Medigap Shopping: Closing the Book & Rate Increases

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?"
 
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.
 
Right, until you receive the EOB from Medicare.gov, you then have what you really owe the providers.
 
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."
 
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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?
 
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.
 
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.
 
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.
 
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
 
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.
 
Indiana has passed a 'same letter' Medigap Birthday Rule effective 1/1/26.

...those who are at least 65 years old, currently have a Medicare supplement policy, and want to switch to a similar policy with a different insurance company within 60 days of their birthday. For these applicants, insurance companies are prohibited from denying coverage, conditioning the policy's effectiveness, or pricing the policy differently based on the applicant's health status, medical history, healthcare usage, or current medical condition.

 
How do you go about having a state implement new legislation for a Birthday rule for Medigap?
Contact your state legislators? I plan to contact mine.
 
The only problem with using your MA "trial Right" and then going back is that you are limited to going back to the previous company and plan according to the agent I spoke with last month.
 
wmc1000 said:
The only problem with using your MA "trial Right" and then going back is that you are limited to going back to the previous company and plan according to the agent I spoke with last month.
Not if your old plan is closed. If I have it correct - presumably you'd only use your MA trial right #2 when/if you find yourself in an expensive closed book supplement group. You can't buy into your old plan because it's a closed book. So you can buy another plan with any provider if within 12 months. However, you can only do this once, so it should be done with careful consideration - if you're unlikely to pass underwriting you will probably find yourself in another closed book situation at higher expense. So if I do it, I will at least make sure I choose a provider who does not have a history of closing the books - though there are no guarantees.

There are about 10 states that have already adopted some form of the birthday rule, and 7 other states in some stage of pending legislation. Hopefully more states will head that direction.
Trial right #2: You dropped a Medigap policy to join a Medicare Advantage plan for the first time, and within the first year of joining, you want to switch back.

If you had a Medigap policy before joining Medicare Advantage, you can purchase the same policy from the same insurance company if it’s still offered. If the same policy isn't available, you can buy a Medigap Plan A, B, C*, D*, F*, G*, K or L that’s sold by any insurance company in your state. You also may be able to purchase additional plans depending on your state.

Just like the first trial right, you can apply for a Medigap policy as early as 60 days before the date your coverage will end but no later than 63 days after your coverage ends. Your rights could extend an extra 12 months under certain conditions here as well.
 
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I asked this in another thread, but the recent mention of the MA Trial Right makes it relevant here.

I'm about to go on Medicare in California. I can try Medicare Advantage for a year and can switch to a Medicare Supplement plan one year later without underwriting. Is there any reason not to do so initially? In other words is there some reason why I might want to preserve this option for a later date? I have access to an employer sponsored MA plan with good coverage and very low premiums and the savings are significant vs any Plan G I'd enroll in otherwise.
 
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 how exactly how it works with an an HD policy, but it seems like it should simply be the remaining 20% to make 100% on top of the 80% Medicare paid, until you meet your HD plan deductible. I don’t see how it could be any different. Certainly talk to billing and get them to explain any discrepancy after you see exactly what Medicare paid. Don’t let assumptions of a collections agency intimidate you up front.
 
Don’t let assumptions of a collections agency intimidate you up front.
Isn't it now the case that medical debt doesn't affect credit reports? If true, even if a debt got turned over to collections, there really wouldn't be any impact other than the calls/letters from the collection agency.
 
Here's the statement from the CFPB

Today, the Consumer Financial Protection Bureau (CFPB) finalized a rule that will remove an estimated $49 billion in medical bills from the credit reports of about 15 million Americans. The CFPB’s action will ban the inclusion of medical bills on credit reports used by lenders and prohibit lenders from using medical information in their lending decisions. The rule will increase privacy protections and prevent debt collectors from using the credit reporting system to coerce people to pay bills they don’t owe. The CFPB has found that medical debts provide little predictive value to lenders about borrowers’ ability to repay other debts, and consumers frequently report receiving inaccurate bills or being asked to pay bills that should have been covered by insurance or financial assistance programs.

I don't know if the current administration has plans to rescind this rule or if they are already in the process of doing so.
 
A general question on financial assistance for aging seniors.

Are there fiduciary (as in, they're legally responsible to protect your financial interests) agencies/services that can help you pay your bills from your own accounts when you're too old to do so yourself?

I'm thinking that this would be helpful if someone is on a high-deductible G medigap plan.
 
Are there fiduciary (as in, they're legally responsible to protect your financial interests) agencies/services that can help you pay your bills from your own accounts when you're too old to do so yourself?

I'm thinking that this would be helpful if someone is on a high-deductible G medigap plan.
United American is a popular HD-G carrier. They have an annuity that acts like a savings account. You deposit funds and UA withdraws as needed to pay the Medicare deductibles, copays and coinsurance that comprise the plan's deductible. You designate a beneficiary to receive any unspent funds.

Bogleheads thread: https://www.bogleheads.org/forum/viewtopic.php?t=376012
 
I asked this in another thread, but the recent mention of the MA Trial Right makes it relevant here.

I'm about to go on Medicare in California. I can try Medicare Advantage for a year and can switch to a Medicare Supplement plan one year later without underwriting. Is there any reason not to do so initially? In other words is there some reason why I might want to preserve this option for a later date? I have access to an employer sponsored MA plan with good coverage and very low premiums and the savings are significant vs any Plan G I'd enroll in otherwise.
The MA Trial Right #2 discussion is for residents of states that do not let you change Medigap plans without underwriting.

California has a Medigap Birthday Rule that takes care of this issue. You might want to save the Trial Right if you know you will be moving to one of the above states after getting Plan G.

Or, go ahead and use the Trial Right for switching to Plan G in a year, and use the CA Medigap birthday rule to switch to a company that doesn't close their books (UHC/AARP, BCBS, etc.) before moving.
 
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Certainly talk to billing and get them to explain any discrepancy after you see exactly what Medicare paid. Don’t let assumptions of a collections agency intimidate you up front.
I'm on-board with that thinking, but my experience with big hospital billing departments is that they essentially ignore messages by replying with boilerplate. If you corner them on the phone, they offer to send you the detailed bill, but I could not get them to analyze the discrepancies. So I took their detailed bills and reconciled with Medicare and told them where they screwed up. So after 9 months of saber rattling about sending to collections, they got down to a zero balance. They didn't alert me that they fixed it, they just silently quit re-sending the bill I'd been seeing every month for 9 months.

One bit of advice that might be helpful is to write the billing department a quick note every time a bad bill comes in; if you ghost them, they're probably more likely to send it to collections.

Not that collections is a big deal...I can ignore them too. And I'm not needing to get any loans or anything. That news about medical bills not hitting credit reports makes me even less concerned.
 
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