement. I explained that, "My policy is I don't pay anything until I see that M/C's and my Supplement insurer's EPB agreed with what the provider was billing me. I asked, " How do we reconcile our different policies?" They decided they would accept my position. The point is if you don't politely push back what you know is how it is supposed to work, you will pay up front when asked. You might get your excess payment returned.

 

[MBSC]

Virginia has passed a "same letter" Medigap Birthday Rule effective 7/1/25.

An insurer...shall offer to an individual currently insured under any such policy or certificate an annual open enrollment period commencing on the day of the individual's birthday and remaining open for at least 60 days thereafter, during which time the individual may purchase any Medicare supplement policy made available by any insurer in the Commonwealth that offers the same benefits as those provided by the current coverage. Innovative benefits, as described in 42 U.S.C. § 1395ss(p)(4)(B), shall not be considered when determining whether a Medicare supplement policy includes the same benefits as those provided by the previous coverage.

Source: https://legiscan.com/VA/text/HB2100/2025

 

[MichaelB]

Virginia has passed a "same letter" Medigap Birthday Rule effective 7/1/25.

Interesting, thanks for the update. It might make MediGap,policies a bit pricier but it sure helps people enrolled in closed plans. It also makes the first enrollment choice easier.